1
|
Otero-Cacho A, Villa MI, López-Otero D, Díaz-Fernández B, Bastos-Fernández M, Pérez-Muñuzuri V, Muñuzuri AP, González-Juanatey JR. Influence of the pressure wire on the fractional flow reserve calculation: CFD analysis of an ideal vessel and clinical patients with stenosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108325. [PMID: 39053351 DOI: 10.1016/j.cmpb.2024.108325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 07/07/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Fractional Flow Reserve (FFR) is generally considered the gold standard in hemodynamics to assess the impact of a stenosis on the blood flow. The standard procedure to measure involves the displacement of a pressure guide along the circulatory system until it is placed next to the lesion to be analyzed. The main objective of the present study is to analyze the influence of the pressure guide on the invasive FFR measurements and its implications in clinical practice. METHODS We studied the influence of pressure wires on the measurement of Fractional Flow Reserve (FFR) through a combination of Computational Fluid Dynamics (CFD) simulations using 45 clinical patient data with 58 lesions and ideal geometries. The analysis is conducted considering patients that were subjected to a computer tomography and also have direct measurements using a pressure guide. Influence of the stenosis severity, degree of occlusion and blood viscosity has also been studied. RESULTS The influence of pressure wires specifically affects severe stenosis with a lumen diameter reduction of 50 % or greater. This type of stenosis leads to reduced hyperemic flow and increased coronary pressure drop. Thus, we identified that the placement of wires during FFR measurements results in partial obstruction of the coronary artery lumen, leading to increased pressure drop and subsequent reduction in blood flow. The severity of low FFR values associated with severe stenosis may be prone to overestimation when compared to stenosis without severe narrowing. These results have practical implications, particularly in the interpretation of lesions falling within the "gray zone" (0,75-0,80). CONCLUSIONS The pressure wire's presence significantly alters the flow on severe lesions, which has an impact on the FFR calculation. In contrast, the impact of the pressure wire appears to be reduced when the FFR is larger than 0.8. The findings provide critical information for physicians, emphasizing the need for cautious interpretation of FFR values, particularly in severe stenosis. It also offers insights into improving the correlation between FFRct models and invasive measurements by incorporating the influence of pressure wires.
Collapse
Affiliation(s)
- Alberto Otero-Cacho
- FlowReserve Labs S.L., Santiago de Compostela, Spain; Galician Center for Mathematical Research and Technology (CITMAga), Santiago de Compostela, E15782, Spain; Group of Nonlinear Physics, Department of Physics, University of Santiago de Compostela, Santiago de Compostela, E15782, Spain.
| | | | - Diego López-Otero
- Cardiology and Intensive Cardiac Care Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Brais Díaz-Fernández
- Cardiology and Intensive Cardiac Care Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - María Bastos-Fernández
- Cardiology and Intensive Cardiac Care Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Vicente Pérez-Muñuzuri
- CRETUS Research Center, University of Santiago de Compostela, Spain; Group of Nonlinear Physics, Department of Physics, University of Santiago de Compostela, Santiago de Compostela, E15782, Spain
| | - Alberto P Muñuzuri
- Galician Center for Mathematical Research and Technology (CITMAga), Santiago de Compostela, E15782, Spain; Group of Nonlinear Physics, Department of Physics, University of Santiago de Compostela, Santiago de Compostela, E15782, Spain
| | - José Ramón González-Juanatey
- Cardiology and Intensive Cardiac Care Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| |
Collapse
|
2
|
Tsigkas GG, Bourantas GC, Moulias A, Karamasis GV, Bekiris FV, Davlouros P, Katsanos K. Rapid and Precise Computation of Fractional Flow Reserve from Routine Two-Dimensional Coronary Angiograms Based on Fluid Mechanics: The Pilot FFR2D Study. J Clin Med 2024; 13:3831. [PMID: 38999397 PMCID: PMC11242488 DOI: 10.3390/jcm13133831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 07/14/2024] Open
Abstract
Objective: To present a novel pipeline for rapid and precise computation of fractional flow reserve from an analysis of routine two-dimensional coronary angiograms based on fluid mechanics equations (FFR2D). Material and methods: This was a pilot analytical study that was designed to assess the diagnostic performance of FFR2D versus the gold standard of FFR (threshold ≤ 0.80) measured with a pressure wire for the physiological assessment of intermediate coronary artery stenoses. In a single academic center, consecutive patients referred for diagnostic coronary angiography and potential revascularization between 1 September 2020 and 1 September 2022 were screened for eligibility. Routine two-dimensional angiograms at optimal viewing angles with minimal overlap and/or foreshortening were segmented semi-automatically to derive the vascular geometry of intermediate coronary lesions, and nonlinear pressure-flow mathematical relationships were applied to compute FFR2D. Results: Some 88 consecutive patients with a single intermediate coronary artery lesion were analyzed (LAD n = 74, RCA n = 9 and LCX n = 5; percent diameter stenosis of 45.7 ± 11.0%). The computed FFR2D was on average 0.821 ± 0.048 and correlated well with invasive FFR (r = 0.68, p < 0.001). There was very good agreement between FFR2D and invasive-wire FFR with minimal measurement bias (mean difference: 0.000 ± 0.048). The overall accuracy of FFR2D for diagnosing a critical epicardial artery stenosis was 90.9% (80 cases classified correctly out of 88 in total). FFR2D identified 24 true positives, 56 true negatives, 4 false positives, and 4 false negatives and predicted FFR ≤ 0.80 with a sensitivity of 85.7%, specificity of 93.3%, positive likelihood ratio of 13.0, and negative likelihood ratio of 0.15. FFR2D had a significantly better discriminatory capacity (area under the ROC curve: 0.95 [95% CI: 0.91-0.99]) compared to 50%DS on 2D-QCA (area under the ROC curve: 0.70 [95% CI: 0.59-0.82]; p = 0.0001) in predicting wire FFR ≤ 0.80. The median time of image analysis was 2 min and the median time of computation of the FFR2D results was 0.1 s. Conclusion: FFR2D may rapidly derive a precise image-based metric of fractional flow reserve with high diagnostic accuracy based on a single two-dimensional coronary angiogram.
Collapse
Affiliation(s)
- Grigorios G. Tsigkas
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (A.M.); (P.D.)
| | | | - Athanasios Moulias
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (A.M.); (P.D.)
| | - Grigorios V. Karamasis
- Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Rimini 1, Chaidari, 12462 Athens, Greece;
| | | | - Periklis Davlouros
- Department of Cardiology, University Hospital of Patras, 26504 Patras, Greece; (A.M.); (P.D.)
| | - Konstantinos Katsanos
- Medlytic Labs, 26222 Patras, Greece; (G.C.B.); (F.V.B.); (K.K.)
- Department of Interventional Radiology, School of Medicine, University of Patras, 26222 Patras, Greece
| |
Collapse
|
3
|
Jong CB, Lu TS, Lin L, Chen TY, Liao MT, Kuo JC. Effect of prolonged pressure equalization on final drifting during pressure wire studies. Sci Rep 2024; 14:11504. [PMID: 38769360 PMCID: PMC11106059 DOI: 10.1038/s41598-024-62440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 05/16/2024] [Indexed: 05/22/2024] Open
Abstract
Pressure drifting is a troublesome error in invasive coronary function tests. This study aimed to evaluate the relationship between prolonged and short-time pressure equalizations in pressure drifting. Pressure drifting was defined as the pressure gradient between the mean pressure of the distal wire sensor (Pd) and aortic pressure (Pa) when the wire was withdrawn to the tip of the guiding catheter. Significant drifts 1 and 2 were defined as the absolute values of pressure gradients > 2 and > 3 mmHg, respectively. A logistic regression model was used to evaluate the associations between prolonged pressure equalization and each pressure drifting. The prolonged pressure equalization strategy was associated with a lower incidence of drift 1 than the short-time pressure equalization strategy (6.84% vs. 16.92%, p < 0.05). However, no statistical differences were found in the incidence of drift 2 between the prolonged and short-time pressure equalization strategies (4.27% vs. 7.69%, p = 0.34). In the multivariable regression model, only the prolonged pressure equalization strategy predicted a lower incidence of pressure drift 1. In conclusion, the prolonged pressure equalization strategy was associated with a lower incidence of significant pressure drifting with more stringent thresholds than the short-time pressure equalization strategy.
Collapse
Affiliation(s)
- Chien-Boon Jong
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Tsui-Shan Lu
- Department of Mathematics, National Taiwan Normal University, Taipei, Taiwan
| | - Lin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Tsung-Yan Chen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jui-Cheng Kuo
- Department of Radiology, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| |
Collapse
|
4
|
Kern MJ, Seto AH. Virtual FFR From Optical Coherence Tomography: A 1-Stop Shop for PCI Guidance? Circ Cardiovasc Interv 2024; 17:e014077. [PMID: 38525652 DOI: 10.1161/circinterventions.124.014077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Morton J Kern
- Interventional Cardiology, Division of Cardiology, Long Beach Veteran's Administration Medical Center, CA
| | - Arnold H Seto
- Interventional Cardiology, Division of Cardiology, Long Beach Veteran's Administration Medical Center, CA
| |
Collapse
|
5
|
Benedetti A, Castaldi G, Poletti E, Moroni A, El Jattari H, Scott B, Convens C, Verheye S, Vermeersch P, Agostoni P, Zivelonghi C. In-vitro validation of coronary physiology assessment with 5 French guiding catheters. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 60:55-63. [PMID: 37863759 DOI: 10.1016/j.carrev.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The trans-radial approach for cardiac catheterization led to an increasing adoption of 5 French (F) catheters. We aim to evaluate reliability and reproducibility of coronary physiology assessment performed with 5F guiding catheter (GC). METHODS Physiological measurements were performed in a coronary flow simulator, which provides two pulsatile flows, the baseline and hyperaemic flows. Two screws, positioned proximally and distally to the distal sensor of a pressure-temperature guidewire, were used to determine various combinations of stenoses and distal obstructions, simulating different pathophysiological conditions. For each setting, 5 measurements of fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microvascular resistance (IMR) were performed with 6F and 5F GCs. RESULTS A total amount of 190 measurements were performed, 95 with 6F GC and 95 with 5F GC. Minimal differences between 6F and 5F GCs were detected for FFR [0.91 (IQR: 0.87-0.94) and 0.87 (IQR: 0.82-0.92) respectively, p < 0.001] and IMR (16.5 ± 8.8 and 15.4 ± 8.3 respectively, p = 0.001). Mean CFR was comparable between 6F and 5F GCs (3.6 ± 1.1 and 3.5 ± 0.7 respectively, p = 0.38). Misclassification rates were 1.0 %, 1.0 % and 0 % for FFR, CFR and IMR, respectively. According to Passing-Bablok analysis, an excellent agreement between 6F and 5F GCs was demonstrated for FFR and IMR, and a modest agreement for CFR. All measurements with 5F GC showed high reproducibility. CONCLUSIONS In our in-vitro model, a complete physiological assessment including FFR, CFR and IMR resulted substantially comparable between 6F and 5F GCs. Further in-vivo analysis is required to support these findings.
