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Mushtaq S, Gigante C, Conte E, Capovilla TM, Sonck J, Tanzilli A, Barbato E, Monizzi G, Belmonte M, De Bruyne B, Bartorelli AL, Schillaci M, Marchetti D, Carerj ML, Pontone G, Collet C, Andreini D. Preoperative angiography-derived fractional flow reserve may predict coronary artery bypass grafting occlusion and disease progression. J Cardiovasc Med (Hagerstown) 2023; 24:651-658. [PMID: 37605957 DOI: 10.2459/jcm.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Graft occlusion after coronary artery bypass grafting (CABG) has been associated with competitive flow of native coronary arteries. OBJECTIVES To assess with coronary computed tomography angiography (CCTA) graft occlusion and coronary artery disease (CAD) progression of native vessels after CABG and their relationship with angiography-derived vessel fractional flow reserve (vFFR) performed before surgery. METHODS Between 2006 and 2018, serial vFFR analyses were obtained before CABG in each major native coronary vessel from two institutions. All patients underwent follow-up CCTA. RESULTS In 171 consecutive patients, serial preoperative angiograms were suitable for vFFR analysis of 298 grafted and 59 nongrafted vessels. Median time between CABG and CCTA was 2.1 years. Preoperative vFFR was assessed in 131 left anterior descending artery (LAD), 132 left circumflex artery (LCX) and 94 right coronary aretry (RCA) and was less than 0.80 in 255 of 298 bypassed vessels. Graft occlusion was observed at CCTA in 28 of 298 grafts. The median preoperative vFFR value of native coronaries was higher in occluded compared with patent grafts (0.75 vs. 0.60, P < 0.001) and was associated with graft. The best vFFR cut-off to predict graft occlusion was 0.67. Progression of CAD was higher in grafted than in nongrafted vessels (89.6 vs. 47.5%, P < 0.001). Pre-CABG vFFR predicted disease progression of grafted native vessels (AUC = 0.83). CONCLUSION Preoperative vFFR derived from invasive coronary angiography was able to predict graft occlusion and CAD progression of grafted coronary arteries.
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Affiliation(s)
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
| | - Matteo Schillaci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Davide Marchetti
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Maria Ludovica Carerj
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, 'G. Martino' University Hospital Messina, Messina
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
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Chiastra C, Zuin M, Rigatelli G, D’Ascenzo F, De Ferrari GM, Collet C, Chatzizisis YS, Gallo D, Morbiducci U. Computational fluid dynamics as supporting technology for coronary artery disease diagnosis and treatment: an international survey. Front Cardiovasc Med 2023; 10:1216796. [PMID: 37719972 PMCID: PMC10501454 DOI: 10.3389/fcvm.2023.1216796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Computational fluid dynamics (CFD) is emerging as an effective technology able to improve procedural outcomes and enhance clinical decision-making in patients with coronary artery disease (CAD). The present study aims to assess the state of knowledge, use and clinical acceptability of CFD in the diagnosis and treatment of CAD. Methods We realized a 20-questions international, anonymous, cross-sectional survey to cardiologists to test their knowledge and confidence on CFD as a technology applied to patients suffering from CAD. Responses were recorded between May 18, 2022, and June 12, 2022. Results A total of 466 interventional cardiologists (mean age 48.4 ± 8.3 years, males 362), from 42 different countries completed the survey, for a response rate of 45.9%. Of these, 66.6% declared to be familiar with the term CFD, especially for optimization of existing interventional techniques (16.1%) and assessment of hemodynamic quantities related with CAD (13.7%). About 30% of respondents correctly answered to the questions exploring their knowledge on the pathophysiological role of some CFD-derived quantities such as wall shear stress and helical flow in coronary arteries. Among respondents, 85.9% would consider patient-specific CFD-based analysis in daily interventional practice while 94.2% declared to be interested in receiving a brief foundation course on the basic CFD principles. Finally, 87.7% of respondents declared to be interested in a cath-lab software able to conduct affordable CFD-based analyses at the point-of-care. Conclusions Interventional cardiologists reported to be profoundly interested in adopting CFD simulations as a technology supporting decision making in the treatment of CAD in daily practice.
