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235 papers 25 to 100 followers Papers relating to the use, value, and limitations of these advanced interventional techniques
By Gregory Gustafson Interventional Cardiologist
Hyung Yoon Kim, Hong-Seok Lim, Joon-Hyung Doh, Chang-Wook Nam, Eun-Seok Shin, Bon-Kwon Koo, Myeong-Ho Yoon, Seung-Jea Tahk, Doo Kyoung Kang, Young Bin Song, Joo-Yong Hahn, Seung Hyuk Choi, Hyeon-Cheol Gwon, Sang-Hoon Lee, Eun-Kyoung Kim, Sung Mok Kim, Yeonhyeon Choe, Jin-Ho Choi
OBJECTIVES: This study investigated the role of fractional myocardial mass (FMM), a vessel-specific myocardial mass, in the evaluation of physiological severity of stenosis. Using computed tomography angiography, the study investigated fractional myocardial mass, a concept of myocardial mass subtended by specific vessel, which could reduce anatomical-physiological mismatch. BACKGROUND: Discordance between anatomical stenosis and physiological severity is common but remains poorly understood...
August 8, 2016: JACC. Cardiovascular Interventions
Morteza Safi, Mohammad Hasan Namazi, Esfandiar Fooladi, Hossein Vakili, Saeed Alipour Parsa, Isa Khaheshi, Mohammad Amin Abbasi, Mohammad Reza Movahed
INTRODUCTION: The aim of this study was to investigate the efficacy and safety of intracoronary (IC) sodium nitroprusside infusion in comparison to IC adenosine for fractional flow reserve (FFR) measurement in moderately diseased coronary artery lesions for functional assessment. METHODS: During a nine month period, a consecutive of 98 patients with suspected or known coronary artery disease with moderate stenosis found during angiography (40% to 70% stenosis), were enrolled in this study...
October 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Hiroyuki Arashi, Junichi Yamaguchi, Mayui Nakazawa, Hisao Otsuki, Shintaro Haruki, Masashi Nakao, Kazuho Kamishima, Kentaro Jujo, Yuichiro Minami, Atsushi Takagi, Hiroshi Ogawa, Nobuhisa Hagiwara
We aimed to clarify the relationships between angiographic lesion characteristics and values of fractional flow reserve (FFR) on intermediate coronary artery stenosis. The clinical meaning and assessment for "visual-functional mismatches," including regular-mismatches [defined as angiographic percent diameter stenosis (%DS) ≥50 % and FFR >0.80] and reverse-mismatches (defined as angiographic %DS <50 %, FFR ≤0.80) remains unresolved in contemporary practice. We retrospectively enrolled 140 consecutive patients who underwent coronary angiography and FFR measurement...
May 28, 2016: Cardiovascular Intervention and Therapeutics
Tadashi Murai, Yoshihisa Kanaji, Taishi Yonetsu, Tetsumin Lee, Junji Matsuda, Eisuke Usui, Makoto Araki, Takayuki Niida, Mitsuaki Isobe, Tsunekazu Kakuta
BACKGROUND: Epicardial focal coronary artery stenosis, diffuse coronary disease, and microvascular resistance (MR) may limit coronary flow. The purpose of percutaneous coronary intervention (PCI) is to increase coronary flow by targeting epicardial lesions. After PCI, MR might change and affect coronary flow. We investigated whether PCI influences MR using the index of microcirculatory resistance (IMR) and if pre-PCI fractional flow reserve (FFR) or MR predicts the post-PCI change in hyperaemic coronary flow...
May 24, 2016: Catheterization and Cardiovascular Interventions
Hitoshi Matsuo, Yoshiaki Kawase
Fractional flow reserve (FFR) is an invasive physiologic index measured in the cardiac catheterization laboratory to assess the functional significance of a coronary stenosis. It is now accepted as the reference standard to indicate whether a stenosis is likely to be responsible for ischemia. It is generally accepted that a stenosis with an ischemic value of FFR is responsible for symptom and a worse outcome and should be revascularized, whereas lesions with a non-ischemic FFR have a more favorable prognosis and can be treated medically...
July 2016: Cardiovascular Intervention and Therapeutics
Neel Khanna, Kathir S Subramanian, Sahil Khera, Wilbert S Aronow, William H Frishman
Ischemic heart disease is the leading cause of mortality worldwide. The assessment and treatment of patients with ischemic heart disease have advanced greatly over the past decade. Particular attention has been given recently to the recognition of lesions that cause ischemia or that are prone to plaque rupture. New invasive measures of coronary artery disease have been developed, including fractional flow reserve, intravascular ultrasound, optical coherence tomography, and most recently, near-infrared spectroscopy...
May 2016: Cardiology in Review
Ahmed M ElGuindy
Contrary to its central role in patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) in stable ischemic heart disease (SIHD) remains largely restricted to patients in whom medical treatment fails to control symptoms, or those with a large area of myocardium at risk and/or high risk findings on non-invasive testing.(1,2) These recommendations are based on a number of studies - the largest of which is COURAGE - that failed to show any reduction in mortality or myocardial infarction (MI) with PCI compared to optimal medical therapy (OMT) in this group of patients...
