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coronary flow reserve

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https://www.readbyqxmd.com/read/29145326/should-fraction-flow-reserve-be-considered-an-important-decision-making-tool-to-stratify-patients-with-stable-coronary-artery-disease-for-percutaneous-coronary-intervention-a-meta-analysis
#1
Pravesh Kumar Bundhun, Chakshu Gupta, Feng Huang
BACKGROUND: Nowadays, fraction flow reserve (FFR) is being discussed in every percutaneous coronary intervention (PCI) capable hospitals. Owing to recent development in the medical field, FFR-guided PCI should be able to find a place in Interventional Cardiology. At present, the importance of FFR to stratify patients who require PCI has seldom systematically been investigated. In this analysis, we aimed to compare the major adverse cardiac events (MACEs) mainly in patients with stable coronary artery disease (CAD) to whom PCI was recommended and deferred respectively based on the FFR value...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29134268/clinical-significance-of-transluminal-attenuation-gradient-in-320-row-area-detector-coronary-ct-angiography
#2
Etsuro Kato, Shinichiro Fujimoto, Kazuhisa Takamura, Yuko Kawaguchi, Chihiro Aoshima, Makoto Hiki, Kanako K Kumamaru, Hiroyuki Daida
The clinical significance of the transluminal attenuation gradient (TAG) has not been established. We evaluated the incremental diagnostic value of TAG by 320-row area detector computed tomography (320-ADCT). Subjects were 65 patients who underwent one-rotation scanning by 320-ADCT and invasive coronary angiography (ICA) within 3 months. TAG values were obtained for the major epicardial vessels 2 mm or more each in RCA, LAD and LCX using automatic analysis software. Moreover, TAG values that excluded calcified lesions in calculation of the regression line were also evaluated (excluded-TAG)...
November 13, 2017: Heart and Vessels
https://www.readbyqxmd.com/read/29132649/doppler-versus-thermodilution-derived-coronary-microvascular-resistance-to-predict-coronary-microvascular-dysfunction-in-patients-with-acute-myocardial-infarction-or-stable-angina-pectoris
#3
Rupert P Williams, Guus A de Waard, Kalpa De Silva, Matthew Lumley, Kaleab Asrress, Satpal Arri, Howard Ellis, Awais Mir, Brian Clapp, Amedeo Chiribiri, Sven Plein, Paul F Teunissen, Maurits R Hollander, Michael Marber, Simon Redwood, Niels van Royen, Divaka Perera
Coronary microvascular resistance is increasingly measured as a predictor of clinical outcomes, but there is no accepted gold-standard measurement. We compared the diagnostic accuracy of 2 invasive indices of microvascular resistance, Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR), at predicting microvascular dysfunction. A total of 54 patients (61 ± 10 years) who underwent cardiac catheterization for stable coronary artery disease (n = 10) or acute myocardial infarction (n = 44) had simultaneous intracoronary pressure, Doppler flow velocity and thermodilution flow data acquired from 74 unobstructed vessels, at rest and during hyperemia...
October 10, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29129256/instantaneous-wave-free-ratio-and-fractional-flow-reserve-for-the-assessment-of-nonculprit-lesions-during-the-index-procedure-in-patients-with-st-segment-elevation-myocardial-infarction-the-wave-study
#4
Carmine Musto, Francesco De Felice, Stefano Rigattieri, Diana Chin, Andrea Marra, Marco Stefano Nazzaro, Alberta Cifarelli, Roberto Violini
BACKGROUND: Functional assessment of non-infarct-related artery lesions during primary percutaneous coronary intervention (PCI) might be useful to avoid revascularization of nonsignificant stenosis and staged procedures, thus reducing hospital stay. We aimed to assess the diagnostic performance of instantaneous wave-free ratio (iFR) as compared with fractional flow reserve (FFR) in this setting. METHODS: In the WAVE study, a prospective, observational, single-center registry (NCT02869906), paired iFR and FFR measurements were performed at the level of non-IRA lesions in patients with ST-segment elevation myocardial infarction both during primary PCI and during staged procedures (5-8 days after)...
