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Tassetti L, Sfriso E, Torlone F, Baggiano A, Mushtaq S, Cannata F, Del Torto A, Fazzari F, Fusini L, Junod D, Maragna R, Volpe A, Carrabba N, Conte E, Guglielmo M, La Mura L, Pergola V, Pedrinelli R, Indolfi C, Sinagra G, Perrone Filardi P, Guaricci AI, Pontone G. The Role of Multimodality Imaging (CT & MR) as a Guide to the Management of Chronic Coronary Syndromes. J Clin Med 2024; 13:3450. [PMID: 38929984 PMCID: PMC11205051 DOI: 10.3390/jcm13123450] [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: 05/20/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Chronic coronary syndrome (CCS) is one of the leading cardiovascular causes of morbidity, mortality, and use of medical resources. After the introduction by international guidelines of the same level of recommendation to non-invasive imaging techniques in CCS evaluation, a large debate arose about the dilemma of choosing anatomical (with coronary computed tomography angiography (CCTA)) or functional imaging (with stress echocardiography (SE), cardiovascular magnetic resonance (CMR), or nuclear imaging techniques) as a first diagnostic evaluation. The determinant role of the atherosclerotic burden in defining cardiovascular risk and prognosis more than myocardial inducible ischemia has progressively increased the use of a first anatomical evaluation with CCTA in a wide range of pre-test probability in CCS patients. Functional testing holds importance, both because the role of revascularization in symptomatic patients with proven ischemia is well defined and because functional imaging, particularly with stress cardiac magnetic resonance (s-CMR), gives further prognostic information regarding LV function, detection of myocardial viability, and tissue characterization. Emerging techniques such as stress computed tomography perfusion (s-CTP) and fractional flow reserve derived from CT (FFRCT), combining anatomical and functional evaluation, appear capable of addressing the need for a single non-invasive examination, especially in patients with high risk or previous revascularization. Furthermore, CCTA in peri-procedural planning is promising to acquire greater importance in the non-invasive planning and guiding of complex coronary revascularization procedures, both by defining the correct strategy of interventional procedure and by improving patient selection. This review explores the different roles of non-invasive imaging techniques in managing CCS patients, also providing insights into preoperative planning for percutaneous or surgical myocardial revascularization.
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Affiliation(s)
- Luigi Tassetti
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Enrico Sfriso
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | | | - Andrea Baggiano
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Saima Mushtaq
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Francesco Cannata
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Alberico Del Torto
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Fabio Fazzari
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Laura Fusini
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Daniele Junod
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Riccardo Maragna
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Alessandra Volpe
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy;
| | - Edoardo Conte
- Department of Clinical Cardiology and Cardiovascular Imaging, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20157 Milan, Italy;
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (L.L.M.); (P.P.F.)
| | - Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy;
| | - Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Gianfranco Sinagra
- Cardiology Specialty School, University of Trieste, 34127 Trieste, Italy;
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34149 Trieste, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (L.L.M.); (P.P.F.)
| | - Andrea Igoren Guaricci
- Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70126 Bari, Italy;
| | - Gianluca Pontone
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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Serruys PW, Kageyama S, Pompilio G, Andreini D, Pontone G, Mushtaq S, La Meir M, De Mey J, Tanaka K, Doenst T, Teichgräber U, Schneider U, Puskas JD, Narula J, Gupta H, Agarwal V, Leipsic J, Masuda S, Kotoku N, Tsai TY, Garg S, Morel MA, Onuma Y. Coronary bypass surgery guided by computed tomography in a low-risk population. Eur Heart J 2024; 45:1804-1815. [PMID: 38583086 PMCID: PMC11129794 DOI: 10.1093/eurheartj/ehae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/22/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND AND AIMS In patients with three-vessel disease and/or left main disease, selecting revascularization strategy based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography (ICA). METHODS In this study, coronary artery bypass grafting (CABG) procedures were planned based on CCTA without knowledge of ICA. The CABG strategy was recommended by a central core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals (CI) for feasibility was ≥75% (NCT04142021). RESULTS The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Unblinding ICA was required in one case yielding a feasibility of 99.1% (95% CI 95.2%-100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Teams was 82.9% with a moderate kappa of 0.58 (95% CI 0.50-0.66) and between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95% CI 0.53-0.68). The 30-day follow-up CCTA in 102 patients (91.9%) showed an anastomosis patency rate of 92.6%, whilst MACCE was 7.2% and major bleeding 2.7%. CONCLUSIONS CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.
