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Intravascular Imaging-Based Physiologic Assessment. Interv Cardiol Clin 2023; 12:289-298. [PMID: 36922069 DOI: 10.1016/j.iccl.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Intravascular imaging (IVI), including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), is clinically useful for assessing the luminal size, lesion length, and plaque characteristics, as well as for evaluating stent deployment; however, it is not designed to estimate myocardial ischemia accurately. Thus, several types of IVI-derived fractional flow reserve (FFR) (IVI-derived FFR) have been developed and reported. In general, the algorithms of virtual FFR are based on basic fluid dynamics equations (mainly Poiseuille and Borda-Carnot equations) and original microvascular models (fixed velocity or calculating coronary flow reserve). Although the models and assumptions used in the past reports were mostly based on the standard population (not independent patient data), the developed software calculated FFR with high accuracy (88% to 94%) with strong correlations between IVI-derived FFR and wire-based FFR (0.69 to 0.89). Given several other less invasive virtual FFR methods currently available for clinical use, IVI-derived FFR would be limited for the sole use of pre-percutaneous coronary intervention (PCI) physiological evaluation; however, it may play a unique role at PCI guidance and optimization, potentially allowing comprehensive and time/cost-saving assessment of both anatomical and physiological lesion properties using a single diagnostic device.
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Lee HJ, Mejía-Rentería H, Escaned J, Doh JH, Lee JM, Hwang D, Yuasa S, Choi KH, Jang HJ, Jeon KH, Lee J, Nam CW, Shin ES, Koo BK. Prediction of functional results of percutaneous coronary interventions with virtual stenting and quantitative flow ratio. Catheter Cardiovasc Interv 2022; 100:1208-1217. [PMID: 36321601 DOI: 10.1002/ccd.30451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/05/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The clinical value of residual quantitative flow ratio (rQFR), a novel function of QFR technique, is unknown. AIM We investigated the clinical value of rQFR, aimed to predict residual ischemia after virtual percutaneous coronary intervention (vPCI). METHODS This is a substudy of the COE-PERSPECTIVE registry, which investigated the prognostic value of post-PCI fractional flow reserve (FFR). From pre-PCI angiograms, QFR and rQFR were analyzed and their diagnostic performance was assessed at blinded fashion using pre-PCI FFR and post-PCI FFR as reference, respectively. The prognostic value of rQFR after vPCI was assessed according to vessel-oriented composite outcome (VOCO) at 2 years. RESULTS We analyzed 274 patients (274 vessels) with FFR-based ischemic causing lesions (49%) from 555 screened patients. Pre-PCI QFR and FFR were 0.63 ± 0.10 and 0.66 ± 0.11 (R = 0.756, p < 0.001). rQFR after vPCI and FFR after real PCI were 0.93 ± 0.06 and 0.86 ± 0.07 (R = 0.528, p < 0.001). The mean difference between rQFR and post-PCI FFR was 0.068 (95% limit of agreement: -0.05 to 0.19). Diagnostic performance of rQFR to predict residual ischemia after PCI was good (area under the curve [AUC]: 0.856 [0.804-0.909], p < 0.001). rQFR predicted well the incidence of 2-year VOCO after index PCI (AUC: 0.712 [0.555-0.869], p = 0.041), being similar to that of actual post-PCI FFR (AUC: 0.691 [0.512-0.870], p = 0.061). rQFR ≤0.89 was associated with increased risk of 2-year VOCO (hazard ratio [HR]: 12.9 [2.32-71.3], p = 0.0035). This difference was mainly driven by a higher rate of target vessel revascularization (HR: 16.98 [2.33-123.29], p = 0.0051). CONCLUSIONS rQFR estimated from pre-PCI angiography and virtual coronary stenting mildly overestimated functional benefit of PCI. However, it well predicted suboptimal functional result and long-term vessel-related clinical events. CLINICAL TRIAL REGISTRATION Influence of fractional flow reserve on the Clinical OutcomEs of PERcutaneouS Coronary Intervention (COE-PESPECTIVE) Registry, NCT01873560.
