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Fractional flow reserve

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https://www.readbyqxmd.com/read/28335895/coronary-collaterals-function-and-clinical-outcome-between-patients-with-acute-and-chronic-total-occlusion
#1
Jang Hoon Lee, Chang-Yeon Kim, Namkyun Kim, Se Yong Jang, Myung Hwan Bae, Dong Heon Yang, Yongkeun Cho, Shung Chull Chae, Hun Sik Park
OBJECTIVES: This study sought to demonstrate how changes in the collateral function and its clinical significance before and after percutaneous coronary interventions (PCIs) are compared between patients with acute coronary syndrome and total or nearly total occlusions (ATOs) and chronic total occlusions (CTOs). BACKGROUND: The functional relevance of the collateral circulation in patients with ATOs and CTOs has not been fully investigated. METHODS: The pressure-derived collateral pressure index (CPI), myocardial fractional flow reserve (FFRmyo), and coronary fractional flow reserve (FFRcor) at maximum hyperemia induced by intravenous adenosine were evaluated in occluded vessels at baseline, after the PCI, and at 1 year in 23 ATO and 74 CTO patients...
March 27, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28331135/applicability-of-3-dimensional-quantitative-coronary-angiography-derived-computed-fractional-flow-reserve-for-intermediate-coronary-stenosis
#2
Kyoichiro Yazaki, Masato Otsuka, Shohei Kataoka, Mitsuru Kahata, Asako Kumagai, Koji Inoue, Hiroshi Koganei, Kenji Enta, Yasuhiro Ishii
BACKGROUND: Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).Methods and Results:We analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined contrast flow QFR, which was derived from 3-dimensional quantitative coronary angiography (3-D QCA) withThrombolysis in Myocardial Infarction (TIMI) frame counts, was compared with FFR as a reference...
March 22, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28329198/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
#3
Yoshinobu Onuma, Carlos Collet, Robert-Jan van Geuns, Bernard de Bruyne, Evald Christiansen, Jacques Koolen, Pieter Smits, Bernard Chevalier, Dougal McClean, Dariusz Dudek, Stephan Windecker, Ian Meredith, Koen Nieman, Susan Veldhof, John Ormiston, Patrick W Serruys
Aims: Multimodality invasive imaging of the first-in-man cohort demonstrated at 5 years stable lumen dimensions and a low rate of major adverse cardiac events (MACE). However, the long-term non-invasive assessment of this device remains to be documented. The objective was to describe the 72-month multislice computed tomography (MSCT) angiographic and functional findings after the implantation of the second iteration of the fully resorbable everolimus-eluting polymeric scaffold. Methods and results: In the ABSORB Cohort B trial patients with non-complex de novo lesions were treated with second iteration bioresobable vascular scaffold (BVS)...
March 16, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28318875/feasibility-of-pet-for-the-management-of-coronary-artery-disease-comparison-between-cfr-and-ffr
#4
REVIEW
Osamu Manabe, Masanao Naya, Nagara Tamaki
Myocardial perfusion imaging using positron emission tomography (PET) allows both qualitative and quantitative measurement. The quantitative myocardial blood flow and coronary flow reserve (CFR) are reliable indices for evaluating functional severity, influenced by both epicardial stenosis and microvascular disease. Fractional flow reserve (FFR) also reflects physiological stenosis, which measures the pressure differences across a coronary artery stenosis during maximum hyperemia. Discordance between CFR and FFR has been noticed in estimating the functional significance of coronary stenosis...
March 16, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/28318655/coronary-artery-stenoses-more-often-overestimated-in-older-patients-angiographic-stenosis-overestimation-in-elderly
#5
Nanette M Borren, Jan Paul Ottervanger, Martijn A Reinders, Elvin Kedhi
BACKGROUND: Angiographic overestimation of coronary artery stenosis severity may result in unnecessary revascularization and is possibly more prevalent with increasing age. AIM: To identify whether age is an independent clinical predictor for angiographic overestimation of a coronary artery stenosis. METHODS: Fractional flow reserve (FFR) of 335 coronary lesions was performed in 260 consecutive patients with stable coronary artery disease (CAD)...
