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Escaned J, Berry C, De Bruyne B, Shabbir A, Collet C, Lee JM, Appelman Y, Barbato E, Biscaglia S, Buszman PP, Campo G, Chieffo A, Colleran R, Collison D, Davies J, Giacoppo D, Holm NR, Jeremias A, Paradies V, Piróth Z, Raposo L, Roguin A, Rudolph T, Sarno G, Sen S, Toth GG, Van Belle E, Zimmermann FM, Dudek D, Stefanini G, Tarantini G. Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology. EUROINTERVENTION 2023; 19:464-481. [PMID: 37171503 PMCID: PMC10436072 DOI: 10.4244/eij-d-23-00194] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
The clinical value of fractional flow reserve and non-hyperaemic pressure ratios are well established in determining an indication for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). In addition, over the last 5 years we have witnessed a shift towards the use of physiology to enhance procedural planning, assess post-PCI functional results, and guide PCI optimisation. In this regard, clinical studies have reported compelling data supporting the use of longitudinal vessel analysis, obtained with pressure guidewire pullbacks, to better understand how obstructive CAD contributes to myocardial ischaemia, to establish the likelihood of functionally successful PCI, to identify the presence and location of residual flow-limiting stenoses and to predict long-term outcomes. The introduction of new functional coronary angiography tools, which merge angiographic information with fluid dynamic equations to deliver information equivalent to intracoronary pressure measurements, are now available and potentially also applicable to these endeavours. Furthermore, the ability of longitudinal vessel analysis to predict the functional results of stenting has played an integral role in the evolving field of simulated PCI. Nevertheless, it is important to have an awareness of the value and challenges of physiology-guided PCI in specific clinical and anatomical contexts. The main aim of this European Association of Percutaneous Cardiovascular Interventions clinical consensus statement is to offer up-to-date evidence and expert opinion on the use of applied coronary physiology for procedural PCI planning, disease pattern recognition and post-PCI optimisation.
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Affiliation(s)
- Javier Escaned
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Colin Berry
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Center Hospital, Lausanne, Switzerland
| | - Asad Shabbir
- Hospital Clínico San Carlos IdISCC, Complutense University of Madrid, Madrid, Spain
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yolande Appelman
- Amsterdam UMC, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Piotr P Buszman
- Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
- American Heart of Poland, Ustroń, Poland
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara, Cona, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Róisín Colleran
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Damien Collison
- West of Scotland Regional Heart & Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Justin Davies
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Daniele Giacoppo
- Cardiovascular Research Institute Dublin and Department of Cardiology, Mater Private Network, Dublin, Ireland
- Department of Cardiology, Alto Vicentino Hospital, Santorso, Italy
- ISAResearch, German Heart Centre Munich, Munich, Germany
| | - Niels R. Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Zsolt Piróth
- Gottsegen National Cardiovascular Center, Budapest, Hungary
| | - Luís Raposo
- Unidade de Intervenção Cardiovascular, Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Ariel Roguin
- Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine, Technion, Haifa, Israel
| | - Tanja Rudolph
- Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Giovanna Sarno
- Cardiology, Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Sayan Sen
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Gabor G Toth
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Coeur Poumon, Lille, France
- Department of Cardiology, Institut Pasteur de Lille, Lille, France
| | | | - Dariusz Dudek
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
- University of Padua Medical School, Padua, Italy
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Kiriyama H, Kiyosue A, Minatsuki S, Kawahara T, Katsushika S, Kamon T, Hirose K, Shinohara H, Miura M, Saito A, Kikuchi H, Kodera S, Hatano M, Ando J, Myojo M, Itoh N, Yamamoto K, Ikenouchi H, Takeda N, Komuro I. Potential value of saline-induced Pd/Pa ratio in patients with coronary artery stenosis. Front Cardiovasc Med 2023; 9:1001833. [PMID: 36684556 PMCID: PMC9853169 DOI: 10.3389/fcvm.2022.1001833] [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: 07/24/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
Background Fractional flow reserve (FFR) is the current gold standard for identifying myocardial ischemia in individuals with coronary artery stenosis. However, FFR is not penetrated as much worldwide due to time consumption, costs associated with adenosine, FFR-related discomfort, and complications. Resting physiological indexes may be widely accepted alternatives to FFR, while the discrepancies with FFR were found in up to 20% of lesions. The saline-induced Pd/Pa ratio (SPR) is a new simplified option for evaluating coronary stenosis. However, the clinical implication of SPR remains unclear. Objectives In the present study, we aimed to compare the accuracies of SPR and resting full-cycle ratio (RFR) and to investigate the incremental value of SPR in clinical practice. Methods In this multicenter prospective study, 112 coronary lesions (105 patients) were evaluated by SPR, RFR, and FFR. Results The overall median age was 71 years, and 84.8% were men. SPR was correlated more strongly with FFR than with RFR (r = 0.874 vs. 0.713, respectively; p < 0.001). Using FFR < 0.80 as the reference standard variable, the area under the receiver-operating characteristic (ROC) curve for SPR was superior to that of RFR (0.932 vs. 0.840, respectively; p = 0.009). Conclusion Saline-induced Pd/Pa ratio predicted FFR more accurately than RFR. SPR could be an alternative method for evaluating coronary artery stenosis and further investigation including elucidation of the mechanism of SPR is needed (225 words).
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Affiliation(s)
- Hiroyuki Kiriyama
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Arihiro Kiyosue
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan,Department of Cardiology, Moriyama Memorial Hospital, Tokyo, Japan
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan,*Correspondence: Shun Minatsuki,
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Susumu Katsushika
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazutoshi Hirose
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroki Shinohara
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Mizuki Miura
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihito Saito
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hironobu Kikuchi
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Jiro Ando
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Myojo
- Department of Cardiology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Nobuhiko Itoh
- Department of Cardiology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, Tokyo, Japan
| | - Keisuke Yamamoto
- Department of Cardiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Hiroshi Ikenouchi
- Department of Cardiology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Liang L, Zhu Y, Li F, Guo K, Chang S, Li Q, Zhang Y, Li D. Comparative analysis of instantaneous wave-free ratio and quantitative real-time myocardial contrast echocardiography for the assessment of myocardial perfusion. Front Cardiovasc Med 2022; 9:893647. [DOI: 10.3389/fcvm.2022.893647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/06/2022] [Indexed: 01/10/2023] Open
Abstract
Background and hypothesisThe field of coronary artery physiology is developing rapidly and changing the practice of interventional cardiology. A new functional evaluation technique using the instantaneous wave-free ratio (iFR) has become an alternative to fractional flow reserve. Future research studies need to determine whether physiological indicators play a role in evaluating myocardial perfusion in the catheter room.Materials and methodsThirty-eight patients scheduled for coronary angiography and iFR evaluation underwent a real-time myocardial contrast echocardiography (RT-MCE) examination at rest. The myocardial perfusion parameters (A, β, and A × β) on the myocardial perfusion curve were quantitatively analyzed using Q-Lab software. Coronary angiography and iFR assessment were completed within 1 week after the RT-MCE examination in all patients. Correlation analysis was used to identify iFR- and MCE-related indicators. The sensitivity and specificity of iFR in the quantitative detection of coronary microcirculation were obtained.ResultsThe correlation coefficients between iFR and A, β, and A × β were 0.81, 0.66, and 0.82, respectively. The cut-off value for iFR was 0.85 for microvascular ischemia detection, while the sensitivity and specificity for the diagnosis of myocardial perfusion were 90.7 and 89.9%, respectively. The receiver operating characteristic (ROC) curve area for iFR was 0.946 in the segments related to myocardial blood flow.ConclusionThe iFR is an effective tool for detecting myocardial microcirculation perfusion, with satisfactory diagnostic performance and a demonstrated role in physiological indices used for the perfusion assessment.