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Affiliation(s)
- Patrick W Serruys
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Shigetaka Kageyama
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Monzino, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant’Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | | | | | - Mark La Meir
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, University Hospital Brussels, Brussels, Belgium
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - Ulf Teichgräber
- Department of Radiology, University Hospital Jena, Jena, Germany
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Jagat Narula
- University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Himanshu Gupta
- Department of Radiology, The Valley Hospital, Ridgewood, NJ, USA
| | - Vikram Agarwal
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY, USA
| | - Jonathon Leipsic
- St. Paul’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Shinichiro Masuda
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Nozomi Kotoku
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Tsung-Ying Tsai
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Marie-Angele Morel
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
| | - Yoshinobu Onuma
- CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, University Road, Galway H91 TK33, Ireland
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Masuda S, Serruys PW, Mushtaq S, Tanaka K, Mandry D, Buechel RR, Digne F, Schneider U, Pompilio G, La Meir M, Doenst T, Teichgraber U, Morel MA, Kotoku N, Ninomiya K, Kageyama S, O'Leary N, Collet C, Garg S, de Mey J, Andreini D, Onuma Y. The ability of computed tomography angiography to predict 5-year mortality in the SYNTAX III REVOLUTION trial. J Cardiovasc Comput Tomogr 2023; 17:318-325. [PMID: 37684158 DOI: 10.1016/j.jcct.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The feasibility of using coronary computed tomography angiography (CCTA) for long-term prediction of vital prognosis post-revascularization remains unknown. OBJECTIVES To compare the prognostic value of the SYNTAX score II 2020 (SS-2020) derived from invasive coronary angiography (ICA) or CCTA in patients with three-vessel disease and/or left main coronary artery disease undergoing percutaneous or surgical revascularization. METHODS In the SYNTAX III REVOLUTION trial, the probability of death at five years was retrospectively assessed by calculating the SS-2020 using ICA and CCTA. High- and low-risk patients for mortality were categorized according to the median percentages of predicted mortality based on both modalities. The discriminative abilities of the SS-2020 were assessed using Harrell's C statistic. RESULTS The vital status at five years of the 215 patients revascularized percutaneously (64 patients, 29.8%) or surgically (151 patients, 70.2%) was established through national registries. In patients undergoing revascularization, the SS-2020 was possibly helpful in discriminating vital prognosis at 5 years, with similar results seen with ICA and CCTA (C-index with ICA = 0.75, intercept = -0.19, slope = 0.92 and C-index with CCTA = 0.75, intercept = -0.22, slope = 0.99). In high- and low-risk patients, Kaplan-Meier estimates showed significant, and almost identical relative differences in observed mortality, irrespective of imaging modality (ICA: 93.8% vs 78.7%, log-lank P < 0.001; CCTA: 93.7% vs 78.5%, log-lank P < 0.001). CONCLUSIONS The predictive ability of the SS-2020 for five-year all-cause mortality derived from ICA and CCTA was comparable, and could helpfully discriminate vital prognosis in high- and low-risk patients.
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Affiliation(s)
| | | | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRRCS, Milan, Italy
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Damien Mandry
- Department of Radiology, CHRU Nancy and University of Lorraine, Nancy, France
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Franck Digne
- Hemodynamic Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | - Giulio Pompilio
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRRCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Mark La Meir
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | - Ulf Teichgraber
- Department of Radiology, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | | | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Neil O'Leary
- Interventional Medicine and Innovation, University of Galway, Galway, Ireland
| | - Carlos Collet
- Onze Lieve Vrouwziekenhuis, Cardiovascular Center Aalst, Aalst, Belgium
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom; Department of Medical Education, University of Central Lancashire, Preston, United Kingdom
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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Sharifkazemi M, Hooshanginezhad Z, Zoroufian A, Shamsa K. Is it the Time to Move Towards Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve Guided Percutaneous Coronary Intervention? The Pros and Cons. Curr Cardiol Rev 2023; 19:e190123212887. [PMID: 36658709 PMCID: PMC10494271 DOI: 10.2174/1573403x19666230119115228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/08/2022] [Accepted: 11/21/2022] [Indexed: 01/21/2023] Open
Abstract
Coronary artery disease is the leading cause of mortality worldwide. Diagnosis is conventionally performed by direct visualization of the arteries by invasive coronary angiography (ICA), which has inherent limitations and risks. Measurement of fractional flow reserve (FFR) has been suggested for a more accurate assessment of ischemia in the coronary artery with high accuracy for determining the severity and decision on the necessity of intervention. Nevertheless, invasive coronary angiography-derived fractional flow reserve (ICA-FFR) is currently used in less than one-third of clinical practices because of the invasive nature of ICA and the need for additional equipment and experience, as well as the cost and extra time needed for the procedure. Recent technical advances have moved towards non-invasive high-quality imaging modalities, such as magnetic resonance, single-photon emission computed tomography, and coronary computed tomography (CT) scan; however, none had a definitive modality to confirm hemodynamically significant coronary artery stenosis. Coronary computed tomography angiography (CCTA) can provide accurate anatomic and hemodynamic data about the coronary lesion, especially calculating fractional flow reserve derived from CCTA (CCTA-FFR). Although growing evidence has been published regarding CCTA-FFR results being comparable to ICA-FFR, CCTA-FFR has not yet replaced the invasive conventional angiography, pending additional studies to validate the advantages and disadvantages of each diagnostic method. Furthermore, it has to be identified whether revascularization of a stenotic lesion is plausible based on CCTA-FFR and if the therapeutic plan can be determined safely and accurately without confirmation from invasive methods. Therefore, in the present review, we will outline the pros and cons of using CCTA-FFR vs. ICA-FFR regarding diagnostic accuracy and treatment decision-making.
