1
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Kotoku N, Ninomiya K, Ding D, O'Leary N, Tobe A, Miyashita K, Masuda S, Kageyama S, Garg S, Leipsic JA, Mushtaq S, Andreini D, Tanaka K, de Mey J, Wijns W, Tu S, Piazza N, Onuma Y, Serruys PW. Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters. Int J Cardiovasc Imaging 2024; 40:195-206. [PMID: 37870715 PMCID: PMC10774209 DOI: 10.1007/s10554-023-02974-z] [Citation(s) in RCA: 1] [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: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
Murray law-based quantitative flow ratio (µQFR) assesses fractional flow reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised in suboptimal angiographic projections. FFRCT is a well-validated non-invasive method measuring FFR from coronary computed tomographic angiography (CCTA). We evaluated the feasibility of µQFR in left main (LM) bifurcations, the impact of the optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance with FFRCT. In 300 patients with three-vessel disease, the values of FFRCT and µQFR were compared at distal LM, proximal left anterior descending artery (pLAD) and circumflex artery (pLCX). The optimal viewing angle of LM bifurcation was defined on CCTA by 3-dimensional coordinates and converted into a 2-dimensional fluoroscopic view. The best fluoroscopic projection was considered the closest angulation to the optimal viewing angle on CCTA. µQFR was successfully computed in 805 projections. In the best projections, µQFR sensitivity was 88.2% (95% CI 76.1-95.6) and 84.8% (71.1-93.7), and specificity was 96.8% (93.8-98.6) and 97.2% (94.4-98.9), in pLAD and pLCX, respectively, with regard to FFRCT. The AUC of µQFR for predicting FFRCT ≤ 0.80 tended to be improved using the best versus suboptimal projections (0.94 vs. 0.89 [p = 0.048] in pLAD; 0.94 vs. 0.88 [p = 0.075] in pLCX). Computation of µQFR in LM bifurcations using a single angiographic view showed high feasibility from post-hoc analysis of coronary angiograms obtained for clinical purposes. The fluoroscopic viewing angle influences the diagnostic performance of physiological assessment using a single angiographic view.
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Affiliation(s)
- Nozomi Kotoku
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Neil O'Leary
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Akihiro Tobe
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kotaro Miyashita
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Saima Mushtaq
- Departments of Cardiovascular Imaging and Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland.
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2
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Aleksandric S, Tesic M, Orlic D. Editorial: Challenges in the contemporary assessment of coronary physiology. Front Cardiovasc Med 2023; 10:1305913. [PMID: 37900567 PMCID: PMC10602796 DOI: 10.3389/fcvm.2023.1305913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 10/31/2023] Open
Affiliation(s)
- Srdjan Aleksandric
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejan Orlic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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3
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Masuda S, Serruys PW, Mushtaq S, Tanaka K, Mandry D, Buechel RR, Digne F, Schneider U, Pompilio G, La Meir M, Doenst T, Teichgraber U, Morel MA, Kotoku N, Ninomiya K, Kageyama S, O'Leary N, Collet C, Garg S, de Mey J, Andreini D, Onuma Y. The ability of computed tomography angiography to predict 5-year mortality in the SYNTAX III REVOLUTION trial. J Cardiovasc Comput Tomogr 2023; 17:318-325. [PMID: 37684158 DOI: 10.1016/j.jcct.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The feasibility of using coronary computed tomography angiography (CCTA) for long-term prediction of vital prognosis post-revascularization remains unknown. OBJECTIVES To compare the prognostic value of the SYNTAX score II 2020 (SS-2020) derived from invasive coronary angiography (ICA) or CCTA in patients with three-vessel disease and/or left main coronary artery disease undergoing percutaneous or surgical revascularization. METHODS In the SYNTAX III REVOLUTION trial, the probability of death at five years was retrospectively assessed by calculating the SS-2020 using ICA and CCTA. High- and low-risk patients for mortality were categorized according to the median percentages of predicted mortality based on both modalities. The discriminative abilities of the SS-2020 were assessed using Harrell's C statistic. RESULTS The vital status at five years of the 215 patients revascularized percutaneously (64 patients, 29.8%) or surgically (151 patients, 70.2%) was established through national registries. In patients undergoing revascularization, the SS-2020 was possibly helpful in discriminating vital prognosis at 5 years, with similar results seen with ICA and CCTA (C-index with ICA = 0.75, intercept = -0.19, slope = 0.92 and C-index with CCTA = 0.75, intercept = -0.22, slope = 0.99). In high- and low-risk patients, Kaplan-Meier estimates showed significant, and almost identical relative differences in observed mortality, irrespective of imaging modality (ICA: 93.8% vs 78.7%, log-lank P < 0.001; CCTA: 93.7% vs 78.5%, log-lank P < 0.001). CONCLUSIONS The predictive ability of the SS-2020 for five-year all-cause mortality derived from ICA and CCTA was comparable, and could helpfully discriminate vital prognosis in high- and low-risk patients.