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Fezzi S, Huang J, Lunardi M, Ding D, Ribichini FL, Tu S, Wijns W. Coronary physiology in the catheterisation laboratory: an A to Z practical guide. ASIAINTERVENTION 2022; 8:86-109. [PMID: 36798834 PMCID: PMC9890586 DOI: 10.4244/aij-d-22-00022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022]
Abstract
Coronary revascularisation, either percutaneous or surgical, aims to improve coronary flow and relieve myocardial ischaemia. The decision-making process in patients with coronary artery disease (CAD) remains largely based on invasive coronary angiography (ICA), even though until recently ICA could not assess the functional significance of coronary artery stenoses. Invasive wire-based approaches for physiological evaluations were developed to properly assess the ischaemic relevance of epicardial CAD. Fractional flow reserve (FFR) and later, instantaneous wave-free ratio (iFR), were shown to improve clinical outcomes in several patient subsets when used for coronary revascularisation guidance or deferral and for procedural optimisation of percutaneous coronary intervention (PCI) results. Despite accumulating evidence and positive guideline recommendations, the adoption of invasive physiology has remained quite low, mainly due to technical and economic issues as well as to operator-resistance to change. Coronary image-based computational physiology has been recently developed, with promising results in terms of accuracy and a reduction in computational time, costs, radiation exposure and risks for the patient. Lastly, the integration of intracoronary imaging and physiology allows for individualised PCI treatment, aiming at complete relief of ischaemia through optimised morpho-functional immediate procedural results. Instead of a conventional state-of-the-art review, this A to Z dictionary attempts to provide a practical guide for the application of coronary physiology in the catheterisation laboratory, exploring several methods, their pitfalls, and useful tips and tricks.
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Affiliation(s)
- Simone Fezzi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland,Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Mattia Lunardi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland,Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Flavio L. Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China,Department of Cardiology, Fujian Medical University Union Hospital, Fujian, China
| | - William Wijns
- The Lambe Institute for Translational Research, Galway National University of Ireland Galway (NUIG), Costello Road, Shantalla, Galway, H91 V4AY, Ireland
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5
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Jeremias A, Nijjer S, Davies J, DiMario C. Physiologic Assessment and Guidance in the Cardiac Catheterization Laboratory. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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6
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Marin F, Scarsini R, Terentes-Printzios D, Kotronias RA, Ribichini F, Banning AP, De Maria GL. The Role of Coronary Physiology in Contemporary Percutaneous Coronary Interventions. Curr Cardiol Rev 2022; 18:e080921196264. [PMID: 34521331 PMCID: PMC9241117 DOI: 10.2174/1573403x17666210908114154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 01/10/2023] Open
Abstract
Invasive assessment of coronary physiology has radically changed the paradigm of myocardial revascularization in patients with coronary artery disease. Despite the prognostic improvement associated with ischemia-driven revascularization strategy, functional assessment of angiographic intermediate epicardial stenosis remains largely underused in clinical practice. Multiple tools have been developed or are under development in order to reduce the invasiveness, cost, and extra procedural time associated with the invasive assessment of coronary physiology. Besides epicardial stenosis, a growing body of evidence highlights the role of coronary microcirculation in regulating coronary flow with consequent pathophysiological and clinical and prognostic implications. Adequate assessment of coronary microcirculation function and integrity has then become another component of the decision-making algorithm for optimal diagnosis and treatment of coronary syndromes. This review aims at providing a comprehensive description of tools and techniques currently available in the catheterization laboratory to obtain a thorough and complete functional assessment of the entire coronary tree (both for the epicardial and microvascular compartments).
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Affiliation(s)
- Federico Marin
- Division of Cardiology, University of Verona, Verona, Italy.,Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | | | | | - Rafail A Kotronias
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
| | | | - Adrian P Banning
- Oxford Heart Centre, Oxford University Hospitals, Oxford, United Kingdom
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Raposo L, Gonçalves M, Roque D, Gonçalves PA, Magno P, Brito J, Leal S, Madeira S, Santos M, Teles RC, E Abreu PF, Almeida M, Morais C, Mendes M, Baptista SB. Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40821 real-world procedures over a 12-year period. Rev Port Cardiol 2021; 40:771-781. [PMID: 34857116 DOI: 10.1016/j.repce.2021.10.008] [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: 10/31/2020] [Accepted: 01/17/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. METHODS We retrospectively determined the per-procedure prevalence of physiological assessment in 40821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. RESULTS Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages <40, 40-55 and >55 years, respectively; p<0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology. CONCLUSIONS Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.
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Affiliation(s)
- Luís Raposo
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal.
| | - Mariana Gonçalves
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - David Roque
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Pedro Araújo Gonçalves
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Pedro Magno
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - João Brito
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sílvio Leal
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sérgio Madeira
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Miguel Santos
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Pedro Farto E Abreu
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Manuel Almeida
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Carlos Morais
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Miguel Mendes
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sérgio Bravo Baptista
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal; University Clinic of Cardiology, Faculty of Medicine at University of Lisbon, Lisboa, Portugal
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8
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Zimbardo G, Cialdella P, DI Giusto F, Migliaro S, Anastasia G, Petrolati E, Galante D, D'Amario D, Leone AM. Physiological assessment after percutaneous coronary intervention: the hard truth. Panminerva Med 2021; 63:519-528. [PMID: 34486363 DOI: 10.23736/s0031-0808.21.04363-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Physiologically guided revascularization, using Fractional Flow Reserve (FFR) or instantaneous wave free ratio (iFR) has been demonstrated to be associated with better long-term outcomes compared to an angiographically-guided strategy, mainly avoiding inappropriate coronary stenting and its associated adverse events. On the contrary, the role of invasive physiological assessment after percutaneous coronary intervention (PCI) is much less well established. However, a large body of evidence suggests that a relevant proportion of patients undergoing PCI with a satisfying angiographic result show instead a suboptimal functional product with a potentially negative prognostic impact. For this reason, many efforts have been focused to identify interventional strategies to physiologically optimize PCI. Measuring the functional result after as PCI, especially when performed after a physiological assessment, implies that the operator is ready to accept the hard truth of an unsatisfactory physiological result despite angiographically optimal and, consequently, to optimize the product with some additional effort. The aim of this review is to bridge this gap in knowledge by better defining the paradigm shift of invasive physiological assessment from a simple tool for deciding whether an epicardial stenosis has to be treated to a thoroughly physiological approach to PCI with the suggestion of a practical flow chart.