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Affiliation(s)
| | - Zahra Hooshanginezhad
- Division of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arezou Zoroufian
- Division of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Shamsa
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
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Zu ZY, Xu PP, Chen Q, Chen YC, Qi JC, Tang CX, Zhou CS, Xu C, Sun XJ, Lu MJ, Lu GM, Wang YN, Xu Y, Zhang LJ. The prognostic value of CT-derived fractional flow reserve in coronary artery bypass graft: a retrospective multicenter study. Eur Radiol 2022; 33:3029-3040. [PMID: 36576550 DOI: 10.1007/s00330-022-09353-7] [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: 06/09/2022] [Revised: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate the predictive value of CT-derived fractional flow reserve (FFRCT) in anastomosis occlusion after coronary artery bypass graft (CABG) surgery. METHODS Patients undergoing CABG with both pre- and post-operative coronary computed tomographic angiography (CCTA) were retrospectively included. Preoperative CCTA studies were used to evaluate anatomical and FFRCT information of target vessels. A diameter stenosis (DS) ≥ 70% or left main > 50% was considered to be anatomically severe, while FFRCT value ≤ 0.80 be functionally significant. The primary endpoint was anastomosis occlusion evaluated on post-operative CCTA during follow-up. Predictors of anastomosis occlusion were assessed by the multivariate binary logistic regression with generalized estimating equations. RESULTS A total of 270 anastomoses were identified in 88 enrolled patients. Forty-one anastomoses from 30 patients exhibited occlusion during a follow-up of 15.3 months after CABG. The occluded group had significantly increased prevalence of non-severe DS (58.5% vs. 40.2%; p = 0.023) and non-significant FFRCT (48.8% vs. 10.0%; p < 0.001). Multivariable analysis indicated FFRCT ≤ 0.80 (odds ratio [OR]: 0.10, 95% CI: 0.03-0.33; p < 0.001) and older age (OR: 0.92, 95% CI: 0.87-0.97; p = 0.001) were predictors for bypass patency during follow-up, while myocardial infarction history and anastomosis to a local lesion or bifurcation (all p value < 0.05) were predictors of occlusion. Adding FFRCT into the model based on the clinical and anatomical predictors had an improved AUC of 0.848 (p = 0.005). CONCLUSIONS FFRCT ≤ 0.80 was associated with a significant risk reduction of anastomosis occlusion after CABG. Preoperative judgment of the hemodynamic significance may improve the CABG surgery strategy and reduce graft failure. KEY POINTS • FFRCT ≤ 0.80 was associated with a significant risk reduction of anastomosis occlusion after CABG. • The addition of FFRCT into the integrated model including clinical (age and history of myocardial infarction) and anatomical CCTA indicators (local lesion and bifurcation) significantly improved the model performance with an AUC of 0.848 (p = 0.005). • Preoperative judgment of the hemodynamic significance may help improve the decision-making and surgery planning in patients indicated for CABG and significantly reduce graft failure, without an extra radiation exposure and risk of invasive procedure.
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Affiliation(s)
- Zi Yue Zu
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Peng Peng Xu
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Chun Chen
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jian Chen Qi
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chun Xiang Tang
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chang Sheng Zhou
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Cheng Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xin Jie Sun
- Department of Radiology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Jie Lu
- Shanghai Jiao Tong University, Shanghai, China
| | - Guang Ming Lu
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Yi Ning Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yi Xu
- Department of Radiology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Long Jiang Zhang
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys PW. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. EUROINTERVENTION 2022; 18:e872-e887. [PMID: 35994043 PMCID: PMC9743242 DOI: 10.4244/eij-e-22-00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/05/2022] [Indexed: 12/12/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil
- DASA, São Paulo, Brazil
- Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano-Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick W Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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7
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Zhang LJ, Tang C, Xu P, Guo B, Zhou F, Xue Y, Zhang J, Zheng M, Xu L, Hou Y, Lu B, Guo Y, Cheng J, Liang C, Song B, Zhang H, Hong N, Wang P, Chen M, Xu K, Liu S, Jin Z, Lu G. Coronary Computed Tomography Angiography-derived Fractional Flow Reserve: An Expert Consensus Document of Chinese Society of Radiology. J Thorac Imaging 2022; 37:385-400. [PMID: 36162081 DOI: 10.1097/rti.0000000000000679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Invasive fractional flow reserve (FFR) measured by a pressure wire is a reference standard for evaluating functional stenosis in coronary artery disease. Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) uses advanced computational analysis methods to noninvasively obtain FFR results from a single conventional coronary computed tomography angiography data to evaluate the hemodynamic significance of coronary artery disease. More and more evidence has found good correlation between the results of noninvasive CT-FFR and invasive FFR. CT-FFR has proven its potential in optimizing patient management, improving risk stratification and prognosis, and reducing total health care costs. However, there is still a lack of standardized interpretation of CT-FFR technology in real-world clinical settings. This expert consensus introduces the principle, workflow, and interpretation of CT-FFR; summarizes the state-of-the-art application of CT-FFR; and provides suggestions and recommendations for the application of CT-FFR with the aim of promoting the standardized application of CT-FFR in clinical practice.
