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Asano T, Tanigaki T, Ikeda K, Ono M, Yokoi H, Kobayashi Y, Kozuma K, Tanaka N, Kawase Y, Matsuo H. Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics. Cardiovasc Interv Ther 2024; 39:109-125. [PMID: 38367157 PMCID: PMC10940478 DOI: 10.1007/s12928-024-00988-5] [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: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 02/19/2024]
Abstract
Invasive functional coronary angiography (FCA), an angiography-derived physiological index of the functional significance of coronary obstruction, is a novel physiological assessment tool for coronary obstruction that does not require the utilization of a pressure wire. This technology enables operators to rapidly evaluate the functional relevance of coronary stenoses during and even after angiography while reducing the burden of cost and complication risks related to the pressure wire. FCA can be used for treatment decision-making for revascularization, strategy planning for percutaneous coronary intervention, and procedure optimization. Currently, various software-computing FCAs are available worldwide, with unique features in their computation algorithms and functions. With the emerging application of this novel technology in various clinical scenarios, the Japanese Association of Cardiovascular Intervention and Therapeutics task force was created to outline expert consensus on the clinical use of FCA. This consensus document advocates optimal clinical applications of FCA according to currently available evidence while summarizing the concept, history, limitations, and future perspectives of FCA along with globally available software.
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Affiliation(s)
- Taku Asano
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, P.O. Box 104-8560, Tokyo, Japan.
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Kazumasa Ikeda
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masafumi Ono
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, P.O. Box 104-8560, Tokyo, Japan
| | - Hiroyoshi Yokoi
- Department of Cardiovascular Medicine, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University, Chiba, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University, Tokyo, Japan
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
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Warisawa T, Akasaka T. Imaging-Based FFR: How Many Steps Toward Replacement for Wire-Based FFR on A Journey of A Thousand Miles. Circ Cardiovasc Imaging 2024; 17:e016700. [PMID: 38502738 DOI: 10.1161/circimaging.124.016700] [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: 03/21/2024]
Affiliation(s)
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center, Japan (T.A.)
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3
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Ki YJ, Kang J, Zhang J, Hu X, Jiang J, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Hwang D, Shin ES, Kim HS, Tahk SJ, Wang J, Koo BK. Prognostic Implications of Quantitative Flow Ratio and Plaque Characteristics in Intravascular Ultrasound-Guided Treatment Strategy. JACC Cardiovasc Interv 2024; 17:461-470. [PMID: 38340104 DOI: 10.1016/j.jcin.2023.11.035] [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: 09/11/2023] [Revised: 10/25/2023] [Accepted: 11/20/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a method for evaluating fractional flow reserve without the use of an invasive coronary pressure wire or pharmacological hyperemic agent. OBJECTIVES The aim of this study was to investigate the prognostic implications of QFR and plaque characteristics in patients who underwent intravascular ultrasound (IVUS)-guided treatment for intermediate lesions. METHODS Among the IVUS-guided strategy group in the FLAVOUR (Fractional Flow Reserve and Intravascular Ultrasound for Clinical Outcomes in Patients with Intermediate Stenosis) trial, vessels suitable for QFR analysis were included in this study. High-risk features were defined as low QFR (≤0.90), quantitative high-risk plaque characteristics (qn-HRPCs) (minimal lumen area ≤3.5 mm2, or plaque burden ≥70%), and qualitative high-risk plaque characteristics (ql-HRPCs) (attenuated plaque, positive remodeling, or plaque rupture) assessed using IVUS. The primary clinical endpoint was target vessel failure (TVF), defined as a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization. RESULTS A total of 415 (46.1%) vessels could be analyzable for QFR. The numbers of qn-HRPCs and ql-HRPCs increased with decreasing QFR. Among deferred vessels, those with 3 high-risk features exhibits a significantly higher risk of TVF compared with those with ≤2 high-risk features (12.0% vs 2.7%; HR: 4.54; 95% CI: 1.02-20.29). CONCLUSIONS Among the IVUS-guided deferred group, vessels with qn-HRPC and ql-HRPC with low QFR (≤0.90) exhibited a significantly higher risk for TVF compared with those with ≤2 features. Integrative assessment of angiography-derived fractional flow reserve and anatomical and morphological plaque characteristics is recommended to improve clinical outcomes in patients undergoing IVUS-guided deferred treatment.
