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Tsukada YT, Aoki-Kamiya C, Mizuno A, Nakayama A, Ide T, Aoyama R, Honye J, Hoshina K, Ikegame T, Inoue K, Bando YK, Kataoka M, Kondo N, Maemura K, Makaya M, Masumori N, Mito A, Miyauchi M, Miyazaki A, Nakano Y, Nakao YM, Nakatsuka M, Nakayama T, Oginosawa Y, Ohba N, Otsuka M, Okaniwa H, Saito A, Saito K, Sakata Y, Harada-Shiba M, Soejima K, Takahashi S, Takahashi T, Tanaka T, Wada Y, Watanabe Y, Yano Y, Yoshida M, Yoshikawa T, Yoshimatsu J, Abe T, Dai Z, Endo A, Fukuda-Doi M, Ito-Hagiwara K, Harima A, Hirakawa K, Hosokawa K, Iizuka G, Ikeda S, Ishii N, Izawa KP, Kagiyama N, Umeda-Kameyama Y, Kanki S, Kato K, Komuro A, Konagai N, Konishi Y, Nishizaki F, Noma S, Norimatsu T, Numao Y, Oishi S, Okubo K, Ohmori T, Otaki Y, Shibata T, Shibuya J, Shimbo M, Shiomura R, Sugiyama K, Suzuki T, Tajima E, Tsukihashi A, Yasui H, Amano K, Kohsaka S, Minamino T, Nagai R, Setoguchi S, Terada K, Yumino D, Tomoike H. JCS/JCC/JACR/JATS 2024 Guideline on Cardiovascular Practice With Consideration for Diversity, Equity, and Inclusion. Circ J 2025:CJ-23-0890. [PMID: 39971310 DOI: 10.1253/circj.cj-23-0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Affiliation(s)
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital
| | | | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University
| | - Rie Aoyama
- Department of Cardiology, Heart and Vascular Institute, Funabashi Municipal Medical Center
| | - Junko Honye
- Cardiovascular Center, Kikuna Memorial Hospital
| | | | | | - Koki Inoue
- Department of Neuropsychiatry, Graduate School of Medicine, Osaka Metropolitan University
| | - Yasuko K Bando
- Department of Molecular Physiology and Cardiovascular Biology, Mie University Graduate School of Medicine
| | - Masaharu Kataoka
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine and School of Public Health, Kyoto University
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine
| | - Asako Mito
- Division of Maternal Medicine, Center for Maternal-Fetal-Reproductive Medicine, National Center for Child Health and Development
| | - Mizuho Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Department of Adult Congenital Heart Disease, Seirei Hamamatsu General Hospital
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yoko M Nakao
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University
| | - Mikiya Nakatsuka
- Faculty of Health Sciences, Okayama University Graduate School of Medicine
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Kyoto University
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | | | - Maki Otsuka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Hiroki Okaniwa
- Department of Technology, Gunma Prefectural Cardiovascular Center
| | - Aya Saito
- Department of Surgery, Division of Cardiovascular Surgery, Yokohama City University, Graduate School of Medicine
| | - Kozue Saito
- Department of Neurology, Stroke Center, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | | | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University
| | - Toshihiro Tanaka
- Department of Human Genetics and Disease Diversity, Tokyo Medical and Dental University
| | - Yuko Wada
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
| | | | - Yuichiro Yano
- Department of General Medicine, Juntendo University Faculty of Medicine
| | - Masayuki Yoshida
- Department of Life Sciences and Bioethics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU)
| | - Toru Yoshikawa
- Research Center for Overwork-Related Disorders (RECORDs), National Institute of Occuatopnal Safety and Health, Japan (JNIOSH)
| | - Jun Yoshimatsu
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Takahiro Abe
- Department of Rehabilitation Medicine, Hokkaido University Hospital
| | - Zhehao Dai
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Ayaka Endo
- Department of Cardiology, Tokyo Saiseikai Central Hospital
| | - Mayumi Fukuda-Doi
- Department of Data Science, National Cerebral and Cardiovascular Center
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Kyoko Hirakawa
- Department of Cardiovascular Medicine, Kumamoto University
| | | | | | - Satoshi Ikeda
- Stroke and Cardiovascular Diseases Support Center, Nagasaki University Hospital
| | - Noriko Ishii
- Department of Nursing, Sakakibara Heart Institute
| | - Kazuhiro P Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University
| | - Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | | | - Sachiko Kanki
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University
| | - Katsuhito Kato
- Department of Hygiene and Public Health, Nippon Medical School
| | - Aya Komuro
- Department of Geriatric Medicine, The University of Tokyo Hospital
| | - Nao Konagai
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Yuto Konishi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Fumie Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Satsuki Noma
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Yoshimi Numao
- Department of Cardiology, Itabasih Chuo Medical Center
| | | | - Kimie Okubo
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine Itabashi Hospital
| | | | - Yuka Otaki
- Department of Radiology, Sakakibara Heart Institute
| | | | - Junsuke Shibuya
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Mai Shimbo
- Department of Cardiovascular Medicine, Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo
| | - Reiko Shiomura
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | | | - Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital
| | - Emi Tajima
- Department of Cardiology, Tokyo General Hospital
| | - Ayako Tsukihashi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Haruyo Yasui
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | | | - Soko Setoguchi
- Division of Education, Department of Medicine, Rutgers Robert Wood Johnson Medical School
- Division of Cardiovascular Disease and Hypertension, Department of Medicine, Rutgers Robert Wood Johnson Medical School
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2
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Mangiacapra F, Toth GG, Paolucci L, Wyffels E, Bartunek J, Vanderheyden M, De Bruyne B, Barbato E. Gender-Based Specificities of Fractional Flow Reserve Measurement. Catheter Cardiovasc Interv 2025; 105:435-441. [PMID: 39658875 DOI: 10.1002/ccd.31313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 11/18/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND The relationship between angiographic findings and fractional flow reserve (FFR) according to gender is currently unknown. AIMS To examine gender-based differences in the concordance between angiographic and functional assessment of coronary stenosis severity. METHODS We examined 3770 coronary stenoses of stable patients undergoing both quantitative coronary angiography and FFR measurements in at least one coronary stenosis. RESULTS Median FFR values were higher in female as compared with male patients (0.84 vs. 0.81, p < 0.001) in the overall cohort and in the first three quartiles of diameter stenosis (DS). At receiver operator characteristics (ROC) analysis, DS was effective in predicting ischemic FFR values in both men and women. A 50% DS was the optimal cut off to identify functionally significant stenoses in the entire cohort and in male patients. In females, a higher DS threshold (≥ 59%) significantly improved lesions classification (69.4% vs. 72.4%, p = 0.034), yet at the cost of an increased false negatives rate (10.5% vs. 20.8%, p < 0.001). A lower cut-off of 50% showed a superior diagnostic accuracy for ischemic FFR values (i.e., FFR values ≤ 0.80, AUC: 0.697 vs. 0.661, p = 0.006). Female gender was independently associated with a reduced risk of ischemic FFR (OR 0.51 95% CI [0.43-0.61]). CONCLUSIONS Female patients show higher FFR values across different DS thresholds compared to male patients. A DS ≥ 50% is the best threshold to identify ischemic FFR in both males and females. A higher threshold of DS (≥ 59%) is associated with a significant improvement in lesion classification, despite leading to increased false negatives rate.
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Affiliation(s)
- Fabio Mangiacapra
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Gabor G Toth
- Divion of Cardiology, Department of Medicine, University Heart Center Graz, Medical University of Graz, Graz, Austria
| | - Luca Paolucci
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | | | | | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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3
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Takahashi K, Otsuki H, Zimmermann FM, Ding VY, Oldroyd KG, Wendler O, Reardon MJ, Woo YJ, Yeung AC, Pijls NHJ, De Bruyne B, Fearon WF. Sex Differences in Patients Undergoing FFR-Guided PCI or CABG in the FAME 3 Trial. JACC Cardiovasc Interv 2025; 18:157-167. [PMID: 39641725 DOI: 10.1016/j.jcin.2024.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/07/2024] [Accepted: 09/10/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Outcomes in women after fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) using current-generation drug-eluting stents (DES) compared with coronary artery bypass grafting (CABG) are unknown. OBJECTIVES This study sought to evaluate differences in clinical outcomes according to sex after FFR-guided PCI with current generation DES compared with CABG. METHODS The FAME 3 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial was an investigator-initiated, randomized controlled trial, comparing FFR-guided PCI with current generation DES or CABG in patients with 3-vessel coronary artery disease. This prespecified subgroup analysis compared the incidence of major adverse cardiac and cerebrovascular events (MACCE) according to sex, defined as the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 3 years. RESULTS Of 1,500 patients included in the FAME 3 trial, 265 (17.7%) were women. Women had a significantly higher risk of MACCE at 3 years compared with men after CABG (18.1% vs 11.7%; adjusted HR: 2.07; 95% CI: 1.19-3.60), whereas women had a similar risk of MACCE at 3 years compared with men after PCI (18.2% vs 19.1%; adjusted HR: 1.27; 95% CI: 0.79-2.03). Regarding treatment effects by sex, women undergoing PCI had a similar risk of MACCE at 3 years compared with CABG (adjusted HR: 1.15; 95% CI: 0.62-2.11). By contrast, men undergoing PCI had a higher risk of MACCE at 3 years compared with CABG (adjusted HR: 1.68; 95% CI: 1.25-2.25; Pinteraction = 0.142), which was mainly driven by a higher risk of myocardial infarction (adjusted HR: 2.11; 95% CI: 1.26-3.56; Pinteraction = 0.102) and repeat revascularization (adjusted HR: 2.26; 95% CI: 1.47-3.47; Pinteraction = 0.071). CONCLUSIONS In the FAME 3 trial, at 3 years, women had similar outcomes with FFR-guided PCI compared with CABG, whereas men had improved outcomes with CABG. (A Comparison of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease [FAME 3]; NCT02100722).
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Affiliation(s)
- Kuniaki Takahashi
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Hisao Otsuki
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Frederik M Zimmermann
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Victoria Y Ding
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | | | | | - Michael J Reardon
- Houston Methodist Debakey Heart & Vascular Center, Houston, Texas, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Alan C Yeung
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - William F Fearon
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford, California, USA; VA Palo Alto Medical Systems, Palo Alto, California, USA.
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4
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López-Palop R, Carrillo P, Lozano Í. Impact of Sex in the Incidence of Heart Failure in Patients with Chronic Coronary Syndrome. Curr Heart Fail Rep 2024; 21:354-366. [PMID: 38703306 DOI: 10.1007/s11897-024-00663-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE OF REVIEW This review examines the available evidence concerning the incidence of heart failure in patients with chronic coronary syndrome, with a focus on gender differences. RECENT FINDINGS The incidence of heart failure in the context of chronic coronary syndrome presents conflicting data. Most of the available information stems from studies involving stable patients' post-acute coronary syndrome, revealing a wide range of incidence rates, from less than 3% to over 20%, observed over 5 years of follow-up. Regarding the gender differences in heart failure incidence, there is no consensus about whether women exhibit a higher incidence, particularly in the presence of evidence of obstructive coronary artery disease. However, in cases where obstructive coronary artery disease is absent, women may face a more unfavourable prognosis due to a higher prevalence of microvascular disease and heart failure with preserved ventricular function. The different profile of ischaemic heart disease in women difficult to establish differences in prognosis independently associated with female sex. Targeted investigations are essential to discern the incidence of heart failure in chronic coronary syndrome and explore potential gender-specific associations.