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Affiliation(s)
| | | | - Federico DI Giusto
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Migliaro
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gianluca Anastasia
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Edoardo Petrolati
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico Galante
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Antonio M Leone
- Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy -
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Raposo L, Gonçalves M, Roque D, Gonçalves PA, Magno P, Brito J, Leal S, Madeira S, Santos M, Teles RC, E Abreu PF, Almeida M, Morais C, Mendes M, Baptista SB. Adoption and patterns of use of invasive physiological assessment of coronary artery disease in a large cohort of 40821 real-world procedures over a 12-year period. Rev Port Cardiol 2021; 40:S0870-2551(21)00322-X. [PMID: 34474954 DOI: 10.1016/j.repc.2021.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Use of invasive physiological assessment in patients with coronary artery disease varies widely and is perceived to be low. We aimed to examine adoption rates as well as patterns and determinants of use in an unselected population undergoing invasive coronary angiography over a long time frame. METHODS We retrospectively determined the per-procedure prevalence of physiological assessment in 40821 coronary cases performed between 2007 and 2018 in two large-volume centers. Adoption was examined according to procedure type and patient- and operator-related variables. Its association with relevant scientific landmarks, such as the release of clinical trial results and practice guidelines, was also assessed. RESULTS Overall adoption was low, ranging from 0.6% in patients undergoing invasive coronary angiography due to underlying valve disease, to 6% in the setting of stable coronary artery disease (CAD); it was 3.1% in patients sustaining an acute coronary syndrome. Of scientific landmarks, FAME 1, the long-term results of FAME 2 and the 2014 European myocardial revascularization guidelines were associated with changes in practice. Publication of instantaneous wave-free ratio (iFR) trials had no influence on adoption rates, except for a higher proportion of iFR use. In 42.9% of stable CAD patients undergoing percutaneous coronary intervention there was no objective non-invasive evidence of ischemia, nor was physiological assessment performed. Younger operator age (4.5% vs. 4.0% vs. 0.9% for ages <40, 40-55 and >55 years, respectively; p<0.001) and later time of procedure during the day (2.9% between 6 and 8 p.m. vs. 4.4% at other times) were independent correlates of use of invasive physiology. CONCLUSIONS Our study confirms the low use of invasive physiology in routine practice. The availability of resting indices did not increase adoption. Strategies are warranted to promote guideline implementation and to improve patient care and clinical outcomes.
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Affiliation(s)
- Luís Raposo
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal.
| | - Mariana Gonçalves
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - David Roque
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Pedro Araújo Gonçalves
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Pedro Magno
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - João Brito
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sílvio Leal
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sérgio Madeira
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Miguel Santos
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Pedro Farto E Abreu
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Manuel Almeida
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal; NOVA Medical School, Lisbon, Portugal
| | - Carlos Morais
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal
| | - Miguel Mendes
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Cardiology Department, Carnaxide, Portugal
| | - Sérgio Bravo Baptista
- Hospital Prof. Doutor Fernando da Fonseca, EPE, Cardiology Department, Amadora, Portugal; University Clinic of Cardiology, Faculty of Medicine at University of Lisbon, Lisboa, Portugal
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Cerrato E, Mejía-Rentería H, Franzè A, Quadri G, Belliggiano D, Biscaglia S, Lo Savio L, Spataro F, Erriquez A, Giacobbe F, Vergara-Uzcategui C, di Girolamo D, Tebaldi M, Varbella F, Campo G, Escaned J. Quantitative flow ratio as a new tool for angiography-based physiological evaluation of coronary artery disease: a review. Future Cardiol 2021; 17:1435-1452. [PMID: 33739146 DOI: 10.2217/fca-2020-0199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The functional evaluation of coronary stenoses has obtained important clinical results in recent years, resulting in strong guideline recommendations. Nonetheless, the use of coronary wire-based functional evaluation has not yet become part of the routine in catheterization laboratories for several reasons, including the need to advance a wire into the coronary vessel to interrogate the stenosis. Angiography-derived indexes have been introduced to expand the current use of physiology to estimate the functional meaning of a stenosis on the basis of angiographic data only. The most studied and validated angiography-derived index is certainly the quantitative flow ratio. This article will summarize the basics of the quantitative flow ratio, the related validation studies and its current and future applications.
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Hernan Mejía-Rentería
- Department of Cardiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos & Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Franzè
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Davide Belliggiano
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Luca Lo Savio
- Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Fabio Spataro
- Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Andrea Erriquez
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Federico Giacobbe
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Carlos Vergara-Uzcategui
- Department of Cardiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos & Universidad Complutense de Madrid, Madrid, Spain
| | | | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos & Universidad Complutense de Madrid, Madrid, Spain
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Contrast medium Pd/Pa ratio in comparison to fractional flow reserve, quantitative flow ratio and instantaneous wave-free ratio for evaluation of intermediate coronary lesions. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 16:384-390. [PMID: 33598010 PMCID: PMC7863821 DOI: 10.5114/aic.2020.101762] [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] [Received: 08/30/2020] [Accepted: 10/01/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Contrast medium Pd/Pa ratio (cFFR) was introduced as an alternative to fractional flow reserve (FFR). Aim To assess the accuracy of cFFR in predicting of FFR, quantitative flow ratio (QFR) and instantaneous wave-free ratio (iFR). Material and methods Resting Pd/Pa, cFFR, FFR, QFR, and iFR were measured in 110 intermediate coronary lesions. cFFR was obtained after intracoronary injection of contrast medium. FFR was measured after the intravenous administration of adenosine. QFR was derived from fixed empiric hyperemic flow velocity based on coronary angiography. iFR was calculated by measuring the resting pressure gradient across a coronary lesion during diastole. Results Forty-four patients with 110 intermediate coronary lesions were enrolled. Mean baseline Pd/Pa was 0.93 ±0.05. Mean cFFR value was similar to FFR value (0.83 ±0.09 vs. 0.81 ±0.09; p = 0.13) and QFR (0.81 ±0.1; p = 0.69) and iFR (0.90 ±0.07; p = 0.1). A total of 46 vessels (41.8%) had FFR ≤ 0.80, 50 (45.5%) vessels had cFFR ≤ 0.83, 44 (40.0%) vessels had QFR ≤ 0.80, and 38 (34.5%) vessels had iFR ≤ 0.89. An excellent agreement between cFFR and resting Pd/Pa, FFR, QFR, and iFR was confirmed (intraclass correlation coefficients of 0.83, 0.99, 0.98, and 0.88, respectively). The optimal cutoff value of cFFR was 0.83 for prediction of FFR ≤ 0.80 with sensitivity, specificity, and accuracy of 96.9%, 97.8%, and 97.3%, respectively. 100% sensitivity was observed for a cutoff value of 0.82 and 100% specificity for a cutoff value of 0.84; AUC = 0.998 (0.995–1.00); p < 0.001. Conclusions Contrast medium Pd/Pa ratio seems to be accurate in predicting the functional significance of borderline coronary lesions assessed with FFR, iFR, and QFR.
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Gong Y, Zheng B, Yi T, Yang F, Hong T, Liu Z, Huo Y, Li J, Huo Y. Coronary angiography-derived contrast fractional flow reserve. Catheter Cardiovasc Interv 2021; 99:763-771. [PMID: 33590679 DOI: 10.1002/ccd.29558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/09/2021] [Accepted: 02/02/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Based on coronary angiography and mean aortic pressure, a specially designed computational flow dynamics (CFD) method is proposed to determine contrast fractional flow reserve (cFFR) without using invasive pressure wire. This substudy assessed diagnostic performance of coronary angiography-derived cFFR in catheterization laboratory, based on a previous multicenter trial for online assessment of coronary angiography-derived FFR (caFFR). METHODS Patients with diagnosis of stable angina pectoris or unstable angina pectoris were enrolled in six centers. Wire-based FFR was measured in coronary arteries with 30-90% diameter stenosis. Offline angiography-derived cFFR was computed in blinded fashion against the wire-based FFR and caFFR at an independent core laboratory. RESULTS A total of 330 patients were enrolled to fulfill inclusion/exclusion criteria from June 26 to December 18, 2018. Offline angiography-derived cFFR and wire-based FFR results were compared in 328 interrogated vessels. The statistical analysis showed the highest diagnostic accuracy of 89.0 and 86.6% for angiography-derived cFFR with a cutoff value of 0.94 and 0.93 against the wire-based FFR with a cutoff value of 0.80 and 0.75, respectively. The corresponding sensitivity and specificity were 92.2 and 87.3% for the cutoff value of 0.94 and 80.0 and 88.4% for the cutoff value of 0.93, which are similar to those against the caFFR. The receiver-operating curve has area under the curve of 0.951 and 0.972 for the wire-based FFR with the cutoff value of 0.80 and 0.75, respectively. CONCLUSIONS Coronary angiography-derived cFFR showed higher accuracy, sensitivity, and specificity against wired-based FFR and caFFR. Hence, angiography-derived cFFR could enhance the hemodynamic assessment of coronary lesions.