2015: Global Cardiology Science & Practice
Alastair J Moss, David E Newby
UNLABELLED: Non-invasive imaging plays a critical role in the assessment of patients presenting with suspected angina chest pain. However, wide variations in practice across Europe and North America highlight the lack of consensus in selecting the appropriate first-line test for the investigation of coronary artery disease (CAD). CT coronary angiography (CTCA) has a high negative predictive value for excluding the presence of CAD. As such, it serves as a potential 'gatekeeper' to downstream testing by reducing the rate of inappropriate invasive coronary angiography...
February 15, 2016: Heart: Official Journal of the British Cardiac Society
Mario Iannaccone, Giorgio Quadri, Salma Taha, Fabrizio D'Ascenzo, Antonio Montefusco, Pierluigi Omede', Ik-Kyung Jang, Giampaolo Niccoli, Geraud Souteyrand, Chen Yundai, Konstantinos Toutouzas, Sara Benedetto, Umberto Barbero, Umberto Annone, Enrica Lonni, Yoichi Imori, Giuseppe Biondi-Zoccai, Christian Templin, Claudio Moretti, Thomas F Luscher, Fiorenzo Gaita
AIMS: The prevalence of plaque rupture at the culprit lesion identified by optical coherence tomography (OCT) in different clinical subset of patients undergoing coronary angiography and its clinical predictors remain to be defined. METHODS: All studies including patients with OCT evaluation of the culprit coronary plaque were included. The prevalence of culprit plaque rupture (CPR) and thin-cap fibro-atheroma (TCFA) were the primary endpoints. The factors associated with these findings were studied in a subset of patients with different clinical presentations [ST-elevation myocardial (STEMI) vs...
October 2016: European Heart Journal Cardiovascular Imaging
Matthias Götberg, Evald H Christiansen, Ingibjörg Gudmundsdottir, Lennart Sandhall, Elmir Omerovic, Stefan K James, David Erlinge, Ole Fröbert
BACKGROUND: Instantaneous wave-free ratio (iFR) is a new hemodynamic resting index for assessment of coronary artery stenosis severity. iFR uses high frequency sampling to calculate a gradient across a coronary lesion during a period of diastole. The index has been tested against fractional flow reserve (FFR) and found to have an overall classification agreement of 80% to 85%. Whether the level of disagreement is clinically relevant is unknown. Clinical outcome data on iFR are scarce...
November 2015: American Heart Journal
Lokien X van Nunen, Frederik M Zimmermann, Pim A L Tonino, Emanuele Barbato, Andreas Baumbach, Thomas Engstrøm, Volker Klauss, Philip A MacCarthy, Ganesh Manoharan, Keith G Oldroyd, Peter N Ver Lee, Marcel Van't Veer, William F Fearon, Bernard De Bruyne, Nico H J Pijls
BACKGROUND: In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up. METHODS: The FAME study was a multicentre trial done in Belgium, Denmark, Germany, the Netherlands, Sweden, the UK, and the USA...
November 7, 2015: Lancet
Matteo Tebaldi, Gianluca Campo, Simone Biscaglia
Flow fractional reserve (FFR) allows to evaluate the functional significance of coronary artery lesions, through the ratio of the mean coronary artery pressure after the stenosis to the mean aortic pressure during maximum hyperemia. The actual widely accepted cut-off value is 0.80. Below this value a coronary lesion is considered significant and therefore it requires invasive revascularization. Several studies [in particular Fractional Flow Reserve vs Angiography for Multivessel Evaluation 1 (FAME-1) and FAME-2] have shown the relationship between FFR measurement and hard end-points (death, myocardial infarction, and urgent revascularization)...
August 16, 2015: World Journal of Clinical Cases
Yu Kataoka, Muhammad Hammadah, Rishi Puri, Bhanu Duggal, Kiyoko Uno, Samir R Kapadia, E Murat Tuzcu, Steven E Nissen, Stephen J Nicholls
OBJECTIVE: Lowering low-density lipoprotein cholesterol (LDL-C) with statins reduces cardiovascular events and slows plaque progression. While this therapeutic approach has been reported to favorably modify plaque composition, this is not well characterized in humans. Also, the benefit of achieving LDL-C levels below current recommended targets remains unknown. Frequency-domain optical coherence tomography (FD-OCT) enables visualization of plaque microstructures associated with plaque instability...