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Affiliation(s)
- Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Chunxiang Tang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Pengpeng Xu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Bangjun Guo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Fan Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Yi Xue
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University-Xi'an
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University
| | - Bin Lu
- Department of Radiology, State Key Laboratory and National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province
| | - Bin Song
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital
| | - Peijun Wang
- Department of Radiology, Tongji Hospital of Tongji University School of Medicine
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Ke Xu
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Shiyuan Liu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
| | - Zhengyu Jin
- Department of Medical Imaging and Nuclear Medicine, Changzheng Hospital of Naval Medical University, Shanghai
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
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8
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Andreini D, Collet C, Leipsic J, Nieman K, Bittencurt M, De Mey J, Buls N, Onuma Y, Mushtaq S, Conte E, Bartorelli AL, Stefanini G, Sonck J, Knaapen P, Ghoshhajra B, Serruys P. Pre-procedural planning of coronary revascularization by cardiac computed tomography: An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2022; 16:558-572. [PMID: 36008263 DOI: 10.1016/j.jcct.2022.08.003] [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: 07/30/2021] [Revised: 06/07/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
Coronary CT angiography (CCTA) demonstrated high diagnostic accuracy for detecting coronary artery disease (CAD) and a key role in the management of patients with low-to-intermediate pretest likelihood of CAD. However, the clinical information provided by this noninvasive method is still regarded insufficient in patients with diffuse and complex CAD and for planning percutaneous coronary intervention (PCI) and surgical revascularization procedures. On the other hand, technology advancements have recently shown to improve CCTA diagnostic accuracy in patients with diffuse and calcific stenoses. Moreover, stress CT myocardial perfusion imaging (CT-MPI) and fractional flow reserve derived from CCTA (CT-FFR) have been introduced in clinical practice as new tools for evaluating the functional relevance of coronary stenoses, with the possibility to overcome the main CCTA drawback, i.e. anatomical assessment only. The potential value of CCTA to plan and guide interventional procedures lies in the wide range of information it can provide: a) detailed evaluation of plaque extension, volume and composition; b) prediction of procedural success of CTO PCI using scores derived from CCTA; c) identification of coronary lesions requiring additional techniques (e.g., atherectomy and lithotripsy) to improve stent implantation success by assessing calcium score and calcific plaque distribution; d) assessment of CCTA-derived Syntax Score and Syntax Score II, which allows to select the mode of revascularization (PCI or CABG) in patients with complex and multivessel CAD. The aim of this Consensus Document is to review and discuss the available data supporting the role of CCTA, CT-FFR and stress CT-MPI in the preprocedural and possibly intraprocedural planning and guidance of myocardial revascularization interventions.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.
| | | | - Jonathon Leipsic
- St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Vancouver, Canada
| | - Koen Nieman
- Stanford University School of Medicine, Departments of Medicine and Radiology, USA
| | - Marcio Bittencurt
- Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; DASA, São Paulo, Brazil; Division of Cardiology and the Heart and Vascular Institute, University of Pittsburgh Medical Center, USA
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Yoshinobu Onuma
- Clinical Science Institute, National University of Ireland, Galway, Ireland
| | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLVZ Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Paul Knaapen
- Vrije Universiteit Medical Center, Amsterdam, Netherlands
| | - Brian Ghoshhajra
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Patrick Serruys
- Clinical Science Institute, National University of Ireland, Galway, Ireland
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9
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Doenst T, Thiele H, Haasenritter J, Wahlers T, Massberg S, Haverich A. The Treatment of Coronary Artery Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:716-723. [PMID: 35912444 PMCID: PMC9835700 DOI: 10.3238/arztebl.m2022.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/06/2022] [Accepted: 07/06/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The first coronary artery bypass operation (CABG) was performed on May 2, 1960. The first percutaneous coro - nary intervention (PCI) was performed almost 20 years later. Since then, the invasive treatment of coronary artery disease (CAD) has moved into the spotlight of cardiac medical care. METHODS We summarize the current status of medical and invasive CAD treatment through a selective review of the literature. RESULTS More than 800 000 patients currently undergo invasive diagnostic and therapeutic procedures for CAD in Germany each year. The number of coronary artery bypass grafting (CABG) procedures rose to 65 000/year by the turn of the millennium and has been declining since then. In contrast, the number of PCIs in Germany rose to approximately 350 000/year by 2017, and a beginning decline is being observed at present. This development occurred even though, for elective patients, a survival advantage from an invasive procedure compared to medical therapy has been shown in direct comparison only for CABG. CONCLUSION Conservative treatment is always the baseline treatment and has undergone major advances in the last few decades. Moreover, non-invasive coronary evaluation with computed tomography, as well as non-invasive cardiac stress imaging studies, are increasingly replacing primary invasive coronary evaluations. In this review, we illustrate a mechanistic concept of the appropriate use of CABG and PCI that can improve patient care, while underscoring the importance of interdisciplinary and intersectoral collaboration.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery at Jena University Hospital, Friedrich-Schiller University of Jena,*Department of Cardiothoracic Surgery at Jena University Hospital Am Klinikum 1, 07747 Jena
| | - Holger Thiele
- University Department of Cardiology, Leipzig Heart Center
| | - Jörg Haasenritter
- Department of General Practice, Preventive and Rehabilitation Medicine, Philipps University of Marburg
| | - Thorsten Wahlers
