scholarly journals Reliability and Reproducibility of Absolute Myocardial Blood Flow: Does It Depend on the PET/CT Technology, the Vasodilator, and/or the Software?

2021 ◽  
Vol 23 (3) ◽  
Author(s):  
K. Lance Gould ◽  
Linh Bui ◽  
Danai Kitkungvan ◽  
Monica B. Patel
Keyword(s):  
Coronary Flow ◽  
Regions Of Interest ◽  
Fractional Flow ◽  
Stress Imaging ◽  
Flow Capacity ◽  
Flow Reserve ◽  
Pet Ct ◽  
Relative Stress ◽  
Ct Technology ◽  
Bull's Eye

Abstract Purpose of Review The COURAGE and ISCHEMIA trials showed no reduced mortality after revascularization compared to medical treatment. Is this lack of benefit due to revascularization having no benefit regardless of CAD severity or to suboptimal patient selection due to non-quantitative cardiac imaging? Recent Findings Comprehensive, integrated, myocardial perfusion quantified by regional pixel distribution of coronary flow capacity (CFC) is the final common expression of objective CAD severity for which revascularization reduces mortality. Current lack of revascularization benefit derives from narrow thinking focused on measuring one isolated aspect of coronary characteristics, such as angiogram stenosis, its fractional flow reserve (FFR), anatomic FFR simulations, relative stress imaging, absolute stress ml/min/g or coronary flow reserve (CFR) alone, or even more narrowly on global CFR or fixed regions of interest in assumed coronary artery distributions, or in arbitrary 17 segments on bull’s-eye displays, rather than regional pixel distribution of perfusion metrics as they actually are in an individual. Summary Comprehensive integration of all quantitative perfusion metrics per regional pixel into coronary flow capacity guides artery-specific interventions for reduced mortality in non-acute CAD but requires addressing the methodologic questions in the title.

AGREEMENT OF FRACTIONAL FLOW RESERVE AND INSTANTANEOUS WAVE-FREE RATIO WITH CORONARY FLOW CAPACITY: A SUB-ANALYSIS OF THE IBERIAN-DUTCH-ENGLISH (IDEAL) STUDY

2018 ◽  
Vol 71 (11) ◽  
pp. A1180
Author(s):  
Yuetsu Kikuta ◽  
Tim van de Hoef ◽  
Ricardo Petraco Da Cunha ◽  
Mauro Echavarria-Pinto ◽  
Gilbert Wijntjens ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Fractional Flow ◽  
Flow Capacity ◽  
Flow Reserve ◽  
Ideal Study

P5618Coronary flow capacity to identify stenosis associated with coronary flow improvement after coronary revascularization

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Murai ◽  
T P Van De Hoef ◽  
V E Stegehuis ◽  
G W M Wijntjens ◽  
T Yonetsu ◽  
...  
Keyword(s):  
Coronary Flow ◽  
Coronary Revascularization ◽  
Multivariate Logistic Regression Analysis ◽  
Diagnostic Efficiency ◽  
Fractional Flow ◽  
Intracoronary Doppler ◽  
Flow Capacity ◽  
Flow Reserve ◽  
Before And After ◽  
Flow Improvement

Abstract Background Coronary flow capacity (CFC) has recently been introduced as a comprehensive assessment of the coronary circulation by combining coronary flow reserve (CFR) and maximal coronary flow velocity to overcome the limitations of using CFR alone, and was reported to provide enhanced risk stratification compared with CFR. However, its potential to identify stenosis that would be associated with clinically relevant flow coronary flow improvement after revascularization has not been investigated. Aims The aim of this study is to quantify coronary flow changes after revascularization in relation to CFC and CFR. Methods and results Using a combined dataset of DEFINE FLOW and the Amsterdam UMC prospective ComboWire database, a total of 133 patients (135 vessels) with intermediate coronary artery lesions who underwent intracoronary physiologic assessment including intracoronary Doppler flow measurement before and after PCI were analyzed. The median values of fractional flow reserve (FFR) and CFR before PCI were 0.70 (Q1–3: 0.56–0.80) and 1.64 (Q1–3: 1.30–2.06). The number of lesions classified by CFC before PCI were 14 for normal CFC, 40 for mildly reduced CFC, 33 for moderately reduced CFC and 48 for severely reduced CFC. The lesions with larger impairment of CFC showed greater increase in coronary flow, and vice versa (median percent increase in coronary flow by revascularization: 4.2% for normal CFC; 25.9% for mildly reduced; 50.1% for moderately reduced; 145.5% for severely reduced, P<0.0001). Using the same CFR distribution based on CFC criteria showed that only lesions with severely reduced CFR showed a significantly higher coronary flow increase after PCI (−2.6% for CFR in the normal zone; 26.6% for CFR in the mildly reduced zone; 33.3% for CFR in the moderately reduced zone; 81.7% for CFR in the severely reduced zone, P=0.0007). Compared with the established CFR cut-off value of 2.0, moderate to severely reduced CFC showed higher specificity and positive predictive value (PPV) to predict at least 20% increase in coronary flow after PCI (specificity and PPV: 86.4% and 72.5% for ischemic CFC vs. 75.8% and 40% for CFR cut-off value 2.0). Multivariate logistic regression analysis revealed that the lesions with moderately or severely reduced CFC (odd ratio [OR] = 7.606 95%interconfidence interval [CI]: 2.834–20.412, P<0.001) and pre-PCI FFR (OR=0.0002, 95% CI: 0.0002–0.0204, P<0.001) were the independent predictors of coronary flow increase after PCI. Conclusion CFC showed a higher diagnostic efficiency for identification of lesions which benefit from revascularization compared to CFR with respect to coronary flow improvement. This study provides the physiological rational of revascularization for the lesions with moderately to severely reduced CFC from the perspective of coronary flow increase. Acknowledgement/Funding Philips Volcano