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Affiliation(s)
- You-Jeong Ki
- Uijeongbu Eulji Medical Center, Gyeonggi-do, Republic of Korea
| | - Jeehoon Kang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jinlong Zhang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyang Hu
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Jiang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Joo-Yong Hahn
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang-Wook Nam
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Joon-Hyung Doh
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Bong-Ki Lee
- Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Weon Kim
- Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Jinyu Huang
- Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fan Jiang
- Hangzhou Normal University Affiliated Hospital, Hangzhou, China
| | - Hao Zhou
- 1st Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Chen
- 2nd Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Wenbing Jiang
- Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China
| | | | - Wenming He
- Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Sung-Gyun Ahn
- Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | | | - Ung Kim
- Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Doyeon Hwang
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun-Seok Shin
- Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyo-Soo Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Jian'an Wang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bon-Kwon Koo
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
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Barrera S, de la Torre Hernández JM. Coronary Physiology by Different Approaches to Guide PCI: Adding Allies to Optimize Outcomes. JACC Cardiovasc Interv 2024; 17:288-291. [PMID: 38267143 DOI: 10.1016/j.jcin.2023.11.016] [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] [Received: 10/24/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Sergio Barrera
- Hospital Universitario Marques de Valdecilla, Servicio de Cardiología, Unidad de Cardiología Intervencionista, IDIVAL, Santander, Spain
| | - José M de la Torre Hernández
- Hospital Universitario Marques de Valdecilla, Servicio de Cardiología, Unidad de Cardiología Intervencionista, IDIVAL, Santander, Spain.
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Kageyama S, O'Leary N, Chenniganahosahalli Revaiah P, Ninomiya K, Masuda S, Kotoku N, Ilancheran N, Garg S, Harte E, Ni Bheolain G, Reiber JHC, Tu S, Zaman A, Sabaté M, Möllmann H, Sharif F, Lemoine J, Wlodarczak A, Onuma Y, Serruys PW, Multivessel Talent Trial Investigators OBOT. Quantitative flow ratio for the prediction of coronary events after percutaneous coronary intervention. EUROINTERVENTION 2024; 20:104-106. [PMID: 38165111 PMCID: PMC10756216 DOI: 10.4244/eij-d-23-00561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/16/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Shigetaka Kageyama
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Neil O'Leary
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
| | | | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
| | | | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Emma Harte
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Grainne Ni Bheolain
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Johan H C Reiber
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Azfar Zaman
- Department of Cardiology, Freeman Hospital, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Manel Sabaté
- Department of Cardiology, Clinic Hospital, Barcelona, Spain
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Faisal Sharif
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Julien Lemoine
- Department of Cardiology, Clinique Louis Pasteur, Nancy, France
| | - Adrian Wlodarczak
- Department of Cardiology, The Copper Health Centre (MCZ), Lubin, Poland
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
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Tache IA, Hatfaludi CA, Puiu A, Itu LM, Popa-Fotea NM, Calmac L, Scafa-Udriste A. Assessment of the functional severity of coronary lesions from optical coherence tomography based on ensembled learning. Biomed Eng Online 2023; 22:127. [PMID: 38104144 PMCID: PMC10724936 DOI: 10.1186/s12938-023-01192-x] [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: 08/12/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Atherosclerosis is one of the most frequent cardiovascular diseases. The dilemma faced by physicians is whether to treat or postpone the revascularization of lesions that fall within the intermediate range given by an invasive fractional flow reserve (FFR) measurement. The paper presents a monocentric study for lesions significance assessment that can potentially cause ischemia on the large coronary arteries. METHODS A new dataset is acquired, comprising the optical coherence tomography (OCT) images, clinical parameters, echocardiography and FFR measurements collected from 80 patients with 102 lesions, with stable multivessel coronary artery disease. Having the ground truth given by the invasive FFR measurement, the dataset is challenging because almost 40% of the lesions are in the gray zone, having an FFR value between 0.75 and 0.85. Twenty-six features are extracted from OCT images, clinical characteristics, and echocardiography and the most relevant are identified by examining the models' accuracy. An ensembled learning is performed for solving the binary classification problem of lesion significance considering the leave-one-out cross-validation approach. RESULTS Ensemble models are designed from the multi-features voting from 5 features models by prediction aggregation with a maximum accuracy of 81.37% and a maximum area under the curve score (AUC) of 0.856. CONCLUSIONS The proposed explainable supervised learning-based lesion classification is a new method that can be improved by training with a larger multicenter dataset for further designing a tool for guiding the decision making of the clinician for the cases outside the gray zone and for the other situation extra clinical information about the lesion is needed.