- Department of Heart Surgery, Intensive Care Medicine and Thoracic Surgery at University Hospital of Cologne
| | - Steffen Massberg
- Medical Clinic and Polyclinic I, University Hospital of Ludwig Maximilian University of Munich,German Center for Cardiovascular Research (DZHK)
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hanover Medical School
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10
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D’Alessio A, Akoumianakis I, Kelion A, Terentes-Printzios D, Lucking A, Thomas S, Verdichizzo D, Keiralla A, Antoniades C, Krasopoulos G. Graft flow assessment and early coronary artery bypass graft failure: a computed tomography analysis. Interact Cardiovasc Thorac Surg 2022; 34:974-981. [PMID: 34718571 PMCID: PMC9159422 DOI: 10.1093/icvts/ivab298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/08/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We evaluated graft patency by computed tomography and explored the determinants of intraoperative mean graft flow (MGF) and its contribution to predict early graft occlusion. METHODS One hundred and forty-eight patients under a single surgeon were prospectively enrolled. Arterial and endoscopically harvested venous conduits were used. Intraoperative graft characteristics and flows were collected. Graft patency was blindly evaluated by a follow-up computed tomography at 11.4 weeks (median). RESULTS Graft occlusion rate was 5.2% (n = 22 of 422; 8% venous and 3% arterial). Thirteen were performed on non-significant proximal stenosis while 9 on occluded or >70% stenosed arteries. Arterial and venous graft MGF were lower in females (Parterial = 0.010, Pvenous = 0.009), with median differences of 10 and 13.5 ml/min, respectively. Arterial and venous MGF were associated positively with target vessel diameter ≥1.75 mm (Parterial = 0.025; Pvenous = 0.002) and negatively with pulsatility index (Parterial < 0.001; Pvenous < 0.001). MGF was an independent predictor of graft occlusion, adjusting for EuroSCORE-II, pulsatility index, graft size and graft type (arterial/venous). An MGF cut-off of 26.5 ml/min for arterial (sensitivity 83.3%, specificity 80%) and 36.5 ml/min for venous grafts (sensitivity 75%, specificity 62%) performed well in predicting early graft occlusion. CONCLUSIONS We demonstrate that MGF absolute values are influenced by coronary size, gender and graft type. Intraoperative MGF of >26.5 ml/min for arterial and >36.5 ml/min for venous grafts is the most reliable independent predictor of early graft patency. Modern-era coronary artery bypass graft is associated with low early graft failure rates when transit time flow measurement is used to provide effective intraoperative quality assurance.
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Affiliation(s)
- Andrea D’Alessio
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | | | - Andrew Kelion
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Andrew Lucking
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sheena Thomas
- Cardiovascular Medicine Division, University of Oxford, Oxford, UK
| | - Danilo Verdichizzo
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Amar Keiralla
- Department of Cardiac Anesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Charalambos Antoniades
- Cardiovascular Medicine Division, University of Oxford, Oxford, UK
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - George Krasopoulos
- Department of Cardiothoracic Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
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11
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Bharmal M, Kern MJ, Kumar G, Seto AH. Physiologic Lesion Assessment to Optimize Multivessel Disease. Curr Cardiol Rep 2022; 24:541-550. [PMID: 35235145 PMCID: PMC9068635 DOI: 10.1007/s11886-022-01675-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review Multivessel coronary artery disease, defined as significant stenosis in two or more major coronary arteries, is associated with high morbidity and mortality. The diagnosis and treatment of multivessel disease have evolved in the PCI era from solely a visual estimation of ischemic risk to a functional evaluation during angiography. This review summarizes the evidence and discusses the commonly used methods of multivessel coronary artery stenosis physiologic assessment. Recent Findings While FFR remains the gold standard in coronary physiologic assessment, several pressure-wire-based non-hyperemic indices of functional stenosis have been developed and validated as well as wire-free angiographically derived quantitative flow ratio. Identifying and treating functionally significant coronary atherosclerotic lesions reduce symptoms and major adverse cardiovascular events. Summary Coronary physiologic assessment in multivessel disease minimizes the observer bias in visual estimates of stenosis, changes clinical management, and improves patient outcomes.
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Affiliation(s)
| | - Morton J Kern
- University of California, Irvine, USA.,Veterans Administration Long Beach Health Care System, Long Beach, USA
| | - Gautam Kumar
- Atlanta Veterans Administration Medical Center, Atlanta, USA.,Emory University, Atlanta, USA
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12
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Kawashima H, Onuma Y, Andreini D, Mushtaq S, Morel MA, Masuda S, Taylor CA, Bartorelli AL, Serruys PW, Pompilio G. Successful coronary artery bypass grafting based solely on non-invasive coronary computed tomography angiography. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40S:187-189. [PMID: 34556432 DOI: 10.1016/j.carrev.2021.09.003] [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: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/03/2022]
Abstract
An 81-year-old female presented with chronic coronary disease (Canadian Cardiovascular Society angina severity grading III). The patient underwent coronary computed tomography angiography (CCTA) that revealed three-vessel coronary artery disease (3VD). This case illustrates that in a patient with 3VD, planning and execution of coronary artery bypass grafting (CABG) were successfully performed based solely on CCTA combined with fractional flow reserve derived from computed tomography angiography (FFRCT). Coronary artery bypass grafting (CABG) was planned and executed as follows: left internal mammary artery grafted to the left anterior descending artery (LAD), saphenous vein graft (SVG) to the right coronary artery (RCA), and SVG to the obtuse marginal artery (OM). Repeat imaging assessment with non-invasive CCTA and FFRCT at 30-day follow-up confirmed the safety of this approach. The FFRCT values of the RCA and LAD were normalized, whereas a borderline pressure drop was observed in the distal run-off of the OM (FFRCT=0.79). Notably, this is the first case in which post-CABG FFRCT assessment was performed. Post-CABG FFRCT is an investigational novel non-invasive tool for assessing the functional improvement of the epicardial conductance vessels following surgical revascularization.