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Affiliation(s)
| | | | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRRCS, Milan, Italy
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Damien Mandry
- Department of Radiology, CHRU Nancy and University of Lorraine, Nancy, France
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Franck Digne
- Hemodynamic Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Ulrich Schneider
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | - Giulio Pompilio
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRRCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Mark La Meir
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | - Ulf Teichgraber
- Department of Radiology, Friedrich-Schiller-University Jena, University Hospital Jena, Jena, Germany
| | | | - Nozomi Kotoku
- Department of Cardiology, University of Galway, Galway, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, Galway, Ireland
| | | | - Neil O'Leary
- Interventional Medicine and Innovation, University of Galway, Galway, Ireland
| | - Carlos Collet
- Onze Lieve Vrouwziekenhuis, Cardiovascular Center Aalst, Aalst, Belgium
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom; Department of Medical Education, University of Central Lancashire, Preston, United Kingdom
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, Galway, Ireland
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4
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Starczyński M, Dudek S, Baruś P, Niedzieska E, Wawrzeńczyk M, Ochijewicz D, Piasecki A, Gumiężna K, Milewski K, Grabowski M, Kochman J, Tomaniak M. Intravascular Imaging versus Physiological Assessment versus Biomechanics-Which Is a Better Guide for Coronary Revascularization. Diagnostics (Basel) 2023; 13:2117. [PMID: 37371012 DOI: 10.3390/diagnostics13122117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 06/29/2023] Open
Abstract
Today, coronary artery disease (CAD) continues to be a prominent cause of death worldwide. A reliable assessment of coronary stenosis represents a prerequisite for the appropriate management of CAD. Nevertheless, there are still major challenges pertaining to some limitations of current imaging and functional diagnostic modalities. The present review summarizes the current data on invasive functional and intracoronary imaging assessment using optical coherence tomography (OCT), and intravascular ultrasound (IVUS). Amongst the functional parameters-on top of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR)-we point to novel angiography-based measures such as quantitative flow ratio (QFR), vessel fractional flow reserve (vFFR), angiography-derived fractional flow reserve (FFRangio), and computed tomography-derived flow fractional reserve (FFR-CT), as well as hybrid approaches focusing on optical flow ratio (OFR), computational fluid dynamics and attempts to quantify the forces exaggerated by blood on the coronary plaque and vessel wall.