November 2017: American Heart Journal
https://www.readbyqxmd.com/read/29128474/clinical-implications-of-guiding-catheter-extubation-during-fractional-flow-reserve-measurements
#5
Christophe Pouillot, Karim Bougrini, Richard Vi Fane, Geoffray Rambaud, Jens Glasenapp, Christophe Geyer, Julien Adjedj
BACKGROUND: Fractional flow reserve (FFR) is defined by the maximal coronary flow ratio with and without stenosis. AIMS: We hypothesized that guiding catheter intubation in coronary ostia during FFR measurements may underestimate FFR value by limiting the increase of coronary flow during maximal hyperaemia. METHODS: Between June 2013 and January 2014, we prospectively included all patients with i.v. adenosine FFR measurements. FFR was measured with the guiding catheter intubated in the coronary ostia (FFRint) and extubated in the aorta (FFRext)...
November 8, 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/29122932/diagnostic-performance-of-an-acoustic-based-system-for-coronary-artery-disease-risk-stratification
#6
Simon Winther, Louise Nissen, Samuel Emil Schmidt, Jelmer Sybren Westra, Laust Dupont Rasmussen, Lars Lyhne Knudsen, Lene Helleskov Madsen, Jane Kirk Johansen, Bjarke Skogstad Larsen, Johannes Jan Struijk, Lars Frost, Niels Ramsing Holm, Evald Høj Christiansen, Hans Erik Botker, Morten Bøttcher
OBJECTIVE: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. METHODS: We included 1675 patients consecutively with low to intermediate likelihood of CAD who had been referred for cardiac CT angiography...
November 9, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29118860/coronary-flow-reserve-is-impaired-in-patients-with-obstructive-sleep-apnea
#7
Serife Savas Bozbas, Serpil Eroglu, Berna Akinci Ozyurek, Fusun Oner Eyuboglu
STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is common in adult populations. Accumulating data indicate that it is independently associated with a variety of cardiovascular diseases and has prognostic importance in affected cases. In this study, we aimed to evaluate coronary flow reserve (CFR) in patients with OSA and controls. METHODS: Sixty-one patients undergoing an overnight polysomnography were enrolled in this study. Patients with an apnea-hypopnea index (AHI) >5 were accepted as OSA group (n = 45) and those with an AHI <5 were taken as controls (n = 16)...
October 2017: Annals of Thoracic Medicine
https://www.readbyqxmd.com/read/29113999/index-of-microcirculatory-resistance-at-the-time-of-primary-percutaneous-coronary-intervention-predicts-early-cardiac-complications-insights-from-the-oxami-oxford-study-in-acute-myocardial-infarction-cohort
#8
Gregor Fahrni, Mathias Wolfrum, Giovanni Luigi De Maria, Florim Cuculi, Sam Dawkins, Mohammad Alkhalil, Niket Patel, John C Forfar, Bernard D Prendergast, Robin P Choudhury, Keith M Channon, Adrian P Banning, Rajesh K Kharbanda
BACKGROUND: Early risk stratification after primary percutaneous coronary intervention (PPCI) for ST-segment-elevation myocardial infarction is currently challenging. Identification of a low-risk group may improve triage of patients to alternative clinical pathways and support early hospital discharge. Our aim was to assess whether the index of microcirculatory resistance (IMR) at the time of PPCI can identify patients at low risk of early major cardiac complications and to compare its performance against guideline-recommended risk scores...
November 7, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29113864/observations-from-a-real-time-ifr-ffr-hybrid-approach-in-patients-with-severe-aortic-stenosis-and-coronary-artery-disease-undergoing-tavi
#9
Roberto Scarsini, Gabriele Pesarini, Mattia Lunardi, Anna Piccoli, Claudia Zanetti, Rosaria Cantone, Michele Bellamoli, Valeria Ferrero, Leonardo Gottin, Giuseppe Faggian, Flavio Ribichini
BACKGROUND: The complexity of coronary physiology in presence of severe aortic stenosis (AS) raises concerns about the reliability of pressure-derived indexes in this clinical setting. Furthermore, neither fractional flow reserve (FFR) nor instantaneous wave-free period (iFR) has been validated in AS. Combining iFR and FFR in a tailored decision-making strategy may help to increase simplicity, accuracy and safety of physiology-guided revascularization in AS. METHODS: In this prospective observational study iFR and FFR were measured before and after TAVI during the same procedure in patients with severe AS and concomitant coronary artery disease (CAD)...