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Affiliation(s)
- Yanjun Gong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Tieci Yi
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fan Yang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Tao Hong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Zhaoping Liu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yunlong Huo
- PKU-HKUST Shenzhen-Hongkong Institution, Shenzhen, Guangdong, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
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13
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Ahmad A, Corban MT, Lerman A. Contrast fractional flow reserve vs adenosine fractional flow reserve: The impact of discordant results. Int J Cardiol 2020; 328:59-60. [PMID: 33316257 DOI: 10.1016/j.ijcard.2020.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ali Ahmad
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michel T Corban
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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Gutiérrez-Barrios A, Noval-Morillas I, Camacho-Freire S, Puche JE, Gheorghe L, Silva E, Alarcon-Lastra I, Cañadas-Pruaño D, Gómez-Menchero A, Calle-Pérez G, Diaz-Fernandez JF, Vázquez-García R. Contrast FFR plus intracoronary injection of nitro-glycerine accurately predicts FFR for coronary stenosis functional assessment. Minerva Cardiol Angiol 2020; 69:449-457. [PMID: 33258564 DOI: 10.23736/s2724-5683.20.05354-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) is the "gold standard" for assessing the physiological significance of coronary disease. In the last decade, several alternative adenosine-free indexes have been proposed in order to facilitate the dissemination of the functional evaluation of coronary stenosis. Our aim was to investigate whether radiographic contrast plus intracoronary nitroglycerin (cFFR-NTG) can predict functional assessment of coronary stenosis offering superior diagnostic agreement with FFR compared to non-hyperemic indexes and contrast mediated FFR (cFFR). METHODS Three hundred twenty-nine lesions evaluated with pressure wire in 266 patients were prospectively included in this multicenter study. RESULTS The ROC curves for cFFR-NTG using an FFR≤0.80 showed a higher accuracy in predicting FFR (AUC=0.97) than resting Pd/Pa (AUC=0.90, P<0.01) and cFFR (AUC=0.93.5, P<0.01). A significant (P<0.01) strong correlation was found between FFR and the four analyzed indexes: Pd/Pa (r=0.78); iFR/RFR (r=0.73); cFFR(r=0.89) and cFFR-NTG (r=0.93). cFFR-NTG showed the closest agreement at Bland-Altman analysis. The cFFR-NTG cut off value >0.84 showed the highest negative predictive value (88%), specificity (91%), sensitivity (94%) and accuracy (92%) of the studied indexes. CONCLUSIONS Submaximal hyperemic adenosine-free indexes are an efficient alternative to adenosine for the physiological assessment of epicardial coronary disease. The most accurate index in predicting the functional significance of coronary stenosis using FFR as reference was cFFR-NTG.
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Affiliation(s)
- Alejandro Gutiérrez-Barrios
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain - .,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain -
| | - Inmaculada Noval-Morillas
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
| | | | - Juan E Puche
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain
| | - Livia Gheorghe
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
| | - Etelvino Silva
- Department of Cardiology, Juan Ramón Jiménez Hospital, Huelva, Spain
| | | | - Dolores Cañadas-Pruaño
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
| | | | - Germán Calle-Pérez
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
| | | | - Rafael Vázquez-García
- Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain.,Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain
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15
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Leone AM, Arioti M, Cialdella P, Vergallo R, Zimbardo G, Migliaro S, Anastasia G, Di Giusto F, Galante D, Basile E, Pepe FL, Ierardi C, D'Amario D, Burzotta F, Aurigemma C, Niccoli G, Trani C, Crea F. Prognostic impact of FFR/contrast FFR discordance. Int J Cardiol 2020; 327:40-44. [PMID: 33186664 DOI: 10.1016/j.ijcard.2020.11.011] [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: 04/05/2020] [Revised: 06/21/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Contrast fractional flow reserve (cFFR) is a relatively new tool for the assessment of intermediate coronary artery stenosis and represents a reliable surrogate of FFR with the advantage of potentially simplifying functional evaluation. We aimed to compare the incidence of major adverse cardiac events (MACE) in patients undergoing functional evaluation with both FFR and cFFR based on the results of the two indexes. METHOD AND RESULT We retrospectively analyzed outcomes in 488 patients who underwent functional evaluation with FFR and cFFR. Patients were divided into four groups using the cutoff values of 0.80 for FFR and 0.85 for cFFR: -/- (n = 298), +/+ (n = 134), -/+(n = 31) and +/- (n = 25). All patients were treated according to FFR value. MACE rate was assessed in each group, including death, myocardial infarction and urgent target vessel revascularization (TVR). Mean follow-up time was 22 ± 15 months. Incidence of MACE at follow-up was 8.3% in FFR-/cFFR-, 14.0% in FFR+/cFFR+, 16.0% in FFR-/cFFR+ and 8.0% in FFR+/cFFR- without a significant difference amongst the 4 groups (p = 0.2). Nevertheless, a significant difference in the rate of TVR comparing FFR-/cFFR- (n = 17) and FFR-/cFFR+ (n = 5) was found at 24 months (5.7% vs 16.0%; p = 0.027). CONCLUSION cFFR is accurate in predicting FFR and consequently reliable in guiding coronary revascularization. In the rare case of discordance, while FFR+/cFFR- patients show a prognosis similar to FFR-/cFFR- patients, FFR-/cFFR+ patients show a prognosis similar to FFR+/cFFR+ patients.