Collapse
Affiliation(s)
- Alice Benedetti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Gianluca Castaldi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Clinical and Interventional Cardiology Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alice Moroni
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Hicham El Jattari
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | | | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.
| |
Collapse
|
6
|
Kern MJ. Editorial: Is a 5F guide as good as a 6F guide catheter for invasive physiology measurements? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 60:64-65. [PMID: 37996261 DOI: 10.1016/j.carrev.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Morton J Kern
- Long Beach Veterans Administration Medical Center, 5901 East 7th Street, 111C, Long Beach, CA 90822, United States of America.
| |
Collapse
|
7
|
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: 1.0] [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.
Collapse
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
| |
Collapse
|
8
|
Westra J, Rasmussen LD, Eftekhari A, Winther S, Karim SR, Johansen JK, Hammid O, Søndergaard HM, Ejlersen JA, Gormsen LC, Mogensen LJH, Bøttcher M, Holm NR, Christiansen EH. Coronary Artery Stenosis Evaluation by Angiography-Derived FFR: Validation by Positron Emission Tomography and Invasive Thermodilution. JACC Cardiovasc Imaging 2023; 16:1321-1331. [PMID: 37052562 DOI: 10.1016/j.jcmg.2023.02.008] [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: 11/16/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) derived from invasive coronary angiography (QFR) is promising for evaluation of intermediate coronary artery stenosis. OBJECTIVES The authors aimed to compare the diagnostic performance of QFR and the guideline-recommended invasive FFR using 82Rubidium positron emission tomography (82Rb-PET) myocardial perfusion imaging as reference standard. METHODS This is a prospective, observational study of symptomatic patients with suspected obstructive coronary artery disease on coronary computed tomography angiography (≥50% diameter stenosis in ≥1 vessel). All patients were referred to 82Rb-PET and invasive coronary angiography with FFR and QFR assessment of all intermediate (30%-90% diameter stenosis) stenoses. Main analyses included a comparison of the ability of QFR and FFR to identify reduced myocardial blood flow (<2 mL/g/min) during vasodilation and/or relative perfusion abnormalities (summed stress score ≥4 in ≥2 adjacent segments). RESULTS A total of 250 patients (320 vessels) with indication for invasive physiological assessment were included. The continuous relationship of 82Rb-PET stress myocardial blood flow per 0.10 increase in FFR was +0.14 mL/g/min (95% CI: 0.07-0.21 mL/g/min) and +0.08 mL/g/min (95% CI: 0.02-0.14 mL/g/min) per 0.10 QFR increase. Using 82Rb-PET as reference, QFR and FFR had similar diagnostic performance on both a per-patient level (accuracy: 73%; 95% CI: 67%-79%; vs accuracy: 71%; 95% CI: 64%-78%) and per-vessel level (accuracy: 70%; 95% CI: 64%-75%; vs accuracy: 68%; 95% CI: 62%-73%). The per-vessel feasibility was 84% (95% CI: 80%-88%) for QFR and 88% (95% CI: 85%-92%) for FFR by intention-to-diagnose analysis. CONCLUSIONS With 82Rb-PET as reference modality, the wire-free QFR solution showed similar diagnostic accuracy as invasive FFR in evaluation of intermediate coronary stenosis. (DAN-NICAD - Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease; NCT02264717).
Collapse
Affiliation(s)
- Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | | | - Jane Kirk Johansen
- Department of Cardiology, Regional Hospital Central Jutland, Silkeborg, Denmark
| | - Osama Hammid
- Department of Cardiology, Regional Hospital East Jutland, Randers, Denmark
| | | | - June Anita Ejlersen
- Department of Clinical Physiology, Regional Hospital Central Jutland, Viborg, Denmark; Department of Nuclear Medicine, Hospital Unit West, Herning, Denmark
| | - Lars C Gormsen
- Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark
| | | | | |
Collapse
|
9
|
Lee OH, Roh JW, Kim Y, Heo SJ, Im E, Cho DK. Invasive physiologic assessment of coronary artery stenosis by resting full-cycle ratio and fractional flow reserve: a prospective observational study. Sci Rep 2023; 13:15783. [PMID: 37737284 PMCID: PMC10516888 DOI: 10.1038/s41598-023-43082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/19/2023] [Indexed: 09/23/2023] Open
Abstract
Resting full-cycle ratio (RFR), an alternative to fractional flow reserve (FFR) for evaluating intermediate coronary artery stenosis, helps reduce patients' time, cost, and discomfort. However, the validation data for RFR and FFR are lacking. We aimed to assess the diagnostic accuracy of RFR and FFR and evaluate effective decision-making for revascularization using their values. Patients subjected to an invasive physiological study for intermediate coronary artery stenosis in Yongin Severance hospital between October 2020 and April 2022 were prospectively and consecutively recruited. We evaluated the correlation between RFR and FFR measurements and the diagnostic performance of RFR (≤ 0.89) versus FFR (≤ 0.80). In all, 474 intermediate coronary stenosis lesions from 400 patients were evaluated using RFR and FFR values. There was a strong linear relationship between RFR and FFR (r = 0.75, 95% CI 0.70-0.78, p < 0.01). Comparing diagnostic performance between RFR and FFR, RFR demonstrated diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 85.0%, 80.0%, 86.7%, 67.1%, and 92.7%, respectively. We analyzed the RFR value in the hyperemia zone (0.86-0.93) according to positive (RFR: 0.86-0.89) and negative (RFR: 0.90-0.93) areas. PPV in positive area is 47.8% (95% Confidence Interval [CI]: 33.8% to 62.0%) and NPV in negative area is 87.7% (95% CI: 80.3% to 93.1%). Excellent correlation exists between RFR and FFR and the diagnostic value of RFR without hyperemia compared with FFR in establishing the accurate functional significance of coronary artery stenosis was shown. RFR alone could evaluate the functional significance of coronary artery stenosis without unnecessary hyperemia, except in the positive area.Trial registration: URL: http://trialsearch.who.int ; Unique identifier: KCT0005255.
Collapse
Affiliation(s)
- Oh-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Ji Woong Roh
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea.
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Eui Im
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea.
| |
Collapse
|
10
|
Huang D, Gong Y, Fan Y, Zheng B, Lu Z, Li J, Huo Y, Escaned J, Huo Y, Ge J. Coronary angiography-derived index for assessing microcirculatory resistance in patients with non-obstructed vessels: The FLASH IMR study. Am Heart J 2023; 263:56-63. [PMID: 37054908 DOI: 10.1016/j.ahj.2023.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Assessing index of microcirculatory resistance (IMR) is customarily performed using intracoronary wires fitted with sensors by at least 3 intracoronary injections of 3 to 4 mL of room-temperature saline during sustained hyperemia, which is time- and cost-consuming. METHODS The FLASH IMR study is a prospective, multicenter, randomized study to assess the diagnostic performance of coronary angiography-derived IMR (caIMR) in patients with suspected myocardial ischemia with nonobstructive coronary arteries using wire-based IMR as a reference. The caIMR was calculated by an optimized computational fluid dynamics model simulating hemodynamics during diastole based on coronary angiograms. TIMI frame count and aortic pressure were included in computation. caIMR was determined onsite in real time and compared blind to wire-based IMR by an independent core laboratory, using wire-based IMR ≥25 units as indicative of abnormal coronary microcirculatory resistance. The primary endpoint was the diagnostic accuracy of caIMR, using wire-based IMR as a reference, with a pre-specified performance goal of 82%. RESULTS A total of 113 patients underwent paired caIMR and wire-based IMR measurements. Order of performance of tests was based on randomization. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values of caIMR were 93.8% (95% CI: 87.7%-97.5%), 95.1% (95% CI: 83.5%- 99.4%), 93.1% (95% CI: 84.5%-97.7%), 88.6% (95% CI: 75.4%-96.2%) and 97.1% (95% CI: 89.9%-99.7%). The receiver-operating curve for caIMR to diagnose abnormal coronary microcirculatory resistance had area under the curve of 0.963 (95% CI: 0.928-0.999). CONCLUSIONS Angiography-based caIMR has a good diagnostic yield with wire-based IMR. CLINICALTRIALS GOV IDENTIFIER NCT05009667.