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Affiliation(s)
- Ramón López-Palop
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Murcia-Cartagena s/n. 30120, Murcia, Spain.
| | - Pilar Carrillo
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Murcia-Cartagena s/n. 30120, Murcia, Spain
| | - Íñigo Lozano
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
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5
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Cha JH, Lee JM, Choi KH, Lee JY, Lee SJ, Lee SY, Kim SM, Yun KH, Cho JY, Kim CJ, Ahn HS, Nam CW, Yoon HJ, Park YH, Jeong JO, Song PS, Doh JH, Jo SH, Yoon CH, Kang MG, Koh JS, Lee KY, Lim YH, Cho YH, Cho JM, Jang WJ, Chun KJ, Hong D, Park TK, Yang JH, Choi SH, Gwon HC, Hahn JY, Lee WS, Song YB. Intravascular Imaging-Guided Optimization of Complex Percutaneous Coronary Intervention by Sex: A Subgroup Analysis of the RENOVATE-COMPLEX-PCI Trial. JAMA Cardiol 2024; 9:466-474. [PMID: 38568686 PMCID: PMC10993152 DOI: 10.1001/jamacardio.2024.0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/02/2024] [Indexed: 04/06/2024]
Abstract
Importance There have been heterogeneous results related to sex differences in prognosis after percutaneous coronary artery intervention (PCI) for complex coronary artery lesions. Objective To evaluate potential differences in outcomes with intravascular imaging-guided PCI of complex coronary artery lesions between women and men. Design, Setting, and Participants This prespecified substudy evaluates the interaction of sex in the investigator-initiated, open-label, multicenter RENOVATE-COMPLEX-PCI randomized clinical trial, which demonstrated the superiority of intravascular imaging-guided PCI compared with angiography-guided PCI in patients with complex coronary artery lesions. The trial was conducted at 20 sites in Korea. Patients with complex coronary artery lesions undergoing PCI were enrolled between May 2018 and May 2021, and the median (IQR) follow-up period was 2.1 (1.4-3.0) years. Data were analyzed from December 2022 to December 2023. Interventions After diagnostic coronary angiography, eligible patients were randomly assigned in a 2:1 ratio to receive intravascular imaging-guided PCI or angiography-guided PCI. The choice and timing of the intravascular imaging device were left to the operators' discretion. Main Outcomes and Measures The primary end point was target vessel failure, defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization. Secondary end points included individual components of the primary end point. Results Of 1639 included patients, 339 (20.7%) were women, and the mean (SD) age was 65.6 (10.2) years. There was no difference in the risk of the primary end point between women and men (9.4% vs 8.3%; adjusted hazard ratio [HR], 1.39; 95% CI, 0.89-2.18; P = .15). Intravascular imaging-guided PCI tended to have lower incidence of the primary end point than angiography-guided PCI in both women (5.2% vs 14.5%; adjusted HR, 0.34; 95% CI, 0.15-0.78; P = .01) and men (8.3% vs 11.7%; adjusted HR, 0.72; 95% CI, 0.49-1.05; P = .09) without significant interaction (P for interaction = .86). Conclusions and Relevance In patients undergoing complex PCI, compared with angiographic guidance, intravascular imaging guidance was associated with similar reduction in the risk of target vessel failure among women and men. The treatment benefit of intravascular imaging-guided PCI showed no significant interaction between treatment strategy and sex. Trial Registration ClinicalTrials.gov Identifier: NCT03381872.
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Affiliation(s)
- Ji Hyun Cha
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo Myung Lee
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lee
- Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yeub Lee
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Chung-Ang University College of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Sang Min Kim
- Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | | | | | - Chan Joon Kim
- The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, Korea
| | - Hyo-Suk Ahn
- The Catholic University of Korea, Uijeongbu St. Mary’s Hospital, Seoul, Korea
| | | | | | - Yong Hwan Park
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jin-Ok Jeong
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Pil Sang Song
- Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | | | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | | | - Min Gyu Kang
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jin-Sin Koh
- Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kwan Yong Lee
- The Catholic University of Korea, Incheon St Mary’s Hospital, Seoul, Korea
| | - Young-Hyo Lim
- Hanyang University Seoul Hospital, College of Medicine, Hanyang University, Seoul, Korea
| | | | - Jin-Man Cho
- Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Woo Jin Jang
- Ewha Womans University College of Medicine, Seoul, Korea
| | - Kook-Jin Chun
- Pusan National University Yangsan Hospital, Yangsan, Korea
| | - David Hong
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wang Soo Lee
- Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Young Bin Song
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Campo Dall'Orto C, Eurípedes Vilela L, Vilella Pinto Filho G, Raphael da Silva M. Impact of Sex Differences on the Outcomes of Coronary Invasive Physiological Assessment: Long-Term Follow-Up in a Brazilian Population. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:93-103. [PMID: 38404671 PMCID: PMC10890956 DOI: 10.1089/whr.2023.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/27/2024]
Abstract
Objective This study aimed to evaluate the rate of major adverse cardiac events (MACEs; the sum of death, myocardial infarction, and revascularization rates) according to interventional strategies guided by invasive physiological methods in both sexes in a Brazilian population during long-term follow-up for an average of 2 years. Methods This retrospective single-center study included 151 consecutive patients (232 lesions) between January 2018 and January 2022. The participants were divided into two groups: the female group (FG), comprising 59 patients with 88 lesions, and the male group (MG), comprising 92 patients with 144 lesions. Results The FG had a greater mean age (FG: 67.96 ± 13.12 vs. MG: 62.36 ± 12.01 years, p = 0.009) and lower mean creatinine clearance (FG: 79.35 ± 38.63 vs. MG: 92.02 ± 38.62 mL/min, p = 0.02) than did the MG. The percentage of lesions in the left main coronary artery was higher in the FG than in the MG (12.5% vs. 2.78%, p = 0.006). The mean follow-up time was longer in the MG than in the FG (795.61 ± 350 vs. 619.19 ± 318 days, respectively; p = 0.001). MACE occurred in 11.86% and 13.04% of patients in the FG and MG, respectively (p = 0.850). Secondary outcomes, such as death, reinfarction, and the need for new revascularization, showed no significant between-sex differences. Conclusions Our study demonstrated the safety of invasive physiological methods to determine coronary revascularization in both male and female patients in a Brazilian population, as evidenced by the low rates of adverse cardiac events and death after a long-term follow-up.
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Affiliation(s)
- Clarissa Campo Dall'Orto
- Department of Hemodynamic and Interventional Cardiology, Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas, Bahia, Brazil
| | - Lara Eurípedes Vilela
- Department of Hemodynamic and Interventional Cardiology, Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas, Bahia, Brazil
| | - Gilvan Vilella Pinto Filho
- Department of Hemodynamic and Interventional Cardiology, Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas, Bahia, Brazil
| | - Marcos Raphael da Silva
- Department of Hemodynamic and Interventional Cardiology, Advanced Hemodynamic Therapy Center, Brazilian Society of Health Support Hospital, Teixeira de Freitas, Bahia, Brazil
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7
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Matsumura M, Maehara A, Davis JE, Kumar G, Sharp A, Samady H, Seto AH, Cohen D, Patel MR, Ali ZA, Stone GW, Jeremias A. Changes in post-PCI physiology based on anatomical vessel location: a DEFINE PCI substudy. EUROINTERVENTION 2023; 19:e903-e912. [PMID: 38031488 PMCID: PMC10719742 DOI: 10.4244/eij-d-23-00517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/24/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Anatomical vessel location affects post-percutaneous coronary intervention (PCI) physiology. AIMS We aimed to compare the post-PCI instantaneous wave-free ratio (iFR) in left anterior descending (LAD) versus non-LAD vessels and to identify the factors associated with a suboptimal post-PCI iFR. METHODS DEFINE PCI was a multicentre, prospective, observational study in which a blinded post-PCI iFR pullback was used to assess residual ischaemia following angiographically successful PCI. RESULTS Pre- and post-PCI iFR recordings of 311 LAD and 195 non-LAD vessels were compared. Though pre-PCI iFR in the LAD vessels (median 0.82 [0.63, 0.86]) were higher compared with those in non-LAD vessels (median 0.72 [0.49, 0.84]; p<0.0001), post-PCI iFR were lower in the LAD vessels (median 0.92 [0.88, 0.94] vs 0.98 [0.95, 1.00]; p<0.0001). The prevalence of a suboptimal post-PCI iFR of <0.95 was higher in the LAD vessels (77.8% vs 22.6%; p<0.0001). While the overall frequency of residual physiological diffuse disease (31.4% vs 38.6%; p=0.26) and residual focal disease in the non-stented segment (49.6% vs 50.0%; p=0.99) were similar in both groups, residual focal disease within the stented segment was more common in LAD versus non-LAD vessels (53.7% vs 27.3%; p=0.0009). Improvement in iFR from pre- to post-PCI was associated with angina relief regardless of vessel location. CONCLUSIONS After angiographically successful PCI, post-PCI iFR is lower in the LAD compared with non-LAD vessels, resulting in a higher prevalence of suboptimal post-PCI iFR in LAD vessels. This difference is, in part, due to a greater frequency of a residual focal pressure gradient within the stented segment which may be amenable to more aggressive PCI.
