Fractional Flow Reserve to Distinguish Significant Stenosis: Use at Diagnostic Catherization

2000 ◽  
pp. 203-229
Author(s):  
Nico H. J. Pijls ◽  
Bernard De Bruyne
Keyword(s):  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Significant Stenosis ◽  
Flow Reserve

scholarly journals Global Fractional Flow Reserve Value Predicts 5‐Year Outcomes in Patients With Coronary Atherosclerosis But Without Ischemia

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Stephane Fournier ◽  
Carlos Collet ◽  
Panagiotis Xaplanteris ◽  
Frederik M. Zimmermann ◽  
Gabor G. Toth ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Fractional Flow ◽  
Significant Stenosis ◽  
Atherosclerotic Burden ◽  
Flow Reserve ◽  
Percutaneous Coronary

Background Global fractional flow reserve (FFR) (ie, the sum of the FFR values in the 3 major coronary arteries) is a physiologic correlate of global atherosclerotic burden. The objective of the present study was to investigate the value of global FFR in predicting long‐term clinical outcome of patients with stable coronary artery disease but no ischemia‐inducing stenosis. Methods and Results We studied major adverse cardiovascular events (MACEs: all‐cause death, myocardial infarction, and any revascularization) after 5 years in 1122 patients without significant stenosis (all FFR >0.80; n=275) or with at least 1 significant stenosis successfully treated by percutaneous coronary intervention (ie, post–percutaneous coronary intervention FFR >0.80; n=847). The patients were stratified into low, mid, or high tertiles of global FFR (≤2.80, 2.80–2.88, and ≥2.88). Patients in the lowest tertile of global FFR showed the highest 5‐year MACE rate compared with those in the mid or high tertile of global FFR (27.5% versus 22.0% and 20.9%, respectively; log‐rank P =0.040). The higher 5‐year MACE rate was mainly driven by a higher rate of revascularization in the low global FFR group (16.4% versus 11.3% and 11.8%, respectively; log‐rank P =0.038). In a multivariable model, an increase in global FFR of 0.1 unit was associated with a significant reduction in the rates of MACE (hazard ratio [HR], 0.988; 95% CI, 0.977–0.998; P =0.023), myocardial infarction (HR, 0.982; 95% CI, 0.966–0.998; P =0.032), and revascularization (HR, 0.985; 95% CI, 0.972–0.999; P =0.040). Conclusions Even in the absence of ischemia‐producing stenoses, patients with a low global FFR, physiologic correlate of global atherosclerotic burden, present a higher risk of MACE at 5‐year follow‐up.

scholarly journals TCT-29 Mechanism of Low Fractional Flow Reserve in Lesions without angiographic significant stenosis: Role of hidden Plaque Burden

2017 ◽  
Vol 70 (18) ◽  
pp. B13
Author(s):  
Jonghanne Park ◽  
Joo Myung Lee ◽  
Eun-Seok Shin ◽  
Chang-Wook Nam ◽  
Joon-Hyung Doh ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Plaque Burden ◽  
Fractional Flow ◽  
Significant Stenosis ◽  
Flow Reserve

scholarly journals CT-derived fractional flow reserve (FFRct) for functional coronary artery evaluation in the follow-up of patients after heart transplantation

2021 ◽  
Author(s):  
Ricardo P. J. Budde ◽  
Fay M. A. Nous ◽  
Stefan Roest ◽  
Alina A. Constantinescu ◽  
Koen Nieman ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Heart Transplantation ◽  
Fractional Flow Reserve ◽  
Heart Transplant ◽  
Coronary Stenosis ◽  
Fractional Flow ◽  
Significant Stenosis ◽  
Transplant Patients ◽  
Flow Reserve ◽  
Focal Stenosis