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Affiliation(s)
- Hyun-Jong Lee
- Department of Internal Medicine, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
| | - Hernán Mejía-Rentería
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Joo Myung Lee
- Department of Internal Medicine, Division of Cardiology, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doyeon Hwang
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sonoka Yuasa
- Department of Internal Medicine, Cardiovascular Center, Tachikawa General Hospital, Nagaoka, Japan
| | - Ki Hong Choi
- Department of Internal Medicine, Division of Cardiology, Samsung Medical Center, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho-Jun Jang
- Department of Internal Medicine, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
| | - Ki-Hyun Jeon
- Department of Internal Medicine, Cardiovascular Center, Sejong General Hospital, Bucheon, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan Hospital, Ulsan, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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Zimbardo G, Cialdella P, DI Giusto F, Migliaro S, Anastasia G, Petrolati E, Galante D, D'Amario D, Leone AM. Physiological assessment after percutaneous coronary intervention: the hard truth. Panminerva Med 2021; 63:519-528. [PMID: 34486363 DOI: 10.23736/s0031-0808.21.04363-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Physiologically guided revascularization, using Fractional Flow Reserve (FFR) or instantaneous wave free ratio (iFR) has been demonstrated to be associated with better long-term outcomes compared to an angiographically-guided strategy, mainly avoiding inappropriate coronary stenting and its associated adverse events. On the contrary, the role of invasive physiological assessment after percutaneous coronary intervention (PCI) is much less well established. However, a large body of evidence suggests that a relevant proportion of patients undergoing PCI with a satisfying angiographic result show instead a suboptimal functional product with a potentially negative prognostic impact. For this reason, many efforts have been focused to identify interventional strategies to physiologically optimize PCI. Measuring the functional result after as PCI, especially when performed after a physiological assessment, implies that the operator is ready to accept the hard truth of an unsatisfactory physiological result despite angiographically optimal and, consequently, to optimize the product with some additional effort. The aim of this review is to bridge this gap in knowledge by better defining the paradigm shift of invasive physiological assessment from a simple tool for deciding whether an epicardial stenosis has to be treated to a thoroughly physiological approach to PCI with the suggestion of a practical flow chart.
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Affiliation(s)
| | | | - Federico DI Giusto
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Migliaro
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianluca Anastasia
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edoardo Petrolati
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico Galante
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio M Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy -
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Belguidoum S, Meneveau N, Motreff P, Ohlman P, Boussaada M, Silvain J, Guillon B, Descotes-Genon V, Lefrançois Y, Morel O, Amabile N. Relationship between stent expansion and fractional flow reserve after percutaneous coronary intervention: a post hoc analysis of the DOCTORS trial. EUROINTERVENTION 2021; 17:e132-e139. [PMID: 32392171 PMCID: PMC9724874 DOI: 10.4244/eij-d-19-01103] [Citation(s) in RCA: 5] [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
BACKGROUND The best criteria for adequate stent expansion assessment by intracoronary imaging remain debated and their correlation with post-PCI FFR values is unknown. AIMS This study aimed to analyse the relationship between stent expansion criteria using optical coherence tomography (OCT) analysis and the final PCI functional result. METHODS This post hoc analysis of the DOCTORS study included non-ST-elevation segment ACS patients undergoing OCT-guided PCI. The procedure functional result was assessed by the measurement of fractional flow reserve (FFR). Stent expansion was assessed on OCT runs according to the DOCTORS criteria and ILUMIEN III criteria. RESULTS The study included N=116 patients (age: 60.8±11.5 years; male gender: 71%). The final expansion was considered optimal in 10%, acceptable in 9% and unacceptable in 81% of the stents according to ILUMIEN III criteria, although being successful in 70% of the patients according to the DOCTORS criteria. Hypertension and larger proximal reference segment dimension were independent predictors of inadequate device ILUMIEN III expansion. FFR values were, respectively, 0.93 (0.91-0.95) versus 0.95 (0.92-0.97) in patients with optimal+acceptable versus unacceptable ILUMIEN III expansion (p=0.22), 0.94 (0.91-0.97) versus 0.95 (0.93-0.97) in patients with optimal versus non-optimal DOCTORS expansion (p=0.23), and 0.95 (0.92-0.97) versus 0.92 (0.90-0.95) in patients with minimal stent area ≥4.5 mm2 versus <4.5 mm2 (p=0.03). CONCLUSIONS In this selected population, no relationship was observed between optimal stent expansion according to ILUMIEN III or DOCTORS OCT criteria and final post-PCI FFR values.