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Affiliation(s)
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Justin E Davis
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom
| | | | - Andrew Sharp
- Royal Devon & Exeter NHS Foundation Trust, Exeter, United Kingdom
| | | | | | - David Cohen
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | | | - Ziad A Ali
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
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8
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Oliveira GMMD, Almeida MCCD, Rassi DDC, Bragança ÉOV, Moura LZ, Arrais M, Campos MDSB, Lemke VG, Avila WS, Lucena AJGD, Almeida ALCD, Brandão AA, Ferreira ADDA, Biolo A, Macedo AVS, Falcão BDAA, Polanczyk CA, Lantieri CJB, Marques-Santos C, Freire CMV, Pellegrini D, Alexandre ERG, Braga FGM, Oliveira FMFD, Cintra FD, Costa IBSDS, Silva JSN, Carreira LTF, Magalhães LBNC, Matos LDNJD, Assad MHV, Barbosa MM, Silva MGD, Rivera MAM, Izar MCDO, Costa MENC, Paiva MSMDO, Castro MLD, Uellendahl M, Oliveira Junior MTD, Souza OFD, Costa RAD, Coutinho RQ, Silva SCTFD, Martins SM, Brandão SCS, Buglia S, Barbosa TMJDU, Nascimento TAD, Vieira T, Campagnucci VP, Chagas ACP. Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023. Arq Bras Cardiol 2023; 120:e20230303. [PMID: 37556656 PMCID: PMC10382148 DOI: 10.36660/abc.20230303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Walkiria Samuel Avila
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Andreia Biolo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | | | | | | | - Celi Marques-Santos
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Hospital São Lucas Rede D'Or São Luis, Aracaju, SE - Brasil
| | | | - Denise Pellegrini
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | - Fabiana Goulart Marcondes Braga
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Lara Terra F Carreira
- Cardiologia Nuclear de Curitiba, Curitiba, PR - Brasil
- Hospital Pilar, Curitiba, PR - Brasil
| | | | | | | | | | | | | | | | | | | | | | - Marly Uellendahl
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
- DASA - Diagnósticos da América S/A, São Paulo, SP - Brasil
| | - Mucio Tavares de Oliveira Junior
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | - Ricardo Quental Coutinho
- Faculdade de Ciências Médicas da Universidade de Pernambuco (UPE), Recife, PE - Brasil
- Hospital Universitário Osvaldo Cruz da Universidade de Pernambuco (UPE), Recife, PE - Brasil
| | | | - Sílvia Marinho Martins
- Pronto Socorro Cardiológico de Pernambuco da Universidade de Pernambuco (PROCAPE/UPE), Recife, PE - Brasil
| | | | - Susimeire Buglia
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Thais Vieira
- Universidade Tiradentes (UNIT), Aracaju, SE - Brasil
- Rede D'Or, Aracaju, SE - Brasil
- Hospital Universitário da Universidade Federal de Sergipe (UFS), Aracaju, SE - Brasil
| | | | - Antonio Carlos Palandri Chagas
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
- Centro Universitário Faculdade de Medicina ABC, Santo André, SP - Brasil
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9
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Baruś P, Piasecki A, Gumiężna K, Bednarek A, Dunaj P, Głód M, Sadowski K, Ochijewicz D, Rdzanek A, Pietrasik A, Grabowski M, Kochman J, Tomaniak M. Multimodality OCT, IVUS and FFR evaluation of coronary intermediate grade lesions in women vs. men. Front Cardiovasc Med 2023; 10:1021023. [PMID: 37424919 PMCID: PMC10325624 DOI: 10.3389/fcvm.2023.1021023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Background The pathophysiology of atherosclerotic plaque formation and its vulnerability seem to differ between genders due to contrasting risk profiles and sex hormones, however this process is still insufficiently understood. The aim of the study was to compare the differences between sexes regarding the optical coherence tomography (OCT), intravascular ultrasound (IVUS) and fractional flow reserve (FFR)-derived coronary plaque indices. Methods In this single-center multimodality imaging study patients with intermediate grade coronary stenoses identified in coronary angiogram (CAG) were evaluated using OCT, IVUS and FFR. Stenoses were considered significant when the FFR value was ≤0.8. Minimal lumen area (MLA), was analyzed by OCT in addition to plaque stratification into fibrotic, calcific, lipidic and thin-cap fibroatheroma (TCFA). IVUS was used for evaluation of lumen-, plaque- and vessel volume, as well as plaque burden. Results A total of 112 patients (88 men and 24 women) with chronic coronary syndromes (CCS), who underwent CAG were enrolled. No significant differences in baseline characteristics were present between the study groups. The mean FFR was 0.76 (0.73-0.86) in women and 0.78 ± 0.12 in men (p = 0.695). OCT evaluation showed a higher prevalence of calcific plaques among women than men p = 0.002 whereas lipid plaques were more frequent in men (p = 0.04). No significant differences regarding minimal lumen diameter and minimal lumen area were found between the sexes. In IVUS analysis women presented with significantly smaller vessel area, plaque area, plaque volume, vessel volume (11.1 ± 3.3 mm2 vs. 15.0 ± 4.6 mm2 p = 0.001, 6.04 ± 1.7 mm2 vs. 9.24 ± 2.89 mm2 p < 0.001, 59.8 ± 35.2 mm3 vs. 96.3 (52.5-159.1) mm3 p = 0.005, 106.9 ± 59.8 mm3 vs. 153.3 (103-253.4) mm3 p = 0.015 respectively). At MLA site plaque burden was significantly greater for men than women (61.50 ± 7.7% vs. 55.5 ± 8.0% p = 0.005). Survival did not differ significantly between women and men (94.6 ± 41.9 months and 103.51 ± 36.7 months respectively; p = 0.187). Conclusion The presented study did not demonstrate significant differences in FFR values between women and men, yet a higher prevalence of calcific plaques by OCT and lower plaque burden at the MLA site by IVUS was found in women vs. men.
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10
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Heydari B, Ge Y, Antiochos P, Islam S, Steel K, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Shanbhag SM, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Raman SV, Ferrari VA, Shah DJ, Schulz-Menger J, Stuber M, Simonetti OP, Kwong RY. Sex-Specific Stress Perfusion Cardiac Magnetic Resonance Imaging in Suspected Ischemic Heart Disease: Insights From SPINS Retrospective Registry. JACC. CARDIOVASCULAR IMAGING 2023:S1936-878X(22)00752-5. [PMID: 36764892 DOI: 10.1016/j.jcmg.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/28/2022] [Accepted: 11/30/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of mortality in women, but current noninvasive cardiac imaging techniques have sex-specific limitations. OBJECTIVES In this study, the authors sought to investigate the effect of sex on the prognostic utility and downstream invasive revascularization and costs of stress perfusion cardiac magnetic resonance (CMR) for suspected CVD. METHODS Sex-specific prognostic performance was evaluated in a 2,349-patient multicenter SPINS (Stress CMR Perfusion Imaging in the United States [SPINS] Study) registry. The primary outcome measure was a composite of cardiovascular death and nonfatal myocardial infarction; secondary outcomes were hospitalization for unstable angina or heart failure, and late unplanned coronary artery bypass grafting. RESULTS SPINS included 1,104 women (47% of cohort); women had higher prevalence of chest pain (62% vs 50%; P < 0.0001) but lower use of medical therapies. At the 5.4-year median follow-up, women with normal stress CMR had a low annualized rate of primary composite outcome similar to men (0.54%/y vs 0.75%/y, respectively; P = NS). In contrast, women with abnormal CMR were at higher risk for both primary (3.74%/y vs 0.54%/y; P < 0.0001) and secondary (9.8%/y vs 1.6%/y; P < 0.0001) outcomes compared with women with normal CMR. Abnormal stress CMR was an independent predictor for the primary (HR: 2.64 [95% CI: 1.20-5.90]; P = 0.02) and secondary (HR: 2.09 [95% CI: 1.43-3.08]; P < 0.0001) outcome measures. There was no effect modification for sex. Women had lower rates of invasive coronary angiography (ICA; 3.6% vs 7.3%; P = 0.0001) and downstream costs ($114 vs $171; P = 0.001) at 90 days following CMR. There was no effect of sex on diagnostic image quality. CONCLUSIONS Stress CMR demonstrated excellent prognostic performance with lower rates of ICA referral in women. Stress CMR should be considered as a first-line noninvasive imaging tool for the evaluation of women. (Stress CMR Perfusion Imaging in the United States [SPINS] Study [SPINS]; NCT03192891).
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Affiliation(s)
- Bobak Heydari
- Stephenson Cardiac Imaging Center, University of Calgary, Calgary, Alberta, Canada
| | - Yin Ge
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Panagiotis Antiochos
- Cardiology Division, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sabeeh Islam
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kevin Steel
- St Joseph Medical Center, Bellingham, Washington, USA
| | | | - Shuaib Abdullah
- VA North Texas Medical Center and University of Texas-Southwestern Medical School, Dallas, Texas, USA
| | - J Ronald Mikolich
- Department of Cardiovascular Medicine, Sharon Regional Health System, Sharon, Pennsylvania, USA
| | - Andrew E Arai
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - W Patricia Bandettini
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Amit R Patel
- Division of Cardiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sujata M Shanbhag
- Division of Intramural Research, Cardiology Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - John F Heitner
- Cardiovascular Division, New York University Grossman School of Medicine, New York, New York, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Steve W Leung
- Division of Cardiovascular Medicine, Gill Heart and Vascular Institute, University of Kentucky, Lexington, Kentucky, USA
| | - Jorge A Gonzalez
- Division of Cardiology and Radiology, Scripps Clinic, La Jolla, California, USA
| | - Subha V Raman
- Indiana University Cardiovascular Institute and Krannert Cardiovascular Research Center, Indianapolis, Indiana, USA
| | - Victor A Ferrari
- Hospital of the University of Pennsylvania and Penn Cardiovascular Institute, Philadelphia, Pennsylvania, USA
| | - Dipan J Shah
- Weill Cornell Medical College, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Jeanette Schulz-Menger
- Charité, Medical Faculty of the Humboldt University, Experimental and Clinical Research Center, Berlin, Germany; Helios Clinics, Cardiology, Berlin, Germany
| | - Matthias Stuber
- Department of Radiology, University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Orlando P Simonetti
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
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11
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Matsumoto H, Masaki R, Higuchi S, Tanaka H, Kondo S, Tsujita H, Shinke T. Impact of overestimation of fractional flow reserve by adenosine on anatomical-functional mismatch. Sci Rep 2022; 12:14962. [PMID: 36056128 PMCID: PMC9440099 DOI: 10.1038/s41598-022-19330-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022] Open
Abstract
Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical-functional mismatch) and its influence on reclassification of functional significance. Distal-to-aortic pressure ratio (Pd/Pa) was measured using adenosine (Pd/PaADN) and papaverine (Pd/PaPAP) in 326 patients (326 vessels). The overestimation of FFR was calculated as Pd/PaADN-Pd/PaPAP. The anatomical-functional mismatch was defined as diameter stenosis > 50% and Pd/PaADN > 0.80. Reclassification was indicated by Pd/PaADN > 0.80 and Pd/PaPAP ≤ 0.80. The mismatch (n = 72) had a greater overestimation of FFR than the non-mismatch (n = 99): median 0.02 (interquartile range 0.01-0.05) versus 0.01 (0.00-0.04), p = 0.014. Multivariable analysis identified the overestimation of FFR (p = 0.003), minimal luminal diameter (p = 0.001), and non-left anterior descending artery (LAD) location (p < 0.001) as determinants of the mismatch. Reclassification was indicated in 29% of the mismatch and was more frequent in the LAD than in the non-LAD (52% vs. 20%, p = 0.005). The overestimation of FFR is an independent determinant of anatomical-functional mismatch. Anatomical-functional mismatch, specifically in the LAD, may suggest a false-negative result.
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Affiliation(s)
- Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
| | - Ryota Masaki
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Satoshi Higuchi
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Hideaki Tanaka
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Seita Kondo
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Hiroaki Tsujita
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
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12
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Rashid M, Stevens C, Zaman S, Pinilla-Echeverri N, Velagapudi P, Chieffo A, Shoaib A, Ludman P, Mills NL, Nolan J, Kinnaird T, Mamas M. Sex Differences in Use of Intracoronary Imaging in Patients Undergoing Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2022; 15:1290-1292. [PMID: 35738756 DOI: 10.1016/j.jcin.2022.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/22/2022] [Accepted: 03/29/2022] [Indexed: 11/19/2022]
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13
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Fernández-Peregrina E, Ahmad H, Mintz GS, Garcia-Garcia HM. When coronary imaging and physiology are discordant, how best to manage coronary lesions? An appraisal of the clinical evidence. Catheter Cardiovasc Interv 2022; 99:2008-2015. [PMID: 35373887 DOI: 10.1002/ccd.30186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/16/2022] [Accepted: 03/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Discordant physiology and anatomy may occur when nonsevere angiographic stenosis has positive physiology as well as the opposite situation. AIM To underline the reasons behind the discrepancy in physiology and anatomy and to summarize the information that coronary imaging may add to physiology. METHODS A review of the published literature on physiology and intravascular imaging assessment of intermediate lesions was carried out. RESULTS The limitations of angiography, the possibility of an underlying diffuse disease, the presence of a "grey zone" in both techniques, the amount of myocardial mass that subtends the stenosis, and plaque vulnerability may play a role in such discrepancy. Intracoronary imaging has a poor diagnostic accuracy compared to physiology. However, it may add information about plaque vulnerability that might be useful in deciding whether to treat or not a certain lesion. CONCLUSIONS Coronary revascularization is recommended for patients with ischemia based on physiology. Intracoronary imaging adds information on plaque vulnerability and can help on the decision whether to revascularize or not a lesion.
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Affiliation(s)
- Estefania Fernández-Peregrina
- Division of Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Huzaifa Ahmad
- Division of Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Gary S Mintz
- Division of Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Hector M Garcia-Garcia
- Division of Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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14
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Lansky A, Baron SJ, Grines CL, Tremmel JA, Al-Lamee R, Angiolillo DJ, Chieffo A, Croce K, Jacobs AK, Madan M, Maehara A, Mehilli J, Mehran R, Ng V, Parikh PB, Saw J, Abbott JD. SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100016. [PMID: 39132570 PMCID: PMC11307953 DOI: 10.1016/j.jscai.2021.100016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 08/13/2024]
Affiliation(s)
| | | | - Cindy L. Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | | | | | | | - Alaide Chieffo
- University of Florida Health Sciences Center, Jacksonville, Florida
| | - Kevin Croce
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Alice K. Jacobs
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Akiko Maehara
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivian Ng
- Columbia University Irving Medical Center, New York, New York
| | - Puja B. Parikh
- Stony Brook University Medical Center, Stony Brook, New York
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - J. Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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15
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Cho SG, Kim HY, Bom HS. Anxiety as a risk factor in coronary artery disease among young women. J Nucl Cardiol 2021; 28:2593-2596. [PMID: 32333278 DOI: 10.1007/s12350-020-02101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Sang-Geon Cho
- Department of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hyung Yoon Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, 322, Seoyang-ro Hwasun-eup, Hwasun-gun, Jeonnam, 58128, Republic of Korea.
