scholarly journals WOMEN HAVE HIGHER FALSE NEGATIVE RESULTS ON NON-INVASIVE STRESS IMAGING IN COMPARISON WITH FRACTIONAL FLOW RESERVE GUIDED CORONARY ANGIOGRAPHY

2012 ◽  
Vol 59 (13) ◽  
pp. E416
Author(s):  
Deepak Pattanshetty ◽  
Pradeep Bhat ◽  
Ashish Aneja ◽  
Dilip Pillai
Keyword(s):  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
False Negative ◽  
Fractional Flow ◽  
Stress Imaging ◽  
Non Invasive ◽  
Negative Results ◽  
Flow Reserve ◽  
False Negative Results

scholarly journals Virtual fractional flow reserve derived from coronary angiography – artery and lesion specific correlations

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Mano ◽  
V Ferreira ◽  
R Ramos ◽  
P Bras ◽  
J Reis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
False Negative ◽  
Lesion Site ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Tertiary Center

Abstract Introduction Virtual Fractional flow reserve (vFFR) from standard non-hyperaemic invasive coronary angiography (ICA) has emerged as a promising non-invasive test to assess hemodynamic severity of coronary artery disease (CAD). Purpose To investigate the difference in vFFR analysis between vessels and specific lesions. Methods Retrospective analysis of consecutive patients (pts) who underwent invasive functional assessment (iFA) in a tertiary center between 2019 and 2020. vFFR was calculated using dedicated software (CAAS Workstation 8.4) based on coronary angiograms of the acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance of vFFR was evaluated and correlated with iFA, according to coronary vessel, vessel diameter at stenosis, diameter stenosis and area stenosis at lesion. vFFR was considered positive when <0.80. FFR <0.8 and iFR/RFR <0.90 were classified as positive according to current clinical standards. Results 106 coronary arteries of 95 pts (78% male, mean age 67.8±9.7 years) underwent vFFR evaluation. ICA indications were chronic coronary syndrome in 63% or acute coronary syndrome (non-culprit lesion) in the remaining pts. VFFR accuracy was good (AUC 0.839 (p<0.001) and Pearson's correlation coefficient 0.533 (p<0.001) when vFFR was measured in the distal vessel segment. The correlation improved when vFFR were assessed at lesion site (r=0.631, p<0.001) or up to 1cm below the stenosis (0.610, p<0.001). Binary concordance of 89% were observed in RCA and LAD (Sensibility -S 68%, Specificity-Sp 96%, False positive -FP 3.8%, False negative - FN 31%, predictive positive value-PPV 87%, predictive negative value- PNV 89%), while in the circumflex coronary artery binary concordance were of 77% (S 50%; Sp 82%; FP 18%; FN 50%; PPV 33% and PNV 90%). Correlation between vFFR and iFA was higher in vessels ≥2mm (r=0.730, p<0.001). and in lesions in the extremes of the severity spectrum (Table 1). Conclusion vFFR has a moderate to high linear correlation to iFA, depending on the artery and type of lesion studied. The higher correlation was found when vFFR were measured at lesion site, in non-circumflex artery stenosis, in vessels ≥2mm and in vessels with mild or severe stenosis. FUNDunding Acknowledgement Type of funding sources: None.

3286Fractional flow reserve-guided treatment strategy for left main coronary artery stenoses. Ten-year clinical outcome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Di Gioia ◽  
S Fournier ◽  
A Milkas ◽  
I Colaiori ◽  
M Hamilos ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Fractional Flow Reserve ◽  
Treatment Strategy ◽  
False Negative ◽  
Left Main ◽  
Fractional Flow ◽  
Target Vessel Revascularization ◽  
Negative Results ◽  
Flow Reserve ◽  
Revascularization Therapy