February 28, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28317458/use-of-the-instantaneous-wave-free-ratio-or-fractional-flow-reserve-in-pci
#6
Justin E Davies, Sayan Sen, Hakim-Moulay Dehbi, Rasha Al-Lamee, Ricardo Petraco, Sukhjinder S Nijjer, Ravinay Bhindi, Sam J Lehman, Darren Walters, James Sapontis, Luc Janssens, Christiaan J Vrints, Ahmed Khashaba, Mika Laine, Eric Van Belle, Florian Krackhardt, Waldemar Bojara, Olaf Going, Tobias Härle, Ciro Indolfi, Giampaolo Niccoli, Flavo Ribichini, Nobuhiro Tanaka, Hiroyoshi Yokoi, Hiroaki Takashima, Yuetsu Kikuta, Andrejs Erglis, Hugo Vinhas, Pedro Canas Silva, Sérgio B Baptista, Ali Alghamdi, Farrel Hellig, Bon-Kwon Koo, Chang-Wook Nam, Eun-Seok Shin, Joon-Hyung Doh, Salvatore Brugaletta, Eduardo Alegria-Barrero, Martijin Meuwissen, Jan J Piek, Niels van Royen, Murat Sezer, Carlo Di Mario, Robert T Gerber, Iqbal S Malik, Andrew S P Sharp, Suneel Talwar, Kare Tang, Habib Samady, John Altman, Arnold H Seto, Jasvindar Singh, Allen Jeremias, Hitoshi Matsuo, Rajesh K Kharbanda, Manesh R Patel, Patrick Serruys, Javier Escaned
Background Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. Methods We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317438/instantaneous-wave-free-ratio-versus-fractional-flow-reserve-to-guide-pci
#7
Matthias Götberg, Evald H Christiansen, Ingibjörg J Gudmundsdottir, Lennart Sandhall, Mikael Danielewicz, Lars Jakobsen, Sven-Erik Olsson, Patrik Öhagen, Hans Olsson, Elmir Omerovic, Fredrik Calais, Pontus Lindroos, Michael Maeng, Tim Tödt, Dimitrios Venetsanos, Stefan K James, Amra Kåregren, Margareta Nilsson, Jörg Carlsson, Dario Hauer, Jens Jensen, Ann-Charlotte Karlsson, Georgios Panayi, David Erlinge, Ole Fröbert
Background The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. Methods We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317428/fractional-flow-reserve-guided-multivessel-angioplasty-in-myocardial-infarction
#8
Pieter C Smits, Mohamed Abdel-Wahab, Franz-Josef Neumann, Bianca M Boxma-de Klerk, Ketil Lunde, Carl E Schotborgh, Zsolt Piroth, David Horak, Adrian Wlodarczak, Paul J Ong, Rainer Hambrecht, Oskar Angerås, Gert Richardt, Elmir Omerovic
Background In patients with ST-segment elevation myocardial infarction (STEMI), the use of percutaneous coronary intervention (PCI) to restore blood flow in an infarct-related coronary artery improves outcomes. The use of PCI in non-infarct-related coronary arteries remains controversial. Methods We randomly assigned 885 patients with STEMI and multivessel disease who had undergone primary PCI of an infarct-related coronary artery in a 1:2 ratio to undergo complete revascularization of non-infarct-related coronary arteries guided by fractional flow reserve (FFR) (295 patients) or to undergo no revascularization of non-infarct-related coronary arteries (590 patients)...
March 18, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28306172/genetic-divergence-with-ongoing-gene-flow-is-maintained-by-the-use-of-different-hosts-in-phytophagous-ladybird-beetles-genus-henosepilachna
#9
Kei W Matsubayashi, Tetsuo I Kohyama, Norio Kobayashi, Satoko Yamasaki, Masakazu Kuwajima, Haruo Katakura
Adaptation to different environments can promote population divergence via natural selection even in the presence of gene flow-a phenomenon that typically occurs during ecological speciation. To elucidate how natural selection promotes and maintains population divergence during speciation, we investigated the population genetic structure, degree of gene flow and heterogeneous genomic divergence in three closely related Japanese phytophagous ladybird beetles: Henosepilachna pustulosa, H. niponica and H. yasutomii...