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16
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Jansen TPJ, Elias-Smale SE, van den Oord S, Gehlmann H, Dimitiriu-Leen A, Maas AHEM, Konst RE, van Royen N, Damman P. Sex Differences in Coronary Function Test Results in Patient With Angina and Nonobstructive Disease. Front Cardiovasc Med 2021; 8:750071. [PMID: 34722680 PMCID: PMC8551605 DOI: 10.3389/fcvm.2021.750071] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/22/2021] [Indexed: 01/16/2023] Open
Abstract
Introduction: Invasive coronary function testing (CFT) has become the recommended diagnostic tool to assess the various endotypes of coronary vasomotor dysfunction in patients with angina and no obstructive coronary artery disease (ANOCA), which has implications for therapy and prognosis. Although the expanding performance of CFT is leading to increased knowledge of coronary vasomotor dysfunction, little is known about sex-related differences in the results of comprehensive CFT. Methods: We conducted a prospective study of all consecutive patients with ANOCA that underwent clinically indicated CFT in a tertiary interventional from February 2019 to February 2021. CFT consisted of acetylcholine testing to diagnose epicardial or microvascular spasm, and adenosine testing to diagnose CMD. CMD was defined as an index of microvascular resistance (IMR) ≥ 25 and/or coronary flow reserve (CFR) < 2.0. Results: In total, 228 women and 38 men underwent CFT. No differences in traditional risk factors were seen, but women had a higher prevalence of migraine (45 vs. 14%, p = 0.001). Men more often had a history of percutaneous coronary intervention (12 vs. 49%, p = 0.001). We found no difference in clinical presentation. Coronary vasomotor dysfunction was present in 95% of men and 88% of women (p = 0.25), but males show more often epicardial spasm and less microvascular spasm than women (63 vs. 42% and 29 vs. 40% respectively, p = 0.039). Impaired CFR was more prevalent among females (6 vs 20%, p = 0.033). IMR [median of 23 (15–32) vs. 19 (13–25), p = 0.08] did not differ between the sexes. Conclusion: Men undergoing CFT show a comparable prevalence of coronary vascular dysfunction as women. However, men have a higher prevalence of epicardial spasm and a lower prevalence of microvascular spasm compared with women. An impaired CFR was more often present in women, with an equally impairment of IMR.
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Affiliation(s)
| | | | | | | | | | | | - Regina E Konst
- Department of Cardiology, Radboudumc, Nijmegen, Netherlands
| | | | - Peter Damman
- Department of Cardiology, Radboudumc, Nijmegen, Netherlands
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17
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Prasad K, Reddy S S, Kaur J, Rao k R, Kumar S, Kadiyala V, Ram Kashyap J, Panwar G. Gender-based in vivo comparison of culprit plaque characteristics and plaque microstructures using optical coherence tomography in acute coronary syndrome. J Cardiovasc Thorac Res 2021; 13:277-284. [PMID: 35047132 PMCID: PMC8749362 DOI: 10.34172/jcvtr.2021.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Women perform worse after acute coronary syndrome (ACS) than men. The reason for these differences is unclear. The aim was to ascertain gender differences in the culprit plaque characteristics in ACS.
Methods: Patients with ACS undergoing percutaneous coronary intervention for the culprit vessel underwent optical coherence tomography (OCT) imaging. Culprit plaque was identified as lipid rich,fibrous, and calcific plaque. Mechanisms underlying ACS are classified as plaque rupture, erosion,or calcified nodule. A lipid rich plaque along with thin-cap fibroatheroma (TCFA) was a vulnerable plaque. Plaque microstructures including cholesterol crystals, macrophages, and microvessels were noted.
Results: A total of 52 patients were enrolled (men=29 and women=23). Baseline demographic features were similar in both the groups except men largely were current smokers (P <0.001). Plaque morphology,men vs. women: lipid rich 88.0% vs. 90.5%; fibrous 4% vs 0%; calcific 8.0% vs. 9.5% (P = 0.64). Of the ACS mechanisms in males versus females; plaque rupture (76.9 % vs. 50 %), plaque erosion (15.4 % vs.40 %) and calcified nodule (7.7 % vs. 10 %) was noted (P = 0.139). Fibrous cap thickness was (50.19 ±11.17 vs. 49.00 ± 10.71 mm, P = 0.71) and thin-cap fibroatheroma (96.2% vs. 95.0%, P = 1.0) in men and women respectively. Likewise no significant difference in presence of macrophages (42.3 % vs. 30%, P = 0.76), microvessels (73.1% vs. 60 %, P = 0.52) and cholesterol crystals (92.3% vs. 80%, P = 0.38).
Conclusion: No significant gender-based in-vivo differences could be discerned in ACS patients’ culprit plaques morphology, characteristics, and underlying mechanisms.
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Affiliation(s)
- Krishna Prasad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sreeniavs Reddy S
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Raghavendra Rao k
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Garima Panwar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
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18
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Velagapudi P, Altin SE, Schneider MD, Alasnag M. Sex Differences in Intracoronary Imaging and Functional Evaluation of Coronary Arteries. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-021-09557-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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19
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Zhang H, Li G, Hou Q, Yang Y, Wei H, Yang Y, Qu Z, Xie J, Qiao A. Research on the Method of Predicting Fractional Flow Reserve Based on Multiple Independent Risk Factors. Front Physiol 2021; 12:716877. [PMID: 34483970 PMCID: PMC8414807 DOI: 10.3389/fphys.2021.716877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
The use of diameter stenosis (DS), as revealed by coronary angiography, for predicting fractional flow reserve (FFR) usually results in a high error rate of detection. In this study, we investigated a method for predicting FFR in patients with coronary stenosis based on multiple independent risk factors. The aim of the study was to improve the accuracy of detection. First, we searched the existing literature to identify multiple independent risk factors and then calculated the corresponding odds ratios. The improved analytic hierarchy process (IAHP) was then used to determine the weighted value of each independent risk factor, based on the corresponding odds ratio. Next, we developed a novel method, based on the top seven independent risk factors with the highest weighted values, to predict FFR. This model was then used to predict the FFR of 253 patients with coronary stenosis, and the results were then compared with previous methods (DS alone and a simplified scoring system). In addition to DS, we identified a range of other independent risk factors, with the highest weighted values, for predicting FFR, including gender, body mass index, location of stenosis, type of coronary artery distribution, left ventricular ejection fraction, and left myocardial mass. The area under the receiver-operating characteristic curve (AUC) for the newly developed method was 84.3% (95% CI: 79.2–89.4%), which was larger than 65.3% (95% CI: 61.5–69.1%) of DS alone and 74.8% (95% CI: 68.4–81.2%) of the existing simplified scoring system. The newly developed method, based on multiple independent risk factors, effectively improves the prediction accuracy for FFR.
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Affiliation(s)
- Honghui Zhang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,College of Engineering, Inner Mongolia University for Nationalities, Tongliao, China
| | - Gaoyang Li
- Institute of Fluid Science, Tohoku University, Miyagi, Japan
| | - Qianwen Hou
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yinlong Yang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Hongge Wei
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yujia Yang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Zhuoran Qu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Jinjie Xie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Aike Qiao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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20
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Geng L, Yuan Y, Du P, Gao L, Wang Y, Li J, Guo W, Huang Y, Zhang Q. Association of quantitative flow ratio-derived microcirculatory indices with anatomical-functional discordance in intermediate coronary lesions. Int J Cardiovasc Imaging 2021; 37:2803-2813. [PMID: 34059977 DOI: 10.1007/s10554-021-02292-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/16/2021] [Indexed: 12/18/2022]
Abstract
Discrepancy between coronary lesion severity and functional significance has always been a relevant issue in the management of patients undergoing coronary angiography and/or revascularization. We sought to investigate the relationship between quantitative flow ratio (QFR)-derived microcirculatory indices and anatomical-functional mismatch/reverse mismatch in intermediate coronary lesions. Intravascular ultrasound (IVUS) imaging and QFR were analyzed in 117 de novo intermediate coronary lesions. Lesions with QFR ≤ 0.8 were considered hemodynamically significant. Anatomical significance of the lesions was defined according to the best cutoff value of combined IVUS parameters for predicting QFR ≤ 0.8. QFR-derived microcirculatory indices including contrast-flow QFR minus fixed-flow QFR (cQFR-fQFR), hyperemic flow velocity and angiography-derived index of microcirculatory resistance (IMRangio) were calculated. The best cutoff values of IVUS parameters for predicting QFR ≤ 0.8 were minimum lumen area (MLA) 3.1mm2 and plaque burden (PB) 70%, with area under the curve of 0.635 and 0.703, respectively. The total discordance rate of lesion functional significance between IVUS and QFR assessments was 26.5%, with 21 lesions (17.9%) being classified as mismatch (MLA ≤ 3.1mm2 and PB ≥ 70% and QFR > 0.8) and 10 lesions (8.5%) as reverse-mismatch (MLA > 3.1 mm2 or PB < 70% and QFR ≤ 0.8). At multivariate analysis, IMRangio was identified as an independent predictor of mismatch (OR1.675, 95%CI:1.176-2.386, P = 0.004), whereas hyperemic flow velocity was identified as an independent predictor of reverse-mismatch (OR 1.233, 95%CI:1.073-1.416, P = 0.003). In intermediate coronary lesions, although MLA 3.1mm2 and PB 70% determined by IVUS are predictive of QFR-defined functional significance, the discordance rate remains substantial. QFR-derived microcirculatory indices are independently associated with anatomical-functional discordance between IVUS and QFR assessments.
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Affiliation(s)
- Liang Geng
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.,Department of Cardiology, JI'AN Hospital, Shanghai East Hospital, Ji An, 343006, China
| | - Yuan Yuan
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Peizhao Du
- Department of Cardiology, Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, 201900, China
| | - Liming Gao
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yunkai Wang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jiming Li
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Wei Guo
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Ying Huang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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21
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Kato Y, Dohi T, Chikata Y, Fukase T, Takeuchi M, Takahashi N, Endo H, Nishiyama H, Doi S, Okai I, Iwata H, Isoda K, Okazaki S, Miyauchi K, Daida H, Minamino T. Predictors of discordance between fractional flow reserve and resting full-cycle ratio in patients with coronary artery disease: Evidence from clinical practice. J Cardiol 2020; 77:313-319. [PMID: 33234404 DOI: 10.1016/j.jjcc.2020.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) is an established method for assessing functional myocardial ischemia. Recently, the resting full-cycle ratio (RFR) has been introduced as a non-hyperemic index of functional coronary stenosis. However, the effects of clinical characteristics on discordance between RFR and FFR have not been fully evaluated. We aimed to identify clinical characteristics that influence FFR-RFR concordance. METHODS We included 410 patients with 573 intermediate coronary lesions who underwent clinically indicated invasive coronary angiography, as well as assessments of FFR and RFR. Receiver-operating characteristic (ROC) curves were created to assess the optimal cut-off values of RFR for predicting FFR ≤0.80. RESULTS RFR exhibited a strong correlation with FFR (r = 0.66, p < 0.0001). ROC analysis identified an optimal RFR cut-off value of 0.92 for categorization based on an FFR cut-off value of 0.8. The discordance of FFR >0.8 and RFR ≤0.92 (high FFR/low RFR) was observed in 112 lesions (20.9%), whereas the discordance of FFR ≤0.8 and RFR >0.92 (low FFR/high RFR) was observed in 35 lesions (6.5%). Higher rate of hemodialysis and lower hemoglobin levels were observed in the high FFR/low RFR group. Multivariate analyses identified female sex, left anterior descending artery (LAD) lesions, and hemodialysis as significant predictors of high FFR/low RFR. Conversely, body surface area and non-LAD lesions were significantly associated with low FFR/high RFR. Hemodialysis [odds ratio (OR): 2.41, 95% confidence interval (CI) 1.31-4.41; p = 0.005] and LAD lesions (OR: 1.86, 95% CI: 1.25-2.79; p = 0.002) were identified as independent predictors of overall FFR-RFR discordance. CONCLUSIONS RFR exhibited good diagnostic performance in the identification of functionally significant stenosis. However, RFR may overestimate functional severity in patients undergoing hemodialysis or in those with LAD lesions. Further prospective trials are required to demonstrate the non-inferiority of RFR to FFR.