October 3, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29112510/prediction-of-postpercutaneous-coronary-intervention-myocardial-infarction-insights-from-intravascular-imaging-coronary-flow-and-biomarker-evaluation
#10
Stephen P Hoole, Jules Hernández-Sánchez, Adam J Brown, Joel P Giblett, Martin R Bennett, Nick E J West
BACKGROUND: Percutaneous coronary intervention-induced myocardial infarction (PMI) has prognostic significance. Identifying patients at high risk for PMI is desirable as it may alter strategy and facilitate early preventative therapy. We therefore sought to establish whether preprocedural demographic, interventional (plaque characteristics and coronary microcirculatory function), and inflammatory, endothelial damage, and platelet-derived biomarker data could predict the risk of PMI. PATIENTS AND METHODS: We performed target vessel pressure wire to assess fractional flow reserve, index of microcirculatory resistance (IMR) and coronary flow reserve, plaque characterization by virtual histology intravascular ultrasound, and assayed peripheral biomarkers before uncomplicated PCI in 88 patients...
November 6, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/29111120/abnormal-coronary-flow-velocity-reserve-and-decreased-myocardial-contractile-reserve-are-main-factors-in-relation-to-physical-exercise-capacity-in-cardiac-amyloidosis
#11
Tor Skibsted Clemmensen, Hans Eiskjær, Henning Mølgaard, Anders Hostrup Larsen, Jens Soerensen, Niels Frost Andersen, Lars Poulsen Tolbod, Hendrik J Harms, Steen Hvitfeldt Poulsen
BACKGROUND: The aim of the present study was to evaluate the clinical importance of echocardiographic coronary flow velocity reserve (CFVR), resting and exercise left ventricular global longitudinal strain (LVGLS), and myocardial work efficiency (MWE) in patients with cardiac amyloidosis (CA). METHODS: The study population comprised 69 subjects: group A, 27 patients with CA confirmed by endomyocardial biopsy (CA positive); group B, 42 healthy control subjects. The amyloid phenotype in group A was as follows: patients with wild-type transthyretin-related amyloidosis (n = 10), carriers of the Danish familial transthyretin amyloidosis mutation with cardiac involvement (n = 5), and patients with amyloid light chain amyloidosis with cardiac involvement (n = 12)...
October 27, 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/29110409/coronary-microvascular-kv1-channels-as-regulatory-sensors-of-intracellular-pyridine-nucleotide-redox-potential
#12
Marc M Dwenger, Vahagn Ohanyan, Manuel F Navedo, Matthew A Nystoriak
Smooth muscle voltage-gated potassium (Kv) channels are important regulators of microvascular tone and tissue perfusion. Recent studies indicate that Kv1 channels represent a key component of the physiological coupling between coronary blood flow and myocardial oxygen demand. While the mechanisms by which metabolic changes in the heart are transduced to alter coronary Kv1 channel gating and promote vasodilation are unclear, a growing body of evidence underscores a pivotal role of Kv1 channels in sensing the cellular redox status...