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Affiliation(s)
- Miłosz Starczyński
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Stanisław Dudek
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Piotr Baruś
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Emilia Niedzieska
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Mateusz Wawrzeńczyk
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Dorota Ochijewicz
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Adam Piasecki
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Karolina Gumiężna
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland, 43-316 Bielsko-Biała, Poland
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 02-097 Warsaw, Poland
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5
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Vardhan M, Randles A. Application of physics-based flow models in cardiovascular medicine: Current practices and challenges. BIOPHYSICS REVIEWS 2021; 2:011302. [PMID: 38505399 PMCID: PMC10903374 DOI: 10.1063/5.0040315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 03/21/2024]
Abstract
Personalized physics-based flow models are becoming increasingly important in cardiovascular medicine. They are a powerful complement to traditional methods of clinical decision-making and offer a wealth of physiological information beyond conventional anatomic viewing using medical imaging data. These models have been used to identify key hemodynamic biomarkers, such as pressure gradient and wall shear stress, which are associated with determining the functional severity of cardiovascular diseases. Importantly, simulation-driven diagnostics can help researchers understand the complex interplay between geometric and fluid dynamic parameters, which can ultimately improve patient outcomes and treatment planning. The possibility to compute and predict diagnostic variables and hemodynamics biomarkers can therefore play a pivotal role in reducing adverse treatment outcomes and accelerate development of novel strategies for cardiovascular disease management.
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Affiliation(s)
- M. Vardhan
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - A. Randles
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
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6
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Katagiri Y, Andreini D, Miyazaki Y, Takahashi K, Komiyama H, Mushtaq S, Sonck J, Schoors D, Maisano F, Kaufman PA, Leal I, Lindeboom W, Piek JJ, Wykrzykowska JJ, Morel MA, Bartorelli AL, Onuma Y, Serruys PW. Site vs. core laboratory variability in computed tomographic angiography-derived SYNTAX scores in the SYNTAX III trial. Eur Heart J Cardiovasc Imaging 2020; 22:1063-1071. [PMID: 32888011 DOI: 10.1093/ehjci/jeaa172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/03/2020] [Accepted: 05/28/2020] [Indexed: 01/30/2023] Open
Abstract
AIMS To investigate the variability between site and core laboratory (CL) calculation of the anatomical SYNTAX score (SS) based on coronary computed tomography angiography (CTA) alone and functional SS based on coronary CTA and fractional flow reserve derived from computed tomography (FFRCT) in the SYNTAX III trial. METHODS AND RESULTS The SYNTAX III trial was a multicentre, international study that included 223 patients with three-vessel disease with or without left main involvement. Functional SS was computed by subtracting non-flow limiting stenoses (FFRCT > 0.80) from anatomical SS. SS was combined with clinical information to generate the SYNTAX score II (SS II) that provides treatment recommendations. The mean anatomical SS based on coronary CTA alone was 33.4 ± 12.7 by sites and 37.1 ± 13.4 by CL (P < 0.001). The mean functional SS based on coronary CTA and FFRCT was 30.5 ± 13.0 by sites and 33.3 ± 13.6 by CL (P < 0.001). The intraclass correlation coefficient was 0.49 [95% confidence interval (CI) 0.37-0.59) in anatomical SS and 0.62 (95% CI 0.52-0.70) in functional SS. The Cohen's κ comparing treatment recommendation between sites and CL was 0.68 (95% CI 0.58-0.78) based on anatomical SS and 0.71 (95% CI 0.60-0.82) based on functional SS. CONCLUSION The mean anatomical SS derived from coronary CTA alone and functional SS based on coronary CTA and FFRCT were higher when assessed by the CL than by the sites themselves. However, substantial agreement in treatment recommendation by SS II between sites and CL was demonstrated. CLINICAL TRIALS.GOV IDENTIFIER NCT02385279.