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Affiliation(s)
- Yoshiteru Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Yuichi Chikata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tatsuya Fukase
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mitsuhiro Takeuchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Norihito Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroki Nishiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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22
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Aoi S, Toklu B, Misumida N, Patel N, Lee W, Fox J, Matsuo H, Kanei Y. Effect of Sex Difference on Discordance Between Instantaneous Wave-Free Ratio and Fractional Flow Reserve. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 24:57-64. [PMID: 32839130 DOI: 10.1016/j.carrev.2020.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Physiology-guided percutaneous coronary intervention (PCI) has demonstrated to improve clinical outcomes. Previous trials showed the agreement between iFR and FFR is approximately 80%, however the details of discordance pattern remain to be elucidated. METHODS We retrospectively reviewed 1024 consecutive intermediate stenotic lesions for which functional evaluation using both iFR and FFR were performed between January 2015 and June 2016. The lesions were classified into 4 groups according to iFR and FFR concordance [(iFR+/FFR+) and (iFR-/FFR-)] or discordance [(iFR+/FFR-) and (iFR-/FFR+)]. RESULTS Our study evaluated 451 lesions, 264 lesions (58.5%) from men and 187 lesions (41.5%) from women. iFR was similar between women and men, however FFR was significantly higher in women than men. The rate of discordance between iFR and FFR was 21.3% (iFR+/FFR- 12.4% and iFR-/FFR+ 8.9%) in overall cohort. The prevalence of overall concordance and discordance were similar between men and women, however iFR+/FFR- discordance was significantly higher in women (17.1% vs. 9.1%) whereas iFR-/FFR+ discordance was significantly higher in men (11.3% vs. 4.8%). In multivariable analysis, female sex and older age were significantly associated with iFR+/FFR- discordance (odds ratio 1.88 and 1.48, respectively). Conversely, younger age, higher stenosis, and concomitant chronic total occlusion were independent predictors for iFR-/FFR+ discordance (odds ratio 0.67, 1.82, and 4.32, respectively). CONCLUSIONS Despite similar prevalence of overall concordance and discordance between men and women, iFR+/FFR- discordance was higher in women and iFR-/FFR+ discordance was higher in men. Multivariable analysis showed female sex to be independent predictor of iFR+/FFR- discordance.
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Affiliation(s)
- Shunsuke Aoi
- Department of Cardiology, Mount Sinai Beth Israel, New York, NY, United States of America.
| | - Bora Toklu
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Naoki Misumida
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Neil Patel
- Department of Cardiology, Mount Sinai Beth Israel, New York, NY, United States of America
| | - Wonkyoung Lee
- Department of Cardiology, Mount Sinai Beth Israel, New York, NY, United States of America
| | - John Fox
- Department of Cardiology, Mount Sinai Beth Israel, New York, NY, United States of America
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Yumiko Kanei
- Department of Cardiology, Mount Sinai Beth Israel, New York, NY, United States of America
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23
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Kim CH, Koo B, Lee JM, Shin E, Park J, Choi KH, Hwang D, Rhee T, Zhang J, Choi Y, Lee S, Choi J, Doh J, Nam C, Wang J, Chen S, Kuramitsu S, Tanaka N, Matsuo H, Akasaka T. Influence of Sex on Relationship Between Total Anatomical and Physiologic Disease Burdens and Their Prognostic Implications in Patients With Coronary Artery Disease. J Am Heart Assoc 2020; 8:e011002. [PMID: 30813812 PMCID: PMC6474930 DOI: 10.1161/jaha.118.011002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Total atherosclerosis disease burden is associated with clinical outcomes in patients with coronary artery disease. However, the influence of sex on the relationship between total anatomical and physiologic disease burdens and their prognostic implications have not been well defined. Methods and Results A total of 1136 patients who underwent fractional flow reserve (FFR) measurement in all 3 major coronary arteries were included in this study. Anatomical and physiologic total disease burden was assessed by SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score, residual SYNTAX score, a total sum of FFR in 3 vessels (3-vessel FFR), and functional SYNTAX score. The primary end point was major adverse cardiac events, a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization at 2 years. There were no differences in angiographic diameter stenosis, SYNTAX score, or residual SYNTAX score between women and men. However, both per-vessel FFR (0.89±0.10 versus 0.87±0.11, P<0.001) and 3-vessel FFR (2.72±0.13 versus 2.69±0.15, P<0.001) were higher in women. Multivariable Cox regression analyses showed that total anatomical and physiologic disease burdens were significantly associated with 2-year major adverse cardiac events, and there was no significant interaction between sex and total disease burden for clinical outcomes. Conclusions Despite similar angiographic disease severity, both per-vessel and per-patient physiologic disease severity was less in women than in men. There was no influence of sex on prognostic implications of total anatomical and physiologic disease burdens in patients with coronary artery disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT01621438.
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Affiliation(s)
- Chee Hae Kim
- Division of CardiologyDepartment of Internal MedicineVHS Medical CenterSeoulKorea
| | - Bon‐Kwon Koo
- Division of CardiologyDepartment of Internal MedicineSeoul National University HospitalSeoulKorea
- Institute on AgingSeoul National UniversitySeoulKorea
| | - Joo Myung Lee
- Division of CardiologyDepartment of Internal MedicineHeart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Eun‐Seok Shin
- Department of CardiologyUlsan University HospitalUniversity of Ulsan College of MedicineUlsanKorea
- Division of CardiologyUlsan HospitalUlsanKorea
| | - Jonghanne Park
- Division of CardiologyDepartment of Internal MedicineSeoul National University HospitalSeoulKorea
| | - Ki Hong Choi
- Division of CardiologyDepartment of Internal MedicineHeart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Doyeon Hwang
- Division of CardiologyDepartment of Internal MedicineSeoul National University HospitalSeoulKorea
| | - Tae‐Min Rhee
- Division of CardiologyDepartment of Internal MedicineSeoul National University HospitalSeoulKorea
| | - Jinlong Zhang
- Division of CardiologyDepartment of Internal MedicineSeoul National University HospitalSeoulKorea
| | - You‐Jung Choi
- Division of CardiologyDepartment of Internal MedicineSeoul National University HospitalSeoulKorea
| | - Seo‐Young Lee
- Division of CardiologyDepartment of Internal MedicineSeoul National University HospitalSeoulKorea
| | - Jin‐Ho Choi
- Division of CardiologyDepartment of Internal MedicineHeart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
- Department of Emergency MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Joon‐Hyung Doh
- Department of MedicineInje University Ilsan Paik HospitalGoyangKorea
| | - Chang‐Wook Nam
- Department of MedicineKeimyung University Dongsan Medical CenterDaeguKorea
| | - Jianan Wang
- Department of CardiologyThe Second Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhouChina
| | - Shaoliang Chen
- Department of CardiologyNanjing First HospitalNanjing Medical UniversityNanjingChina
| | | | | | | | - Takashi Akasaka
- Department of CardiologyWakayama Medical UniversityWakayamaJapan
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24
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Yonetsu T, Hoshino M, Lee T, Murai T, Sumino Y, Hada M, Yamaguchi M, Kanaji Y, Sugiyama T, Niida T, Matsuda J, Hatano Y, Umemoto T, Sasano T, Kakuta T. Impact of Sex Difference on the Discordance of Revascularization Decision Making Between Fractional Flow Reserve and Diastolic Pressure Ratio During the Wave-Free Period. J Am Heart Assoc 2020; 9:e014790. [PMID: 32102614 PMCID: PMC7335550 DOI: 10.1161/jaha.119.014790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Sex difference in fractional flow reserve (FFR) and resting index has not been fully clarified. We sought to investigate the impact of sex on the discordance of revascularization decision making between FFR and diastolic pressure ratio during the diastolic wave‐free period (dPRWFP). Methods and Results A total of 759 angiographically intermediate lesions with 30% to 80% diameter stenosis by quantitative coronary angiography in 577 patients in whom FFR and dPRWFP were measured were investigated. dPRWFP was measured during the wave‐free window of 5 heart cycles at an independent core laboratory. FFR ≤0.80 and dPRWFP ≤0.89 were considered positive studies. A total of 164 vessels in 126 women (21.6%) and 595 vessels in 451 men (78.4%) were included. In lesions with negative dPRWFP, positive FFR was less frequently observed in women (13 of 73; 17.8%) than in men (97 of 286; 33.9%) (P=0.009). In lesions with positive dPRWFP, the frequency of negative FFR was observed in 22 of 91 vessels (24.2%) in women and 51 of 309 vessels (16.5%) in men, which did not reach statistical significance (P=0.098). In multivariable analyses, female sex was independently associated with FFR‐dPRWFP discordance both in negative dPRWFP cohort (odds ratio, 0.44; 95% CI, 0.21–0.98; P=0.036) and in positive dPRWFP cohort (odds ratio, 2.41; 95% CI, 1.17–4.96; P=0.017) after adjustment for age, weight, quantitative coronary angiography data, and baseline physiological indexes. Conclusions The frequency of FFR‐dPRWFP discordance was significantly associated with sex, which may indicate potential shift of optimal threshold of either FFR or dPRWFP, or both of them, according to sex.