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Affiliation(s)
- Salim Belguidoum
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Meneveau
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Pascal Motreff
- Department of Cardiology, University Hospital Gabriel Montpied, and Université d’Auvergne, Clermont Ferrand, France
| | - Patrick Ohlman
- Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Mohamed Boussaada
- Department of Cardiology, Institut Mutualiste Montsouris, Paris, France
| | - Johanne Silvain
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Benoit Guillon
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | | | | | - Olivier Morel
- Department of Cardiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Nicolas Amabile
- Department of Cardiology, Institut Mutualiste Montsouris, 42 Bd Jourdan, 75014 Paris, France
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Diletti R, Masdjedi K, Daemen J, van Zandvoort LJ, Neleman T, Wilschut J, Den Dekker WK, van Bommel RJ, Lemmert M, Kardys I, Cummins P, de Jaegere P, Zijlstra F, Van Mieghem NM. Impact of Poststenting Fractional Flow Reserve on Long-Term Clinical Outcomes: The FFR-SEARCH Study. Circ Cardiovasc Interv 2021; 14:e009681. [PMID: 33685214 PMCID: PMC7982137 DOI: 10.1161/circinterventions.120.009681] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Kaneshka Masdjedi
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Laurens J.C. van Zandvoort
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Tara Neleman
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Wijnand K. Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | | | - Miguel Lemmert
- Department of Cardiology, Isala Hospital, Zwolle, the Netherlands (M.L.)
| | - Isabella Kardys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Paul Cummins
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Peter de Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Felix Zijlstra
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
| | - Nicolas M. Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, the Netherlands (R.D., K.M., J.D., L.J.C.v.Z., T.N., J.W., W.K.D.D., I.K., P.C., P.d.J., F.Z., N.M.V.M.)
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6
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Fournier S, Ciccarelli G, Toth GG, Milkas A, Xaplanteris P, Tonino PAL, Fearon WF, Pijls NHJ, Barbato E, De Bruyne B. Association of Improvement in Fractional Flow Reserve With Outcomes, Including Symptomatic Relief, After Percutaneous Coronary Intervention. JAMA Cardiol 2020; 4:370-374. [PMID: 30840026 DOI: 10.1001/jamacardio.2019.0175] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Whether the improvement in myocardial perfusion provided by percutaneous coronary intervention (PCI) is associated with symptomatic relief or improved outcomes has not been well investigated. Objective To investigate the prognostic value of the improvement in fractional flow reserve (FFR) after PCI (ΔFFR) on patients' symptoms and 2-year outcomes. Design, Setting, and Participants This study is a post hoc analysis of data from patients undergoing FFR-guided PCI in the randomized clinical trials Fractional Flow Reserve vs Angiography for Multivessel Evaluation (FAME) 1 (NCT00267774; 2009) and FAME 2 (NCT01132495; 2012), with inclusion of 2 years of follow-up data. The FAME 1 trial included patients with multivessel coronary artery disease from 20 medical centers in Europe and the United States. The FAME 2 trial included patients with stable coronary artery disease involving up to 3 vessels from 28 sites in Europe and North America. Lesions from the group in the FAME 1 trial from whom FFR was measured and the group in the FAME 2 trial who received FFR-guided PCI plus medical therapy were analyzed. Data analysis occurred from May 2017 to May 2018. Interventions Measure of post-PCI FFR. Main Outcomes and Measures Vessel-oriented clinical events at 2 years, a composite of cardiac death, target vessel-associated myocardial infarction, and target vessel revascularization. Results This analysis included 639 patients from whom pre-PCI and post-PCI FFR values were available. Of their 837 lesions, 277 were classified into the lowest tertile (ΔFFR≤0.18), 282 into the middle tertile (0.19≤ΔFFR≤0.31), and 278 into the highest tertile (ΔFFR>0.31). Vessel-oriented clinical events were significantly more frequent in the lowest tertile (n = 25 of 277 [9.1%]) compared with the highest tertile (n = 13 of 278 [4.7%]; hazard ratio, 2.01 [95% CI, 1.03-3.92]; P = .04). In addition, a significant association was observed between ΔFFR and symptomatic relief (odds ratio, 1.33 [95% CI, 1.02-1.74]; P = .02). Conclusions and Relevance In this analysis of 2 randomized clinical trials, the larger the improvement in FFR, the larger the symptomatic relief and the lower the event rate. This suggests that measuring FFR before and after PCI provides clinically useful information.