October 2015: Atherosclerosis
Jamie Layland, Samuli Rauhalammi, Stuart Watkins, Nadeem Ahmed, John McClure, Matthew M Y Lee, David Carrick, Anna O'Donnell, Arvind Sood, Mark C Petrie, Vannesa Teng Yue May, Hany Eteiba, Mitchell Lindsay, Margaret McEntegart, Keith G Oldroyd, Aleksandra Radjenovic, Colin Berry
BACKGROUND: The use of fractional flow reserve (FFR) in acute coronary syndromes is controversial. The British Heart Foundation Fractional Flow Reserve Versus Angiography in Guiding Management to Optimize Outcomes in Non-ST-Elevation Myocardial Infarction (FAMOUS-NSTEMI) study (NCT01764334) has recently demonstrated the safety and feasibility of FFR measurement in patients with non-ST-segment-elevation myocardial infarction. We report the findings of the cardiac magnetic resonance (CMR) substudy to assess the diagnostic accuracy of FFR compared with 3...
August 2015: Circulation. Cardiovascular Interventions
Yu Kataoka, Muhammad Hammadah, Rishi Puri, Bhanu Duggal, Kiyoko Uno, Samir R Kapadia, E Murat Tuzcu, Steven E Nissen, Stephen J Nicholls
BACKGROUND: Obesity is associated with adverse atherosclerotic cardiovascular events. While various metabolic abnormalities associated with obesity promote plaque formation, the morphological phenotype of atherosclerotic plaque has not been well characterized in the setting of obesity. Frequency-domain optical coherence tomography (FD-OCT) enables in vivo visualization of plaque microstructures associated with vulnerability. We characterized plaque microstructures in obese patients. METHODS: FD-OCT imaging was performed in 308 patients with coronary artery disease undergoing percutaneous coronary intervention...
October 2015: European Journal of Preventive Cardiology
Nils P Johnson, Daniel T Johnson, Richard L Kirkeeide, Colin Berry, Bernard De Bruyne, William F Fearon, Keith G Oldroyd, Nico H J Pijls, K Lance Gould
OBJECTIVES: This study classified and quantified the variation in fractional flow reserve (FFR) due to fluctuations in systemic and coronary hemodynamics during intravenous adenosine infusion. BACKGROUND: Although FFR has become a key invasive tool to guide treatment, questions remain regarding its repeatability and stability during intravenous adenosine infusion because of systemic effects that can alter driving pressure and heart rate. METHODS: We reanalyzed data from the VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice) study, which enrolled consecutive patients who were infused with intravenous adenosine at 140 μg/kg/min and measured FFR twice...
July 2015: JACC. Cardiovascular Interventions
Colin Berry, David Corcoran, Barry Hennigan, Stuart Watkins, Jamie Layland, Keith G Oldroyd
Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, and improvements in the diagnosis and treatment of CAD can reduce the health and economic burden of this condition. Fractional flow reserve (FFR) is an evidence-based diagnostic test of the physiological significance of a coronary artery stenosis. Fractional flow reserve is a pressure-derived index of the maximal achievable myocardial blood flow in the presence of an epicardial coronary stenosis as a ratio to maximum achievable flow if that artery were normal...
December 1, 2015: European Heart Journal
Jingwei Pan, Siyi Huang, Zhigang Lu, Jingbo Li, Qing Wan, Jiayin Zhang, Chengjie Gao, Xin Yang, Meng Wei
The goal of this study was to evaluate the diagnostic accuracy of transmural perfusion gradient (TPG) and transmural perfusion gradient reserve (TPGR) with 3.0 T cardiac magnetic resonance (CMR) against invasively determined fractional flow reserve (FFR) to detect coronary artery stenosis. Quantitative analysis of myocardial perfusion with CMR to diagnosis coronary artery disease (CAD) has been widely accepted. However, traditional transmural myocardial perfusion analysis with CMR neglects that endocardium is more vulnerable to ischemia than epicardium...
May 15, 2015: American Journal of Cardiology
Italo Porto, Alessio Mattesini, Serafina Valente, Francesco Prati, Filippo Crea, Leonardo Bolognese
Coronary angiography is the "golden standard" imaging technique in interventional cardiology and it is still widely used to guide interventions. A major drawback of this technique, however, is that it is inaccurate in the evaluation and quantification of intracoronary thrombus burden, a critical prognosticator and predictor of intraprocedural complications in acute coronary syndromes. The introduction of optical coherence tomography (OCT) holds the promise of overcoming this important limitation, as near-infrared light is uniquely sensitive to hemoglobin, the pigment of red blood cells trapped in the thrombus...
April 2015: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Song-Bai Deng, Xiao-Dong Jing, Jing Wang, Chuan Huang, Shuang Xia, Jian-Lin Du, Ya-Jie Liu, Qiang She
BACKGROUND: The study performed a meta-analysis of the diagnostic performance of fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFRCT) to assess the functional significance of coronary stenosis using FFR as the reference standard. METHODS: We searched the electronic databases of PubMed, EMBASE, The Chorance Library, Medion and Web of Science for relevant articles published until August 2014. Pooled estimates of sensitivity, specificity, positive (LR+) and negative likelihood ratios (LR-) with the corresponding 95% confidence intervals (CIs) and the summary receiver operating characteristic curve (SROC) were determined...
April 1, 2015: International Journal of Cardiology
2015-03-22 16:09:09
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