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Affiliation(s)
- Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Interventional Cardiology Unit, Department of Cardiology, Madre Teresa Hospital, Padova, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | | | - Yiannis S. Chatzizisis
- Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Diego Gallo
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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Starczyński M, Dudek S, Baruś P, Niedzieska E, Wawrzeńczyk M, Ochijewicz D, Piasecki A, Gumiężna K, Milewski K, Grabowski M, Kochman J, Tomaniak M. Intravascular Imaging versus Physiological Assessment versus Biomechanics-Which Is a Better Guide for Coronary Revascularization. Diagnostics (Basel) 2023; 13:2117. [PMID: 37371012 DOI: 10.3390/diagnostics13122117] [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: 05/21/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 06/29/2023] Open
Abstract
Today, coronary artery disease (CAD) continues to be a prominent cause of death worldwide. A reliable assessment of coronary stenosis represents a prerequisite for the appropriate management of CAD. Nevertheless, there are still major challenges pertaining to some limitations of current imaging and functional diagnostic modalities. The present review summarizes the current data on invasive functional and intracoronary imaging assessment using optical coherence tomography (OCT), and intravascular ultrasound (IVUS). Amongst the functional parameters-on top of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR)-we point to novel angiography-based measures such as quantitative flow ratio (QFR), vessel fractional flow reserve (vFFR), angiography-derived fractional flow reserve (FFRangio), and computed tomography-derived flow fractional reserve (FFR-CT), as well as hybrid approaches focusing on optical flow ratio (OFR), computational fluid dynamics and attempts to quantify the forces exaggerated by blood on the coronary plaque and vessel wall.
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Affiliation(s)
- Miłosz Starczyński
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Stanisław Dudek
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Piotr Baruś
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Emilia Niedzieska
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Mateusz Wawrzeńczyk
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Dorota Ochijewicz
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Adam Piasecki
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Karolina Gumiężna
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, 43-316 Bielsko-Biała, Poland
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
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Dobrić M, Furtula M, Tešić M, Timčić S, Borzanović D, Lazarević N, Lipovac M, Farkić M, Ilić I, Boljević D, Rakočević J, Aleksandrić S, Juričić S, Ostojić M, Bojić M. Current status and future perspectives of fractional flow reserve derived from invasive coronary angiography. Front Cardiovasc Med 2023; 10:1181803. [PMID: 37346287 PMCID: PMC10279845 DOI: 10.3389/fcvm.2023.1181803] [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: 03/07/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Assessment of the functional significance of coronary artery stenosis using invasive measurement of fractional flow reserve (FFR) or non-hyperemic indices has been shown to be safe and effective in making clinical decisions on whether to perform percutaneous coronary intervention (PCI). Despite strong evidence from clinical trials, utilization of these techniques is still relatively low worldwide. This may be to some extent attributed to factors that are inherent to invasive measurements like prolongation of the procedure, side effects of drugs that induce hyperemia, additional steps that the operator should perform, the possibility to damage the vessel with the wire, and additional costs. During the last few years, there was a growing interest in the non-invasive assessment of coronary artery lesions, which may provide interventionalist with important physiological information regarding lesion severity and overcome some of the limitations. Several dedicated software solutions are available on the market that could provide an estimation of FFR using 3D reconstruction of the interrogated vessel derived from two separated angiographic projections taken during diagnostic coronary angiography. Furthermore, some of them use data about aortic pressure and frame count to more accurately calculate pressure drop (and FFR). The ideal non-invasive system should be integrated into the workflow of the cath lab and performed online (during the diagnostic procedure), thereby not prolonging procedural time significantly, and giving the operator additional information like vessel size, lesion length, and possible post-PCI FFR value. Following the development of these technologies, they were all evaluated in clinical trials where good correlation and agreement with invasive FFR (considered the gold standard) were demonstrated. Currently, only one trial (FAVOR III China) with clinical outcomes was completed and demonstrated that QFR-guided PCI may provide better results at 1-year follow-up as compared to the angiography-guided approach. We are awaiting the results of a few other trials with clinical outcomes that test the performance of these indices in guiding PCI against either FFR or angiography-based approach, in various clinical settings. Herein we will present an overview of the currently available data, a critical review of the major clinical trials, and further directions of development for the five most widely available non-invasive indices: QFR, vFFR, FFRangio, caFFR, and AccuFFRangio.