Collapse
Affiliation(s)
- Dong Huang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yanjun Gong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yongzhen Fan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, Guangdong, China; Institute of Mechanobiology & Medical Engineering, School of Life Sciences & Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos IDISSC, Universidad Complutense de Madrid, Madrid, Spain
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
11
|
Scoccia A, Byrne RA, Banning AP, Landmesser U, Van Belle E, Amat-Santos IJ, Sabaté M, Tijssen JGP, Spitzer E, Daemen J. Fractional flow reserve or 3D-quantitative-coronary-angiography based vessel-FFR guided revascularization. Rationale and study design of the prospective randomized fast III trial. Am Heart J 2023; 260:1-8. [PMID: 36796573 DOI: 10.1016/j.ahj.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/29/2023] [Accepted: 02/05/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Physiological assessment of intermediate coronary lesions to guide coronary revascularization is currently recommended by international guidelines. Vessel fractional flow reserve (vFFR) has emerged as a new approach to derive fractional flow reserve (FFR) from 3D-quantitative coronary angiography (3D-QCA) without the need for hyperemic agents or pressure wires. STUDY DESIGN AND OBJECTIVES The FAST III is an investigator-initiated, open label, multicenter randomized trial comparing vFFR guided versus FFR guided coronary revascularization in approximately 2228 patients with intermediate coronary lesions (defined as 30%-80% stenosis by visual assessment or QCA). Intermediate lesions are physiologically assessed using on-line vFFR or FFR and treated if vFFR or FFR ≤0.80. The primary end point is a composite of all-cause death, any myocardial infarction, or any revascularization at 1-year post-randomization. Secondary end points include the individual components of the primary end point and cost-effectiveness will be investigated. CONCLUSIONS FAST III is the first randomized trial to explore whether a vFFR guided revascularization strategy is non-inferior to an FFR guided strategy in terms of clinical outcomes at 1-year follow-up in patients with intermediate coronary artery lesions.
Collapse
Affiliation(s)
- Alessandra Scoccia
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert A Byrne
- Dept. of Cardiology and Cardiovascular Research Institute (CVRI) Dublin, Mater Private Network, Dublin, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Adrian P Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, German Center of Cardiovascular Research (DZHK) - Partner Site Berlin; Germany
| | - Eric Van Belle
- Department of Cardiology, Institut Cœur Poumon, CHU Lille, Lille, France; Department of Interventional Cardiology for Coronary Valves and Structural Heart Diseases, Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Manel Sabaté
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Ernest Spitzer
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands; European Cardiovascular Research Institute, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
12
|
Chen YC, Zhou F, Wang YN, Zhang JY, Yu MM, Hou Y, Xu PP, Zhang XL, Xue Y, Zheng MW, Zhang B, Zhang DM, Hu XH, Xu L, Liu H, Lu GM, Tang CX, Zhang LJ. Optimal Measurement Sites of Coronary-Computed Tomography Angiography-derived Fractional Flow Reserve: The Insight From China CT-FFR Study. J Thorac Imaging 2023; 38:194-202. [PMID: 36469852 DOI: 10.1097/rti.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the optimal measurement site of coronary-computed tomography angiography-derived fractional flow reserve (FFR CT ) for the assessment of coronary artery disease (CAD) in the whole clinical routine practice. MATERIALS AND METHODS This retrospective multicenter study included 396 CAD patients who underwent coronary-computed tomography angiography, FFR CT , and invasive FFR. FFR CT was measured at 1 cm (FFR CT -1 cm), 2 cm (FFR CT -2 cm), 3 cm (FFR CT -3 cm), and 4 cm (FFR CT -4 cm) distal to coronary stenosis, respectively. FFR CT and invasive FFR ≤0.80 were defined as lesion-specific ischemia. The diagnostic performance of FFR CT to detect ischemia was obtained using invasive FFR as the reference standard. Reduced invasive coronary angiography rate and revascularization efficiency were calculated. After a median follow-up of 35 months in 267 patients for major adverse cardiovascular events (MACE), Cox hazard proportional models were performed with FFR CT values at each measurement site. RESULTS For discriminating lesion-specific ischemia, the areas under the curve of FFR CT -1 cm (0.91) as well as FFR CT -2 cm (0.91) were higher than those of FFR CT -3 cm (0.89) and FFR CT -4 cm (0.88), respectively (all P <0.05). The higher reduced invasive coronary angiography rate (81.6%) was found at FFR CT -1 cm than FFR CT -2 cm (81.6% vs. 62.6%, P <0.05). Revascularization efficiency did not differ between FFR CT -1 cm and FFR CT -2 cm (80.8% vs. 65.5%, P =0.019). In 12.4% (33/267) MACE occurred and only values of FFR CT -2 cm were independently predictive of MACE (hazard ratio: 0.957 [95% CI: 0.925-0.989]; P =0.010). CONCLUSIONS This study indicates FFR CT -2 cm is the optimal measurement site with superior diagnostic performance and independent prognostic role.
Collapse
Affiliation(s)
- Yan Chun Chen
- Department of Diagnostic Radiology, Jinling Hospital
| | - Fan Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Yi Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jia Yin Zhang
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Institute of Diagnostic and Interventional Radiology, Shanghai
| | - Meng Meng Yu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Institute of Diagnostic and Interventional Radiology, Shanghai
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang
| | - Peng Peng Xu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Xiao Lei Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Yi Xue
- Department of Diagnostic Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing
| | - Min Wen Zheng
- Department of Radiology, Xijing Hospital, Air Force Military Medical University, Xi'an
| | - Bo Zhang
- Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu
| | - Dai Min Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University
| | - Xiu Hua Hu
- Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Guang Ming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Chun Xiang Tang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| |
Collapse
|
13
|
Agujetas R, Ferrera C, González-Fernández R, Nogales-Asensio JM, Fernández-Tena A. Influence of the position of the distal pressure measurement point on the Fractional Flow Reserve using in-silico simulations. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
14
|
Chiabrando JG, Seropian IM. A Correct FFR Trace Interpretation Is Important for a Clinical Decision. JACC Case Rep 2022; 4:1387. [PMID: 36299655 PMCID: PMC9588584 DOI: 10.1016/j.jaccas.2022.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Ignacio M. Seropian
- Interventional Cardiology Department, Hospital Italiano de Buenos Aires 4190, Presidente Juan Domingo Peron Street, Buenos Aires City C1199, Argentina
| |
Collapse
|
15
|
Jeremias A, Nijjer S, Davies J, DiMario C. Physiologic Assessment and Guidance in the Cardiac Catheterization Laboratory. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
16
|
Prognostic value of post-percutaneous coronary intervention diastolic pressure ratio. Neth Heart J 2022; 30:352-359. [PMID: 35391616 PMCID: PMC9270544 DOI: 10.1007/s12471-022-01680-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/20/2022] Open
Abstract
Aim To evaluate the distribution of a generic diastolic pressure ratio (dPR) after angiographically successful percutaneous coronary intervention (PCI) and to assess its association with the 2‑year incidence of target vessel failure (TVF), defined as a composite of cardiac mortality, target vessel revascularisation, target vessel myocardial infarction and stent thrombosis. Methods The dPR SEARCH study is a post hoc analysis of the prospective single-centre FFR-SEARCH registry, in which physiological assessment was performed after angiographically successful PCI in a total of 1000 patients, using a dedicated microcatheter. dPR was calculated offline with recently validated software in a subset of 735 patients. Results Mean post-PCI dPR was 0.95 ± 0.06. Post-PCI dPR was ≤ 0.89 in 15.2% of the patients. The cumulative incidence of TVF at 2‑year follow-up was 9.4% in patients with a final post-PCI dPR ≤ 0.89 as compared to 6.1% in patients with a post-PCI dPR > 0.89 (adjusted hazard ratio [HR] for dPR ≤ 0.89: 1.53; 95% CI 0.74–3.13; p = 0.249). dPR ≤ 0.89 was associated with significantly higher cardiac mortality at 2 years; adjusted HR 2.40; 95% CI 1.01–5.68; p = 0.047. Conclusions In a real-world setting, despite optimal angiographic PCI results, 15.2% of the patients had a final post-PCI dPR of ≤ 0.89, which was associated with a higher incidence of TVF and a significantly higher cardiac mortality rate. Supplementary Information The online version of this article (10.1007/s12471-022-01680-0) contains supplementary material, which is available to authorized users.
Collapse
|
17
|
Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease. Int J Cardiol 2022; 355:59-64. [DOI: 10.1016/j.ijcard.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
|
18
|
Rajiah P, Cummings KW, Williamson E, Young PM. CT Fractional Flow Reserve: A Practical Guide to Application, Interpretation, and Problem Solving. Radiographics 2022; 42:340-358. [PMID: 35119968 DOI: 10.1148/rg.210097] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CT fractional flow reserve (FFRCT) is a physiologic simulation technique that models coronary flow from routine coronary CT angiography (CTA). To evaluate lesion-specific ischemia, FFRCT is measured 2 cm distal to a stenotic lesion. FFRCT greater than 0.8 is normal, 0.76-0.8 is borderline, and 0.75 or less is abnormal. FFRCT should always be interpreted in correlation with clinical and anatomic coronary CTA findings. FFRCT increases the specificity of coronary CTA in the evaluation of coronary artery disease, decreases the prevalence of nonobstructive disease in invasive coronary angiography (ICA), and helps with revascularization decisions and planning. Patients with intermediate-risk coronary anatomy at CTA and abnormal FFRCT can undergo ICA and revascularization, whereas those with normal FFRCT can be safely deferred from ICA. In borderline FFRCT values, management is decided in the context of the clinical scenario, but many cases could be safely managed with medical treatment. There are some limitations and pitfalls of FFRCT. Abnormal FFRCT values can be seen in mild stenosis, and normal FFRCTvalues can be seen in severe stenosis. Gradually decreasing or abnormal low FFRCT values at the distal vessel without a proximal focal lesion could be due to diffuse atherosclerosis. Coronary stents, bypass grafts, coronary anomalies, coronary dissection, transcatheter aortic valve replacement, unstable angina, and acute or recent myocardial infarction are situations in which FFRCT has not been validated and should not be used at this time. The authors provide a practical guide to the applications and interpretation of FFRCT, focusing on common pitfalls and challenges. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (P.R., E.W., P.M.Y.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.)
| | - Kristopher W Cummings
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (P.R., E.W., P.M.Y.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.)
| | - Eric Williamson
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (P.R., E.W., P.M.Y.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.)
| | - Phillip M Young
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (P.R., E.W., P.M.Y.); and Department of Radiology, Mayo Clinic, Phoenix, Ariz (K.W.C.)
