Coronary pressure measurements and myocardial fractional flow reserve for clinical decision making in the catheterization laboratory

1996 ◽  
pp. 403-410
Author(s):  
Nico H. J. Pijls ◽  
Bernard De Bruyne
Keyword(s):  
Decision Making ◽  
Fractional Flow Reserve ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Pressure Measurements ◽  
Fractional Flow ◽  
Catheterization Laboratory ◽  
Coronary Pressure ◽  
Flow Reserve ◽  
Myocardial Fractional Flow Reserve

scholarly journals DISENGAGE Registry

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Mariano Pellicano ◽  
Giovanni Ciccarelli ◽  
Panagiotis Xaplanteris ◽  
Giuseppe Di Gioia ◽  
Anastasios Milkas ◽  
...  
Keyword(s):  
Decision Making ◽  
Fractional Flow Reserve ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Coronary Ostium ◽  
Fractional Flow ◽  
Flow Reserve ◽  
The Impact ◽  
Guiding Catheter ◽  
Hyperemic Flow

Background: During fractional flow reserve (FFR) measurement, the simple presence of the guiding catheter (GC) within the coronary ostium might create artificial ostial stenosis, affecting the hyperemic flow. We aimed to investigate whether selective GC engagement of the coronary ostium might impede hyperemic flow, and therefore impact FFR measurements and related clinical decision-making. Methods: In the DISENGAGE (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, FFR was prospectively measured twice (with GC engaged [FFR eng ] and disengaged [FFR dis ]) in 202 intermediate stenoses of 173 patients. We assessed (1) whether ΔFFR eng –FFR dis was significantly different from the intrinsic variability of repeated FFR measurements (test-retest repeatability); (2) whether the extent of ΔFFR eng –FFR dis could be clinically significant and therefore able to impact clinical decision-making; and (3) whether ΔFFR eng –FFR dis related to the stenosis location, that is, proximal and middle versus distal coronary segments. Results: Overall, FFR significantly changed after GC disengagement: FFR eng 0.84±0.08 versus FFR dis 0.80±0.09, P <0.001. Particularly, in 38 stenoses (19%) with FFR values in the 0.81 to 0.85 range, GC disengagement was associated with a shift from above to below the 0.80 clinical cutoff, resulting into a change of the treatment strategy from medical therapy to percutaneous coronary intervention. The impact of GC disengagement was significantly more pronounced with stenoses located in proximal and middle as compared with distal coronary segments (ΔFFR eng –FFR dis , proximal and middle 0.04±0.03 versus distal segments 0.03±0.03; P =0.042). Conclusions: GC disengagement results in a shift of FFR values from above to below the clinical cutoff FFR value of 0.80 in 1 out of 5 measurements. This occurs mostly when the stenosis is located in proximal and middle coronary segments and the FFR value is close to the cutoff value.

scholarly journals The FAME Trials: Impact on Clinical Decision Making

2016 ◽  
Vol 11 (2) ◽  
pp. 116 ◽  
Author(s):  
Guy R Heyndrickx ◽  
Gábor G Tóth ◽  
◽  
Keyword(s):  
Medical Treatment ◽  
Fractional Flow Reserve ◽  
Clinical Decision Making ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Clinical Decision ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Stenosis Severity ◽  
Artery Disease

Careful and stepwise evaluation of the fractional flow reserve (FFR) index has been performed over the years, culminating in the landmark Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) and Fractional Flow Reserve-Guided Percutaneous Coronary Intervention Plus Optimal Medical Treatment Versus Optimal Medical Treatment Alone in Patients with Stable Coronary Artery Disease (FAME II) trials. Findings from these studies demonstrated unequivocally the overall inadequacy of angiography versus FFR to correctly assess stenosis severity. Thus, proof of concept and clinical applicability was established beyond debate and will be discussed here.

scholarly journals Case Report of First Angiography-Based On-Line FFR Assessment during Coronary Catheterization