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Affiliation(s)
- Yuki Katagiri
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Daniele Andreini
- Centro Cardiologico Monzino, University of Milano, Via Carlo Parea, 4, 20138 Milano, Italy.,Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Via della Commenda 19, 20122 Milano, Italy
| | - Yosuke Miyazaki
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Hidenori Komiyama
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Saima Mushtaq
- Centro Cardiologico Monzino, University of Milano, Via Carlo Parea, 4, 20138 Milano, Italy
| | - Jeroen Sonck
- Department of Cardiology, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, 9300 Aalst, Belgium.,Department of Advanced Biomedical Sciences, Federico II University of Naples, Corso Umberto I 40 - 80138 Napoli, Italy
| | - Danny Schoors
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Jette, Brussel, Belgium
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Philipp A Kaufman
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Ingrid Leal
- Cardialysis BV, Westblaak 98, 3012 KM Rotterdam, The Netherlands
| | - Wietze Lindeboom
- Cardialysis BV, Westblaak 98, 3012 KM Rotterdam, The Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, University of Milano, Via Carlo Parea, 4, 20138 Milano, Italy.,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Via Festa del Perdono, 7, 20122 Milano MI, Italy
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway, Ireland H91 TK33
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), University Road, Galway, Ireland H91 TK33.,Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College of London, Kensington, London SW7 2AZ, UK
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7
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Kogame N, Ono M, Kawashima H, Tomaniak M, Hara H, Leipsic J, Andreini D, Collet C, Patel MR, Tu S, Xu B, Bourantas CV, Lerman A, Piek JJ, Davies JE, Escaned J, Wijns W, Onuma Y, Serruys PW. The Impact of Coronary Physiology on Contemporary Clinical Decision Making. JACC Cardiovasc Interv 2020; 13:1617-1638. [DOI: 10.1016/j.jcin.2020.04.040] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 01/10/2023]
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8
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Tomaniak M, Serruys PW. Combining anatomy and physiology: New angiography-based and computed tomography coronary angiography-derived fractional flow reserve indices. Cardiol J 2020; 27:225-229. [PMID: 32583402 DOI: 10.5603/cj.2020.0080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/25/2020] [Accepted: 05/16/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
| | - Patrick W Serruys
- National Heart and Lung Institute, Imperial College London, United Kingdom. .,Department of Cardiology, National University of Ireland, Galway, Ireland.
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9
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Serruys PW, Chichareon P, Modolo R, Leaman DM, Reiber JH, Emanuelsson H, Di Mario C, Pijls NH, Morel MA, Valgimigli M, Farooq V, van Klaveren D, Capodanno D, Andreini D, Bourantas CV, Davies J, Banning AP, Escaned J, Piek JJ, Echavarría-Pinto M, Taylor CA, Thomsen B, Collet C, Pompilio G, Bartorelli AL, Glocker B, Dressler O, Stone GW, Onuma Y. The SYNTAX score on its way out or … towards artificial intelligence: part I. EUROINTERVENTION 2020; 16:44-59. [DOI: 10.4244/eij-d-19-00543a] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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10
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Serruys PW, Chichareon P, Modolo R, Leaman DM, Reiber JH, Emanuelsson H, Di Mario C, Pijls NH, Morel MA, Valgimigli M, Farooq V, van Klaveren D, Capodanno D, Andreini D, Bourantas CV, Davies J, Banning AP, Escaned J, Piek JJ, Echavarría-Pinto M, Taylor CA, Thomsen B, Collet C, Pompilio G, Bartorelli AL, Glocker B, Dressler O, Stone GW, Onuma Y. The SYNTAX score on its way out or … towards artificial intelligence: part II. EUROINTERVENTION 2020; 16:60-75. [DOI: 10.4244/eij-d-19-00543b] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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11
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FFR CT and CT perfusion: A review on the evaluation of functional impact of coronary artery stenosis by cardiac CT. Int J Cardiol 2019; 300:289-296. [PMID: 31466886 DOI: 10.1016/j.ijcard.2019.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/14/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022]
Abstract
Coronary computed tomography angiography (CCTA) is at the frontline of the diagnostic strategies to detect coronary artery disease (CAD). Anatomical information have proven to be insufficient to detect hemodynamic significant epicardial stenosis. In the present invited review we discuss on FFRCT and stress CTP, emerging technologies for an accurate and comprehensive evaluation of patients with suspected CAD, offering both anatomical (i.e. luminal and plaque) and functional assessment in one single technique.