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Affiliation(s)
- Stephane Fournier
- Cardiovascular Center Aalst, Aalst, Belgium.,Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Gabor G Toth
- University Heart Centre Graz, Medical University Graz, Graz, Austria
| | | | | | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Aalst, Belgium.,Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
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Burzotta F, Leone AM, Aurigemma C, Zambrano A, Zimbardo G, Arioti M, Vergallo R, De Maria GL, Cerracchio E, Romagnoli E, Trani C, Crea F. Fractional Flow Reserve or Optical Coherence Tomography to Guide Management of Angiographically Intermediate Coronary Stenosis. JACC Cardiovasc Interv 2020; 13:49-58. [DOI: 10.1016/j.jcin.2019.09.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/16/2022]
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8
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Chang CC, Kogame N, Onuma Y, Byrne RA, Capodanno D, Windecker S, Morel MA, Cutlip DE, Krucoff MW, Stone GW, Lansky AJ, Mehran R, Spitzer E, Fraser AG, Baumbach A, Serruys PW. Defining device success for percutaneous coronary intervention trials: a position statement from the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology. EUROINTERVENTION 2020; 15:1190-1198. [DOI: 10.4244/eij-d-19-00552] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Gosling RC, Morris PD, Lawford PV, Hose DR, Gunn JP. Personalised fractional flow reserve: a novel concept to optimise myocardial revascularisation. EUROINTERVENTION 2019; 15:707-713. [PMID: 30561366 DOI: 10.4244/eij-d-18-00668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS Fractional flow reserve (FFR) represents the percentage reduction in coronary flow relative to a hypothetically normal artery; however, percutaneous coronary intervention (PCI) seldom achieves physiological normality (FFR 1.00), particularly in the context of diffuse disease. In this study we describe a method for calculating the vessel-specific maximal achievable FFR (FFRmax) providing a personalised assessment of what PCI can achieve. METHODS AND RESULTS FFR measurements were obtained from 71 patients (100 arteries) undergoing angiography. Three-dimensional (3D) coronary anatomy was reconstructed from angiographic images. An ideal intervention, in which all stenoses are removed, was modelled, and the FFRmax calculated. The "personalised" FFR (FFRpers) was calculated as measured FFR/FFRmax. PCI was performed in 52 vessels and post-PCI FFR measured in 50. FFRmax was compared to post-PCI measured FFRs. The mean FFRmax was 0.92 (±0.04). This was on average 0.04 (±0.05) higher than the corresponding post-PCI measured FFR (p<0.001). FFRpers was significantly higher (0.06±0.04) than measured FFR (p<0.001), indicating that FFR overestimates flow restoration achievable with PCI. CONCLUSIONS A patient's maximal achievable FFR can now be determined prior to PCI. This approach provides a more realistic assessment of the physiological benefit of PCI than is implied by baseline FFR and may prevent unnecessary intervention.
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Affiliation(s)
- Rebecca C Gosling
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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Hoshino M, Kanaji Y, Hamaya R, Kanno Y, Hada M, Yamaguchi M, Sumino Y, Usui E, Sugano A, Murai T, Lee T, Yonetsu T, Kakuta T. Prognostic value of post-intervention fractional flow reserve after intravascular ultrasound-guided second-generation drug-eluting coronary stenting. EUROINTERVENTION 2019; 15:e779-e787. [DOI: 10.4244/eij-d-18-01032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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Leone AM, Burzotta F, Aurigemma C, De Maria GL, Zambrano A, Zimbardo G, Arioti M, Cerracchio E, Vergallo R, Trani C, Crea F. Prospective Randomized Comparison of Fractional Flow Reserve Versus Optical Coherence Tomography to Guide Revascularization of Intermediate Coronary Stenoses: One-Month Results. J Am Heart Assoc 2019; 8:e012772. [PMID: 31331219 PMCID: PMC6761662 DOI: 10.1161/jaha.119.012772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/24/2019] [Indexed: 12/23/2022]
Abstract