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Affiliation(s)
- Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; CÚRAM, the SFI Research Centre for Medical Devices, Galway, Ireland
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Marie-Angèle Morel
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG) and CORRIB Corelab and Center for Research and Imaging, Galway, Ireland; CÚRAM, the SFI Research Centre for Medical Devices, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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13
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Serruys PW, Hara H, Garg S, Kawashima H, Nørgaard BL, Dweck MR, Bax JJ, Knuuti J, Nieman K, Leipsic JA, Mushtaq S, Andreini D, Onuma Y. Coronary Computed Tomographic Angiography for Complete Assessment of Coronary Artery Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:713-736. [PMID: 34384554 DOI: 10.1016/j.jacc.2021.06.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/09/2023]
Abstract
Coronary computed tomography angiography (CTA) has shown great technological improvements over the last 2 decades. High accuracy of CTA in detecting significant coronary stenosis has promoted CTA as a substitute for conventional invasive coronary angiography in patients with suspected coronary artery disease. In patients with coronary stenosis, CTA-derived physiological assessment is surrogate for intracoronary pressure and velocity wires, and renders possible decision-making about revascularization solely based on computed tomography. Computed tomography coronary anatomy with functionality assessment could potentially become a first line in diagnosis. Noninvasive imaging assessment of plaque burden and morphology is becoming a valuable substitute for intravascular imaging. Recently, wall shear stress and perivascular inflammation have been introduced. These assessments could support risk management for both primary and secondary cardiovascular prevention. Anatomy, functionality, and plaque composition by CTA tend to replace invasive assessment. Complete CTA assessment could provide a 1-stop-shop for diagnosis, risk management, and decision-making on treatment.
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Affiliation(s)
- Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. https://twitter.com/hara_hironori
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Juhani Knuuti
- Heart Center, Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Koen Nieman
- Department of Radiology and Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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14
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Improving Terminology to Describe Coronary Artery Procedures: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:180-188. [PMID: 34238439 DOI: 10.1016/j.jacc.2021.05.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/29/2021] [Accepted: 05/07/2021] [Indexed: 12/28/2022]
Abstract
Coronary artery disease (CAD) is treated with medical therapy with or without percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The latter 2 options are commonly referred to as "myocardial revascularization" procedures. We reason that this term is inappropriate because it is suggestive of a single treatment effect of PCI and CABG (ie, the reestablishment of blood flow to ischemic myocardium) and obscures key mechanisms, such as the improvement in coronary flow capability in the absence of ongoing ischemia, the reperfusion in the presence of ischemia, and the prevention of myocardial infarction from CAD progression. We review the current evidence on the topic and suggest the use of a purely descriptive terminology ("invasive treatment by PCI or CABG") which has the potential to improve clinical decision making and guide future trial design.
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15
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Luo Y, Mao M, Xiang R, Han B, Chang J, Zuo Z, Wu F, Ma K. Diagnostic performance of computed tomography-based fraction flow reserve in identifying myocardial ischemia caused by coronary artery stenosis: A meta-analysis. Hellenic J Cardiol 2021; 63:1-7. [PMID: 34107338 DOI: 10.1016/j.hjc.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND As a new noninvasive diagnostic technique, computed tomography (CT)-based fraction flow reserve (FFR) has been used to identify hemodynamically significant coronary artery stenosis. This meta-analysis used invasive FFR as the standard to evaluate the diagnostic performance of FFRCT. METHODS We searched the PubMed, Cochrane library, and EMBASE for articles published between January 2009 and January 2021. The synthesized sensitivity and specificity of invasive FFR and FFRCT were analyzed at both the patient and vessel levels. We generated a summary receiver operating characteristic curve (SROC) and then calculated the area under the curve (AUC). RESULTS We included a total of 23 studies, including 2,178 patients and 3,029 vessels or lesions. Analysis at each patient level demonstrated a synthesized sensitivity of 88%, specificity of 79%, LR+ of 4.16, LR-of 0.15, and AUC of 0.89 for FFRCT. Analysis at the level of each vessel or lesion showed a synthesized sensitivity of 85%, specificity of 81%, LR+ of 4.44, LR-of 0.19, and AUC of 0.87 for FFRCT. CONCLUSION Our research reveals that FFRCT has high diagnostic performance in patients with coronary artery stenosis, regardless of whether it is at the patient level or the vessel level.