P4159Coronary flow capacity guidance optimizes the efficacy of percutaneous coronary intervention in patients with stable lesions: international registry of comprehensive physiologic evaluation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Hamaya ◽  
M Hoshino ◽  
Y Kanaji ◽  
Y Kanno ◽  
M Hada ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Flow ◽  
Mean Transit Time ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Capacity ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Optimal Criterion

Abstract Background Fractional flow reserve (FFR) is the current standard for determining severity of epicardial stenosis and indication for percutaneous coronary intervention (PCI). However in practice, FFR is not enough robust to select lesions that will truly benefit from PCI. Coronary flow capacity (CFC) provides integrated information of coronary flow reserve (CFR) and coronary flow during hyperemia that is useful for identifying flow-limiting stenosis considering both epicardial and microvascular conditions. Objective We hypothesized that the effect of FFR-guided PCI would be enhanced by further consideration of CFC. This study aimed to investigate the prognostic effect of PCI according to CFC status of the stable lesions, using pressure-temperature sensor-tipped wire for FFR and CFC evaluation. Methods From a global, multicenter registry of comprehensive physiological assessment, a total of 1397 patients (1694 vessels) were enrolled. Three patients/vessels were excluded due to lost follow-up. Low CFC was defined for lesions with reduced CFR and the corresponding inverse of thermodilution-derived mean transit time under hyperemia, which represents hyperemic coronary flow. The effect of FFR-guided PCI on vessel-oriented composite outcomes (VOCO) was assessed by multivariate marginal COX proportional regression model with or without the interaction term between PCI and CFC, using the CFC definition with the CFR threshold of 2.0 (Figure: red + green area showing low CFC). Using the same model, variously defined CFC was tested to determine the optimal thresholds (Figure: red only area ∼ red + green + blue area). Results During the 5-year follow-up period, VOCO was identified for a total of 113 vessels. In the multivariate model, the HR of PCI was 0.963 (95% CI: 0.538–1.723). When the interaction was added to the model, the effect of PCI on VOCO incidence was significantly different according to CFC status (p=0.069 for interaction). The optimal criterion of CFC was made where Akaike Information Criterion of the model was minimized (CFR threshold of 2.9 for the CFC definition), where PCI had HR of 0.443 (95% CI: 0.196–0.999) and 1.521 (95% CI: 0.828–2.796) for lesions low and high CFC, respectively. CFR had no significant interaction with PCI (p=0.26). CFC Map Conclusion The effect of PCI on VOCO was significantly different according to CFC status. PCI to lesions with low CFC was prognostically beneficial. Our results suggested the potential of CFC for optimizing PCI benefit in stable lesions after FFR assessment.

scholarly journals Discordance Between Fractional Flow Reserve and Coronary Flow Reserve

2017 ◽  
Vol 10 (10) ◽  
pp. 999-1007 ◽  
Author(s):  
Sung Gyun Ahn ◽  
Jon Suh ◽  
Olivia Y. Hung ◽  
Hee Su Lee ◽  
Yasir H. Bouchi ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Fractional Flow ◽  
Flow Reserve