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12
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Sonck J, Miyazaki Y, Collet C, Onuma Y, Asano T, Takahashi K, Kogame N, Katagiri Y, Modolo R, Serruys PW, Bartorelli AL, Andreini D, Doenst T, Maureira JP, Plass A, La Meir M, Pompillio G. Feasibility of planning coronary artery bypass grafting based only on coronary computed tomography angiography and CT-derived fractional flow reserve: a pilot survey of the surgeons involved in the randomized SYNTAX III Revolution trial. Interact Cardiovasc Thorac Surg 2019; 29:209–216. [PMID: 30887024 DOI: 10.1093/icvts/ivz046] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/04/2019] [Accepted: 02/10/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Invasive coronary angiography has been the preferred diagnostic method to guide the decision-making process between coronary artery bypass grafting (CABG) and percutaneous coronary intervention and plan a surgical revascularization procedure. Guidelines recommend a heart team approach and assessment of coronary artery disease (CAD) complexity, objectively quantified by the anatomical SYNTAX score. Coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (FFRCT) are emerging technologies in the diagnosis of stable CAD. In this study, data from patients with left main or 3-vessel CAD who underwent CABG were evaluated to assess the feasibility of developing a surgical plan based on CCTA integrated with FFRCT. The primary objective was to assess the theoretical feasibility of surgical decision-making and treatment planning based only on non-invasive imaging. METHODS This study represents a survey of surgeons involved in the SYNTAX III Revolution trial. In this trial, heart teams were randomized to make treatment decisions using CTA. CCTAs and FFRCT results of 20 patients were presented to 5 cardiac surgeons. RESULTS Surgical treatment decision-making based on CCTA with FFRCT was considered feasible by a panel of surgeons in 84% of the cases with an excellent agreement on the number of anastomoses to be made in each patient (intraclass correlation coefficient 0.77, 95% confidence interval 0.35-0.96). CONCLUSIONS Using non-invasive imaging only in patients with left main or 3-vessel CAD, an excellent agreement on treatment planning and the number of anastomoses was found among cardiac surgeons. Thus, CABG planning based on non-invasive imaging appears feasible. Further investigation is warranted to determine the safety and feasibility in clinical practice.
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Affiliation(s)
- Jeroen Sonck
- Department of Cardiology and Cardiovascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Yosuke Miyazaki
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Carlos Collet
- Department of Cardiology and Cardiovascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yoshinobu Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands.,Cardialysis BV, Rotterdam, Netherlands
| | - Taku Asano
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Norihiro Kogame
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Patrick W Serruys
- Cardialysis BV, Rotterdam, Netherlands.,Department of Cardiology, Imperial College of London, London, UK
| | - Antonio L Bartorelli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy.,Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | | | - Andre Plass
- Division of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Mark La Meir
- Department of Cardiology and Cardiovascular Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Giulio Pompillio
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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13
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Sonck J, Miyazaki Y, Mandry D, Andreini D. Non-invasive treatment planning of tandem coronary artery lesions using an interactive planner for PCI. EUROINTERVENTION 2018; 14:924-925. [DOI: 10.4244/eij-d-17-00815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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14