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Affiliation(s)
- Milan Dobrić
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Matija Furtula
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Milorad Tešić
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Stefan Timčić
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Dušan Borzanović
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Nikola Lazarević
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Mirko Lipovac
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Mihajlo Farkić
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Ivan Ilić
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Darko Boljević
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Jelena Rakočević
- Institute of Histology and Embryology “Aleksandar Đ. Kostić”, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Srđan Aleksandrić
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Stefan Juričić
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Miodrag Ostojić
- University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Milovan Bojić
- Cardiology Clinic, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
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Tomaniak M, Neleman T, Ziedses des Plantes A, Masdjedi K, van Zandvoort LJC, Kochman J, den Dekker WK, Wilschut JM, Diletti R, Kardys I, Zijlstra F, Van Mieghem NM, Daemen J. Diagnostic Accuracy of Coronary Angiography-Based Vessel Fractional Flow Reserve (vFFR) Virtual Stenting. J Clin Med 2022; 11:jcm11051397. [PMID: 35268488 PMCID: PMC8910880 DOI: 10.3390/jcm11051397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
3D coronary angiography-based vessel fractional flow reserve (vFFR) proved to be an accurate diagnostic alternative to invasively measured pressure wire based fractional flow reserve (FFR). The ability to compute post-PCI vFFR using pre-PCI vFFR virtual stent analysis is unknown. We aimed to assess the feasibility and diagnostic accuracy of pre-PCI vFFR virtual stenting analysis (residual vFFR) with post-PCI FFR as a reference. This is an observational, single-center retrospective cohort study including consecutive patients from the FFR-SEARCH registry. We blindly calculated residual vFFR from pre-PCI angiograms and compared them to invasive pressure-wire based post-PCI FFR. Inclusion criteria involved presentation with either stable or unstable angina or non-ST elevation myocardial infarction (NSTEMI), ≥1 significant stenosis in one of the epicardial coronary arteries (percentage diameter stenosis of >70% by QCA or hemodynamically relevant stenosis with FFR ≤0.80) and pre procedural angiograms eligible for vFFR analysis. Exclusion criteria comprised patients with ST elevation myocardial infarction (STEMI), coronary bypass grafts, cardiogenic shock or severe hemodynamic instability. Eighty-one pre-PCI residual vFFR measurements were compared to post-PCI FFR and post-PCI vFFR measurements. Mean residual vFFR was 0.91 ± 0.06, mean post-PCI FFR 0.91 ± 0.06 and mean post-PCI vFFR was 0.92 ± 0.05. Residual vFFR showed a high linear correlation (r = 0.84) and good agreement (mean difference (95% confidence interval): 0.005 (−0.002−0.012)) with post-PCI FFR, as well as with post-PCI-vFFR (r = 0.77, mean difference −0.007 (−0.015−0.0003)). Residual vFFR showed good accuracy in the identification of lesions with post-PCI FFR < 0.90 (sensitivity 94%, specificity 71%, area under the curve (AUC) 0.93 (95% CI: 0.86−0.99), p < 0.001). Virtual stenting using vFFR provided an accurate estimation of post-PCI FFR and post-PCI vFFR. Further studies are needed to prospectively validate a vFFR-guided PCI strategy.
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Affiliation(s)
- Mariusz Tomaniak
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Tara Neleman
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Anniek Ziedses des Plantes
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Kaneshka Masdjedi
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Laurens J. C. van Zandvoort
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Wijnand K. den Dekker
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Jeroen M. Wilschut
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Roberto Diletti
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Isabella Kardys
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Felix Zijlstra
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Nicolas M. Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, ThoraxCenter, 3000 CA Rotterdam, The Netherlands; (M.T.); (T.N.); (A.Z.d.P.); (K.M.); (L.J.C.v.Z.); (W.K.d.D.); (J.M.W.); (R.D.); (I.K.); (F.Z.); (N.M.V.M.)
- Correspondence: ; Tel.: +31-10-703-5260
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