Abstract Background Revascularization decisions regarding left main (LM) coronary stenoses are often very challenging. Non-invasive tests can yield false negative results. On the other hand, some technical aspects of fractional flow reserve (FFR) measurement, as well as the interpretation of their results, are less codified than for other coronary segments. Purpose To investigate the 10-year clinical outcome of patients with isolated angiographically intermediate LM coronary stenosis in whom the treatment strategy was based on Fractional Flow Reserve (FFR) measurements. Methods From 1999 to 2009 we included 96 patients with isolated intermediate LM coronary disease (DS% 30–70%) evaluated with FFR measurement. When FFR was >0.80, patients were deferred to medical therapy (Deferral-group, n=71). When FFR was ≤0.8, surgical revascularization therapy was proposed (Revascularization-group, n=25). Death, the occurrence of myocardial infarction (MI) and the need for target vessel revascularization (TVR) were evaluated in both groups. Results There were no significant differences in clinical characteristics between the 2 groups. Mean DS% was 35% in the Deferral-group and 43% in the Revascularization-group (p<0.01). Average FFR was 0.88 in the Deferral-group and 0.71 in the Revascularization-group (p<0.01). In the latter, the 10-year survival estimate was 72% while it was 77% in the Deferral group (HR [95% CI]: 1.28 [0.53–3.10]; p=NS). No difference was found between the 2 groups in terms of MI (4.5% vs. 1.6%; HR [95% CI]: 3.5 [0.22–56.0]; p=NS) or TVR (9% vs. 12%; HR [95% CI]: 0.94 [0.20–4.43]; p=NS). Conclusions The use of FFR to defer revascularization in patients with non-significant isolated LM stenosis is safe and is associated with favourable clinical outcome at 10 years.

scholarly journals Validation of the diagnostic performance of ‘HeartMedi V.1.0’, a novel CT-derived fractional flow reserve measurement, for patients with coronary artery disease: a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037780
Author(s):  
Soo-Hyun Kim ◽  
Si-Hyuck Kang ◽  
Woo-Young Chung ◽  
Chang-Hwan Yoon ◽  
Sang-Don Park ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Invasive Coronary Angiography ◽  
Fractional Flow ◽  
Non Invasive ◽  
Link Type ◽  
Flow Reserve

IntroductionCoronary CT angiography (CCTA) is widely used for non-invasive coronary artery evaluation, but it is limited in identifying the nature of functional characteristics that cause ischaemia. Recent computational fluid dynamic (CFD) techniques applied to CCTA images permit non-invasive computation of fractional flow reserve (FFR), a measure of lesion-specific ischaemia. However, this technology has limitations, such as long computational time and the need for expensive equipment, which hinder widespread use.Methods and analysisThis study is a prospective, multicentre, comparative and confirmatory trial designed to evaluate the diagnostic performance of HeartMedi V.1.0, a novel CT-derived FFR measurement for the detection of haemodynamically significant coronary artery stenoses identified by CCTA, based on invasive FFR as a reference standard. The invasive FFR values ≤0.80 will be considered haemodynamically significant. The study will enrol 184 patients who underwent CCTA, invasive coronary angiography and invasive FFR. Computational FFR (c-FFR) will be analysed by CFD techniques using a lumped parameter model based on vessel length method. Blinded core laboratory interpretation will be performed for CCTA, invasive coronary angiography, invasive FFR and c-FFR. The primary objective of the study is to compare the area under the receiver–operator characteristic curve between c-FFR and CCTA to non-invasively detect the presence of haemodynamically significant coronary stenosis. The secondary endpoints include diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and correlation of c-FFR with invasive FFR.Ethics and disseminationThe study has ethic approval from the ethics committee of Seoul National University Bundang Hospital (E-1709/420-001) and informed consent will be obtained for all enrolled patients. The result will be published in a peer-reviewed journal.Trial registration numberKCT0002725; Pre-results.

Fractional Flow Reserve: Does a Cut-off Value add Value?

2016 ◽  
Vol 11 (1) ◽  
pp. 17
Author(s):  
Shah R Mohdnazri ◽  
◽  
◽  
◽  
Thomas R Keeble ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Grey Zone ◽  
Fractional Flow ◽  
Non Invasive ◽  
Invasive Test ◽  
Flow Reserve ◽  
A Value ◽  
Percutaneous Coronary ◽  
Value Add

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a ‘grey zone’ for FFR values of between 0.76 and 0.80 was demonstrated, where a positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI.

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