| |
Collapse
|
19
|
Patel MR, Jeremias A, Maehara A, Matsumura M, Zhang Z, Schneider J, Tang K, Talwar S, Marques K, Shammas NW, Gruberg L, Seto A, Samady H, Sharp ASP, Ali ZA, Mintz G, Davies J, Stone GW. 1-Year Outcomes of Blinded Physiological Assessment of Residual Ischemia After Successful PCI: DEFINE PCI Trial. JACC Cardiovasc Interv 2022; 15:52-61. [PMID: 34991824 DOI: 10.1016/j.jcin.2021.09.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to identify the post-percutaneous coronary intervention (PCI) target value of instantaneous wave-free ratio (iFR) that would best discriminate clinical events at 1 year in the DEFINE PCI (Physiologic Assessment of Coronary Stenosis Following PCI) study. BACKGROUND The impact of residual ischemia detected by iFR post-PCI on clinical and symptom-related outcomes is unknown. METHODS Blinded iFR pull back was performed after successful stent implantation in 500 patients. The primary endpoint was the rate of residual ischemia, defined as iFR ≤0.89, after operator-assessed angiographically successful PCI. Secondary endpoints included clinical events at 1 year and change in Seattle Angina Questionnaire angina frequency (SAQ-AF) score during follow-up. RESULTS As reported, 24.0% of patients had residual ischemia (iFR ≤0.89) after successful PCI, with 81.6% of cases attributable to angiographically inapparent focal lesions. Post-PCI iFR ≥0.95 (present in 182 cases [39%]) was associated with a significant reduction in the composite of cardiac death, spontaneous myocardial infarction, or clinically driven target vessel revascularization compared with post-PCI iFR <0.95 (1.8% vs 5.7%; P = 0.04). Baseline SAQ-AF score was 73.3 ± 22.8. For highly symptomatic patients (baseline SAQ-AF score ≤60), SAQ-AF score increased by ≥10 points more frequently in patients with versus without post-PCI iFR ≥0.95 (100.0% vs 88.5%; P = 0.01). CONCLUSIONS In DEFINE PCI, despite angiographically successful PCI, highly symptomatic patients at baseline without residual ischemia by post-PCI iFR had greater reductions in anginal symptoms at 1 year compared with patients with residual ischemia. Achieving post-PCI iFR ≥0.95 was also associated with improved 1-year event-free survival. (Physiologic Assessment of Coronary Stenosis Following PCI [DEFINE PCI]; NCT03084367).
Collapse
Affiliation(s)
- Manesh R Patel
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | - Allen Jeremias
- St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Akiko Maehara
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Mitsuaki Matsumura
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Zixuan Zhang
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Joel Schneider
- North Carolina Heart and Vascular, Raleigh, North Carolina, USA
| | - Kare Tang
- Essex Cardiothoracic Centre, Basildon, United Kingdom
| | - Suneel Talwar
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Koen Marques
- VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Arnold Seto
- Veterans Affairs Medical Center of Long Beach, Long Beach, California, USA
| | - Habib Samady
- Emory University Hospital, Atlanta, Georgia, USA
| | - Andrew S P Sharp
- University Hospital of Wales, Cardiff, United Kingdom; University of Exeter, Exeter, United Kingdom
| | - Ziad A Ali
- St. Francis Hospital, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | - Gary Mintz
- Cardiovascular Research Foundation, New York, New York, USA; Columbia University Medical Center, New York, New York, USA
| | | | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
20
|
Jain P, Udelson JE, Kimmelstiel C. Physiologic Guidance for Percutaneous Coronary Intervention: State of the Evidence. Trends Cardiovasc Med 2022:S1050-1738(22)00014-7. [DOI: 10.1016/j.tcm.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/10/2022] [Accepted: 01/25/2022] [Indexed: 01/10/2023]
|
21
|
Tanaka H, Matsumoto H, Takahashi H, Hosonuma M, Sato S, Ogura K, Oishi Y, Masaki R, Sakai K, Sekimoto T, Kondo S, Tsujita H, Tsukamoto S, Sumida A, Okada N, Inoue K, Shinke T. Linear concentration-response relationship of serum caffeine with adenosine-induced fractional flow reserve overestimation: a comparison with papaverine. EUROINTERVENTION 2021; 17:e925-e931. [PMID: 34647891 PMCID: PMC9725067 DOI: 10.4244/eij-d-21-00453] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Caffeine intake from one cup of coffee one hour before adenosine stress tests, corresponding to serum caffeine levels of 3-4 mg/L, is thought to be acceptable for non-invasive imaging. AIMS We aimed to elucidate whether serum caffeine is independently associated with adenosine-induced fractional flow reserve (FFR) overestimation and their concentration-response relationship. METHODS FFR was measured using adenosine (FFRADN) and papaverine (FFRPAP) in 209 patients. FFRADN overestimation was defined as FFRADN - FFRPAP. The locally weighted scatterplot smoothing (LOWESS) approach was applied to evaluate the relationship between serum caffeine level and FFRADN overestimation. Multiple regression analysis was used to determine independent factors associated with FFRADN overestimation. RESULTS Caffeine was ingested at <12 hours in 85 patients, at 12-24 hours in 35 patients, and at >24 hours in 89 patients. Multiple regression analysis identified serum caffeine level as the strongest factor associated with FFRADN overestimation (p<0.001). The LOWESS curve demonstrated that FFRADN overestimation started from just above the lower detection limit of serum caffeine and increased approximately 0.01 FFR unit per 1 mg/L increase in serum caffeine level with a linear relationship. The 90th percentile of serum caffeine levels for the ≤12-hour, the 12-24-hour, and the >24-hour groups corresponded to FFRADN overestimations by 0.06, 0.03, and 0.02, respectively. CONCLUSIONS Serum caffeine overestimates FFRADN values in a linear concentration-response manner. FFRADN overestimation occurs at much lower serum caffeine levels than those that were previously believed. Our results highlight that standardised caffeine control is required for reliable adenosine-induced FFR measurements.
Collapse
Affiliation(s)
- Hideaki Tanaka
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hidenari Matsumoto
- Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Haruya Takahashi
- Division of Food Science and Biotechnology, Graduate School of Agriculture, Kyoto University, Uji, Kyoto, Japan
| | - Masahiro Hosonuma
- Department of Clinical Immuno Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Shunya Sato
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Kunihiro Ogura
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Yosuke Oishi
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryota Masaki
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Koshiro Sakai
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Teruo Sekimoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Seita Kondo
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Tsujita
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Shigeto Tsukamoto
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Arihiro Sumida
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Natsumi Okada
- Department of Clinical Immuno Oncology, Clinical Research Institute for Clinical Pharmacology and Therapeutics, Showa University, Tokyo, Japan
| | - Kazuo Inoue
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|
22
|
Shlofmitz E, Busch J. Recognition of drift: A key to success with invasive physiology. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:57-58. [PMID: 34893445 DOI: 10.1016/j.carrev.2021.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Evan Shlofmitz
- St. Francis Hospital - The Heart Center, Roslyn, NY, USA.
| | - Jordan Busch
- St. Francis Hospital - The Heart Center, Roslyn, NY, USA
| |
Collapse
|
23
|
Al-Lamee R, Rajkumar CA, Ganesananthan S, Jeremias A. Optimising physiological endpoints of percutaneous coronary intervention. EUROINTERVENTION 2021; 16:e1470-e1483. [PMID: 33792544 PMCID: PMC9753914 DOI: 10.4244/eij-d-20-00988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have persistence or recurrence of angina after angiographically successful percutaneous coronary intervention (PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
Collapse
Affiliation(s)
- Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, 2nd Floor, B Block, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom
| | - Christopher A. Rajkumar
- National Heart and Lung Institute, Imperial College London, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Allen Jeremias
- Department of Cardiology, St. Francis Hospital, The Heart Center, Roslyn, NY, USA
| |
Collapse
|
24
|
Assessing the Accuracy of a second-generation optical sensor pressor wire in a wire to wire comparison (The ACCURACY study). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:51-56. [PMID: 33775553 DOI: 10.1016/j.carrev.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/18/2021] [Accepted: 03/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The phenomenon of "pressure drift" increases uncertainty about the correct FFR value. Redesigned and incorporating an optical pressure sensor, the "OptoWire Deux™" is purported to be less prone to the pressure drift seen with piezoelectric coronary pressure wires. The aim of this first in vivo real-world clinical study is to evaluate the performance of OptoWire Deux™ in terms of measurements agreement and propensity to pressure drift in a wire to wire comparison. METHODS This is a single center, prospective, non-blinded clinical investigation enrolling 45 consecutive patients with a clinical indication for coronary lesion FFR assessment. Lesions were either simultaneously assessed with two optical sensor pressure wires (OSPW) (Group O-O; 30 patients, 34 lesions) or one OSPW and one piezoelectric pressure wire (PEPW) simultaneously (Group O-P; 15 patients, 15 lesions). Significant drift was defined as a pressure ratio deviation of >0.03. RESULTS Mean FFR measurements in Group OO were not statistically different between the two sets of OSPW (overall 0.84±0.10; P = 0.52). In Group OP, however, mean FFR measurement with PEPW (0.85±0.09) was numerically lower than that observed with the OSPW (0.88±0.08; P = 0.09). Level of agreement using the Bland-Altman method was higher when 2 OSPW were used for FFR assessment (-0.002 95% CI [-0.033,0.029] vs. 0.026 95% CI [-0.078, 0.130], respectively). The rate of drift was significantly lower with an OSPW compared to a PEPW (4.8% vs. 26.7% respectively, P = 0.02). CONCLUSION The optical sensor guidewire showed a high level of readings' agreement after simultaneous usage of 2 optical sensor guidewires. There was also significantly less drift when compared to a piezoelectric guidewire.