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Affiliation(s)
- Yue Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Min Mao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Baoru Han
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jing Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhong Zuo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fan Wu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kanghua Ma
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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16
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Kawashima H, Pompilio G, Andreini D, Bartorelli AL, Mushtaq S, Ferrari E, Maisano F, Buechel RR, Tanaka K, La Meir M, De Mey J, Schneider U, Doenst T, Teichgräber U, Stone GW, Sharif F, de Winter R, Thomsen B, Taylor C, Rogers C, Leipsic J, Wijns W, Onuma Y, Serruys PW. Safety and feasibility evaluation of planning and execution of surgical revascularisation solely based on coronary CTA and FFR CT in patients with complex coronary artery disease: study protocol of the FASTTRACK CABG study. BMJ Open 2020; 10:e038152. [PMID: 33303435 PMCID: PMC7733219 DOI: 10.1136/bmjopen-2020-038152] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 07/18/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The previously published SYNTAX III REVOLUTION trial demonstrated that clinical decision-making between coronary artery bypass graft (CABG) and percutaneous coronary intervention based on coronary CT angiography (CCTA) had a very high agreement with the treatment decision derived from invasive coronary angiography (ICA). The study objective of the FASTTRACK CABG is to assess the feasibility of CCTA and fractional flow reserve derived from CTA (FFRCT) to replace ICA as a surgical guidance method for planning and execution of CABG in patients with three-vessel disease with or without left main disease. METHODS AND ANALYSIS The FASTTRACK CABG is an investigator-initiated single-arm, multicentre, prospective, proof-of-concept and first-in-man study with feasibility and safety analysis. Surgical revascularisation strategy and treatment planning will be solely based on CCTA and FFRCT without knowledge of the anatomy defined by ICA. Clinical follow-up visit including CCTA will be performed 30 days after CABG in order to assess graft patency and adequacy of the revascularisation with respect to the surgical planning based on non-invasive imaging (CCTA) with functional assessment (FFRCT) and compared with ICA. Primary feasibility endpoint is CABG planning and execution solely based on CCTA and FFRCT in 114 patients. Primary safety endpoint based on 30 day CCTA is graft assessment and topographical adequacy of the revascularisation procedure. Automatic non-invasive assessment of functional coronary anatomy complexity is also evaluated with FFRCT for functional Synergy Between percutaneous coronary intervention With Taxus and Cardiac Surgery Score assessment on CCTA. CCTA with FFRCT might provide better anatomical and functional analysis of the coronary circulation leading to appropriate anatomical and functional revascularisation, and thereby contributing to a better outcome. ETHICS AND DISSEMINATION Each patient has to provide written informed consent as approved by the ethical committee of the respective clinical site. Results will be submitted for publication in peer-reviewed journals and will be disseminated at scientific conferences. TRIAL REGISTRATION NUMBER NCT04142021.
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Affiliation(s)
- Hideyuki Kawashima
- National University of Ireland Galway, Galway, Ireland
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Giulio Pompilio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Enrico Ferrari
- University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Ronny R Buechel
- University Hospital and University of Zurich, Zurich, Switzerland
| | - Kaoru Tanaka
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Mark La Meir
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan De Mey
- Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Ulrich Schneider
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Torsten Doenst
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Ulf Teichgräber
- Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Cardiovascular Research Foundation, New York City, NY, USA
| | - Faisal Sharif
- National University of Ireland Galway, Galway, Ireland
| | | | | | | | | | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - William Wijns
- National University of Ireland Galway, Galway, Ireland
| | | | - Patrick W Serruys
- National University of Ireland Galway, Galway, Ireland
- NHLI, Imperial College London, London, UK
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Andreini D, Mushtaq S, Conte E, Mei M, Nicoli F, Melotti E, Pompilio G, Pepi M, Bartorelli AL, Onuma Y, Serruys PW. The usefulness of cardiac CT integrated with FFRCT for planning myocardial revascularization in complex coronary artery disease: a lesson from SYNTAX studies. Cardiovasc Diagn Ther 2020; 10:2036-2047. [PMID: 33381442 PMCID: PMC7758756 DOI: 10.21037/cdt.2019.11.07] [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: 09/30/2019] [Accepted: 11/20/2019] [Indexed: 11/06/2022]
Abstract
After two decades of clinical use, during which coronary CT angiography (CCTA) was considered an appropriate method for the non-invasive assessment of patients with suspected stable coronary artery disease (CAD) and low-to-intermediate pretest likelihood of CAD, a growing body of literature is showing that CCTA may have also a clinical role in patients with high pretest likelihood of CAD, known CAD and complex and diffuse CAD. Particularly, the SYNTAX studies demonstrated the usefulness of CCTA in the field of non-invasive assessment of these patients and planning of interventional and surgical coronary procedures, thanks to its ability to combine, in a single method, precise stenosis quantification, accurate plaque characterization, functional assessment and selection of the revascularization modality for any individual patient and of the vessels that need to be revascularized. Of note, the SYNTAX III Revolution trial showed, in patients with three-vessel CAD, that treatment decision-making between PCI and CABG based on CCTA only has an almost perfect agreement with the treatment decision derived from invasive coronary angiography (ICA). Moreover, the SYNTAX Score II demonstrated a high degree of correlation between the two diagnostic strategies, suggesting the potential feasibility of a treatment decision-making based solely on non-invasive imaging and clinical information. New research prospects have opened up for the future to demonstrate the true feasibility and safety of this innovative approach in the clinical arena.