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Affiliation(s)
- Taishi Yonetsu
- Department of Interventional Cardiology Tokyo Medical and Dental University Tokyo Japan.,Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Masahiro Hoshino
- Department of Cardiology Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tetsumin Lee
- Department of Interventional Cardiology Tokyo Medical and Dental University Tokyo Japan.,Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tadashi Murai
- Department of Cardiology Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yohei Sumino
- Department of Cardiology Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masahiro Hada
- Department of Cardiology Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Masao Yamaguchi
- Department of Cardiology Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Yoshihisa Kanaji
- Department of Cardiology Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Tomoyo Sugiyama
- Department of Cardiology Tsuchiura Kyodo General Hospital Ibaraki Japan
| | - Takayuki Niida
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Junji Matsuda
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Yu Hatano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tomoyuki Umemoto
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Tsunekazu Kakuta
- Department of Cardiology Tsuchiura Kyodo General Hospital Ibaraki Japan
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25
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Hoshino M, Hamaya R, Kanaji Y, Kanno Y, Hada M, Yamaguchi M, Sumino Y, Hirano H, Horie T, Usui E, Sugiyama T, Murai T, Lee T, Yonetsu T, Lee JM, Choi KH, Hwang D, Park J, Jung JH, Kim HY, Jung HW, Cho YK, Yoon HJ, Song YB, Hahn JY, Doh JH, Nam CW, Shin ES, Hur SH, Mejía-Rentería H, Lauri F, Goto S, Macaya F, McInerney A, Gravina G, Vera R, Gonzalo N, Jimenez-Quevedo P, Nuñez-Gil I, Salinas P, Nombela-Franco L, Del Trigo M, Fernández-Ortiz A, Macaya C, Koo BK, Escaned J, Kakuta T. Sex Differences in Long-Term Outcomes in Patients With Deferred Revascularization Following Fractional Flow Reserve Assessment: International Collaboration Registry of Comprehensive Physiologic Evaluation. J Am Heart Assoc 2020; 9:e014458. [PMID: 32063120 PMCID: PMC7070212 DOI: 10.1161/jaha.119.014458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Sex‐specific differences may influence prognosis after deferred revascularization following fractional flow reserve (FFR) measurement. This study sought to investigate the sex differences in long‐term prognosis of patients with deferred revascularization following FFR assessment. Methods and Results A total of 879 patients (879 vessels) with deferred revascularization with FFR >0.75 who underwent FFR and coronary flow reserve measurements were enrolled from 3 countries (Korea, Japan, and Spain). Long‐term outcomes were assessed in 649 men and 230 women by the patient‐oriented composite outcome (POCO, a composite of any death, any myocardial infarction, and any revascularization). We applied inverse‐probability weighting based on propensity scores to account for differences at baseline between women and men (age, hyperlipidemia, diabetes mellitus, diameter stenosis, lesion length, multivessel disease, FFR, coronary flow reserve. The median follow‐up duration was 1855 days (745–1855 days). Median FFR values were 0.88 (0.83–0.93) in men and 0.89 (0.85–0.94) in women, respectively. The occurrences of POCO were significantly high in men compared with that in women (10.5% versus 4.2%, P=0.007). Kaplan–Meier analysis revealed that women had a significantly lower risk of POCO (χ2=7.2, P=0.007). Multivariate COX proportional hazards regression analysis revealed that age, male, diabetes mellitus, diameter stenosis, lesion length, and coronary flow reserve were independent predictors of POCO. After applying IPW, the hazard ratio of males for POCO was 2.07 (95% CI, 1.07–4.04, P=0.032). Conclusions This large multinational study reveals that long‐term outcome differs between women and men in favor of women after FFR‐guided revascularization deferral. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT02186093.
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Ramasamy A, Chen Y, Zanchin T, Jones DA, Rathod K, Jin C, Onuma Y, Zhang YJ, Amersey R, Westwood M, Ozkor M, O’Mahony C, Lansky A, Crake T, Serruys PW, Mathur A, Baumbach A, Bourantas CV. Optical coherence tomography enables more accurate detection of functionally significant intermediate non-left main coronary artery stenoses than intravascular ultrasound: A meta-analysis of 6919 patients and 7537 lesions. Int J Cardiol 2020; 301:226-234. [DOI: 10.1016/j.ijcard.2019.09.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/19/2019] [Accepted: 09/25/2019] [Indexed: 01/18/2023]
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Faes TJC, Meer R, Heyndrickx GR, Kerkhof PLM. Fractional Flow Reserve Evaluated as Metric of Coronary Stenosis - A Mathematical Model Study. Front Cardiovasc Med 2020; 6:189. [PMID: 31993441 PMCID: PMC6970943 DOI: 10.3389/fcvm.2019.00189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 12/11/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction: Coronary arterial stenosis may impair myocardial perfusion with myocardial ischemia and associated morbidity and mortality as result. The myocardial fractional flow reserve (FFR) is clinically used as a stenosis-specific index. Aim: This study aims to identify the relation between the FFR and the degree of coronary arterial stenosis using a simple mathematical model of the coronary circulation. Methods: A mathematical model of the coronary circulation, including an arterial stenosis of variable degree, was developed. The relation between the FFR and the degree of stenosis (defined as the fractional cross sectional area narrowing) was investigated, including the influence of the aortic and venous pressures and the capillary resistance. An additional study concerning 22 patients with coronary artery disease permits comparison of clinical data and in silico findings. Results: The FFR shows an S-shaped relationship with the stenosis index. We found a marked influence of venous and aortic pressure and capillary resistance. The FFR is accompanied by a clinically relevant co-metric (FFR C ), defined by the Pythagorean sum of the two pressures in the definition formula for FFR. In the patient group the FFR C is strongly related to the post-stenotic pressure (R = 0.91). The FFR C requires establishment of a validated cut-off point using future trials. Conclusion: The S-shaped dependence of FFR on the severity of the stenosis makes the FFR a measure of the ordinal scale. The marked influences of the aortic and venous pressures and the capillary resistance on the FFR will be interpreted as significant variations in intra- and inter-individual clinical findings. These fluctuations are partly connected to the neglect of considering the FFR C . At otherwise identical conditions the FFR as measured at baseline differs from the value obtained during hyperemic conditions. This expected observation requires further investigation, as the current hyperemia based evaluation fails to take advantage of available baseline data.
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Affiliation(s)
- Theo J. C. Faes
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Romain Meer
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | | | - Peter L. M. Kerkhof
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
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Tsao AL, Faxon DP. Fractional Flow Reserve: Does Sex Matter? JACC Cardiovasc Interv 2019; 12:2047-2049. [DOI: 10.1016/j.jcin.2019.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 01/10/2023]
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Kang SJ, Kim YH, Lee JG, Kang DY, Lee PH, Ahn JM, Park DW, Lee SW, Lee CW, Park SW, Park SJ, Koo HJ, Yun SC, Jung J, Kim N, Kweon J, Kang JW, Lim TH, Yang DH. Impact of Subtended Myocardial Mass Assessed by Coronary Computed Tomographic Angiography-Based Myocardial Segmentation. Am J Cardiol 2019; 123:757-763. [PMID: 30545479 DOI: 10.1016/j.amjcard.2018.11.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
Abstract
Although decision-making for revascularization is based on the extent of ischemic myocardium, the prognostic implication of supplying myocardial territories has not yet been studied. To evaluate the clinical impact of the coronary artery-based myocardial segmentation (CAMS)-derived myocardial volume subtended to the poststenotic segment, and to determine clinically relevant coronary lesions, coronary computed tomography angiography, invasive coronary angiography, and preprocedure fractional flow reserve (FFR) data were analyzed in 664 deferred lesions (in 577 patients) and 401 treated lesions (in 369 patients) with drug-eluting stent implantation, respectively. Using CAMS method, the myocardial volume subtended to a stenotic coronary segment (Vsub) was assessed. The primary composites included target vessel-related major adverse cardiac event (MACE) including cardiac death, myocardial infarction, and target vessel revascularization over 3 years. Independent predictors of 3-year MACE in deferred lesions were Vsub (adjusted hazard ratio [HR] 1.02), FFR (adjusted HR per 0.1 = 0.60), and distal reference luminal diameter (adjusted HR 2.04, all p < 0.05). A Vsub ≥ 36.2cc was predictive of MACE in deferred lesions with a sensitivity 72% and a specificity 67% (area under curve 0.71, 95% confidence interval 0.67 to 0.74, p < 0.001). Vsub was not associated with target vessel-related MACE. For the prediction of FFR < 0.80, the area under curve of Vsub/MLD4 > 6.3 was greater than those of angiographic diameter stenosis (0.78 vs 0.69) and minimal luminal diameter (0.78 vs 0.71), (all p < 0.05). CAMS-derived Vsub predicted 3-year clinical outcomes in untreated coronary lesions, and improved the diagnostic performance of angiography-derived parameters to identify ischemia-producing lesions.
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Chieffo A, Buchanan GL, Mehilli J, Capodanno D, Kunadian V, Petronio AS, Mikhail GW, Capranzano P, Gonzal N, Karam N, Manzo-Silberman S, Schüpke S, Byrne RA, Capretti G, Appelman Y, Morice MC, Presbitero P, Radu M, Mauri J. Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee. EUROINTERVENTION 2018; 14:e1227-e1235. [PMID: 29786536 DOI: 10.4244/eij-d-18-00225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Several expert documents on sex-based differences in interventional outcomes are now available, however this is the first position paper from the EAPCI Women Committee discussing the potential influence of sex in the percutaneous treatment of coronary and structural heart disease. Despite the misconception that coronary artery disease is a 'man's disease', contemporary data shows a growing incidence in women. However, women are under-represented in randomised coronary clinical trials (~25%). The generalisation of such studies is therefore problematic in decision-making for females undergoing coronary intervention. Differences in pathophysiology between sexes exist, highlighting the need for greater awareness amongst healthcare professionals to enable best evidence-based therapies for women as well as for men. Reassuringly, women represent half of the population included in transcatheter aortic valve implantation clinical trials and may actually benefit more. Growing evidence is also emerging for other interventional atrial procedures which may well be advantageous to women. Awareness of sex disparities is increasing, and we must all work collaboratively within our profession to ensure we provide effective care for all patients with heart disease. The EAPCI Women Committee aim to highlight such issues through this position paper and through visibility within the interventional community.
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Abbott JD. Functional Significance of Epicardial Coronary Artery Disease in Women: One Piece of the Puzzle. JACC Cardiovasc Interv 2018; 11:1464-1466. [PMID: 30031723 DOI: 10.1016/j.jcin.2018.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- J Dawn Abbott
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island.
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Shah SV, Zimmermann FM, Johnson NP, Nishi T, Kobayashi Y, Witt N, Berry C, Jeremias A, Koo BK, Esposito G, Rioufol G, Park SJ, Oldroyd KG, Barbato E, Pijls NHJ, De Bruyne B, Fearon WF. Sex Differences in Adenosine-Free Coronary Pressure Indexes: A CONTRAST Substudy. JACC Cardiovasc Interv 2018; 11:1454-1463. [PMID: 30031722 DOI: 10.1016/j.jcin.2018.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The goal of this study was to investigate sex differences in adenosine-free coronary pressure indexes. BACKGROUND Several adenosine-free coronary pressure wire indexes have been proposed to assess the functional significance of coronary artery lesions; however, there is a theoretical concern that sex differences may affect diagnostic performance because of differences in resting flow and distal myocardial mass. METHODS In this CONTRAST (Can Contrast Injection Better Approximate FFR Compared to Pure Resting Physiology?) substudy, contrast fractional flow reserve (cFFR), obtained during contrast-induced submaximal hyperemia, the instantaneous wave-free ratio (iFR), and distal/proximal coronary pressure ratio (Pd/Pa) were compared with fractional flow reserve (FFR) in 547 men and 216 women. Using FFR ≤0.8 as a reference, the diagnostic performance of each index was compared. RESULTS Men and women had similar diameter stenosis (p = 0.78), but women were less likely to have FFR ≤0.80 than men (42.5% vs. 51.5%, p = 0.04). Sensitivity was similar among cFFR, iFR, and Pd/Pa when comparing women and men, respectively (cFFR, 77.5% vs. 75.3%; p = 0.69; iFR, 84.9% vs. 79.4%; p = 0.30; Pd/Pa, 78.8% vs. 77.3%; p = 0.78). cFFR was more specific than iFR or Pd/Pa regardless of sex (cFFR, 94.3% vs. 95.8%; p = 0.56; iFR, 75.6% vs. 80.1%; p = 0.38; Pd/Pa, 80.6% vs. 78.7%; p = 0.69). By receiver-operating characteristic curve analysis, cFFR provided better diagnostic accuracy than resting indexes irrespective of sex (p ≤ 0.0001). CONCLUSIONS Despite the theoretical concern, the diagnostic sensitivity and specificity of cFFR, iFR, and Pd/Pa did not differ between the sexes. Irrespective of sex, cFFR provides the best diagnostic performance.