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Affiliation(s)
| | | | | | - Rocco Vergallo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | | | | | | | | | | | | | - Carolina Ierardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Giampaolo Niccoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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16
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DI Pietro R, Versaci F, Prati F, Burzotta F. Adenosine and fractional flow reserve: no reason to be afraid anymore! Minerva Cardiol Angiol 2020; 69:446-448. [PMID: 33146487 DOI: 10.23736/s2724-5683.20.05501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Riccardo DI Pietro
- Unit of Hemodynamics, Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy -
| | - Francesco Versaci
- Unit of Hemodynamics, Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy
| | - Francesco Prati
- Department of Cardiovascular Surgery, San Giovanni Addolorata Hospital, Rome, Italy.,Center for Stroke Research Foundation (CLI), Rome, Italy
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17
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Contrast Fractional Flow Reserve (cFFR) and Computed Tomography Fractional Flow Reserve (CT-FFR) Guidance for Percutaneous Coronary Intervention (PCI). CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-09543-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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18
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Utility of Saline-Induced Resting Full-Cycle Ratio Compared with Resting Full-Cycle Ratio and Fractional Flow Reserve. J Interv Cardiol 2020; 2020:5787439. [PMID: 32327943 PMCID: PMC7166294 DOI: 10.1155/2020/5787439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/22/2020] [Accepted: 02/24/2020] [Indexed: 11/18/2022] Open
Abstract
Background The saline-induced distal coronary pressure/aortic pressure ratio predicted fractional flow reserve (FFR). The resting full-cycle ratio (RFR) represents the maximal relative pressure difference in a cardiac cycle. Therefore, the present study aimed to compare the results of saline-induced RFR (sRFR) with FFR. Methods Seventy consecutive lesions with only moderate stenosis were included. The FFR, RFR, and sRFR values were compared. The sRFR was assessed using an intracoronary bolus infusion of saline (2 mL/s) for five heartbeats. The FFR was obtained after an intravenous injection of papaverine. Results Overall, the FFR, sRFR, and RFR values were 0.78 ± 0.12, 0.79 ± 0.13, and 0.83 ± 0.14, respectively. With regard to anatomical morphology were 40, 18, and 12 cases of focal, diffuse, and tandem lesion. There was a significant correlation between the sRFR and FFR (R = 0.96, p < 0.01). There were also significant correlations between the sRFR and FFR in the left coronary and right coronary artery (R = 0.95, p < 0.01 and R = 0.98, p < 0.01). Furthermore, significant correlations between sRFR and FFR were observed in not only focal but also in nonfocal lesion including tandem and diffuse lesions (R = 0.93, p < 0.01 and R = 0.97, p < 0.01). A close agreement on FFR and sRFR was shown using the Bland–Altman analysis (95% CI of agreement: −0.08–0.07). In the receiver operating characteristic curve analysis, the cutoff value of sRFR to predict an FFR of 0.80 was 0.81 (area under curve, 0.97; sensitivity 90.6%; and specificity 98.2%). Conclusion The sRFR can accurately and safely predict the FFR and might be effective for diagnosing ischemia.
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19
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De Maria GL, Garcia-Garcia HM, Scarsini R, Hideo-Kajita A, Gonzalo López N, Leone AM, Sarno G, Daemen J, Shlofmitz E, Jeremias A, Tebaldi M, Bezerra HG, Tu S, Lemos PA, Ozaki Y, Dan K, Collet C, Banning AP, Barbato E, Johnson NP, Waksman R. Novel Indices of Coronary Physiology. Circ Cardiovasc Interv 2020; 13:e008487. [DOI: 10.1161/circinterventions.119.008487] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Fractional flow reserve is the current invasive gold standard for assessing the ischemic potential of an angiographically intermediate coronary stenosis. Procedural cost and time, the need for coronary vessel instrumentation, and the need to administer adenosine to achieve maximal hyperemia remain integral components of invasive fractional flow reserve. The number of new alternatives to fractional flow reserve has proliferated over the last ten years using techniques ranging from alternative pressure wire metrics to anatomic simulation via angiography or intravascular imaging. This review article provides a critical description of the currently available or under-development alternatives to fractional flow reserve with a special focus on the available evidence, pros, and cons for each with a view towards their clinical application in the near future for the functional assessment of coronary artery disease.
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Affiliation(s)
- Giovanni Luigi De Maria
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom (G.L.D.M., R.S., A.P.B.)
| | - Hector M. Garcia-Garcia
- MedStar Washington Hospital Centre, Interventional Cardiology Department, Washington, DC (Y.O., H.M.G.-G., A.H.-K., E.S., K.D., R.W.)
| | - Roberto Scarsini
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom (G.L.D.M., R.S., A.P.B.)
| | - Alexandre Hideo-Kajita
- MedStar Washington Hospital Centre, Interventional Cardiology Department, Washington, DC (Y.O., H.M.G.-G., A.H.-K., E.S., K.D., R.W.)
| | - Nieves Gonzalo López
- Interventional Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain (N.G.L.)
| | | | - Giovanna Sarno
- Interventional Cardiology Department, Uppsala University, Sweden (G.S.)
| | - Joost Daemen
- Interventional Cardiologist at Erasmus University Rotterdam, the Netherlands (J.D.)
| | - Evan Shlofmitz
- MedStar Washington Hospital Centre, Interventional Cardiology Department, Washington, DC (Y.O., H.M.G.-G., A.H.-K., E.S., K.D., R.W.)
| | - Allen Jeremias
- Cardiac Catheterization Laboratory, St. Francis Hospital, Roslyn, NY (A.J.)
| | - Matteo Tebaldi
- Department of Cardiology, University of Ferrara, Italy (M.T.)
| | | | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T.)
| | - Pedro A. Lemos
- Instituto do Coracao (InCor), Universidade de São Paulo, Brazil (P.A.L.)
- Hospital Israelita Albert Einstein, Brazil (P.A.L.)
| | - Yuichi Ozaki
- MedStar Washington Hospital Centre, Interventional Cardiology Department, Washington, DC (Y.O., H.M.G.-G., A.H.-K., E.S., K.D., R.W.)
| | - Kazuhiro Dan
- MedStar Washington Hospital Centre, Interventional Cardiology Department, Washington, DC (Y.O., H.M.G.-G., A.H.-K., E.S., K.D., R.W.)
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Belgium (C.C.)
| | - Adrian P. Banning
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom (G.L.D.M., R.S., A.P.B.)
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy (E.B.)
| | - Nils P. Johnson
- McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX (N.P.J.)
| | - Ron Waksman
- MedStar Washington Hospital Centre, Interventional Cardiology Department, Washington, DC (Y.O., H.M.G.-G., A.H.-K., E.S., K.D., R.W.)
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20
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Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses. J Interv Cardiol 2020. [DOI: 10.1155/2020/7352150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Use of the fractional flow reserve (FFR) technique is recommended to evaluate coronary stenosis severity and guide revascularization. However, its high cost, time to administer, and the side effects of adenosine reduce its clinical utility. Two novel adenosine-free indices, contrast-FFR (cFFR) and quantitative flow ratio (QFR), can simplify the functional evaluation of coronary stenosis. This study aimed to analyze the diagnostic performance of cFFR and QFR using FFR as a reference index. Methods. We conducted a systematic review and meta-analysis of observational studies in which cFFR or QFR was compared to FFR. A bivariate model was applied to pool diagnostic parameters. Cochran’s Q test and the I2 index were used to assess heterogeneity and identify the potential source of heterogeneity by metaregression and sensitivity analysis. Results. Overall, 2220 and 3000 coronary lesions from 20 studies were evaluated by cFFR and QFR, respectively. The pooled sensitivity and specificity were 0.87 (95% CI: 0.81, 0.91) and 0.92 (95% CI: 0.88, 0.94) for cFFR and 0.87 (95% CI: 0.82, 0.91) and 0.91 (95% CI: 0.87, 0.93) for QFR, respectively. No statistical significance of sensitivity and specificity for cFFR and QFR were observed in the bivariate analysis (P=0.8406 and 0.4397, resp.). The area under summary receiver-operating curve of cFFR and QFR was 0.95 (95% CI: 0.93, 0.97) for cFFR and 0.95 (95% CI: 0.93, 0.97). Conclusion. Both cFFR and QFR have good diagnostic performance in detecting functional severity of coronary arteries and showed similar diagnostic parameters.