November 7, 2017: Microcirculation: the Official Journal of the Microcirculatory Society, Inc
https://www.readbyqxmd.com/read/29110288/myocardial-perfusion-imaging-lessons-learned-and-work-to-be-done-update
#13
Ami E Iskandrian, Vasken Dilsizian, Ernest V Garcia, Rob S Beanlands, Manuel Cerqueira, Prem Soman, Daniel S Berman, Alberto Cuocolo, Andrew J Einstein, Charity J Morgan, Fadi G Hage, Heinrich R Schelbert, Jeroen J Bax, Joseph C Wu, Leslee J Shaw, Mehran M Sadeghi, Nagara Tamaki, Philipp A Kaufmann, Robert Gropler, Sharmila Dorbala, William Van Decker
As the second term of our commitment to Journal begins, we, the editors, would like to reflect on a few topics that have relevance today. These include prognostication and paradigm shifts; Serial testing: How to handle data? Is the change in perfusion predictive of outcome and which one? Ischemia-guided therapy: fractional flow reserve vs perfusion vs myocardial blood flow; positron emission tomography (PET) imaging using Rubidium-82 vs N-13 ammonia vs F-18 Flurpiridaz; How to differentiate microvascular disease from 3-vessel disease by PET? The imaging scene outside the United States, what are the differences and similarities? Radiation exposure; Special issues with the new cameras? Is attenuation correction needed? Are there normal databases and are these specific to each camera system? And finally, hybrid imaging with single-photon emission tomography or PET combined with computed tomography angiography or coronary calcium score...
November 6, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/29105325/coronary-resting-gradients-for-hemodynamic-lesion-assessment-the-future-of-coronary-physiology
#14
EDITORIAL
Evan Shlofmitz, Allen Jeremias
Coronary resting gradient measurements with cut-off values of ≤0.87 and ≥0.93 portend a high degree of certainty with respect to appropriateness of coronary revascularization Less agreement exists in patients in the so called indeterminate "gray zone" Pressure-bounded coronary flow reserve may aid in our understanding of the underlying physiologic principles and facilitate the clinical assessment of these lesions.
November 1, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29103734/relationship-between-optical-coherence-tomography-derived-morphological-criteria-and-functional-relevance-as-determined-by-fractional-flow-reserve
#15
Eisuke Usui, Taishi Yonetsu, Yoshihisa Kanaji, Masahiro Hoshino, Masao Yamaguchi, Masahiro Hada, Tadashi Fukuda, Hiroaki Ohya, Yohei Sumino, Rikuta Hamaya, Yoshinori Kanno, Tadashi Murai, Tetsumin Lee, Tsunekazu Kakuta
BACKGROUND: Although several previous studies have indicated that optical coherence tomography (OCT)-derived minimal lumen area (MLA) correlates with fractional flow reserve (FFR) severity, other morphologic criteria for functionally significant coronary stenosis assessed by FFR have not been fully elucidated. This study aimed to identify OCT-based morphological predictors of physiologically significant ischemia assessed by FFR in angiographically intermediate coronary lesions. METHODS: We investigated 194 de novo intermediate coronary lesions in 178 patients with stable angina pectoris who underwent OCT imaging and FFR measurement...
November 2, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/29103656/percutaneous-coronary-intervention-in-stable-angina-orbita-a-double-blind-randomised-controlled-trial
#16
Rasha Al-Lamee, David Thompson, Hakim-Moulay Dehbi, Sayan Sen, Kare Tang, John Davies, Thomas Keeble, Michael Mielewczik, Raffi Kaprielian, Iqbal S Malik, Sukhjinder S Nijjer, Ricardo Petraco, Christopher Cook, Yousif Ahmad, James Howard, Christopher Baker, Andrew Sharp, Robert Gerber, Suneel Talwar, Ravi Assomull, Jamil Mayet, Roland Wensel, David Collier, Matthew Shun-Shin, Simon A Thom, Justin E Davies, Darrel P Francis
BACKGROUND: Symptomatic relief is the primary goal of percutaneous coronary intervention (PCI) in stable angina and is commonly observed clinically. However, there is no evidence from blinded, placebo-controlled randomised trials to show its efficacy. METHODS: ORBITA is a blinded, multicentre randomised trial of PCI versus a placebo procedure for angina relief that was done at five study sites in the UK. We enrolled patients with severe (≥70%) single-vessel stenoses...