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Affiliation(s)
- Sonia V Shah
- Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | | | - Nils P Johnson
- McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Takeshi Nishi
- Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | - Yuhei Kobayashi
- Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California
| | - Nils Witt
- Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Colin Berry
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom; British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Allen Jeremias
- Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, New York; Cardiovascular Research Foundation, New York, New York
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, South Korea
| | | | | | - Seung-Jung Park
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Keith G Oldroyd
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Emanuele Barbato
- University of Naples Federico II, Naples, Italy; Cardiovascular Center Aalst, Aalst, Belgium
| | - Nico H J Pijls
- Catharina Hospital, Eindhoven, the Netherlands; Eindhoven University of Technology, Eindhoven, the Netherlands
| | | | - William F Fearon
- Stanford University School of Medicine, Stanford, California; Stanford Cardiovascular Institute, Stanford, California.
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Regitz-Zagrosek V. Unsettled Issues and Future Directions for Research on Cardiovascular Diseases in Women. Korean Circ J 2018; 48:792-812. [PMID: 30146804 DOI: 10.4070/kcj.2018.0249] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023] Open
Abstract
Biological sex (being female or male) significantly influences the course of disease. This simple fact must be considered in all cardiovascular diagnosis and therapy. However, major gaps in knowledge about and awareness of cardiovascular disease in women still impede the implementation of sex-specific strategies. Among the gaps are a lack of understanding of the pathophysiology of women-biased coronary artery disease syndromes (spasms, dissections, Takotsubo syndrome), sex differences in cardiomyopathies and heart failure, a higher prevalence of cardiomyopathies with sarcomeric mutations in men, a higher prevalence of heart failure with preserved ejection fraction in women, and sex-specific disease mechanisms, as well as sex differences in sudden cardiac arrest and long QT syndrome. Basic research strategies must do more to include female-specific aspects of disease such as the genetic imbalance of 2 versus one X chromosome and the effects of sex hormones. Drug therapy in women also needs more attention. Furthermore, pregnancy-associated cardiovascular disease must be considered a potential risk factor in women, including pregnancy-related coronary artery dissection, preeclampsia, and peripartum cardiomyopathy. Finally, the sociocultural dimension of gender should be included in research efforts. The organization of gender medicine must be established as a cross-sectional discipline but also as a centered structure with its own research resources, methods, and questions.
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Affiliation(s)
- Vera Regitz-Zagrosek
- CHARITÉ Universitätsmedizin Berlin, Institute of Gender in Medicine and CCR, and DZHK (partner site Berlin), Berlin, Germany.
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Vijayan S, Barmby DS, Pearson IR, Davies AG, Wheatcroft SB, Sivananthan M. Assessing Coronary Blood Flow Physiology in the Cardiac Catheterisation Laboratory. Curr Cardiol Rev 2017; 13:232-243. [PMID: 28545351 PMCID: PMC5633718 DOI: 10.2174/1573403x13666170525102618] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 05/09/2017] [Accepted: 05/17/2017] [Indexed: 01/10/2023] Open
Abstract
Background: Contemporary management of coronary disease focuses on the treatment of stenoses in the major epicardial vessels. However, myocardial blood flow is known to be contingent on a range of factors in addition to the patency of the epicardial vessels. These include anatomical and physiological factors such as the extent of myocardium supplied by the vessel, systemic blood pres-sure, the natural variation in vascular tone in response to physiological needs which allows for coro-nary autoregulation and pathological factors such as the presence of downstream obstruction to flow due to disease of the small coronary vessels or myocardium. The assessment of clinical effectiveness and adequacy of coronary revascularisation requires the ability to comprehensively and accurately as-sess and measure myocardial perfusion. Conclusion: In this article, we review the current methods of evaluating coronary blood flow and my-ocardial perfusion in the cardiac catheterisation laboratory.
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Affiliation(s)
- Sethumadhavan Vijayan
- Interventional Fellow, Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom
| | - David S Barmby
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Ian R Pearson
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Andrew G Davies
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Stephen B Wheatcroft
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Mohan Sivananthan
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Picard F, Pighi M, Ly HQ. Fractional flow reserve and resting indices for coronary physiologic assessment: Practical guide, tips, and tricks. Catheter Cardiovasc Interv 2017; 90:598-611. [PMID: 28160376 DOI: 10.1002/ccd.26933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 11/19/2016] [Accepted: 12/22/2016] [Indexed: 01/10/2023]
Abstract
Physiologic assessment using fractional flow reserve (FFR) to guide percutaneous coronary interventions (PCI) has been demonstrated to improve clinical outcomes, compared to angiography-guided PCI. Recently, resting indices such as resting Pd/Pa, "instantaneous wave-free ratio", and contrast medium induced FFR have been evaluated for the assessment of the functional consequences of coronary lesions. Herein, we review and discuss the use of FFR and other indices for the functional assessment of coronary lesions. This review will cover theoretical aspects, as well as practical points and common pitfalls related to coronary physiological assessment. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Fabien Picard
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
| | - Michele Pighi
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
| | - Hung Q Ly
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
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Lee JM, Koo BK, Shin ES, Nam CW, Doh JH, Hu X, Ye F, Chen S, Yang J, Chen J, Tanaka N, Yokoi H, Matsuo H, Takashima H, Shiono Y, Hwang D, Park J, Kim KJ, Akasaka T, Wang J. Clinical Outcomes of Deferred Lesions With Angiographically Insignificant Stenosis But Low Fractional Flow Reserve. J Am Heart Assoc 2017; 6:JAHA.117.006071. [PMID: 28862970 PMCID: PMC5586447 DOI: 10.1161/jaha.117.006071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Data are limited regarding outcomes of deferred lesions in patients with angiographically insignificant stenosis but low fractional flow reserve (FFR). We investigated the natural history of angiographically insignificant stenosis with low FFR among patients who underwent routine 3‐vessel FFR measurement. Methods and Results From December 2011 to March 2014, 1136 patients with 3298 vessels underwent routine 3‐vessel FFR measurement (3V FFR‐FRIENDS study, ClinicalTrials.gov identifier NCT01621438), and this study analyzed the 2‐year clinical outcomes of 1024 patients with 2124 lesions with angiographically insignificant stenosis (percentage of diameter stenosis <50%), in which revascularization was deferred. All lesions were classified according to FFR values, using a cutoff of 0.80 (high FFR >0.80 versus low FFR ≤0.80). The primary end point was outcome of major adverse cardiovascular events (a composite of cardiac death, myocardial infarction, and ischemia‐driven revascularization) at 2 years. Mean angiographic percentage of diameter stenosis and FFR of total lesions were 32.5±10.3% and 0.91±0.08%, respectively. Among the total lesions with angiographically insignificant stenosis, 8.7% showed low FFR (185 lesions). The incidence of lesions with low FFR was 2.5%, 3.8%, 9.0%, and 15.1% in categories of percentage of diameter stenosis <20%, 20% to 30%, 30% to 40%, and 40% to 50%, respectively. At 2‐year follow‐up, the low‐FFR group showed a significantly higher risk of major adverse cardiovascular events compared with the high FFR group (3.3% versus 1.2%, hazard ratio: 3.371; 95% CI, 1.346–8.442; P=0.009). In multivariable analysis, low FFR was the most powerful independent predictor of future MACE in deferred lesions with angiographically insignificant stenosis (adjusted hazard ratio: 2.617; 95% CI, 1.026–6.679; P=0.044). Conclusions In deferred angiographically insignificant stenosis, lesions with low FFR showed significantly higher event rates than those with high FFR. FFR was an independent predictor of future major adverse cardiovascular events in lesions with angiographically insignificant stenosis. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01621438.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea .,Institute on Aging, Seoul National University, Seoul, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shaoliang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junqing Yang
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jiyan Chen
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | | | - Hitoshi Matsuo
- Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | | | | | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Jonghanne Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Jin Kim
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | | | - Jianan Wang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
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Coronary artery stenoses more often overestimated in older patients. Int J Cardiol 2017; 241:46-49. [DOI: 10.1016/j.ijcard.2017.02.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/27/2017] [Indexed: 11/23/2022]
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Corcoran D, Hennigan B, Berry C. Fractional flow reserve: a clinical perspective. Int J Cardiovasc Imaging 2017; 33:961-974. [PMID: 28577046 PMCID: PMC5489582 DOI: 10.1007/s10554-017-1159-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/02/2017] [Indexed: 01/10/2023]
Abstract
Fractional flow reserve (FFR) is a reference invasive diagnostic test to assess the physiological significance of an epicardial coronary artery stenosis. FFR-guided percutaneous coronary intervention in stable coronary artery disease has been assessed in three seminal clinical trials and the indications for FFR assessment are expanding into other clinical scenarios. In this article we review the theoretical, experimental and clinical basis for FFR measurement. We place FFR measurement in the context of the comprehensive invasive assessment of coronary physiology in patients presenting with known or suspected angina pectoris in daily clinical practice, and review the recent developments in FFR assessment.
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Affiliation(s)
- David Corcoran
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Barry Hennigan
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK
| | - Colin Berry
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK. .,BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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Paul TK, Sivanesan K, Schulman-Marcus J. Sex differences in nonobstructive coronary artery disease: Recent insights and substantial knowledge gaps. Trends Cardiovasc Med 2017; 27:173-179. [DOI: 10.1016/j.tcm.2016.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 10/21/2022]
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Giavarini A, Kilic ID, Redondo Diéguez A, Longo G, Vandormael I, Pareek N, Kanyal R, De Silva R, Di Mario C. Intracoronary Imaging. Heart 2017; 103:708-725. [DOI: 10.1136/heartjnl-2015-307888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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42
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Intravascular ultrasound-guided drug-eluting stent implantation. Cardiovasc Interv Ther 2016; 32:1-11. [DOI: 10.1007/s12928-016-0438-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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43
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Coronary Physiology Assessment for the Diagnosis and Treatment of Stable Ischemic Heart Disease. Curr Atheroscler Rep 2016; 18:62. [DOI: 10.1007/s11883-016-0613-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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44
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Lee JM, Kim CH, Koo BK, Hwang D, Park J, Zhang J, Tong Y, Jeon KH, Bang JI, Suh M, Paeng JC, Cheon GJ, Na SH, Ahn JM, Park SJ, Kim HS. Integrated Myocardial Perfusion Imaging Diagnostics Improve Detection of Functionally Significant Coronary Artery Stenosis by
13
N-ammonia Positron Emission Tomography. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004768. [DOI: 10.1161/circimaging.116.004768] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/21/2016] [Indexed: 12/25/2022]
Abstract
Background—
Recent evidence suggests that the diagnostic accuracy of myocardial perfusion imaging is improved by quantifying stress myocardial blood flow (MBF) in absolute terms. We evaluated a comprehensive quantitative
13
N-ammonia positron emission tomography (
13
NH
3
-PET) diagnostic panel, including stress MBF, coronary flow reserve (CFR), and relative flow reserve (RFR) in conjunction with relative perfusion defect (PD) assessments to better detect functionally significant coronary artery stenosis.
Methods and Results—
A total of 130 patients (307 vessels) with coronary artery disease underwent both
13
NH
3
-PET and invasive coronary angiography with fractional flow reserve (FFR) measurement. Diagnostic accuracy, optimal cut points, and discrimination indices of respective
13
NH
3
-PET quantitative measures were compared, with FFR as standard reference. The capacity to discern disease with stepwise addition of stress MBF, CFR, and RFR to qualitatively assessed relative PD was also gauged, using the category-free net reclassification index. All quantitative measures showed significant correlation with FFR (PET-derived CFR,
r
=0.388; stress MBF,
r
=0.496; and RFR,
r
=0.780; all
P
<0.001). Optimal respective cut points for FFR ≤0.8 and ≤0.75 were 1.99 and 1.84 mL/min per g for stress MBF and 2.12 and 2.00 for PET-derived CFR. Discrimination indices of quantitative measures that correlated with FFR ≤0.8 were all significantly higher than that of relative PD (area under the curve: 0.626, 0.730, 0.806, and 0.897 for relative PD, CFR, stress MBF, and RFR, respectively; overall comparison
P
<0.001). The capacity for functionally significant coronary stenosis was incrementally improved by the successive addition of CFR (net reclassification index=0.629), stress MBF (net reclassification index=0.950), and RFR (net reclassification index=1.253; all
P
<0.001) to relative PD.