Abstract 14743: Usefulness of Estimated Coronary Flow Velocity Using Quantitative Flow Ratio for Intermediate Coronary Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eiji Ichimoto ◽  
Nao Konagai ◽  
Sawako Horie ◽  
Atsushi Hasegawa ◽  
Hirofumi Miyahara ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Stenosis ◽  
Coronary Flow ◽  
Flow Ratio ◽  
Operating Characteristics ◽  
Fractional Flow ◽  
Coronary Flow Velocity ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Introduction: Quantitative flow ratio (QFR) is a diagnostic modality for functional assessment for intermediate coronary stenosis without the use of pressure wire. QFR is calculated from 3-dimensional quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis. Hypothesis: We assessed the usefulness of QFR and the association with an estimated coronary flow velocity (eCFV) for intermediate coronary stenosis. Methods: A total of 100 lesions in 80 consecutive patients were assessed Fractional Flow Reserve (FFR) for intermediate coronary stenosis between January 2011 and April 2019. Of these, 97 lesions in 77 patients who underwent QFR were included in this study. Patients were classified into two groups (FFR ≤ 0.80 or FFR > 0.80). QFR and eCFV using contrast were measured by Thrombolysis in Myocardial Infarction (TIMI) frame counts. Results: There was no significant differences in target vessels (p = 0.90) and diffuse lesions (p = 0.06) between the two groups (FFR ≤ 0.80 or FFR > 0.80). Mean FFR and QFR values were 0.78 ± 0.12 and 0.77 ± 0.11, respectively. QFR had a good correlation with FFR values (r = 0.86, p < 0.0001). The diagnostic accuracy, sensitivity, and specificity on QFR ≤ 0.80 were 91.8%, 92.7% and 90.5%, respectively. The eCFV of FFR ≤ 0.80 was greater than that of FFR > 0.80 (0.19 ± 0.08 m/s vs. 0.14 ± 0.06 m/s, p<0.001). Figure showed that the eCFV correlated with FFR values (r = -0.29, p < 0.01). Moreover, the eCFV had a high area under the curve (AUC = 0.71, p < 0.01) on Receiver operating characteristics curve (ROC) analysis with FFR ≤ 0.80. Conclusions: QFR was useful for the assessment of functional stenosis severity. As eCFV was faster, FFR was lower for intermediate coronary stenosis. The eCFV had a good correlation with FFR and may become one of the evaluations for ischemia.

Optimal Dosage and Method of Administration of Adenosine for Measuring the Coronary Flow Reserve and the Fractional Flow Reserve in Koreans

2006 ◽  
Vol 36 (4) ◽  
pp. 300 ◽  
Author(s):  
Jung Won Suh ◽  
Bon Kwon Koo ◽  
Sang Ho Jo ◽  
Hyun Jae Kang ◽  
Young Seok Cho ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Optimal Dosage ◽  
Fractional Flow ◽  
Flow Reserve

Abstract 19177: Loss of Coronary Perfusion Efficiency in Microvascular Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Matthew Lumley ◽  
Matthew Ryan ◽  
Kaleab Asrress ◽  
Rupert Williams ◽  
Satpal Ari ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Flow ◽  
Microvascular Disease ◽  
Rate Pressure Product ◽  
Coronary Perfusion ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Wave Separation ◽  
Flow Reserve ◽  
Response To Stress

Introduction: Coronary Microvascular Disease (MVD) is associated with an unfavorable prognosis, even in the absence of significant epicardial disease. The pathophysiological basis of increased cardiac events is unclear. The aim of this study was to characterize the forces that govern myocardial perfusion at rest and during stress. Methods: Patients with chest pain syndromes requiring Fractional Flow Reserve (FFR) assessment were screened and those with a FFR>0.80 were included. MVD was defined by coronary flow reserve (CFR) < 2.0. Controls were those with CFR>2.0. Simultaneous intracoronary pressure (P d ) and flow velocity (U) recordings were made at rest and hyperemia. Microvascular Resistance (MR)= P d /U. Wave intensity = dP d /dt x dU/dt and wave separation analysis was used to identify the waves that accelerate and decelerate flow. The proportional contribution of accelerating waves was assessed as an index of coronary perfusion efficiency. Results: 39 consecutive patients were enrolled, 21 had MVD and 18 comprised controls. The groups were matched for atherosclerotic risk factors, rate-pressure-product and P d . Coronary flow velocity in MVD patients was higher at rest (21.5±6.4 vs. 14.1±4.5cms -1 , p < 0.001) but lower during hyperemia (28.3±13.0 vs. 45.1±13.1cms -1 , p < 0.001) compared to controls. While resting MR was lower in MVD (501±162 vs. 755±262 mmHg.cm -1 .s, p = 0.001), hyperemic MR was significantly lower in controls. At rest the magnitude of the accelerating waves was higher in the MVD group than controls. The percentage contribution of accelerating waves increased with hyperemia in controls but decreased in MVD patients (figure). Conclusion: MVD manifests as resting microvascular dilation as well as diminished response to stress. While the normal heart has improved efficiency during hyperemia, in MVD efficiency decreases and as a result, flow augmentation is attenuated. These processes render the myocardium more susceptible to ischemia.

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