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Asano T, Katagiri Y, Collet C, Tenekecioglu E, Miyazaki Y, Sotomi Y, Amoroso G, Aminian A, Brugaletta S, Vrolix M, Hernandez-Antolín R, van de Harst P, Íñiguez-Romo A, Janssens L, Smits PC, Wykrzykowska JJ, Ribeiro VG, Pereira H, da Silva PC, Piek JJ, Reiber JH, von Birgelen C, Sabaté M, Onuma Y, Serruys PW. Functional comparison between the BuMA Supreme biodegradable polymer sirolimus-eluting stent and a durable polymer zotarolimus-eluting coronary stent using quantitative flow ratio: PIONEER QFR substudy. EUROINTERVENTION 2018; 14:e570-e579. [DOI: 10.4244/eij-d-17-00461] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Xie X, Zheng M, Wen D, Li Y, Xie S. A new CFD based non-invasive method for functional diagnosis of coronary stenosis. Biomed Eng Online 2018; 17:36. [PMID: 29566702 PMCID: PMC5863834 DOI: 10.1186/s12938-018-0468-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background Accurate functional diagnosis of coronary stenosis is vital for decision making in coronary revascularization. With recent advances in computational fluid dynamics (CFD), fractional flow reserve (FFR) can be derived non-invasively from coronary computed tomography angiography images (FFRCT) for functional measurement of stenosis. However, the accuracy of FFRCT is limited due to the approximate modeling approach of maximal hyperemia conditions. To overcome this problem, a new CFD based non-invasive method is proposed. Methods Instead of modeling maximal hyperemia condition, a series of boundary conditions are specified and those simulated results are combined to provide a pressure-flow curve for a stenosis. Then, functional diagnosis of stenosis is assessed based on parameters derived from the obtained pressure-flow curve. Results The proposed method is applied to both idealized and patient-specific models, and validated with invasive FFR in six patients. Results show that additional hemodynamic information about the flow resistances of a stenosis is provided, which cannot be directly obtained from anatomy information. Parameters derived from the simulated pressure-flow curve show a linear and significant correlations with invasive FFR (r > 0.95, P < 0.05). Conclusion The proposed method can assess flow resistances by the pressure-flow curve derived parameters without modeling of maximal hyperemia condition, which is a new promising approach for non-invasive functional assessment of coronary stenosis.
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Affiliation(s)
- Xinzhou Xie
- Department of Electronic Science and Technology, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi, People's Republic of China.
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 15 West Changle Road, Xi'an, Shaanxi, People's Republic of China
| | - Didi Wen
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, 15 West Changle Road, Xi'an, Shaanxi, People's Republic of China
| | - Yabing Li
- Department of Electronic Science and Technology, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi, People's Republic of China
| | - Songyun Xie
- Department of Electronic Science and Technology, Northwestern Polytechnical University, 127 West Youyi Road, Xi'an, Shaanxi, People's Republic of China
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16
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17
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Onuma Y, Collet C, van Geuns RJ, de Bruyne B, Christiansen E, Koolen J, Smits P, Chevalier B, McClean D, Dudek D, Windecker S, Meredith I, Nieman K, Veldhof S, Ormiston J, Serruys PW. Long-term serial non-invasive multislice computed tomography angiography with functional evaluation after coronary implantation of a bioresorbable everolimus-eluting scaffold: the ABSORB cohort B MSCT substudy. Eur Heart J Cardiovasc Imaging 2017; 18:870-879. [DOI: 10.1093/ehjci/jex022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/01/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Yoshinobu Onuma
- Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center,’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
- Cardiology Department, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Amsterdam, The Netherlands
| | - Carlos Collet
- Cardiology Department, Academic Medical Center, Amsterdam, Cardialysis, Westblaak 98, 3012 KM Rotterdam, The Netherlands
| | - Robert-Jan van Geuns
- Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center,’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Bernard de Bruyne
- Department of Cardiology, Onze-Lieve-Vrouwziekenhuis, Moorselbaan 164, 9300 Aalst, Belgium
| | - Evald Christiansen
- Department of Cardiology, Skejby Sygehus, Aarhus Universitet Skejby Sygehus, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark
| | - Jacques Koolen
- Department of Cardiology, Catharina Ziekenhuis, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Pieter Smits
- Department of Cardiology, Maasstad Ziekenhuis, Maasstadweg 21, 3079 DZ, Rotterdam, the Netherlands
| | - Bernard Chevalier
- Department of Interventional Cardiology, Institut Hospital Jacques Cartier, 6 Avenue du Noyer Lambert, 91300 Massy, France
| | - Dougal McClean