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Affiliation(s)
- Irina-Andra Tache
- Department of Automatic Control and Systems Engineering, University Politehnica of Bucharest, Bucharest, Romania.
- Siemens Advanta SRL, 15 Noiembrie Bvd, 500097, Brasov, Romania.
- Romanian Academy of Scientists, Bucharest, Romania.
| | - Cosmin-Andrei Hatfaludi
- Siemens Advanta SRL, 15 Noiembrie Bvd, 500097, Brasov, Romania
- Department of Automation and Information Technology, Transilvania University of Brasov, Mihai Viteazu Nr. 5, 5000174, Brasov, Romania
| | - Andrei Puiu
- Siemens Advanta SRL, 15 Noiembrie Bvd, 500097, Brasov, Romania
- Department of Automation and Information Technology, Transilvania University of Brasov, Mihai Viteazu Nr. 5, 5000174, Brasov, Romania
| | - Lucian Mihai Itu
- Siemens Advanta SRL, 15 Noiembrie Bvd, 500097, Brasov, Romania
- Department of Automation and Information Technology, Transilvania University of Brasov, Mihai Viteazu Nr. 5, 5000174, Brasov, Romania
- Romanian Academy of Scientists, Bucharest, Romania
| | - Nicoleta-Monica Popa-Fotea
- Department of Cardiology, Emergency Clinical Hospital, 8 Calea Floreasca, 014461, Bucharest, Romania
- Department Cardio-Thoracic, University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari, 050474, Bucharest, Romania
| | - Lucian Calmac
- Department of Cardiology, Emergency Clinical Hospital, 8 Calea Floreasca, 014461, Bucharest, Romania
- Department Cardio-Thoracic, University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari, 050474, Bucharest, Romania
| | - Alexandru Scafa-Udriste
- Department of Cardiology, Emergency Clinical Hospital, 8 Calea Floreasca, 014461, Bucharest, Romania
- Department Cardio-Thoracic, University of Medicine and Pharmacy "Carol Davila", 8 Eroii Sanitari, 050474, Bucharest, Romania
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Kern MJ. Quantitative flow ratio and cardiovascular risk: paralleling the FFR ischaemic continuum. EUROINTERVENTION 2023; 19:e365-e367. [PMID: 37548002 PMCID: PMC10397658 DOI: 10.4244/eij-e-23-00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Affiliation(s)
- Morton J Kern
- Tibor Rubin VA Medical Center, Long Beach, CA, USA; University of California, Irvine, Orange, CA, USA
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Allana SS, Sandoval Y, Brilakis ES. Angiographic Fractional Flow Reserve: Easier, Potentially Faster, and Less Invasive but Is It Better? JACC Cardiovasc Interv 2023:S1936-8798(23)00819-1. [PMID: 37191609 DOI: 10.1016/j.jcin.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Salman S Allana
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Center for Coronary Artery Disease, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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