Conclusions—
Integrating quantitative
13
NH
3
-PET measures with qualitative myocardial perfusion assessment provides superior diagnostic accuracy and improves the capacity to detect functionally significant coronary artery stenosis.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT01621438 and NCT01366404.
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Affiliation(s)
- Joo Myung Lee
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Chee Hae Kim
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Bon-Kwon Koo
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Doyeon Hwang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jonghanne Park
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jinlong Zhang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Yaliang Tong
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Ki-Hyun Jeon
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Ji-In Bang
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Minseok Suh
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jin Chul Paeng
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Gi Jeong Cheon
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Sang-Hoon Na
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Jung-Min Ahn
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Seung-Jung Park
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
| | - Hyo-Soo Kim
- From the Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine, Cardiovascular Center (C.H.K., B.-K.K., D.H., J.P., J.Z., Y.T., H.-S.K.), Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), and Department of Internal Medicine, Emergency Medical Center (S.-H.N.), Seoul National University Hospital, Korea; Institute of Aging, Seoul
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Kang SJ, Yang DH, Koo HJ, Yun SC, Lee JG, Kang JW, Lim TH, Mintz GS, Park SW, Kim YH. Intravascular ultrasound-derived morphological predictors of myocardial ischemia assessed by stress myocardial perfusion computed tomography. Catheter Cardiovasc Interv 2016; 89:E207-E216. [DOI: 10.1002/ccd.26710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/21/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Soo-Jin Kang
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Dong Hyun Yang
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Hyun Jung Koo
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Sung-Cheol Yun
- Department of Biostatistics; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - June-Goo Lee
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Joon-Won Kang
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Tae-Hwan Lim
- Department of Radiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Gary S. Mintz
- Cardiovascular Research Foundation; New York New York
| | - Seong-Wook Park
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
| | - Young-Hak Kim
- Department of Cardiology; University of Ulsan College of Medicine, Asan Medical Center; Seoul Korea
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Matar FA, Falasiri S, Glover CB, Khaliq A, Leung CC, Mroue J, Ebra G. When should fractional flow reserve be performed to assess the significance of borderline coronary artery lesions: Derivation of a simplified scoring system. Int J Cardiol 2016; 222:606-610. [PMID: 27517648 DOI: 10.1016/j.ijcard.2016.07.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 07/27/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To derive a simplified scoring system (SSS) that can assist in selecting patients who would benefit from the application of fractional flow reserve (FFR). BACKGROUND Angiographers base decisions to perform FFR on their interpretation of % diameter stenosis (DS), which is subject to variability. Recent studies have shown that the amount of myocardium at jeopardy is an important factor in determining the degree of hemodynamic compromise. METHODS We conducted a retrospective multivariable analysis to identify independent predictors of hemodynamic compromise in 289 patients with 317 coronary vessels undergoing FFR. A SSS was derived using the odds ratios as a weighted factor. The receiver operator characteristics curve was used to identify the optimal cutoff (≥3) to discern a functionally significant lesion (FFR≤0.8). RESULTS Male gender, left anterior descending artery apical wrap, disease proximal to lesion, minimal lumen diameter and % DS predicted abnormal FFR (≤0.8) and lesion location in the left circumflex predicted a normal FFR. Using a cutoff score of ≥3 on the SSS, a specificity of 90.4% (95% CI: 83.0-95.3) and a sensitivity of 38.0% (95% CI: 31.5-44.9) was generated with a positive predictive value of 89.0% (95% CI: 80.7%-94.6%) and negative predictive value of 41.6% (95% CI: 35.1%-48.3%). CONCLUSIONS The decision to use FFR should be based not only on the % DS but also the size of the myocardial mass jeopardized. A score of ≥3 on the SSS should prompt further investigation with a pressure wire.
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Affiliation(s)
- Fadi A Matar
- Department of Cardiovascular Sciences, The University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
| | - Shayan Falasiri
- Department of Cardiovascular Sciences, The University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Charles B Glover
- Department of Cardiovascular Sciences, The University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Asma Khaliq
- Department of Cardiovascular Sciences, The University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Calvin C Leung
- Department of Cardiovascular Sciences, The University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Jad Mroue
- Department of Cardiovascular Sciences, The University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - George Ebra
- Department of Cardiovascular Sciences, The University of South Florida, Morsani College of Medicine, Tampa, FL, USA
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47
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Kang SJ, Kweon J, Yang DH, Lee JG, Jung J, Kim N, Mintz GS, Kang JW, Lim TH, Park SW, Kim YH. Mathematically Derived Criteria for Detecting Functionally Significant Stenoses Using Coronary Computed Tomographic Angiography-Based Myocardial Segmentation and Intravascular Ultrasound-Measured Minimal Lumen Area. Am J Cardiol 2016; 118:170-6. [PMID: 27236253 DOI: 10.1016/j.amjcard.2016.04.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 04/27/2016] [Accepted: 04/27/2016] [Indexed: 11/29/2022]
Abstract
The lack of practical method for quantifying myocardial territories has made it difficult to link anatomic lesion morphology to the hemodynamic significance of coronary artery stenosis. The aim of this study was to develop and validate mathematically derived morphologic criteria for predicting fractional flow reserve (FFR) <0.80 using intravascular ultrasound (IVUS) parameters and a coronary artery-based myocardial segmentation (CAMS) of the affected myocardial territory. Coronary computed tomography angiography, IVUS, and FFR data were analyzed in 103 non-left main intermediate coronary artery lesions (30% to 80% of angiographic stenosis). Using CAMS method, the total left ventricular myocardial volume and the myocardial volume subtended by a stenotic coronary segment (Vsub) were assessed. The morphologic criteria for detecting an FFR <0.80 using the IVUS and CAMS parameters were mathematically derived. Overall, an IVUS-measured minimal lumen area (MLA) <2.79 mm(2) predicted an FFR <0.80 with sensitivity of 76%, specificity of 78%, positive predictive value of 71%, and negative predictive value of 82%. A Vsub/MLA(2) >4.04 best predicted an FFR <0.80 (sensitivity 88%, specificity 90%, positive predictive value 86%, and negative predictive value 92%, area under curve = 0.944). There was a significant difference in the areas under the curves between IVUS-MLA versus Vsub/MLA(2) (difference = 0.068, p = 0.005). Conversely, adjusting for body or vessel size did not improve the diagnostic accuracy.
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Affiliation(s)
- Soo-Jin Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jihoon Kweon
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong Hyun Yang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - June-Goo Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joonho Jung
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Namkug Kim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, New York
| | - Joon-Won Kang
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Hwan Lim
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seong-Wook Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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48
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López-Palop R, Carrillo P, Agudo P, Cordero A, Frutos A, Mashlab S, Martínez R, El Amrani A, Ramos D. Factors Associated With Errors in Visual Estimation of the Functional Significance of Coronary Lesions. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:657-663. [PMID: 27068021 DOI: 10.1016/j.rec.2015.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/03/2015] [Indexed: 06/05/2023]
Abstract
UNLABELLED INTRODUCTION AND OBJECTIVES Visual angiographic assessment continues to be used when decisions are made on whether to revascularize ambiguous coronary lesions. Multiple factors, other than the degree of stenosis, have been associated with the functional significance of a coronary lesion. The aim of this study was to investigate the ability of interventionists to visually predict the functional significance of a coronary lesion and the clinical and angiographic characteristics associated with errors in prediction. METHODS We conducted a concordance study of the functional significance of coronary lesions predicted by experienced interventionists and fractional flow reserve values measured by intracoronary pressure wire in 665 intermediate lesions (40%-70% diameter stenosis) in 587 patients. We determined which factors were independently associated with errors in prediction. RESULTS There was disagreement between the predicted fractional flow reserve value of ≤ 0.80 and the observed value in 30.1% of the lesions (overestimation: 11.3%; underestimation, 18.8%). Stent location in an artery other than the anterior descending artery or in a bifurcation was associated with overestimation. Male sex, severe calcification, and a greater myocardial territory distal to the lesion were significantly associated with the functional significance of the underestimated lesion. CONCLUSIONS Even when taking into account angiographic and clinical characteristics, there is a high rate of disagreement between visual estimation and direct measurement of intermediate coronary stenosis in relation to its functional significance. Specific angiographic and clinical characteristics are associated with an increased tendency to overestimate or underestimate the significance of lesions.
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Affiliation(s)
- Ramón López-Palop
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
| | - Pilar Carrillo
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Pilar Agudo
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Alberto Cordero
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Araceli Frutos
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Samer Mashlab
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Rubén Martínez
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Amin El Amrani
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - David Ramos
- Unidad de Hemodinámica, Sección de Cardiología, Hospital Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
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49
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López-Palop R, Carrillo P, Agudo P, Cordero A, Frutos A, Mashlab S, Martínez R, El Amrani A, Ramos D. Factores asociados al error en la estimación visual de la importancia funcional de lesiones coronarias. Rev Esp Cardiol (Engl Ed) 2016. [DOI: 10.1016/j.recesp.2015.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Kang SJ, Yang DH, Kweon J, Kim YH, Lee JG, Jung J, Kim N, Mintz GS, Kang JW, Lim TH, Park SW. Better Diagnosis of Functionally Significant Intermediate Sized Narrowings Using Intravascular Ultrasound-Minimal Lumen Area and Coronary Computed Tomographic Angiography-Based Myocardial Segmentation. Am J Cardiol 2016; 117:1282-8. [PMID: 26892449 DOI: 10.1016/j.amjcard.2016.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/25/2022]
Abstract
Lesion morphology poorly predicts functional significance of intermediate coronary artery stenosis. The aim of this study was to determine whether a coronary artery-based myocardial segmentation method that quantifies subtended myocardium can improve the diagnostic accuracy of intravascular ultrasound (IVUS)-derived parameters for detecting ischemia-producing lesions. Coronary computed tomography angiography, IVUS, and fractional flow reserve (FFR) data were analyzed in 101 non-left main lesions (20% to 80% angiographic stenosis). Using the coronary artery-based myocardial segmentation method, total left ventricular myocardial volume (Vtotal), myocardial volume subtended by the stenotic coronary segment (Vsub), and Vratio (the ratio of the Vsub to the Vtotal) were assessed. Both Vsub >30.7 cm(3) and Vratio >25.4% were determinants of FFR ≤0.75 (area under the curve = 0.696 and 0.744). Overall, an IVUS-measured minimum lumen area (IVUS-MLA) ≤2.83 mm(2) predicted FFR ≤0.75 with a sensitivity 88% and specificity 73%. Among lesions with IVUS-MLA ≤2.83 mm(2) and FFR >0.75, 89% showed Vsub <30.7 cm(3). In 50 lesions with Vsub >30.7 cm(3), an IVUS-MLA ≤2.85 mm(2) predicted FFR ≤0.75 with sensitivity 85%, specificity 92%, positive predictive value 92%, and negative predictive value 85%. Conversely, in 51 lesions with a Vsub ≤30.7 cm(3), IVUS-MLA ≤2.67 mm(2) showed sensitivity 100%, specificity 69%, positive predictive value 38%, and negative predictive value 100% for predicting FFR ≤0.75. Body surface area, reference lumen diameter, and vessel area had modest correlations with Vsub. In those lesion subsets, IVUS-MLA ≈2.8 mm(2) accurately predicted an FFR ≤0.75, whereas the clinical relevance of assessing and treating lesions with a smaller myocardial territory may be limited (ClinicalTrials.gov number NCT1696006).
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