Abstract Objectives Invasively measured fractional flow reserve (FFR) is associated with outcome in heart transplant (HTx) patients. Coronary computed tomography angiography (CCTA)–derived FFR (FFRct) provides additional functional information from anatomical CT images. We describe the first use of FFRct in HTx patients. Methods HTx patients underwent CCTA with FFRct to screen for cardiac allograft vasculopathy. FFRct was measured distal to each coronary stenosis > 30% and FFRct ≤ 0.8 indicated hemodynamically significant stenosis. FFRct was also measured at the most distal location of each vessel. Overall distal FFRct was calculated as the mean of the distal values in the left, right, and circumflex coronary artery in each patient. Results Seventy-three patients (age 56 (42–65) years, 63% males) at 11 (8–16) years after HTx were included. Eighteen (25%) patients had a focal hemodynamically significant stenosis (stenosis > 30% with FFRct ≤ 0.8). In the 55 patients without a hemodynamically significant focal FFRct stenosis (FFRct > 0.80), the distal left anterior descending artery FFRct was < 0.90 in 74% of the patients and 10 (18%) patients had ≥ 1 coronary artery with a distal FFRct ≤ 0.8, including 1 with a distal FFRct ≤ 0.8 in all coronaries. Overall distal FFRct in patients without focal stenosis was 0.88 (0.86–0.91), 0.87 (0.86–0.90), and 0.88 (0.86–0.91) (median with 25th–75th percentile) at 5–9, 10–14, or ≥ 15 years post-transplantation, respectively (p = 0.93). Conclusions FFRct performed on CCTA scans of HTx patients demonstrated that 25% of patients had a focal coronary stenosis with FFRct ≤ 0.8. Even without a focal stenosis, FFRct values are often abnormal in HTx patients. Key Points • This is the first report describing the use of FFRct in in heart transplant patients. • FFRct identifies patients after heart transplantation with hemodynamically significant coronary stenosis. • Even without a focal stenosis, FFRct values are often abnormal in heart transplant patients.

Abstract 10412: The Effect of Positive Remodeling Area Index and Large Plaque Burden over Fractional Flow Reserve

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shunsuke Imai ◽  
Takeshi Kondoh ◽  
Yoshiaki Kawase ◽  
Hitoshi Matsuo
Keyword(s):  
Fractional Flow Reserve ◽  
Plaque Burden ◽  
Coronary Risk Factors ◽  
Lumen Area ◽  
Fractional Flow ◽  
Area Index ◽  
Significant Stenosis ◽  
Large Plaque ◽  
Vessel Area ◽  
Flow Reserve

Introduction: Coronary angiographic anatomical stenosis has not been well correlated with physiological fractional flow reserve (FFR), however, the mechanism of the discordance remains poorly understood. We focused on the patients who had no anatomical significant stenosis by coronary angiogram (CAG) but physiological significant stenosis by FFR (reverse mismatch) in the proximal or mid left anterior descending artery (LAD). We explored what coronary CT angiography (CCTA) findings of the target lesion of the LAD predict abnormal FFR. Methods: ECG-gated CCTA was performed using SOMATOM Definition AS+ (128 slice Siemens) and CAG underwent within 4 weeks. FFR was measured using a pressure guide wire (verrata, Volcano) during ATP infusion. Forty consecutive reverse mismatch (with no anatomical stenosis and FFR≦0.8) pts and 40 no mismatch (with no anatomical stenosis and FFR>0.8) pts were selected. Results: There were no significant differences in mean age (72±10y vs 74±8y), gender (M/F 21/19 vs 28/12), coronary risk factors (DM (9 vs 17), HT(32 vs 30), dyslipidemia (23 vs 18), Smoking (5 vs 4)), angle of LAD and LCX (70±21vs71±20 deg.), proximal reference lumen area (0.14±0.14 vs 0.14±0.11 mm2) and vessel area (0.15±0.04 vs 0.15±0.06mm2), distal reference lumen area (0.11±0.12 vs 0.10±0.04mm2) and vessel area (0.14±0.13 vs 0.12±0.04mm2), grade of plaque calcification, and presence of low density plaque (8 vs 7 pts) between no mismatch and reverse mismatch groups. However, vessel area (0.21±0.07mm2, P=0.0004) and positive remodeling area index (1.40±0.26, P<0.0001) at the minimum lumen area (MLA) in reverse mismatch group were higher than those (0.16±0.05mm2, 1.01±0.18) in no mismatch groups, respectively. AUC of remodeling area index was 0.924 for diagnosis of reverse mismatch on ROC analysis. Sensitivity was 82.5%, specificity was 84.6% when the remodeling area index was 1.13. Conclusions: Even if anatomical significant stenosis is not observed, FFR was depressed in patients with large vessel area and positive remodeling area index derived from CCTA at MLA. Large plaque at MLA may be one of the mechanisms of reverse mismatch.

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