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Adenosine-Free Indexes vs. Fractional Flow Reserve for Functional Assessment of Coronary Stenoses: Systematic Review and Meta-Analysis. Int J Cardiol 2020; 299:93-99. [DOI: 10.1016/j.ijcard.2019.07.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 06/30/2019] [Accepted: 07/09/2019] [Indexed: 01/10/2023]
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Leone AM, Cialdella P, Lassandro Pepe F, Basile E, Zimbardo G, Arioti M, Ciriello G, D'Amario D, Buffon A, Burzotta F, Porto I, Aurigemma C, Niccoli G, Rebuzzi AG, Trani C, Crea F. Fractional flow reserve in acute coronary syndromes and in stable ischemic heart disease: clinical implications. Int J Cardiol 2019; 277:42-46. [DOI: 10.1016/j.ijcard.2018.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/25/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Aoun J, Lahsaei S, Zahm C, Bhat T, Carrozza JP. Validation and comparison of non‐hyperemic pressure reserve to fractional flow reserve for assessment of coronary artery stenosis: A real world study. Catheter Cardiovasc Interv 2019; 93:250-255. [DOI: 10.1002/ccd.27834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/26/2018] [Accepted: 07/28/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Joe Aoun
- Department of MedicineSt. Elizabeth's Medical Center, Tufts University School of Medicine Boston Massachusetts
| | - Saba Lahsaei
- Department of Cardiovascular MedicineSt. Elizabeth's Medical Center, Tufts University School of Medicine Boston Massachusetts
| | - Caroline Zahm
- Department of MedicineSt. Elizabeth's Medical Center, Tufts University School of Medicine Boston Massachusetts
| | - Tariq Bhat
- Department of Cardiovascular MedicineSt. Elizabeth's Medical Center, Tufts University School of Medicine Boston Massachusetts
| | - Joseph P. Carrozza
- Department of Cardiovascular MedicineSt. Elizabeth's Medical Center, Tufts University School of Medicine Boston Massachusetts
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Maznyczka A, Berry C. Contrast fractional flow reserve: Attractive alternative to non-hyperaemic pressure ratios for coronary disease evaluation. Int J Cardiol 2019; 275:46-47. [PMID: 30509373 DOI: 10.1016/j.ijcard.2018.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/05/2018] [Accepted: 10/17/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Annette Maznyczka
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, UK.
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Gili S, Barbero U, Errigo D, De Luca G, Biondi-Zoccai G, Leone AM, Iannaccone M, Montefusco A, Omedé P, Moretti C, D'Amico M, Gaita F, D'Ascenzo F. Intracoronary versus intravenous adenosine to assess fractional flow reserve: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2018; 19:274-283. [PMID: 29553991 DOI: 10.2459/jcm.0000000000000652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Intravenous infusion of adenosine is the reference method to measure fractional flow reserve (FFR). Intracoronary boluses are often used because of time and convenience, but their effectiveness has yet to be assessed. METHODS We conducted a systematic review and meta-analysis of prospective studies directly comparing intravenous and intracoronary adenosine administration for FFR measurement. FFR values and prevalence of functionally critical lesions obtained with the different methods of adenosine administration were compared. RESULTS Twelve studies evaluating 781 lesions from 731 patients were included (63.7 years, 25.5% women, median FFR 0.82). FFR values were significantly lower with intravenous adenosine than with intracoronary adenosine [mean difference 0.01, 95% confidence interval (CI) 0.00-0.02, P = 0.005], even if no significant differences were observed when only high doses of intracoronary adenosine (≥150 μg) were considered. The prevalence of functionally critical lesions did not significantly differ between intracoronary and intravenous adenosine. Concerning the use of different doses of intracoronary adenosine, low doses (≤60 μg) were associated with higher FFR values (mean difference 0.02, 95% CI 0.01-0.03, P < 0.001) and fewer functionally critical lesions (OR 0.57, 95% CI 0.40-0.81, P = 0.002) compared with high doses. Meta-regression analysis did not show any significant interaction between the way of adenosine administration and main clinical features. Intracoronary adenosine was associated with a higher incidence of atrioventricular blocks, whereas angina and/or systemic symptoms were more frequent with intravenous adenosine. CONCLUSION Intracoronary adenosine might be as effective as intravenous adenosine to measure FFR, provided that adequate doses are used. Intracoronary adenosine represents a valuable alternative to intravenous adenosine whenever appropriately administered.
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Affiliation(s)
- Sebastiano Gili
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Umberto Barbero
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Daniele Errigo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliera-Universitaria 'Maggiore della Carità,' Eastern Piedmont University, Novara
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza Università di Roma, Rome.,Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli
| | - Antonio Maria Leone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Mario Iannaccone
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Antonio Montefusco
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Pierluigi Omedé
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Claudio Moretti
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Maurizio D'Amico
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Fiorenzo Gaita
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
| | - Fabrizio D'Ascenzo
- Department of Medical Sciences, Division of Cardiology, AOU Città della Salute e della Scienza, University of Turin
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Fujimori Y, Baba T, Yamazaki K, Hashimoto S, Yamanaka Y, Ebisuda K, Kurihara K, Koike N, Takeuchi N, Nishiyama S, Terasawa Y, Wakabayashi T, Imai T. Saline-induced Pd/Pa ratio predicts functional significance of coronary stenosis assessed using fractional flow reserve. EUROINTERVENTION 2018; 14:898-906. [PMID: 29688181 DOI: 10.4244/eij-d-17-01010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Fractional flow reserve (FFR), assessed using distal coronary pressure/aortic pressure (Pd)/(Pa) ratio, functionally evaluates coronary stenosis. An assessment method without vasodilators would be helpful. A single intracoronary bolus of saline decreases Pd because of the speculated low-viscosity effect. We hypothesised that saline-induced Pd/Pa ratio (SPR) could functionally evaluate coronary stenosis. This study aimed to test the accuracy and utility of SPR for predicting FFR ≤0.80. METHODS AND RESULTS In 137 coronary lesions with over 50% angiographic diameter stenosis, SPR was assessed using an intracoronary bolus of saline (2 mL/s) for five heartbeats (SPR-5) and three heartbeats (SPR-3). FFR was obtained after intravenous adenosine infusion (140 µg/kg/min). There was a strong correlation between FFR and SPR-5 or SPR-3 (R=0.941 and R=0.933, respectively). Receiver operating characteristic (ROC) curve analysis demonstrated good accuracy (86.3%) for SPR-5, with a cut-off of ≤0.84 for predicting FFR ≤0.80 (area under ROC curve 0.96, specificity 94.3, sensitivity 79.9). Thirty-three lesions (24%) were located in the "grey zone" (SPR 0.83-0.88). No complications were observed in 673 SPR measurements. CONCLUSIONS SPR may accurately predict FFR and can limit adenosine use to one in four lesions. Further studies are needed to confirm the validity of SPR.