November 1, 2017: Lancet
https://www.readbyqxmd.com/read/29103607/experience-with-an-on-site-coronary-computed-tomography-derived-fractional-flow-reserve-algorithm-for-the-assessment-of-intermediate-coronary-stenoses
#17
Patrick M Donnelly, Márton Kolossváry, Júlia Karády, Peter A Ball, Stephanie Kelly, Donna Fitzsimons, Mark S Spence, Csilla Celeng, Tamás Horváth, Bálint Szilveszter, Hendrik W van Es, Martin J Swaans, Béla Merkely, Pál Maurovich-Horvat
Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64...
October 10, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29102362/drug-eluting-stents-in-elderly-patients-with-coronary-artery-disease-senior-a-randomised-single-blind-trial
#18
Olivier Varenne, Stéphane Cook, Georgios Sideris, Sasko Kedev, Thomas Cuisset, Didier Carrié, Thomas Hovasse, Philippe Garot, Rami El Mahmoud, Christian Spaulding, Gérard Helft, José F Diaz Fernandez, Salvatore Brugaletta, Eduardo Pinar-Bermudez, Josepa Mauri Ferre, Philippe Commeau, Emmanuel Teiger, Kris Bogaerts, Manel Sabate, Marie-Claude Morice, Peter R Sinnaeve
BACKGROUND: Elderly patients regularly receive bare-metal stents (BMS) instead of drug-eluting stents (DES) to shorten the duration of double antiplatelet therapy (DAPT). The aim of this study was to compare outcomes between these two types of stents with a short duration of DAPT in such patients. METHODS: In this randomised single-blind trial, we recruited patients from 44 centres in nine countries. Patients were eligible if they were aged 75 years or older; had stable angina, silent ischaemia, or an acute coronary syndrome; and had at least one coronary artery with a stenosis of at least 70% (≥50% for the left main stem) deemed eligible for percutaneous coronary intervention (PCI)...
October 31, 2017: Lancet
https://www.readbyqxmd.com/read/29102036/coronary-computed-tomographic-angiography-derived-fractional-flow-reserve-for-therapeutic-decision-making
#19
Christian Tesche, Rozemarijn Vliegenthart, Taylor M Duguay, Carlo N De Cecco, Moritz H Albrecht, Domenico De Santis, Marcel C Langenbach, Akos Varga-Szemes, Brian E Jacobs, David Jochheim, Moritz Baquet, Richard R Bayer, Sheldon E Litwin, Ellen Hoffmann, Daniel H Steinberg, U Joseph Schoepf
This study investigated the performance of coronary computed tomography angiography (cCTA) with cCTA-derived fractional flow reserve (CT-FFR) compared with invasive coronary angiography (ICA) with fractional flow reserve (FFR) for therapeutic decision making in patients with suspected coronary artery disease (CAD). Seventy-four patients (62 ± 11 years, 62% men) with at least 1 coronary stenosis of ≥50% on clinically indicated dual-source cCTA, who had subsequently undergone ICA with FFR measurement, were retrospectively evaluated...
September 19, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29101020/angiography-based-quantitative-flow-ratio-for-online-assessment-of-coronary-stenosis-favor-ii-china-study
#20
Bo Xu, Shengxian Tu, Shubin Qiao, Xinkai Qu, Yundai Chen, Junqing Yang, Lijun Guo, Zhongwei Sun, Zehang Li, Feng Tian, Weiyi Fang, Jiyan Chen, Wei Li, Changdong Guan, Niels R Holm, William Wijns, Shengshou Hu
OBJECTIVES: To assess the diagnostic performance of quantitative flow ratio (QFR) for diagnosis of hemodynamically-significant coronary stenosis defined by fractional flow reserve (FFR) ≤0.80. BACKGROUND: QFR is a novel angiography-based method for deriving FFR without pressure wire or induction of hyperemia. The accuracy of QFR when assessed online in the catheterization laboratory has not been adequately examined to date. METHODS: This prospective, multicenter trial enrolled patients who had at least one lesion with diameter stenosis of 30-90% and reference diameter ≥ 2mm by visual estimation...
October 20, 2017: Journal of the American College of Cardiology
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