March 17, 2017: Journal of Evolutionary Biology
https://www.readbyqxmd.com/read/28303683/factors-associated-with-deferred-lesion-failure-following-fractional-flow-reserve-assessment-in-patients-with-diabetes-mellitus
#10
Mark W Kennedy, Enrico Fabris, Renicus S Hermanides, Emel Kaplan, Nanette Borren, Balazs Berta, Petra C Koopmans, Jan Paul Ottervanger, Harry Suryapranata, Elvin Kedhi
OBJECTIVE: To explore the predictors of deferred lesion failure (DLF) in patients with diabetes mellitus (DM) and lesions with a fractional flow reserve (FFR) >0.80 and to examine whether a predictive relationship between negative FFR values (>0.80-1.00) and DLF exists. BACKGROUND: DM is associated with rapidly progressive atherosclerosis and predictors of DLF in FFR negative lesions in this high-risk group are unknown. METHODS: All DM patients who underwent FFR-assessment between 1/01/2010 and 31/12/2013 were included, and followed until 1/7/2015...
March 17, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28303473/incremental-role-of-resting-myocardial-computed-tomography-perfusion-for-predicting-physiologically-significant-coronary-artery-disease-a-machine-learning-approach
#11
Donghee Han, Ji Hyun Lee, Asim Rizvi, Heidi Gransar, Lohendran Baskaran, Joshua Schulman-Marcus, Bríain Ó Hartaigh, Fay Y Lin, James K Min
BACKGROUND: Evaluation of resting myocardial computed tomography perfusion (CTP) by coronary CT angiography (CCTA) might serve as a useful addition for determining coronary artery disease. We aimed to evaluate the incremental benefit of resting CTP over coronary stenosis for predicting ischemia using a computational algorithm trained by machine learning methods. METHODS: 252 patients underwent CCTA and invasive fractional flow reserve (FFR). CT stenosis was classified as 0%, 1-30%, 31-49%, 50-70%, and >70% maximal stenosis...
March 16, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/28296167/what-can-intracoronary-pressure-measurements-tell-us-about-flow-reserve-pressure-bounded-coronary-flow-reserve-and-example-application-to-the-randomized-defer-trial
#12
Frederik M Zimmermann, Nico H J Pijls, Bernard De Bruyne, G Jan-Willem Bech, Pepijn van Schaardenburgh, Richard L Kirkeeide, K Lance Gould, Nils P Johnson
OBJECTIVE: We propose a novel technique called pressure-bounded coronary flow reserve (pb-CFR) and demonstrate its application to the randomized DEFER trial. BACKGROUND: Intracoronary flow reserve assessment remains underutilized relative to pressure measurements partly due to less robust tools. METHODS: While rest and hyperemic intracoronary pressure measurements cannot quantify CFR exactly, they do provide upper and lower bounds. We validated pb-CFR invasively against traditional CFR, then applied it to high fractional flow reserve (FFR ≥ 0...
March 15, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28291726/change-in-angiogram-derived-management-strategy-of-patients-with-chest-pain-when-some-ffr-data-are-available-how-consistent-is-the-effect
#13
Vinayak Nagaraja, Mamas Mamas, Michael Mahmoudi, Campbell Rogers, Nick Curzen
BACKGROUND: The assessment of patients presenting with angina using invasive angiography alone is imperfect. By contrast, fractional flow reserve (FFR) allows for assessment of lesion-specific ischemia, which is predictive of clinical outcome. A series of studies has demonstrated that the availability of FFR data at the time of diagnostic angiography leads to significant differences in the management of those patients. HYPOTHESIS: The objective of this paper is to describe assess the consistency in the difference in management resulting from an FFR-directed versus and angiogram-directed strategy in appropriate observational and randomized trials...
February 27, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28283374/outcomes-after-a-left-anterior-descending-artery-endarterectomy-in-advanced-coronary-artery-disease
#14
Charalampos Katselis, George Samanidis, Anastasia Papasotiriou, George Karatasakis, Ioannis Nenekidis, Eftichia Demerouti, Theofani Antoniou, Konstantinos Perreas
BACKGROUND: Coronary endarterectomy albeit infrequently utilized remains a pivotal treatment modality for advanced atherosclerotic heart disease. Benefits of coronary endarterectomy are explored in terms of better mid-term survival, freedom of major adverse cardiac and cerebrovascular events and improved left ventricular ejection fraction. METHODS: 50 patients with coronary artery disease including extensive diffuse LAD disease underwent a left anterior descending artery endarterectomy with coronary by-pass grafting and left internal mammary artery as conduit between 2006 and 2014...