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ran Kornowski ◽  
Hana Vaknin-Assa
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Clinical Decision Making ◽  
Guide Wire ◽  
Coronary Revascularization ◽  
Three Dimensional ◽  
Clinical Decision ◽  
Fractional Flow ◽  
Flow Reserve ◽  
On Line

Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from hyperemic pressure measurements and requires a pressure-monitoring guide wire and hyperemic stimulus. Although it has become the standard of reference for decision-making regarding coronary revascularization, the procedure remains underutilized due to its invasive nature. FFRangio is a novel technology that uses the patient’s hemodynamic data and routine angiograms to generate a complete three-dimensional coronary tree, with color-coded display of the FFR values at each point along the vessels. After being proven to be as accurate as invasive FFR measurements in an off-line study, this case report presents the first on-line application of the system in the catheterization lab. Here too, a high concordance between FFRangio and invasive FFR was observed. In light of the demonstrated capabilities of the FFRangio system, it should emerge as an important tool for clinical decision-making regarding revascularization in patients with coronary artery disease.

scholarly journals Opportunities and challenges of implementing computed tomography fractional flow reserve into clinical practice

Heart ◽  
2020 ◽  
Vol 106 (18) ◽  
pp. 1387-1393 ◽  
Author(s):  
Muhummad Sohaib Nazir ◽  
Tarun K Mittal ◽  
Jonathan Weir-McCall ◽  
Koen Nieman ◽  
Keith Channon ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Fractional Flow Reserve ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Outcome Data ◽  
Resource Utilisation ◽  
Clinical Implementation ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Pre Treatment

CT-derived fractional flow reserve (CT-FFR) uses computational fluid dynamics to derive non-invasive FFR to determine the haemodynamic significance of coronary artery lesions. Studies have demonstrated good diagnostic accuracy of CT-FFR and reassuring short-term clinical outcome data.As a prerequisite, high-quality CT coronary angiography (CTCA) images are required with good heart rate control and pre-treatment with glyceryl trinitrate, which would otherwise render CTCA as unsuitable for CT-FFR. CT-FFR can determine the functional significance of CAD lesions, and there are supportive data for its use in clinical decision-making. However, the downstream impact on myocardial ischaemic burden or viability cannot be obtained.Several challenges remain with implementation of CT-FFR, including interpretation, training, availability, resource utilisation and funding. Further research is required to determine which cases should be considered for clinical CT-FFR analysis, with additional practical guidance on how to implement this emerging technique in clinical practice. Furthermore, long-term prognostic data are required before widespread clinical implementation of CT-FFR can be recommended.While there are several potential opportunities for CT-FFR, at present there remain important systemic and technical limitations and challenges that need to be overcome prior to routine integration of CT-FFR into clinical practice.

Fractional flow reserve

2021 ◽  
pp. 63-67
Author(s):  
Giovanni Ciccarelli ◽  
Emanuele Barbato ◽  
Bernard De Bruyne
Keyword(s):  
Blood Flow ◽  
Myocardial Blood Flow ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Coronary Intervention ◽  
Aortic Pressure ◽  
Fractional Flow ◽  
Coronary Pressure ◽  
Flow Reserve ◽  
Percutaneous Coronary

Fractional flow reserve is an index of the physiological significance of a coronary stenosis, defined as the ratio of maximal myocardial blood flow in the presence of the stenosis to the theoretically normal maximal myocardial blood flow (i.e. in the absence of the stenosis). This flow ratio can be calculated from the ratio of distal coronary pressure to central aortic pressure during maximal hyperaemia. More practically, fractional flow reserve indicates to what extent the epicardial segment can be responsible for myocardial ischaemia and, accordingly, fractional flow reserve quantifies the expected perfusion benefit from revascularization by percutaneous coronary intervention. Very limited evidence exists on the role on fractional flow reserve for bypass grafts.

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