Background Fractional flow reserve (FFR) and optical coherence tomography (OCT) may help both in assessment and in percutaneous coronary intervention optimization of angiographically intermediate coronary lesions. We designed a prospective trial comparing the clinical and economic outcomes associated with FFR or OCT in angiographically intermediate coronary lesions. Methods and Results Three hundred fifty patients with angiographically intermediate coronary lesions (n=446) were randomized to FFR or OCT guidance. In the FFR arm, percutaneous coronary intervention was performed if FFR was ≤0.80 aiming for a postprocedure FFR >0.90. In the OCT arm, percutaneous coronary intervention was performed if percentage of area stenosis was ≥75% or 50% to 75% with minimal lumen area <2.5 mm2 or plaque ulceration. Costs, angina frequency, and major adverse cardiac events were assessed at 1 month and at 13 months. We present early data at 1 month consistent with a prespecified analysis of secondary end points. Patients randomized to FFR, as compared with OCT, were significantly more commonly managed with medical therapy alone (67.7% versus 41.1%; P<0.001), required less contrast media (245±137 versus 280±129 mL; P=0.004), and exhibited a lower occurrence of contrast-induced acute kidney injury (1.7% versus 8.6%; P=0.034). At 1 month, in comparison to FFR, OCT was associated with increased total costs (2831±1288 versus 4292±3844 euros/patient; P<0.001) whereas occurrence of major adverse cardiac events or significant angina was similar. Conclusions In patients with angiographically intermediate coronary lesions, a functional guidance by FFR, as compared with OCT, increased the rate of patients treated with medical therapy alone. This translated into a significant reduction in administered contrast, contrast-induced acute kidney injury, and total costs at 1 month with FFR. Clinical Trial Registration URL: http://www.clinicaltrialsgov. Unique identifier: NCT01824030.
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Affiliation(s)
| | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | | | - Giovanni Luigi De Maria
- Department of CardiologyJohn Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUnited Kingdom
| | - Aniello Zambrano
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Giuseppe Zimbardo
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Manfredi Arioti
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Emma Cerracchio
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Rocco Vergallo
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
- Università Cattolica del Sacro CuoreRomeItaly
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12
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Ieroncig F, Breau JB, Bélair G, David LP, Noiseux N, Hatem R, Avram R. Novel Approaches to Define Outcomes in Coronary Revascularization. Can J Cardiol 2019; 35:967-982. [DOI: 10.1016/j.cjca.2018.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/10/2018] [Accepted: 12/10/2018] [Indexed: 01/10/2023] Open
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13
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van Zandvoort LJC, Masdjedi K, Tovar Forero MN, Lenzen MJ, Ligthart J, Diletti R, Lemmert ME, Wilschut J, de Jaegere PPT, Zijlstra F, van Mieghem NM, Daemen J. Fractional flow reserve guided percutaneous coronary intervention optimization directed by high-definition intravascular ultrasound versus standard of care: Rationale and study design of the prospective randomized FFR-REACT trial. Am Heart J 2019; 213:66-72. [PMID: 31128504 DOI: 10.1016/j.ahj.2019.03.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post percutaneous coronary intervention (PCI) fractional flow reserve (FFR) is a significant predictor of major adverse cardiac events (MACE). The rationale for low post procedural FFR values often remains elusive based on angiographic findings alone, warranting further assessment using an FFR pullback or additional intravascular imaging. It is currently unknown if additional interventions intended to improve the PCI, decrease MACE rates. STUDY DESIGN The FFR REACT trial is a prospective, single-center randomized controlled trial in which 290 patients with a post PCI FFR <0.90 will be randomized (1:1) to either standard of care (no additional intervention) or intravascular ultrasound (IVUS)-directed optimization of the FFR (treatment arm). Eligible patients are those treated with angiographically successful PCI for (un)stable angina or non-ST elevation myocardial infarction (MI). Assuming 45% of patients will have a post PCI FFR <0.90, approximately 640 patients undergoing PCI will need to be enrolled. Patients with a post PCI FFR ≥ 0.90 will be enrolled in a prospective registry. The primary end point is defined as a composite of cardiac death, target vessel MI and clinically driven target vessel revascularisation (target vessel failure) at 1 year. Secondary end points will consist of individual components of the primary end point, procedural success, stent thrombosis and correlations on clinical outcome, changes in post PCI Pd/Pa and FFR and IVUS derived dimensions. All patients will be followed for 3 years. CONCLUSION The FFR-REACT trial is designed to explore the potential benefit of HD-IVUS-guided PCI optimization in patients with a post PCI FFR <0.90 (Dutch trial register: NTR6711).