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Affiliation(s)
- Daniele Andreini
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | | | | | | | | | - Giulio Pompilio
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | - Mauro Pepi
- Monzino Cardiology Center, IRCCS, Milan, Italy
| | - Antonio L. Bartorelli
- Monzino Cardiology Center, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
| | | | - Patrick W. Serruys
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London, London, UK
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18
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Bartorelli AL, Andreini D, Mushtaq S, Serruys PW. The revolution project: replacing coronary artery angiography with coronary computed tomography with functional evaluation. Eur Heart J Suppl 2020; 22:L15-L18. [PMID: 33654462 PMCID: PMC7904056 DOI: 10.1093/eurheartj/suaa126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In the last two decades, several studies and widespread clinical use demonstrated that coronary computed tomography angiography (CCTA) is an appropriate method for the non-invasive assessment of patients with suspected stable coronary artery disease (CAD) and low-to-intermediate pretest likelihood of CAD. Moreover, a growing body of literature is showing that CCTA may have also a clinical role in patients with high pretest likelihood of CAD, known CAD and complex and diffuse disease. Particularly, the SYNTAX II trial demonstrated the feasibility of planning interventional and surgical coronary procedures with CCTA thanks to its ability to combine, in a single method, precise stenosis quantification, accurate plaque characterization, functional assessment with fractional flow reserve derived from standard acquired CCTA datasets, and selection of the revascularization modality for any individual patient and of the vessels that need to be revascularized. More recently, the SYNTAX III Revolution trial showed, in patients with three-vessel CAD with or without left main involvement, that treatment decision-making between percutaneous coronary intervention and coronary artery bypass grafting based on CCTA only has an almost perfect agreement with the treatment decision derived from invasive coronary angiography (ICA). The high degree of correlation between CCTA and ICA suggests the potential feasibility of treatment decision-making based solely on non-invasive imaging and clinical information. New research prospects have opened up for the future to demonstrate the true feasibility and safety of this innovative approach in the clinical arena.
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Affiliation(s)
- Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
| | | | - Patrick W Serruys
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London, London, UK
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Feasibility of coronary CT angiography for guidance of CABG. J Cardiovasc Comput Tomogr 2020; 15:281-284. [PMID: 32981883 DOI: 10.1016/j.jcct.2020.09.005] [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: 05/17/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the clinical safety and effectiveness of coronary revascularization in patients who underwent coronary artery bypass grafting (CABG) based exclusively on coronary computed tomography angiography (CCTA) results. METHODS 53 patients (62.3 ± 7.1 years) underwent CCTA before a CABG surgery without prior invasive coronary angiography (ICA). Primary endpoints were all-cause mortality and major adverse cardiovascular events (MACE). The secondary endpoint was quality of life (QoL) assessed with the Minnesota Living with Heart Failure Questionnaire (MLHFQ). All were collected one year after the surgery. RESULTS CCTA revealed multivessel coronary artery disease (CAD) in 52 patients. Indication for bypass surgery was made exclusively based on CCTA results. 136 distal anastomoses were performed. Assessment at 1 year (13.3 ± 1.4 months) was completed in 98.1% of the patients. MACE and mortality rates were 0%. The MLHFQ total score was 21.8 ± 8.7, and active lifestyle was maintained in all patients. CONCLUSIONS In this proof of concept prospective pilot study, we observed that non-invasive coronary angiography may provide adequate anatomic detail to guide CABG surgery. Further study of this concept is warranted.
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Sumin AN. A New Diagnostic Algorithm for Examining Patients with Suspected Chronic Coronary Syndrome: Questions Remain? RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-06-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- A. N. Sumin
- Research Institute for Complex Issues of Cardiovascular Diseases
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21
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Serruys PW, Chichareon P, Modolo R, Leaman DM, Reiber JH, Emanuelsson H, Di Mario C, Pijls NH, Morel MA, Valgimigli M, Farooq V, van Klaveren D, Capodanno D, Andreini D, Bourantas CV, Davies J, Banning AP, Escaned J, Piek JJ, Echavarría-Pinto M, Taylor CA, Thomsen B, Collet C, Pompilio G, Bartorelli AL, Glocker B, Dressler O, Stone GW, Onuma Y. The SYNTAX score on its way out or … towards artificial intelligence: part I. EUROINTERVENTION 2020; 16:44-59. [DOI: 10.4244/eij-d-19-00543a] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Serruys PW, Chichareon P, Modolo R, Leaman DM, Reiber JH, Emanuelsson H, Di Mario C, Pijls NH, Morel MA, Valgimigli M, Farooq V, van Klaveren D, Capodanno D, Andreini D, Bourantas CV, Davies J, Banning AP, Escaned J, Piek JJ, Echavarría-Pinto M, Taylor CA, Thomsen B, Collet C, Pompilio G, Bartorelli AL, Glocker B, Dressler O, Stone GW, Onuma Y. The SYNTAX score on its way out or … towards artificial intelligence: part II. EUROINTERVENTION 2020; 16:60-75. [DOI: 10.4244/eij-d-19-00543b] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Serruys PW, Hara H, Onuma Y. Did the SYNTAX Score Pass the Test of Time? JACC Cardiovasc Interv 2020; 13:1207-1210. [DOI: 10.1016/j.jcin.2020.03.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
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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.
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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.)
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