Collapse
|
25
|
Peper J, van Hamersvelt RW, Rensing BJWM, van Kuijk JP, Voskuil M, Berg JMT, Schaap J, Kelder JC, Grobbee DE, Leiner T, Swaans MJ. Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio-FFR revascularization decision-making strategy. Sci Rep 2021; 11:6425. [PMID: 33742077 PMCID: PMC7979768 DOI: 10.1038/s41598-021-85933-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/18/2021] [Indexed: 11/24/2022] Open
Abstract
Invasive fractional flow reserve (FFR) adoption remains low mainly due to procedural and operator related factors as well as costs. Alternatively, quantitative flow ratio (QFR) achieves a high accuracy mainly outside the intermediate zone without the need for hyperaemia and wire-use. We aimed to determine the diagnostic performance of QFR and to evaluate a QFR-FFR hybrid strategy in which FFR is measured only in the intermediate zone. This retrospective study included 289 consecutive patients who underwent invasive coronary angiography and FFR. QFR was calculated for all vessels in which FFR was measured. The QFR-FFR hybrid approach was modelled using the intermediate zone of 0.77-0.87 in which FFR-measurements are recommended. The sensitivity, specificity, and accuracy on a per vessel-based analysis were 84.6%, 86.3% and 85.6% for QFR and 88.0%, 92.9% and 90.3% for the QFR-FFR hybrid approach. The diagnostic accuracy of QFR-FFR hybrid strategy with invasive FFR measurement was 93.4% and resulted in a 56.7% reduction in the need for FFR. QFR has a good correlation and agreement with invasive FFR. A hybrid QFR-FFR approach could extend the use of QFR and reduces the proportion of invasive FFR-measurements needed while improving accuracy.
Collapse
Affiliation(s)
- Joyce Peper
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | | | - Benno J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Johannes C Kelder
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Diederick E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| |
Collapse
|
26
|
Nogi K, Soeda T, Hara M, Iwama H, Toyokawa N, Sakai S, Yano H, Iwai A, Hashimoto Y, Fujimoto H, Suzuki M, Nakai T, Doi N, Saito Y. Functional assessment of intermediate coronary artery stenosis with 4-Fr catheters. Heart Vessels 2021; 36:638-645. [PMID: 33389064 DOI: 10.1007/s00380-020-01746-2] [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: 09/07/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
The 4-Fr catheter system is not recommended for invasive functional assessment of coronary artery stenosis, because it tends to distort the aortic waveform. This study aimed to identify the incidence of aortic waveform distortion and a feasible method for correct diagnosis of coronary artery stenosis with a 4-Fr catheter. We retrospectively investigated 178 lesions with intermediate coronary artery stenosis. Non-hyperemic distal coronary artery pressure (Pd) and aortic pressure (Pa) were measured with a 4-Fr diagnostic or 6-Fr guiding catheter before and after saline flush. The mean Pd/mean Pa (Pd/Pa) and instantaneous wave-free ratio (iFR) were calculated before and after flushing. We compared the effect of flushing on the changes in Pd/Pa and iFR between the 4-Fr diagnostic and 6-Fr guiding catheters. Using the 4-Fr diagnostic catheter, there was a significant decrease in incidence of aortic waveform distortion from 42.0% (47 lesions) before flushing to 1.8% (2 lesions) after flushing (p < 0.001); the incidence was only 3.0% before saline flush and decreased to 0% after saline flush when using the 6-Fr guiding catheter. The presence of aortic waveform distortion influenced the iFR when the 4-Fr system was used. Functional measurements with the 4-Fr diagnostic catheter require adequate saline flush to remove the influence of aortic waveform distortion.
Collapse
Affiliation(s)
- Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.,Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.
| | - Masahiko Hara
- Center for Community-Based Healthcare Research and Education, Shimane University, Izumo, Japan
| | - Hajime Iwama
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Nozomi Toyokawa
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Satoshi Sakai
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Hiroki Yano
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.,Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Atsushi Iwai
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.,Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Hajime Fujimoto
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Megumi Suzuki
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Takehito Nakai
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Naofumi Doi
- Department of Cardiovascular Medicine, Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan
| |
Collapse
|
27
|
Smit JM, Koning G, van Rosendael AR, El Mahdiui M, Mertens BJ, Schalij MJ, Jukema JW, Delgado V, Reiber JHC, Bax JJ, Scholte AJ. Referral of patients for fractional flow reserve using quantitative flow ratio. Eur Heart J Cardiovasc Imaging 2020; 20:1231-1238. [PMID: 30535361 DOI: 10.1093/ehjci/jey187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/10/2018] [Indexed: 01/11/2023] Open
Abstract
AIMS Quantitative flow ratio (QFR) is a recently developed technique to calculate fractional flow reserve (FFR) based on 3D quantitative coronary angiography and computational fluid dynamics, obviating the need for a pressure-wire and hyperaemia induction. QFR might be used to guide patient selection for FFR and subsequent percutaneous coronary intervention (PCI) referral in hospitals not capable to perform FFR and PCI. We aimed to investigate the feasibility to use QFR to appropriately select patients for FFR referral. METHODS AND RESULTS Patients who underwent invasive coronary angiography in a hospital where FFR and PCI could not be performed and were referred to our hospital for invasive FFR measurement, were included. Angiogram images from the referring hospitals were retrospectively collected for QFR analysis. Based on QFR cut-off values of 0.77 and 0.86, our patient cohort was reclassified to 'no referral' (QFR ≥0.86), referral for 'FFR' (QFR 0.78-0.85), or 'direct PCI' (QFR ≤0.77). In total, 290 patients were included. Overall accuracy of QFR to detect an invasive FFR of ≤0.80 was 86%. Based on a QFR cut-off value of 0.86, a 50% reduction in patient referral for FFR could be obtained, while only 5% of these patients had an invasive FFR of ≤0.80 (thus, these patients were incorrectly reclassified to the 'no referral' group). Furthermore, 22% of the patients that still need to be referred could undergo direct PCI, based on a QFR cut-off value of 0.77. CONCLUSION QFR is feasible to use for the selection of patients for FFR referral.
Collapse
Affiliation(s)
- Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Gerhard Koning
- Medis Medical Imaging Systems B.V., Schuttersveld 9, XG Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Johan H C Reiber
- Medis Medical Imaging Systems B.V., Schuttersveld 9, XG Leiden, The Netherlands.,Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| |
Collapse
|
28
|
Johnson NP, Li W, Chen X, Hennigan B, Watkins S, Berry C, Fearon WF, Oldroyd KG. Diastolic pressure ratio: new approach and validation vs. the instantaneous wave-free ratio. Eur Heart J 2020; 40:2585-2594. [PMID: 31329863 DOI: 10.1093/eurheartj/ehz230] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/16/2018] [Accepted: 03/31/2019] [Indexed: 01/10/2023] Open
Abstract
AIMS The instantaneous wave-free ratio (iFR) and whole-cycle Pd/Pa investigate coronary physiology during non-hyperaemic conditions. To test for unique physiologic properties of the wave-free period when making resting coronary pressure measurements, we compared post hoc a diastolic pressure ratio (dPR) and Pd/Pa against iFR for numerical similarity and test/retest repeatability. METHODS AND RESULTS Eight hundred and ninety-three lesions from 833 subjects were included from the VERIFY 2 and CONTRAST studies. Diastolic pressure ratio and a linear transform of Pd/Pa were compared against iFR for diagnostic performance. Mean difference between dPR and iFR [Δ = -0.006 ± 0.011, r2 = 0.993, area under receiver operating characteristic (ROC) curve (AUC) = 0.997] mirrored the difference of two iFR measurements repeated immediately (Δ = <0.001 ± 0.004, r2 = 0.998, AUC = 1.00). Minor variations in the definition of dPR changed its value by <1-2% over a broad range of the cardiac cycle. A linear transform of Pd/Pa showed very good diagnostic performance (Δ = -0.012 ± 0.031, r2 = 0.927, AUC = 0.979). Post hoc iFR values were validated against real-time iFR values and matched almost exactly (average Δ = <0.001 ± 0.004, 99.6% within ±0.01). CONCLUSIONS Our dPR offers numerical equivalency to iFR. Despite different technical approaches for identifying the relevant period of diastole, the agreement between dPR and iFR and the insensitivity of dPR to minor variations in its definition further confirm numerical equivalency among resting metrics.
Collapse
Affiliation(s)
- Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, USA
| | | | - Xi Chen
- Boston Scientific Corporation, CA, USA
| | - Barry Hennigan
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Agamemnon Street, Glasgow, UK
| | - Stuart Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Agamemnon Street, Glasgow, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Agamemnon Street, Glasgow, UK
| | | | - Keith G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.,West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Agamemnon Street, Glasgow, UK
| |
Collapse
|
29
|
Masdjedi K, van Zandvoort LJ, Balbi MM, Gijsen FJ, Ligthart JM, Rutten MC, Lemmert ME, Wilschut JM, Diletti R, de Jaegere P, Zijlstra F, Van Mieghem NM, Daemen J. Validation of a three-dimensional quantitative coronary angiography-based software to calculate fractional flow reserve: the FAST study. EUROINTERVENTION 2020; 16:591-599. [DOI: 10.4244/eij-d-19-00466] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
30
|
Johnson DT, Fournier S, Kirkeeide RL, De Bruyne B, Gould KL, Johnson NP. Phasic pressure measurements for coronary and valvular interventions using fluid-filled catheters: Errors, automated correction, and clinical implications. Catheter Cardiovasc Interv 2020; 96:E268-E277. [PMID: 32077561 PMCID: PMC7539962 DOI: 10.1002/ccd.28780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We sought to develop an automatic method for correcting common errors in phasic pressure tracings for physiology-guided interventions on coronary and valvular stenosis. BACKGROUND Effective coronary and valvular interventions rely on accurate hemodynamic assessment. Phasic (subcycle) indexes remain intrinsic to valvular stenosis and are emerging for coronary stenosis. Errors, corrections, and clinical implications of fluid-filled catheter phasic pressure assessments have not been assessed in the current era of ubiquitous, high-fidelity pressure wire sensors. METHODS We recruited patients undergoing invasive coronary physiology assessment. Phasic aortic pressure signals were recorded simultaneously using a fluid-filled guide catheter and 0.014″ pressure wire before and after standard calibration as well as after pullback. We included additional subjects undergoing hemodynamic assessment before and after transcatheter aortic valve implantation. Using the pressure wire as reference standard, we developed an automatic algorithm to match phasic pressures. RESULTS Removing pressure offset and temporal shift produced the largest improvements in root mean square (RMS) error between catheter and pressure wire signals. However, further optimization <1 mmHg RMS error was possible by accounting for differential gain and the oscillatory behavior of the fluid-filled guide. The impact of correction was larger for subcycle (like systole or diastole) versus whole-cycle metrics, indicating a key role for valvular stenosis and emerging coronary pressure ratios. CONCLUSIONS When calibrating phasic aortic pressure signals using a pressure wire, correction requires these parameters: offset, timing, gain, and oscillations (frequency and damping factor). Automatically eliminating common errors may improve some clinical decisions regarding physiology-based intervention.