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Affiliation(s)
| | | | | | - Mattie J Lenzen
- Department of cardiology, Thoraxcenter, Erasmus Medical Center
| | - Jurgen Ligthart
- Department of cardiology, Thoraxcenter, Erasmus Medical Center
| | - Roberto Diletti
- Department of cardiology, Thoraxcenter, Erasmus Medical Center
| | | | - Jeroen Wilschut
- Department of cardiology, Thoraxcenter, Erasmus Medical Center
| | | | - Felix Zijlstra
- Department of cardiology, Thoraxcenter, Erasmus Medical Center
| | | | - Joost Daemen
- Department of cardiology, Thoraxcenter, Erasmus Medical Center.
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14
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van Bommel RJ, Masdjedi K, Diletti R, Lemmert ME, van Zandvoort L, Wilschut J, Zijlstra F, de Jaegere P, Daemen J, van Mieghem NM. Routine Fractional Flow Reserve Measurement After Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2019; 12:e007428. [DOI: 10.1161/circinterventions.118.007428] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | - Roberto Diletti
- Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Jeroen Wilschut
- Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter de Jaegere
- Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Thorax Center, Erasmus Medical Center, Rotterdam, the Netherlands
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15
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Karamasis GV, Kalogeropoulos AS, Mohdnazri SR, Al-Janabi F, Jones R, Jagathesan R, Aggarwal RK, Clesham GJ, Tang KH, Kelly PA, Davies JR, Werner GS, Keeble TR. Serial Fractional Flow Reserve Measurements Post Coronary Chronic Total Occlusion Percutaneous Coronary Intervention. Circ Cardiovasc Interv 2018; 11:e006941. [DOI: 10.1161/circinterventions.118.006941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Grigoris V. Karamasis
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | | | - Shah R. Mohdnazri
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | - Firas Al-Janabi
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | - Richard Jones
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - Rohan Jagathesan
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - Rajesh K. Aggarwal
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - Gerald J. Clesham
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | - Kare H. Tang
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - Paul A. Kelly
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
| | - John R. Davies
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
| | - Gerald S. Werner
- Medizinische Klinik I (Cardiology & Intensive care), Klinikum Darmstadt GmbH, Darmstadt, Germany (G.S.W.)
| | - Thomas R. Keeble
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom (G.V.K., S.R.M., F.A.-J., R. Jones, R. Jagathesan, R.K.A., G.J.C., K.H.T., P.A.K., J.R.D., T.R.K.)
- School of Medicine, Faculty of Medical Science, Anglia Ruskin University, Cambridge and Chelmsford, United Kingdom (G.V.K., S.R.M., F.A.-J., G.J.C., J.R.D., T.R.K.)
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16
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Ali ZA, Cao JJ. Going Against the Flow: Assessing Coronary Hemodynamics Combining Invasive and Noninvasive Physiology. Circ Cardiovasc Interv 2018; 11:e007010. [PMID: 30006337 DOI: 10.1161/circinterventions.118.007010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ziad A Ali
- Center for Interventional Vascular Therapy, New York Presbyterian Hospital/Columbia University Medical Center and Cardiovascular Research Foundation (Z.A.A.).
| | - J Jane Cao
- The Heart Center, St. Francis Hospital, Roslyn, NY (J.J.C.)
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17
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Piroth Z, Toth GG, Tonino PA, Barbato E, Aghlmandi S, Curzen N, Rioufol G, Pijls NH, Fearon WF, Jüni P, De Bruyne B. Prognostic Value of Fractional Flow Reserve Measured Immediately After Drug-Eluting Stent Implantation. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.005233. [DOI: 10.1161/circinterventions.116.005233] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/26/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Zsolt Piroth
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Gabor G. Toth
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Pim A.L. Tonino
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Emanuele Barbato
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Soheila Aghlmandi
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Nick Curzen
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Gilles Rioufol
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Nico H.J. Pijls
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - William F. Fearon
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Peter Jüni
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
| | - Bernard De Bruyne
- From the Hungarian Institute of Cardiology, Budapest, Hungary (Z.P.); University Heart Centre Graz, Medical University Graz, Austria (G.G.T.); Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Belgium (G.G.T., E.B., B.D.B.); Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.); Institute of Social and Preventive Medicine, University of Bern, Switzerland (S.A.); Institute for Clinical
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