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Contrast Fractional Flow Reserve (cFFR): A pragmatic response to the call for simplification of invasive functional assessment. Int J Cardiol 2018; 268:45-50. [DOI: 10.1016/j.ijcard.2018.04.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 01/29/2023]
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Nishi T, Johnson NP, De Bruyne B, Berry C, Gould KL, Jeremias A, Oldroyd KG, Kobayashi Y, Choi DH, Pijls NHJ, Fearon WF. Influence of Contrast Media Dose and Osmolality on the Diagnostic Performance of Contrast Fractional Flow Reserve. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.004985. [PMID: 29042397 DOI: 10.1161/circinterventions.117.004985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/15/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Contrast fractional flow reserve (cFFR) is a method for assessing functional significance of coronary stenoses, which is more accurate than resting indices and does not require adenosine. However, contrast media volume and osmolality may affect the degree of hyperemia and therefore diagnostic performance. METHODS AND RESULTS cFFR, instantaneous wave-free ratio, distal pressure/aortic pressure at rest, and FFR were measured in 763 patients from 12 centers. We compared the diagnostic performance of cFFR between patients receiving low or iso-osmolality contrast (n=574 versus 189) and low or high contrast volume (n=341 versus 422) using FFR≤0.80 as a reference standard. The sensitivity, specificity, and overall accuracy of cFFR for the low versus iso-osmolality groups were 73%, 93%, and 85% versus 87%, 90%, and 89%, and for the low versus high contrast volume groups were 69%, 99%, and 83% versus 82%, 93%, and 88%. By receiver operating characteristics (ROC) analysis, cFFR provided better diagnostic performance than resting indices regardless of contrast osmolality and volume (P<0.001 for all groups). There was no significant difference between the area under the curve of cFFR in the low- and iso-osmolality groups (0.938 versus 0.957; P=0.40) and in the low- and high-volume groups (0.939 versus 0.949; P=0.61). Multivariable logistic regression analysis showed that neither contrast osmolality nor volume affected the overall accuracy of cFFR; however, both affected the sensitivity and specificity. CONCLUSIONS The overall accuracy of cFFR is greater than instantaneous wave-free ratio and distal pressure/aortic pressure and not significantly affected by contrast volume and osmolality. However, contrast volume and osmolality do affect the sensitivity and specificity of cFFR. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02184117.
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Affiliation(s)
- Takeshi Nishi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Nils P Johnson
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Bernard De Bruyne
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Colin Berry
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - K Lance Gould
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Allen Jeremias
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Keith G Oldroyd
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Yuhei Kobayashi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Dong-Hyun Choi
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - Nico H J Pijls
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.)
| | - William F Fearon
- From the Stanford University Medical Center, CA (T.N., Y.K., D.-H.C., W.F.F.); Stanford Cardiovascular Institute, CA (T.N., Y.K., D.-H.C., W.F.F.); University of Texas Medical School and Memorial Hermann Hospital, Houston (N.P.J., K.L.G.); Cardiovascular Center Aalst, Belgium (B.D.B.); West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland (C.B., K.G.O.); British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland (C.B.); Division of Cardiovascular Medicine, Stony Brook University Medical Center, NY (A.J.); Cardiovascular Research Foundation (CFR), New York, NY (A.J.); Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P.); and Eindhoven University of Technology, the Netherlands (N.H.J.P.).
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Maini R, Moscona J, Sidhu G, Katigbak P, Fernandez C, Irimpen A, Mogabgab O, Ward C, Samson R, LeJemtel T. Pooled diagnostic accuracy of resting distal to aortic coronary pressure referenced to fractional flow reserve: The importance of resting coronary physiology. J Interv Cardiol 2018; 31:588-598. [PMID: 29707808 DOI: 10.1111/joic.12517] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/19/2018] [Accepted: 04/02/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Both resting and hyperemic physiologic methods to guide coronary revascularization improve cardiovascular outcomes compared with angiographic guidance alone. Fractional flow reserve (FFR) remains underutilized due to concerns regarding hyperemia, prompting study of resting distal to aortic coronary pressure (Pd/Pa). Pd/Pa is a vasodilator-free resting index unlike FFR. While Pd/Pa is similar to another resting index, instantaneous wave-free ratio (iFR), it is a whole-cycle measurement not limited to the wave-free diastolic period. Pd/Pa is not validated clinically although multiple accuracy studies have been performed. Our meta-analysis examines the overall diagnostic accuracy of Pd/Pa referenced to FFR, the accepted invasive standard of ischemia. METHODS We searched PubMed, EMBASE, Central, ProQuest, and Web of Science databases for full text articles published through August 9, 2017 addressing the diagnostic accuracy of Pd/Pa referenced to FFR < 0.80. The following keywords were used: "distal coronary artery pressure" OR "Pd/Pa" AND "fractional flow reserve" OR "FFR." RESULTS In total, 14 studies comprising 7004 lesions were identified. Pooled diagnostic accuracy estimates of Pd/Pa versus FFR < 0.80 were: sensitivity, 0.77 (95% CI, 0.75-0.78); specificity, 0.82 (0.81-0.83); positive likelihood ratio, 4.7 (3.3-6.6); negative likelihood ratio, 0.29 (0.24-0.34); diagnostic odds ratio, 18.1 (14.4-22.6); area under the summary receiver-operating characteristic curve of 0.88; and diagnostic accuracy of 0.80 (0.76-0.83). CONCLUSIONS Pd/Pa shows adequate agreement with FFR as a resting index of coronary stenosis severity without the undesired effects and cost of hyperemic agents. Pd/Pa has the potential to guide coronary revascularization with easier application and availability compared with iFR and FFR.
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Affiliation(s)
- Rohit Maini
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | - John Moscona
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Gursukhman Sidhu
- The Wright Center for Graduate Medical Education, Scranton, Pennsylvania
| | - Paul Katigbak
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Camilo Fernandez
- Division of Precision Medicine, HeartGEN Institute, Boston, Massachusetts
| | - Anand Irimpen
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Owen Mogabgab
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Charisse Ward
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Rohan Samson
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana
| | - Thierry LeJemtel
- Division of Cardiology, Department of Medicine, Tulane University, New Orleans, Louisiana
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Spagnoli V, Picard F, Tadros VX, Cournoyer D, Doucet S, Tanguay JF, Gosselin G, de Guise P, Gallo R. Simplifying the assessment of coronary artery stenosis by enhancing instantaneous wave free ratio. Cardiovasc Diagn Ther 2018; 8:156-163. [PMID: 29850406 DOI: 10.21037/cdt.2017.12.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Instantaneous wave free ratio (iFR) does not require adenosine, but has a relatively wide intermediate range where functional assessment remains inconclusive. In this pilot study, we sought to enhance iFR through with the use of intracoronary (IC) saline (iFRs) and contrast media (iFRc) and determine whether these techniques correlated well with fractional flow reserve (FFR). Methods Patients with coronary artery stenosis (CAS) associated with an iFR in the intermediate zone (≥0.86 and ≤0.93) were prospectively assessed with resting distal coronary pressure/aorta pressure (Pd/Pa), iFR, iFRs, iFRc and FFR. Results A total of 40 coronary lesions were studied (40 patients). Pearson correlation coefficients for FFR and iFR, FFR and iFRs, FFR and iFRc were respectively: 0.57 (P=0.0002), 0.80 (P<0.0001) and 0.77 (P<0.0001). Receiver-operating characteristic (ROC) curve analysis showed similar area under the curve (AUC) of iFRs and iFR [0.90 (95% CI: 0.76-1) vs. 0.89 (95% CI: 0.79-0.99), P=0.89]. Youden's index established cut-off values of ≤0.90 for iFR (sensitivity =91%, specificity =74%) and ≤0.78 for iFRs (sensitivity =73%, specificity =100%). In contrast, the AUC of iFRc was superior to the AUC of iFR [0.99 (95% CI: 0.98-1), P=0.049]. iFRc showed excellent accuracy and established cut-off values of ≤0.81 in predicting an FFR value of ≤0.80 (sensitivity =100%, specificity =93%). Conclusions When iFR is in the intermediate zone, functional assessment of CAS by iFR is enhanced with the use of contrast media but not saline. This pilot study could be hypothesis generating for further study to enhance iFR specificity and sensibility.