Collapse
Affiliation(s)
- Daniel T. Johnson
- Weatherhead PET Center, Division of Cardiology, Department of MedicineMcGovern Medical School at UTHealth and Memorial Hermann HospitalHoustonTexas
| | - Stephane Fournier
- Department of CardiologyCardiovascular Center Aalst OLV HospitalAalstBelgium
- Department of CardiologyLausanne University Center HospitalSwitzerland
| | - Richard L. Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of MedicineMcGovern Medical School at UTHealth and Memorial Hermann HospitalHoustonTexas
| | - Bernard De Bruyne
- Department of CardiologyCardiovascular Center Aalst OLV HospitalAalstBelgium
| | - K. Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of MedicineMcGovern Medical School at UTHealth and Memorial Hermann HospitalHoustonTexas
| | - Nils P. Johnson
- Weatherhead PET Center, Division of Cardiology, Department of MedicineMcGovern Medical School at UTHealth and Memorial Hermann HospitalHoustonTexas
| |
Collapse
|
31
|
Matsumura M, Maehara A, Davies JE, Sharp A, Samady H, Seto AH, Ali ZA, Stone GW, Patel MR, Jeremias A. Intensive Training and Real-Time Quality Control by a Physiology Core Laboratory: Lessons From DEFINE-PCI. Circ Cardiovasc Interv 2020; 13:e009077. [PMID: 32611202 DOI: 10.1161/circinterventions.120.009077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mitsuaki Matsumura
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.)
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.).,Columbia University Irving Medical Center, New York, NY (A.M., Z.A.A.)
| | - Justin E Davies
- Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom (J.E.D,)
| | - Andrew Sharp
- University Hospital of Wales and University of Exeter, Cardiff, United Kingdom (A.S.).,Emory University Hospital, Atlanta, GA (A.S.)
| | | | - Arnold H Seto
- Long Beach VA Medical Center, Long Beach, CA (A.H.S.)
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.).,Columbia University Irving Medical Center, New York, NY (A.M., Z.A.A.).,St. Francis Hospital, Roslyn, NY (Z.A.A., A.J.)
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (G.W.S.)
| | | | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (M.M., A.M., Z.A.A., G.W.S., A.J.).,St. Francis Hospital, Roslyn, NY (Z.A.A., A.J.)
| |
Collapse
|
32
|
Song X, Saito N, Kawase Y, Yoshikawa Y, Yamamoto E, Okubo M, Shiomi H, Watanabe S, Kimura T, Matsuo H. Prediction of post-intervention fractional flow reserve in diffuse or sequential coronary stenosis considering the residual trans-stent pressure gradient: Post-intervention FFR in diffuse/sequential lesions. ASIAINTERVENTION 2020; 6:34-42. [PMID: 34912982 PMCID: PMC8525731 DOI: 10.4244/aij-d-19-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/09/2020] [Indexed: 08/18/2024]
Abstract
AIMS Prediction of post-intervention fractional flow reserve (FFR) in a diffuse or sequential coronary lesion is difficult due to complex haemodynamic interactions between individual stenoses. Furthermore, the existence of a residual intra-stent pressure gradient makes the prediction difficult. We developed an equation predicting the post-intervention FFR in a diffuse/sequential lesion by considering intra-stent FFR gradient. The present study aims to validate the equation in an in vitro model and in clinical data. METHODS AND RESULTS In the in vitro experiment, three sequential coronary stenoses were made with a collateral flow. The correlation coefficient of the predicted FFR and the actual post-intervention FFR was 0.99, and the absolute difference was 0.008±0.006 (n=50). In the clinical data analysis, the correlation coefficient was 0.41, and the absolute difference was 0.06±0.05 (n=67). We applied a fixed value of intra-stent FFR gradient and a collateral flow index so that the equation can be used in clinical practice. The correlation coefficient became 0.28 and the absolute difference became 0.06±0.06. CONCLUSIONS In clinical practice, prediction of post-intervention FFR in a diffuse/sequential lesion is difficult even when residual intra-stent pressure gradient is considered.
Collapse
Affiliation(s)
- Xiaoyang Song
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Munenori Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| |
Collapse
|
33
|
Ahn JM, Park DW, Kim SO, Kang DY, Lee CH, Lee PH, Lee SW, Park SW, Park SJ. Prognostic Value of Resting Distal-to-Aortic Coronary Pressure in Clinical Practice. Circ Cardiovasc Interv 2020; 13:e007868. [PMID: 32345039 DOI: 10.1161/circinterventions.118.007868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The resting distal-to-aortic coronary pressure ratio (Pd/Pa) is a universally available, hyperemia-free physiological index of coronary stenosis. We investigated clinical outcomes according to resting Pd/Pa versus hyperemic fractional flow reserve (FFR). METHODS From the IRIS-FFR (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve) registry, 7014 lesions in 4707 patients with valid resting Pd/Pa and FFR were included in this study. The primary outcome was major adverse cardiac events (MACE; a composite of cardiac death, myocardial infarction, and repeat intervention). The MACE rate was compared among resting Pd/Pa ≤0.92 and FFR ≤0.80. A marginal Cox model accounted for correlated data in patients with multiple lesions. RESULTS During a median follow-up of 2.0 years, 223 MACEs occurred. Resting Pd/Pa was an independent predictor for the occurrence of MACE (adjusted hazard ratio [aHR], 1.89 [95% CI, 1.32-2.71]; P=0.001) over clinical and angiographic variables. When resting Pd/Pa and FFR were added into a multivariable model, MACE was no longer significantly associated with resting Pd/Pa (aHR, 1.35 [95% CI, 0.93-1.97]; P=0.12) but remained to be associated with FFR (aHR, 2.34 [95% CI, 1.56-3.54]; P<0.001). Compared with lesions with normal value of resting Pa/Pa and FFR, lesions with abnormal values of either resting Pd/Pa (aHR, 2.12 [95% CI, 1.17-3.84]; P=0.014) or FFR (aHR, 2.32 [95% CI, 1.52-3.55]; P<0.001) or both (aHR, 2.37 [95% CI, 1.57-3.57]; P<0.001) showed a significantly increased risk of the occurrence of MACE. CONCLUSIONS Resting Pd/Pa appeared to be a less-robust prognostic index than FFR. Resting Pd/Pa could be used as a prognostic index when hyperemic agents are contraindicated or not easily available. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01366404.
Collapse
Affiliation(s)
- Jung-Min Ahn
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics (S.-O.K.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheol-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (C.-H.L.)
| | - Pil Hyung Lee
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Wook Park
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
34
|
Matsuo Y, Shiono Y, Kashiyama K, Ino Y, Nishi T, Terada K, Emori H, Higashioka D, Katayama Y, Mahfouz AK, Wada T, Fujita S, Takahata M, Shimamura K, Kashiwagi M, Kuroi A, Tanaka A, Hozumi T, Kubo T, Akasaka T. Extent of the difference between microcatheter and pressure wire-derived fractional flow reserve and its relation to optical coherence tomography-derived parameters. IJC HEART & VASCULATURE 2020; 27:100500. [PMID: 32195316 PMCID: PMC7075984 DOI: 10.1016/j.ijcha.2020.100500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 12/01/2022]
Abstract
Background Although previous studies demonstrated that microcatheter-derived fractional flow reserve (mc-FFR) tends to overestimate lesion severity compared to pressure wire-derived FFR (pw-FFR), the clinical utility of mc-FFR remains obscure. The extent of differences between the two FFR systems and its relation to a lesion-specific parameter remain unknown. In this study, we sought to compare mc-FFR with pw-FFR and determine the lower and upper mc-FFR cut-offs predicting ischemic and non-ischemic stenosis, using an ischemic and a clinical FFR threshold of 0.75 and 0.80 as references, respectively. We further explored optical coherence tomography (OCT) parameters influencing the difference in FFR between the two systems. Methods and results In this study, 44 target vessels with intermediate de novo coronary artery lesion in 36 patients with stable ischemic heart disease were evaluated with mc-FFR, pw-FFR and OCT. Bland-Altman plots for mc-FFR versus pw-FFR showed a bias of −0.04 for lower mc-FFR values compared to pw-FFR values. The mc-FFR cut-off values of 0.73 and 0.79 corresponded to the 0.75 ischemic pw-FFR and 0.80 clinical pw-FFR thresholds with high predictive values, respectively. The differences in the two FFR measurements (pw-FFR minus mc-FFR) were negatively correlated with OCT-derived minimum lumen area (MLA) (R = −0.359, p = 0.011). The OCT-derived MLA of 1.36 mm2 was a cut-off value for predicting the clinically significant difference between the two FFR measurements defined as >0.03. Conclusion Mc-FFR is clinically useful when the specific cut-offs are applied. An OCT-derived MLA accounts for the clinically significant difference in FFR between the two systems.
Collapse
Affiliation(s)
- Yoshiki Matsuo
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kuninobu Kashiyama
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasushi Ino
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takahiro Nishi
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kosei Terada
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Emori
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Higashioka
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yosuke Katayama
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Amir Khalifa Mahfouz
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Teruaki Wada
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Suwako Fujita
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kunihiro Shimamura
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwagi
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Hozumi
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- The Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| |
Collapse
|
35
|
Weir-McCall JR, Fairbairn TA. Fractional Flow Reserve Derived from CT: The State of Play in 2020. Radiol Cardiothorac Imaging 2020; 2:e190153. [PMID: 33778538 PMCID: PMC7977733 DOI: 10.1148/ryct.2019190153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/19/2019] [Accepted: 10/23/2019] [Indexed: 06/12/2023]
Abstract
Fractional flow reserve derived from CT is a rapidly developing technique, with an increasing burden of literature supporting its potential role in the workup of patients suspected of having coronary artery disease.
