IMPACT OF AGEING ON THE FUNCTIONAL EVALUATION OF INTERMEDIATE CORONARY STENOSES WITH ADENOSINE-BASED FRACTIONAL FLOW RESERVE (FFR) AND INSTANTANEOUS WAVE-FREE RATIO (IFR)

The optimal strategy for assessing the ischemic significance of intermediate coronary stenoses with adenosine-induced fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) is still debated. Few studies have previously assessed the impact of age on FFR and iFR, which was the aim of our study. Patients undergoing FFR and iFR evaluation for intermediate (40%-70%) coronary lesions were included and divided according to age. Fractional flow reserve was performed by intracoronary boluses of adenosine (60-1440 μg). Instantaneous wave-free ratio was automatically calculated. Among 148 patients undergoing FFR measurement of 166 lesions, 45.3% were ≥70 years. Elderly patients had higher minimal lumen diameter ( P = .03). We also observed a linear relationship between iFR and FFR independently of age. Fractional flow reserve values were higher in the elderly patients, whereas iFR was not related to age. A total of 33 lesions had a positive iFR with no difference for age (17.3% vs 22%, P = .56), while FFR <0.80 was more infrequent in the elderly patients (17.1% vs 34.8%, P = .02). In intermediate coronary stenoses, iFR and FFR correlation is unaffected by age. Fractional flow reserve is higher in the elderly patients, whereas iFR is less affected by age. Future large-scale studies are needed to define whether iFR should be the preferred choice in elderly patients.

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Physiological Evaluation of Anomalous Aortic Origin of a Coronary Artery Using Computed Tomography–Derived Fractional Flow Reserve

Journal of the American Heart Association ◽

10.1161/jaha.120.018593 ◽

2021 ◽

Author(s):

Julien Adjedj ◽

Fabien Hyafil ◽

Xavier Halna du Fretay ◽

Patrick Dupouy ◽

Jean‐Michel Juliard ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery ◽

Ct Angiography ◽

Fractional Flow Reserve ◽

Coronary Ct Angiography ◽

Functional Evaluation ◽

Fractional Flow ◽

Coronary Ct ◽

Flow Reserve

Background With the emergence of coronary computed tomography (CT) angiography, anomalous aortic origin of a coronary artery (ANOCOR) is more frequently diagnosed. Fractional flow reserve derived from CT (FFRCT) is a noninvasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features of anatomical and functional evaluation derived from CT could help for the management of patients with ANOCOR. We aimed to retrospectively evaluate the physiological and clinical impact of FFRCT analysis in the ANOCOR registry population. Methods and Results The ANOCOR registry included patients with ANOCOR detected during invasive coronary angiography or coronary CT angiography between January 2010 and January 2013, with a planned 5‐year follow‐up. We retrospectively performed FFRCT analysis in patients with coronary CT angiography of adequate quality. Follow‐up was performed with a clinical composite end point (cardiac death, myocardial infarction, and unplanned revascularization). We obtained successful FFRCT analyses and 5‐year clinical follow‐up in 54 patients (average age, 60±13 years). Thirty‐eight (70%) patients had conservative treatment, and 16 (30%) patients had coronary revascularization after coronary CT angiography. The presence of an ANOCOR course was associated with a moderate reduction of FFRCT value from 1.0 at the ostium to 0.90±0.10 downstream the ectopic course and 0.82±0.11 distally. No significant difference in FFRCT values was identified between at‐risk and not at‐risk ANOCOR. After a 5‐year follow‐up, only one unplanned percutaneous revascularization was reported. Conclusions The presence of ANOCOR was associated with a moderate hemodynamic decrease of FFRCT values and associated with a low risk of cardiovascular events after a 5‐year follow‐up in this middle‐aged population.

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CT Determination of Fractional Flow Reserve in Coronary Lesions

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2016-0070 ◽

2016 ◽

Vol 1 (3) ◽

pp. 237-241 ◽

Cited By ~ 1

Author(s):

András Mester ◽

Monica Chiţu ◽

Nora Rat ◽

Diana Opincariu ◽

Lehel Bordi ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Computational Techniques ◽

Functional Evaluation ◽

Fractional Flow ◽

Gold Standard Method ◽

Flow Reserve ◽

Ct Evaluation ◽

Coronary Lesions

Abstract Invasively determined fractional flow reserve (FFR) represents the gold-standard method for the functional evaluation of coronary lesions. Coronary computed tomography angiography (CCTA) provides characterization of the coronary anatomy, with important morphological information on the atherosclerotic plaques, but does not offer a hemodynamic evaluation of coronary artery lesions. CT evaluation of FFR (FFRCT) is a new noninvasive diagnostic method, which provides anatomical and functional assessment of the whole coronary tree, based on computational techniques, with no more radiation or hyperemic agent administration compared with routine CCTA. Recent studies demonstrated the safety and accuracy of FFRCT and its therapeutic use and cost benefits in real-world clinical use.

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Prospective Randomized Comparison of Fractional Flow Reserve Versus Optical Coherence Tomography to Guide Revascularization of Intermediate Coronary Stenoses: One‐Month Results

Journal of the American Heart Association ◽

10.1161/jaha.119.012772 ◽

2019 ◽

Vol 8 (15) ◽

Cited By ~ 3

Author(s):

Antonio Maria Leone ◽

Francesco Burzotta ◽

Cristina Aurigemma ◽

Giovanni Luigi De Maria ◽

Aniello Zambrano ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Fractional Flow Reserve ◽

Optical Coherence ◽

Fractional Flow ◽

Flow Reserve ◽

Coronary Stenoses

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Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation

European Heart Journal ◽

10.1093/eurheartj/ehz918 ◽

2019 ◽

Vol 41 (34) ◽

pp. 3271-3279 ◽

Cited By ~ 8

Author(s):

Shengxian Tu ◽

Jelmer Westra ◽

Julien Adjedj ◽

Daixin Ding ◽

Fuyou Liang ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Diagnostic Methods ◽

Functional Evaluation ◽

Fractional Flow ◽

Catheterization Laboratory ◽

Flow Reserve ◽

Pressure Wire ◽

Stenosis Severity ◽

Procedural Guidance ◽

Invasive Measurement

Abstract Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance of epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, there remains a gap between guideline recommendations and the clinical adoption of functional evaluation of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologies, we sought to highlight the principles, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization laboratory. Computational FFR has the potential to expand and facilitate the use of physiology for diagnosis, procedural guidance, and evaluation of therapies, with anticipated impact on resource utilization and patient outcomes.

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