- Department of Cardiology, Christchurch Hospital, 2 Riccarton Ave, Christchurch Central, Christchurch 4710, New Zealand
| | - Dariusz Dudek
- Jagiellonian University Institute of Cardiology, University Hospital Krakow, Mikołaja Kopernika 36, 31-501 Kraków, Poland
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Ian Meredith
- Monash Heart, Monash Medical Centre, 246 Clayton Rd, Clayton VIC 3168, Melbourne, Australia
| | - Koen Nieman
- Department of Interventional Cardiology, ThoraxCenter, Erasmus University Medical Center,’s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
- Cardiology Department, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Amsterdam, The Netherlands
| | - Susan Veldhof
- Clinical Development, Abbott Vascular, Diegem, Belgium
| | - John Ormiston
- Department of Cardiology, Auckland City Hospital, 2 Park Rd, Grafton, Auckland 1023, New Zealand
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18
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Gonçalves PDA, Rodríguez-Granillo GA, Spitzer E, Suwannasom P, Loewe C, Nieman K, Garcia-Garcia HM. Functional Evaluation of Coronary Disease by CT Angiography. JACC Cardiovasc Imaging 2016; 8:1322-35. [PMID: 26563862 DOI: 10.1016/j.jcmg.2015.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/30/2015] [Accepted: 09/03/2015] [Indexed: 12/24/2022]
Abstract
In recent years, several technical developments in the field of cardiac computed tomography (CT) have made possible the extraction of functional information from an anatomy-based examination. Several different lines have been explored and will be reviewed in the present paper, namely: 1) myocardial perfusion imaging; 2) transluminal attenuation gradients and corrected coronary opacification indexes; 3) fractional flow reserve computed from CT; and 4) extrapolation from atherosclerotic plaque characteristics. In view of these developments, cardiac CT has the potential to become in the near future a truly 2-in-1 noninvasive evaluation for coronary artery disease.
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Affiliation(s)
| | - Gastón A Rodríguez-Granillo
- Department of Cardiovascular Imaging, Diagnostico Maipu, and Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | | | | | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Koen Nieman
- Departments of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hector M Garcia-Garcia
- Cardialysis B.V., Rotterdam, the Netherlands; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
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19
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Huo Y, Kassab GS. Scaling laws of coronary circulation in health and disease. J Biomech 2016; 49:2531-9. [DOI: 10.1016/j.jbiomech.2016.01.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 01/28/2016] [Indexed: 02/07/2023]
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20
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Bypass Grafting Versus Percutaneous Intervention-Which Is Better in Multivessel Coronary Disease: Lessons From SYNTAX and Beyond. Prog Cardiovasc Dis 2015; 58:316-34. [PMID: 26529569 DOI: 10.1016/j.pcad.2015.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The landmark Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Trial has aided in reducing the area of uncertainty in decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with complex coronary artery disease. As part of the SYNTAX Trial, quantification of the coronary artery disease burden was prospectively undertaken by the Heart Team - consisting of at least an interventional cardiologist and cardiac surgeon - utilising the anatomical SYNTAX Score (www.syntaxscore.com) as a clinical tool in order to agree that equivalent anatomical revascularisation could be achieved. The anatomical SYNTAX Score is now advocated in both European and US revascularisation guidelines to guide decision-making between CABG and PCI as part of the SYNTAX pioneered Heart Team approach. In addition, the SYNTAX Trial has lead to the development and validation of the SYNTAX Score II, in which the anatomical SYNTAX Score was augmented with clinical variables, to allow for more objective and tailored decision making for the individual patient. Prospective validation of the SYNTAX Score II tool is currently ongoing in the SYNTAX II (ClinicalTrials.gov Identifier: NCT02015832) and EXCEL (ClinicalTrials.gov identifier: NCT01205776) trials. The present paper presents lessons learned from SYNTAX, including the development and/or validation of several SYNTAX based clinical tools, and the potential implications for current and future clinical practice.