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Affiliation(s)
- Vincent Spagnoli
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Fabien Picard
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Victor-Xavier Tadros
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | | | - Serge Doucet
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Jean François Tanguay
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Gilbert Gosselin
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Pierre de Guise
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
| | - Richard Gallo
- Department of Cardiology, Montréal Heart Institute, Université de Montréal, Montréal, Canada
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Westra J, Tu S, Winther S, Nissen L, Vestergaard MB, Andersen BK, Holck EN, Fox Maule C, Johansen JK, Andreasen LN, Simonsen JK, Zhang Y, Kristensen SD, Maeng M, Kaltoft A, Terkelsen CJ, Krusell LR, Jakobsen L, Reiber JHC, Lassen JF, Bøttcher M, Bøtker HE, Christiansen EH, Holm NR. Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography: The WIFI II Study (Wire-Free Functional Imaging II). Circ Cardiovasc Imaging 2018; 11:e007107. [PMID: 29555835 PMCID: PMC5895131 DOI: 10.1161/circimaging.117.007107] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/11/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire-Free Functional Imaging II) was to evaluate the feasibility and diagnostic performance of QFR in unselected consecutive patients. METHODS AND RESULTS WIFI II was a predefined substudy to the Dan-NICAD study (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease), referring 362 consecutive patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50±12%. Mean difference between FFR and QFR was 0.01±0.08. QFR correctly classified 83% of the lesions using FFR with cutoff at 0.80 as reference standard. The area under the receiver operating characteristic curve was 0.86 (95% confidence interval, 0.81-0.91) with a sensitivity, specificity, negative predictive value, and positive predictive value of 77%, 86%, 75%, and 87%, respectively. A QFR-FFR hybrid approach based on the present results enables wire-free and adenosine-free procedures in 68% of cases. CONCLUSIONS Functional lesion evaluation by QFR assessment showed good agreement and diagnostic accuracy compared with FFR. Studies comparing clinical outcome after QFR- and FFR-based diagnostic strategies are required. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02264717.
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Affiliation(s)
- Jelmer Westra
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.).
| | - Shengxian Tu
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.).
| | - Simon Winther
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Louise Nissen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Mai-Britt Vestergaard
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Birgitte Krogsgaard Andersen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Emil Nielsen Holck
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Camilla Fox Maule
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Jane Kirk Johansen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Lene Nyhus Andreasen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Jo Krogsgaard Simonsen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Yimin Zhang
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Steen Dalby Kristensen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Michael Maeng
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Anne Kaltoft
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Christian Juhl Terkelsen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Lars Romer Krusell
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Lars Jakobsen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Johan H C Reiber
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Jens Flensted Lassen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Morten Bøttcher
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Hans Erik Bøtker
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Evald Høj Christiansen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Niels Ramsing Holm
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
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AL-Obaidi FR, Fearon WF, Yong AS. Invasive physiological indices to determine the functional significance of coronary stenosis. IJC HEART & VASCULATURE 2018; 18:39-45. [PMID: 29876502 PMCID: PMC5988484 DOI: 10.1016/j.ijcha.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/13/2018] [Indexed: 01/10/2023]
Abstract
Physiological measurements are now commonly used to assess coronary lesions in the cardiac catheterisation laboratory, and this practice is evidence-based and supported by clinical guidelines. Fractional flow reserve is currently the gold standard method to determine whether coronary lesions are functionally significant, and is used to guide revascularization. There are however several other physiological measurements that have been proposed as alternatives to the fractional flow reserve. This review aims to comprehensively discuss physiological indices that can be used in the cardiac catheterisation laboratory to determine the functional significance of coronary lesions. We will focus on their advantages and disadvantages, and the current evidence supporting their use.
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Affiliation(s)
- Firas R. AL-Obaidi
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- College of Medicine, University of Thi Qar, Iraq
| | - William F. Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Andy S.C. Yong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
- ANZAC Research Institute, Concord Hospital, Sydney, Australia
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Leone A, Cialdella P, Martin-Reyes R, Baptista S, Amabile N, Raposo L. cFFR as an alternative to FFR: please do not contrast simplicity! EUROINTERVENTION 2017; 13:e1487-e1488. [DOI: 10.4244/eijv13i12a236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Ihdayhid AR, Yong A, Harper R, Rankin J, Wong C, Brown AJ, Leung M, Ko B. A Practical Guide for Fractional Flow Reserve Guided Revascularisation. Heart Lung Circ 2017; 27:406-419. [PMID: 29191506 DOI: 10.1016/j.hlc.2017.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/04/2017] [Accepted: 09/13/2017] [Indexed: 11/15/2022]
Abstract
The presence and extent of myocardial ischaemia is a major determinant of prognosis and benefit from revascularisation in patients with stable coronary artery disease. Fractional Flow Reserve (FFR) is accepted as the reference standard for invasive assessment of ischaemia. Its ability to detect lesion specific ischaemia makes it a useful test in a wide range of patient and lesion subsets, with FFR guided intervention improving clinical outcomes and reducing health care costs compared to assessment with coronary angiography alone. This article will review the basic principles in FFR, practical tips in FFR guided revascularisation and the role of emerging non-hyperaemic indices of ischaemia.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Andy Yong
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia
| | - Richard Harper
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | | | - Christopher Wong
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Michael Leung
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia.
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Picard F, Pighi M, Ly HQ. Fractional flow reserve and resting indices for coronary physiologic assessment: Practical guide, tips, and tricks. Catheter Cardiovasc Interv 2017; 90:598-611. [PMID: 28160376 DOI: 10.1002/ccd.26933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 11/19/2016] [Accepted: 12/22/2016] [Indexed: 01/10/2023]
Abstract
Physiologic assessment using fractional flow reserve (FFR) to guide percutaneous coronary interventions (PCI) has been demonstrated to improve clinical outcomes, compared to angiography-guided PCI. Recently, resting indices such as resting Pd/Pa, "instantaneous wave-free ratio", and contrast medium induced FFR have been evaluated for the assessment of the functional consequences of coronary lesions. Herein, we review and discuss the use of FFR and other indices for the functional assessment of coronary lesions. This review will cover theoretical aspects, as well as practical points and common pitfalls related to coronary physiological assessment. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Fabien Picard
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
| | - Michele Pighi
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
| | - Hung Q Ly
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
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Kobayashi Y, Johnson NP, Zimmermann FM, Witt N, Berry C, Jeremias A, Koo BK, Esposito G, Rioufol G, Park SJ, Nishi T, Choi DH, Oldroyd KG, Barbato E, Pijls NH, De Bruyne B, Fearon WF. Agreement of the Resting Distal to Aortic Coronary Pressure With the Instantaneous Wave-Free Ratio. J Am Coll Cardiol 2017; 70:2105-2113. [DOI: 10.1016/j.jacc.2017.08.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/10/2017] [Accepted: 08/10/2017] [Indexed: 01/09/2023]
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Macaya F, Cerrato E, Mejía-Rentería H, Ryan N, Salinas P, Núñez-Gil I, Escaned J. cFFR as an alternative to FFR: does the contrast still need to be contrasted? EUROINTERVENTION 2017; 12:e2278-e2279. [DOI: 10.4244/eij-d-16-00848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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