Collapse
Affiliation(s)
- Jonathan R. Weir-McCall
- From the Department of Radiology, University of Cambridge School of Clinical Medicine, Box 219, Level 5, Biomedical Campus, Cambridge CB2 0QQ, England (J.R.W.); Royal Papworth Hospital, Cambridge, England (J.R.W.); and Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.)
| | - Timothy A. Fairbairn
- From the Department of Radiology, University of Cambridge School of Clinical Medicine, Box 219, Level 5, Biomedical Campus, Cambridge CB2 0QQ, England (J.R.W.); Royal Papworth Hospital, Cambridge, England (J.R.W.); and Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, England (T.A.F.)
| |
Collapse
|
36
|
Li J, Gong Y, Wang W, Yang Q, Liu B, Lu Y, Xu Y, Huo Y, Yi T, Liu J, Li Y, Xu S, Zhao L, Ali ZA, Huo Y. Accuracy of computational pressure-fluid dynamics applied to coronary angiography to derive fractional flow reserve: FLASH FFR. Cardiovasc Res 2019; 116:1349-1356. [PMID: 31693092 DOI: 10.1093/cvr/cvz289] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/12/2019] [Accepted: 11/03/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Aims
Conventional fractional flow reserve (FFR) is measured invasively using a coronary guidewire equipped with a pressure sensor. A non-invasive derived FFR would eliminate risk of coronary injury, minimize technical limitations, and potentially increase adoption. We aimed to evaluate the diagnostic performance of a computational pressure-flow dynamics derived FFR (caFFR), applied to coronary angiography, compared to invasive FFR.
Methods and results
The FLASH FFR study was a prospective, multicentre, single-arm study conducted at six centres in China. Eligible patients had native coronary artery target lesions with visually estimated diameter stenosis of 30–90% and diagnosis of stable or unstable angina pectoris. Using computational pressure-fluid dynamics, in conjunction with thrombolysis in myocardial infarction (TIMI) frame count, applied to coronary angiography, caFFR was measured online in real-time and compared blind to conventional invasive FFR by an independent core laboratory. The primary endpoint was the agreement between caFFR and FFR, with a pre-specified performance goal of 84%. Between June and December 2018, matched caFFR and FFR measurements were performed in 328 coronary arteries. Total operational time for caFFR was 4.54 ± 1.48 min. caFFR was highly correlated to FFR (R = 0.89, P = 0.76) with a mean bias of −0.002 ± 0.049 (95% limits of agreement −0.098 to 0.093). The diagnostic performance of caFFR vs. FFR was diagnostic accuracy 95.7%, sensitivity 90.4%, specificity 98.6%, positive predictive value 97.2%, negative predictive value 95.0%, and area under the receiver operating characteristic curve of 0.979.
Conclusions
Using wire-based FFR as the reference, caFFR has high accuracy, sensitivity, and specificity. caFFR could eliminate the need of a pressure wire, technical error and potentially increase adoption of physiological assessment of coronary artery stenosis severity.
Clinical Trial Registration
URL: http://www.chictr.org.cn Unique Identifier: ChiCTR1800019522.
Collapse
Affiliation(s)
- Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yanjun Gong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Weimin Wang
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Bin Liu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yuan Lu
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, China
| | - Tieci Yi
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jian Liu
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Yongle Li
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Shaopeng Xu
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei Zhao
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ziad A Ali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
- Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
- St. Francis Hospital, Roslyn, NY, USA
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| |
Collapse
|
37
|
Computed tomography angiography-derived fractional flow reserve (CT-FFR) for the detection of myocardial ischemia with invasive fractional flow reserve as reference: systematic review and meta-analysis. Eur Radiol 2019; 30:712-725. [DOI: 10.1007/s00330-019-06470-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/21/2019] [Accepted: 09/19/2019] [Indexed: 12/22/2022]
|
38
|
Kumar G, Desai R, Gore A, Rahim H, Maehara A, Matsumura M, Kirtane A, Jeremias A, Ali Z. Real world validation of the nonhyperemic index of coronary artery stenosis severity—Resting full‐cycle ratio—RE‐VALIDATE. Catheter Cardiovasc Interv 2019; 96:E53-E58. [DOI: 10.1002/ccd.28523] [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: 06/20/2019] [Revised: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Gautam Kumar
- Atlanta VA Medical CenterEmory University Atlanta Georgia
| | - Rupak Desai
- Atlanta VA Medical CenterEmory University Atlanta Georgia
| | - Ankita Gore
- New York‐Presbyterian Hospital/Columbia University Medical Center New York New York
| | - Hussein Rahim
- New York‐Presbyterian Hospital/Columbia University Medical Center New York New York
| | - Akiko Maehara
- New York‐Presbyterian Hospital/Columbia University Medical Center New York New York
- Clinical Trials Center, Cardiovascular Research Foundation New York New York
| | - Mitsuaki Matsumura
- New York‐Presbyterian Hospital/Columbia University Medical Center New York New York
- Clinical Trials Center, Cardiovascular Research Foundation New York New York
| | - Ajay Kirtane
- New York‐Presbyterian Hospital/Columbia University Medical Center New York New York
| | - Allen Jeremias
- Clinical Trials Center, Cardiovascular Research Foundation New York New York
- Interventional Cardiology Research, Saint Francis Hospital Roslyn New York
| | - Ziad Ali
- New York‐Presbyterian Hospital/Columbia University Medical Center New York New York
- Clinical Trials Center, Cardiovascular Research Foundation New York New York
- Interventional Cardiology Research, Saint Francis Hospital Roslyn New York
| |
Collapse
|
39
|
Ding D, Yang J, Westra J, Chen Y, Chang Y, Sejr-Hansen M, Zhang S, Christiansen EH, Holm NR, Xu B, Tu S. Accuracy of 3-dimensional and 2-dimensional quantitative coronary angiography for predicting physiological significance of coronary stenosis: a FAVOR II substudy. Cardiovasc Diagn Ther 2019; 9:481-491. [PMID: 31737519 DOI: 10.21037/cdt.2019.09.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Three-dimensional quantitative coronary angiography (3D-QCA) enables reconstruction of a coronary artery in 3D from two angiographic image projections. This study compared the diagnostic accuracy of 3D-QCA vs. 2-dimensional (2D) QCA in predicting physiologically significant coronary stenosis, using fractional flow reserve (FFR) as the reference standard. Methods All interrogated vessels in the FAVOR II China study and the FAVOR II Europe-Japan study were assessed by 2D-QCA and 3D-QCA according to standard operating procedures in core laboratories. QCA analysts were blinded to the corresponding FFR values. Results A total of 645 vessels from 576 patients with 3D-QCA, 2D-QCA, and FFR were analyzed. Using the conventional cut-off value of 50% for percent diameter stenosis (DS%), 3D-QCA was more accurate in predicting FFR ≤0.80 than 2D-QCA [accuracy 74.0% (95% CI: 69.9-77.7%) vs. 64.9% (95% CI: 61.3-68.7%), difference: 9.1%, P<0.001]. Sensitivity was higher by 3D-QCA compared with 2D-QCA [69.1% (95% CI: 63.0-75.1%) vs. 47.1% (95% CI: 40.5-53.6%), difference: 22.0%, P<0.001] and specificity was similar [76.5% (95% CI: 72.5-80.6%) vs. 74.4% (95% CI: 70.2-78.6%), difference: 2.1%, P=0.40]. Area under the receiver operating characteristic curve was significantly higher for 3D-QCA than for 2D-QCA [0.81 (95% CI: 0.77-0.84) vs. 0.66 (95% CI: 0.62-0.71), P<0.001]. Conclusions 3D-QCA demonstrated better diagnostic performance in predicting physiologically significant coronary stenosis compared with 2D-QCA, when FFR was used as the reference standard.
Collapse
Affiliation(s)
- Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Junqing Yang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou 510055, China
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Yundai Chen
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | | | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| |
Collapse
|
40
|
Renard BM, Cami E, Jiddou-Patros MR, Said A, Kado H, Trivax J, Berman A, Gulati A, Rabah M, Timmis S, Shoukfeh M, Abbas AE, Hanzel G, Hanson I, Dixon S, Safian RD. Optimizing the Technique for Invasive Fractional Flow Reserve to Assess Lesion-Specific Ischemia. Circ Cardiovasc Interv 2019; 12:e007939. [DOI: 10.1161/circinterventions.119.007939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Invasive fractional flow reserve (FFR
INV
) is the standard technique for assessing myocardial ischemia. Pressure distortions and measurement location may influence FFR
INV
interpretation. We report a technique for performing invasive fractional flow reserve (FFR
INV
) by minimizing pressure distortions and identifying the proper location to measure FFR
INV
.
Methods:
FFR
INV
recordings were obtained prospectively during manual hyperemic pullback in 100 normal and diseased coronary arteries with single stenosis, using 4 measurements from the terminal vessel, distal-to-the-lesion, proximal vessel, and guiding catheter. FFR
INV
profiles were developed by plotting FFR
INV
values (
y
-axis) and site of measurement (
x
-axis), stratified by stenosis severity. FFR
INV
≤0.8 was considered positive for lesion-specific ischemia.
Results:
Erroneous FFR
INV
values were observed in 10% of vessels because of aortic pressure distortion and in 21% because of distal pressure drift; these were corrected by disengagement of the guiding catheter and re-equalization of distal pressure/aortic pressure, respectively. There were significant declines in FFR
INV
from the proximal to the terminal vessel in normal and stenotic coronary arteries (
P
<0.001). The rate of positive FFR
INV
was 41% when measured from the terminal vessel and 20% when measured distal-to-the-lesion (
P
<0.001); 41.5% of positive terminal measurements were reclassified to negative when measured distal-to-the-lesion. Measuring FFR
INV
20 to 30 mm distal-to-the-lesion (rather than from the terminal vessel) can reduce errors in measurement and optimize the assessment of lesion-specific ischemia.