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Garcia-Garcia HM, Serruys PW, Campos CM, Muramatsu T, Nakatani S, Zhang YJ, Onuma Y, Stone GW. Assessing Bioresorbable Coronary Devices. JACC Cardiovasc Imaging 2014; 7:1130-48. [DOI: 10.1016/j.jcmg.2014.06.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/11/2014] [Accepted: 06/26/2014] [Indexed: 11/29/2022]
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22
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Pantos I, Katritsis D. Fractional Flow Reserve Derived from Coronary Imaging and Computational Fluid Dynamics. Interv Cardiol 2014; 9:145-150. [PMID: 29588793 DOI: 10.15420/icr.2014.9.3.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The assessment of functional severity of atherosclerotic stenoses in patients with coronary artery disease by invasive fractional flow reserve (FFR) measurement requires coronary artery cannulation, advancement of a wire and intravenous adenosine infusion with inherent procedure-related risk and costs. Coronary computed tomographic angiography (CCTA) and rotational coronary angiography (RA) have been recently used in conjunction with computational fluid dynamics (CFD) and image-based modelling for the determination of FFR without the need for additional imaging, modification of acquisition protocols or administration of medication. FFR derived from CCTA was demonstrated as superior to measures of CCTA stenosis severity for determination of lesion-specific ischaemia. Estimation of FFR from RA images and CFD provides a less invasive alternative to conventional FFR measurement while estimated values are in agreement with measured values. These new, combined anatomic-functional assessments have the potential to simplify the noninvasive diagnosis of coronary artery disease with a single study to identify patients with ischaemia-causing stenosis who may benefit from revascularisation.
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Affiliation(s)
- Ioannis Pantos
- Athens Euroclinic, Athens, Greece.,University of Athens, Greece
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23
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Lüscher TF, de Feyter P, Sabate M, Van Mieghem NM, Mahfoud F, Serruys PW. The European Heart Journal and EuroIntervention: information and education in interventional cardiology. EUROINTERVENTION 2013; 9:669-80. [DOI: 10.4244/eijv9i6a109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Affiliation(s)
- Nils P. Johnson
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing Atherosclerosis, University of Texas Medical School and Memorial Hermann Hospital, Houston
| | - Richard L. Kirkeeide
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing Atherosclerosis, University of Texas Medical School and Memorial Hermann Hospital, Houston
| | - K. Lance Gould
- From the Division of Cardiology, Department of Medicine, Weatherhead PET Center For Preventing and Reversing Atherosclerosis, University of Texas Medical School and Memorial Hermann Hospital, Houston
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25
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Abstract
The SYNTAX Score (http://www.syntaxscore.com) has established itself as an anatomical based tool for objectively determining the complexity of coronary artery disease and guiding decision-making between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Since the landmark SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) Trial comparing CABG with PCI in patients with complex coronary artery disease (unprotected left main or de novo three vessel disease), numerous validation studies have confirmed the clinical validity of the SYNTAX Score for identifying higher-risk subjects and aiding decision-making between CABG and PCI in a broad range of patient types. The SYNTAX Score is now advocated in both the European and US revascularisation guidelines for decision-making between CABG and PCI as part of a SYNTAX-pioneered heart team approach. Since establishment of the SYNTAX Score, widening clinical applications of this clinical tool have emerged. The purpose of this review is to systematically examine the widening applications of tools based on the SYNTAX Score: (1) by improving the diagnostic accuracy of the SYNTAX Score by adding a functional assessment of lesions; (2) through amalgamation of the anatomical SYNTAX Score with clinical variables to enhance decision-making between CABG and PCI, culminating in the development and validation of the SYNTAX Score II, in which objective and tailored decisions can be made for the individual patient; (3) through assessment of completeness of revascularisation using the residual and post-CABG SYNTAX Scores for PCI and CABG patients, respectively. Finally, the future direction of the SYNTAX Score is covered through discussion of the ongoing development of a non-invasive, functional SYNTAX Score and review of current and planned clinical trials.
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Affiliation(s)
- Vasim Farooq
- Department of Interventional Cardiology, Erasmus University Medical Centre, Thoraxcenter, , Rotterdam, The Netherlands
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