February 21, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28281728/comparison-between-fractional-flow-reserve-and-visual-assessment-for-moderate-coronary-artery-stenosis
#15
Bilge Duran Karaduman, Murat Akçay, Hüseyin Ayhan, Hacı Ahmet Kasapkara, Murat Can Güney, Tahir Durmaz, Telat Keleş, Nihal Akar Bayram, Emine Bilen, Engin Bozkurt
BACKGROUND: 'Fractional flow reserve (FFR)' is an interventional diagnostic method based on intracoronary pressure measurement used for the assessment of the severity of coronary artery stenoses. Our study aimed to compare visual measurements made by multiple observers with fractional flow reserve measurement in the assessment of angiographically moderate coronary artery stenosis. METHODS: The angiographic images of moderate coronary artery lesions 359 patients enrolled in the study that had interpreted independently by three interventional cardiologists assigned as observers (O1, O2, O3)...
March 10, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28281238/practical-considerations-of-fractional-flow-reserve-utilization-to-guide-revascularization
#16
REVIEW
Tara Shah, Joshua D Geleris, Joshua Schulman-Marcus, Dmitriy N Feldman, Rajesh V Swaminathan
Invasive angiography has long been the gold standard for the diagnosis of obstructive coronary artery disease (CAD). However, the relationship between angiographic measures of stenosis and coronary blood flow is complex, and there is frequent discordance between the visual assessment of a stenotic lesion and its effect on myocardial perfusion. Fractional flow reserve is a rapidly emerging invasive means of assessing the physiologic significance of an epicardial stenosis. This review provides a pragmatic understanding of the physiologic principles that guide fractional flow reserve (FFR), sheds light on its nuances, and explores the most landmark investigations...
February 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28279401/dense-calcium-and-lesion-specific-ischemia-a-comparison-of-ccta-with-fractional-flow-reserve
#17
Lohendran Baskaran, Bríain Ó Hartaigh, Joshua Schulman-Marcus, Heidi Gransar, Fay Lin, James K Min
BACKGROUND AND AIMS: Studies evaluating the relationship between dense coronary calcium (DC) and myocardial ischemia have had incongruent results. We sought to clarify whether DC, as detected by computed coronary tomographic angiography (CCTA), is an independent predictor of ischemia as measured by invasive fractional flow reserve (FFR). METHODS: In total, 249 (399 lesions) stable patients undergoing CCTA and invasive FFR were enrolled for this post-hoc analysis...
February 24, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28279384/can-functional-testing-for-ischemia-and-viability-guide-revascularization
#18
REVIEW
Lisa M Mielniczuk, Gabor G Toth, Joe X Xie, Bernard De Bruyne, Leslee J Shaw, Rob S Beanlands
Cardiac imaging procedures are a cornerstone of the diagnosis and management of patients with cardiac disease. The optimal management of the patient with stable ischemic heart disease or ischemic heart failure often rests on the totality of symptom burden, patient risk, and disease severity, whether assessed anatomically or functionally. Recent trials have demonstrated the power of flow measurements to direct revascularization as well as the strengths and limitations of ischemia and viability/hibernation imaging as markers of risk to direct interventions...
March 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28279382/trials-of-imaging-use-in-the-emergency-department-for-acute-chest-pain
#19
REVIEW
Gilbert L Raff, Udo Hoffmann, James E Udelson
Over 8 million patients seek emergency department care for acute chest pain annually in the United States alone, and <5% have an acute coronary syndrome. In the absence of overt electrocardiographic or biomarker evidence, expensive and time-consuming diagnostic strategies are frequently required. Beginning in 2000, radionuclide myocardial perfusion, stress echocardiography, cardiac magnetic resonance imaging, and coronary computed tomographic angiography have become increasingly common in evaluating these patients...
March 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28276071/cfd-and-bernoulli-based-pressure-drop-estimates-a-comparison-using-patient-anatomies-from-heart-and-aortic-valve-segmentation-of-ct-images
#20
Jürgen Weese, Angela Lungu, Jochen Peters, Frank M Weber, Irina Waechter-Stehle, D Rodney Hose
PURPOSE: An aortic valve stenosis is an abnormal narrowing of the aortic valve (AV). It impedes blood flow and is often quantified by the geometric orifice area of the AV (AVA) and the pressure drop (PD). Using the Bernoulli equation, a relation between the PD and the effective orifice area (EOA) represented by the area of the vena contracta (VC) downstream of the AV can be derived. We investigate the relation between the AVA and the EOA using patient anatomies derived from cardiac computed tomography (CT) angiography images and computational fluid dynamic (CFD) simulations...
March 9, 2017: Medical Physics
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