Conclusions:
Meticulous technique (disengagement of the guiding catheter, FFR
INV
pullback) is required to avoid erroneous FFR
INV
, which occur in 31% of vessels. Even with optimal technique, FFR
INV
values are influenced by stenosis severity and the site of pressure measurement. FFR
INV
values from the terminal vessel may overestimate lesion-specific ischemia, leading to unnecessary revascularization.
Collapse
Affiliation(s)
- Brian M. Renard
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Elvis Cami
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | | | - Ahmad Said
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Herman Kado
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Justin Trivax
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Aaron Berman
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Akhil Gulati
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Maher Rabah
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Steven Timmis
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Mazen Shoukfeh
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Amr E. Abbas
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - George Hanzel
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Ivan Hanson
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Simon Dixon
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Robert D. Safian
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| |
Collapse
|
41
|
Blinded Physiological Assessment of Residual Ischemia After Successful Angiographic Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:1991-2001. [DOI: 10.1016/j.jcin.2019.05.054] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 01/10/2023]
|
42
|
Koo BK, Samady H. Strap In for the Artificial Intelligence Revolution in Interventional Cardiology. JACC Cardiovasc Interv 2019; 12:1325-1327. [DOI: 10.1016/j.jcin.2019.05.039] [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: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 10/26/2022]
|
43
|
|
44
|
Matsumura M, Maehara A, Johnson NP, Fearon WF, De Bruyne B, Oldroyd KG, Pijls NHJ, Jenkins P, Ali ZA, Mintz GS, Stone GW, Jeremias A. Qualitative resting coronary pressure wave form analysis to predict fractional flow reserve. EUROINTERVENTION 2019; 14:e1601-e1608. [PMID: 29581085 DOI: 10.4244/eij-d-17-01149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The aim of this study was to evaluate the predictability of resting distal coronary pressure wave forms for fractional flow reserve (FFR). METHODS AND RESULTS Resting coronary wave forms were qualitatively evaluated for the presence of (i) dicrotic notch, (ii) diastolic dipping, and (iii) ventricularisation. In a development cohort (n=88), a scoring system was developed that was then applied to a validation cohort (n=428) using a multivariable linear regression model to predict FFR and receiver operating characteristics (ROC) to predict FFR ≤0.8. In the development cohort, all three qualitative parameters were independent predictors of FFR. However, in a multivariable linear regression model in the validation cohort, qualitative wave form analysis did not further improve the ability of resting distal coronary to aortic pressure ratio (Pd/Pa) (p=0.80) or instantaneous wave-free ratio (iFR) (p=0.26) to predict FFR. Using ROC, the area under the curve of resting Pd/Pa (0.86 versus 0.86, p=0.08) and iFR (0.86 versus 0.86, p=0.26) did not improve by adding qualitative analysis. CONCLUSIONS Qualitative coronary wave form analysis showed moderate classification agreement in predicting FFR but did not add substantially to the resting pressure gradients Pd/Pa and iFR; however, when discrepancies between quantitative and qualitative analyses are observed, artefact or pressure drift should be considered.
Collapse
Affiliation(s)
- Mitsuaki Matsumura
- Intravascular Imaging and Physiology Core Laboratory, Cardiovascular Research Foundation, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Abstract
BACKGROUND The only indication for coronary revascularization is elimination of ischaemia. Invasive hemodynamic methods (fractional flow reserve - FFR and instantaneous wave-free ratio (iFR) are superior to coronary angiography in detection of lesions causing myocardial ischaemia. Current European guidelines for myocardial revascularization recommend using of FFR for detection of functional assessment of lesions severity in category IA and number of these procedures increases. However, routine usage of these methods requires knowledge of technical requirements and limitations. AIM The aim of the study is to summarise good clinical practice for FFR and iFR measurements with explanation of possible technical challenges, that are necessary for increasing of measurement accuracy. CONCLUSIONS Authors describe frequent technical mistakes and malpractice during invasive assessment of lesion severity in coronary arteries.
Collapse
Affiliation(s)
- Stepan Jerabek
- 2nd Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic
| | - Tomas Kovarnik
- 2nd Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic
| |
Collapse
|
46
|
CT morphological index provides incremental value to machine learning based CT-FFR for predicting hemodynamically significant coronary stenosis. Int J Cardiol 2019; 265:256-261. [PMID: 29885695 DOI: 10.1016/j.ijcard.2018.01.075] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/06/2023]
Abstract
AIMS To study the diagnostic performance of the ratio of Duke jeopardy score (DJS) to the minimal lumen diameter (MLD) at coronary computed tomographic angiography (CCTA) and machine learning based CT-FFR for differentiating functionally significant from insignificant lesions, with reference to fractional flow reserve (FFR). METHODS AND RESULTS Patients who underwent both coronary CTA and FFR measurement at invasive coronary angiography (ICA) within 2 weeks were retrospectively included in our study. CT-FFR, DJS/MLDCT ratio, along with other parameters, including minimal luminal area (MLA), MLD, lesion length (LL), diameter stenosis, area stenosis, plaque burden, and remodeling index of lesions, were recorded. Lesions with FFR ≤0.8 were considered to be functionally significant. One hundred and twenty-nine patients with 166 lesions were ultimately included for analysis. The LL, diameter stenosis, area stenosis, plaque burden, DJS and DJS/MLDCT ratio were all significantly longer or larger in the group of FFR ≤ 0.8 (p < 0.001 for all), while smaller MLA, MLD and CT-FFR value were also noted (p < 0.001 for all). CT-FFR and DJS/MLDCT ratio showed the largest AUC among all single parameters (AUC = 0.85 and AUC = 0.83, respectively; p < 0.001 for both) for diagnosing functionally significant stenosis. Combining CT-FFR and DJS/MLDCT ratio provided incremental value for discrimination between flow-limiting and non-flow-limiting coronary lesions and yielded the best diagnostic performance (accuracy of 83.7%). CONCLUSIONS The combination of ML-based CT-FFR and DJS/MLDCT allows accurate non-invasive discrimination between flow-limiting and non-flow-limiting coronary lesions.
Collapse
|
47
|
Ligthart J, Masdjedi K, Witberg K, Mastik F, van Zandvoort L, Lemmert ME, Wilschut J, Diletti R, de Jaegere P, Zijlstra F, Kardys I, Van Mieghem NM, Daemen J. Validation of Resting Diastolic Pressure Ratio Calculated by a Novel Algorithm and Its Correlation With Distal Coronary Artery Pressure to Aortic Pressure, Instantaneous Wave–Free Ratio, and Fractional Flow Reserve. Circ Cardiovasc Interv 2018; 11:e006911. [DOI: 10.1161/circinterventions.118.006911] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jurgen Ligthart
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Kaneshka Masdjedi
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Karen Witberg
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Frits Mastik
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Laurens van Zandvoort
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Miguel E. Lemmert
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jeroen Wilschut
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Roberto Diletti
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
48
|
Cami E, Tagami T, Raff G, Fonte TA, Renard B, Gallagher MJ, Chinnaiyan K, Bilolikar A, Fan A, Hafeez A, Safian RD. Assessment of lesion-specific ischemia using fractional flow reserve (FFR) profiles derived from coronary computed tomography angiography (FFRCT) and invasive pressure measurements (FFRINV): Importance of the site of measurement and implications for patient referral for invasive coronary angiography and percutaneous coronary intervention. J Cardiovasc Comput Tomogr 2018; 12:480-492. [DOI: 10.1016/j.jcct.2018.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/07/2018] [Accepted: 09/09/2018] [Indexed: 11/27/2022]
|
49
|
Casadonte L, Piek JJ, VanBavel E, Spaan JAE, Siebes M. Discordance between pressure drift after wire pullback and intracoronary distal pressure offset affects stenosis physiology appraisal. Int J Cardiol 2018; 277:29-34. [PMID: 30173920 DOI: 10.1016/j.ijcard.2018.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/07/2018] [Accepted: 08/17/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Drift is a well-known issue affecting intracoronary pressure measurements. A small pressure offset at the end of the procedure is generally considered acceptable, while repeat assessment is advised for drift exceeding ±2 mmHg. This practice implies that drift assessed after wire pullback equals that at the time of stenosis appraisal, but this assumption has not been systematically investigated. Our aim was to compare intra-and post-procedural pressure sensor drift and assess benefits of correction for intra-procedural drift and its effect on diagnostic classification. METHODS In 70 patients we compared intra- and post-procedural pressure drift for 120 hemodynamic tracings obtained at baseline and throughout the hyperemic response to intracoronary adenosine. Intra-procedural drift was derived from the intercept of the stenosis pressure gradient-velocity relationship. Diagnostic reclassification after correction for intra-procedural drift was assessed for the mean distal-to-aortic pressure ratio at baseline (Pd/Pa) and hyperemia (fractional flow reserve, FFR), and corresponding stenosis resistances. RESULTS Post- and intra-procedural drift exceeding the tolerated threshold was observed in 73% and 64% of the hemodynamic tracings, respectively. Discordance in terms of acceptable drift level was present for 42% of the tracings, with avoidable repeat physiological assessment in 25% and unacceptable intra-procedural drift unrecognized at final drift check in 17% of the tracings. Correction for intra-procedural drift caused higher reclassification rates for baseline than hyperemic functional indices. CONCLUSIONS Post-procedural pressure drift frequently does not match drift during physiological assessment. Tracing-specific correction for intra-procedural drift can potentially lower the risk of inadvertent diagnostic misclassification and prevent unnecessary repeats.
Collapse
Affiliation(s)
- Lorena Casadonte
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Ed VanBavel
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jos A E Spaan
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Maria Siebes
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, the Netherlands.
| |
Collapse
|
50
|
Kern MJ, Seto AH. Instantaneous Wave-Free Ratio Pressure Pullback With Virtual Percutaneous Coronary Intervention Planning. JACC Cardiovasc Interv 2018; 11:768-770. [DOI: 10.1016/j.jcin.2018.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/08/2018] [Indexed: 11/29/2022]
|