scholarly journals 806 Scout post-PCI instantaneous wave-free ratio as a driver of functional complete

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Dario Calderone ◽  
Maria Sara Mauro ◽  
Marco Legnazzi ◽  
Federica Agnello ◽  
Lorenzo Scalia ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Multivessel Disease ◽  
Complete Revascularization ◽  
Illustrative Case ◽  
Low Grade ◽  
Fractional Flow ◽  
Relative Contribution ◽  
Flow Reserve ◽  
Proximal Lesion ◽  
Coronary Lesions

Abstract Aims Physiology assessment by means of instantaneous wave-free ratio (iFR) is non-inferior to fractional flow reserve for the assessment of intermediate coronary lesions that are candidates to percutaneous coronary intervention (PCI). However, in pivotal trials assessing iFR, tandem coronary lesions (i.e. two serial lesions located in the same coronary artery) were excluded. In addition, the role of iFR after PCI as a way to optimize its success is poorly understood, particularly in the context of ST-segment elevation myocardial infarction (STEMI) with multivessel disease and tandem stenoses. We describe an illustrative case of post-PCI iFR in a STEMI patient with multivessel disease that led to a significant change in the revascularization strategy. Methods A 71-year old man presented with infero-lateral STEMI and received PCI with 1 drug-eluting stent (DES) 2.25 × 18 mm on the distal right coronary artery. The left coronary artery presented a 30–40% stenosis of the proximal left circumflex (LCX) and a 90% bifurcation stenosis of the mid portion of the same artery. PCI of the distal lesion was performed with implantation of 1 DES 3.0 × 22 with flaring of the stent at the level of the side branch and proximal optimization technique. Post-PCI iFR of the LCX was performed to assess the success of the procedure, with a value of 0.74. To understand the relative contribution of the two tandem stenoses, a pullback of the iFR wire was performed, which showed an unexpectedly small jump of the pressure when the wire was between the two lesions (0.80). Results As such, the significant contribution of the proximal lesion was unravelled, which led to implantation of a second DES 4.0 × 26 mm, partially overlapping with the previously implanted DES. Post-PCI iFR confirmed the complete success of the procedure (1.00). Conclusions In the context of complete revascularization for STEMI presenting with non-infarct related artery tandem stenoses, post-PCI physiology contributes to unravel the relative contribution of low-grade angiographic stenoses corresponding to functionally significant atherosclerosis left untreated. This case example illustrates the emerging procedural value of post-PCI iFR in achieving the goal of complete functional revascularization.

Differential influence of lesion length on fractional flow reserve in intermediate coronary lesions between each coronary artery

2019 ◽  
Vol 95 (6) ◽  
Author(s):  
Hiroki Shibutani ◽  
Kenichi Fujii ◽  
Koichiro Matsumura ◽  
Munemitsu Otagaki ◽  
Shun Morishita ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Lesion Length ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Lesions

Comparison of FFR with iFR and QFR in assessment of intermediate coronary artery disease in patients with severe aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Kleczynski ◽  
A Dziewierz ◽  
L Rzeszutko ◽  
D Dudek ◽  
J Legutko
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Funding Source ◽  
Fractional Flow ◽  
Roc Curve Analysis ◽  
Flow Reserve ◽  
Coronary Lesions ◽  
Artery Disease

Abstract Background The functional assessment of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) has been barely examined so far, and the best strategy to physiologically investigate the relevance of coronary stenosis in this specific setting of patients remains undetermined. The aim of the study is to compare the diagnostic performance of instantaneous wave-free ratio (iFR), quantitative flow ratio (QFR) and fractional flow reserve (FFR) in patients with severe AS. Methods The functional significance of 416 coronary lesions was investigated with iFR, FFR and QFR measurements in 221 AS patients. The iFR-FFR and QFR-FFR diagnostic agreement has been tested using the conventional 0.80 FFR cut-off. Results Mean value of FFR was 0.85±0.07; iFR – 0.90±0.04; QFR – 0.84±0.07. The correlation between iFR and FFR was good (r=0.83, p<0.001) and QFR and FFR was goot too (r=0.77, p<0.001), as well as the area under the curve at ROC curve analysis 0,995 (0,983 to 0,999, p<0.001) for iFR and 0,988 (0,972 to 0,996, p<0.001) for QFR. However, using the standard iFR 0.89 and QFR 0.8 threshold, the diagnostic accuracy of iFR was 100% sensitivity and 90.26% specificity and for QFR – 100% and 92.21%, respectively. According to ROC analysis, the best iFR cut-off in predicting FFR ≤0.8 was 0.88 (J=0.94), the best QFR cut-off value was 0.80 (J=0.92). Conclusions In the presence of severe AS, iFR and QFR had good agreement with FFR values for assessment of borderline coronary lesions. However, iFR threshold for predicting FFR below 0.8 may be different from a standard value of 0.89. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Centre

scholarly journals Impact of preoperative fractional flow reserve on arterial bypass graft anastomotic function: the IMPAG trial

2019 ◽  
Vol 40 (29) ◽  
pp. 2421-2428 ◽  
Author(s):  
David Glineur ◽  
Juan B Grau ◽  
Pierre-Yves Etienne ◽  
Umberto Benedetto ◽  
Jacqueline H Fortier ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Graft Function ◽  
Double Blind Study ◽  
Fractional Flow ◽  
Surgical Revascularization ◽  
Flow Reserve ◽  
Coronary Lesions

Abstract Aims Visual estimation is the most commonly used method to evaluate the degree of coronary artery stenosis prior to coronary artery bypass grafting. In interventional cardiology, the use of fractional flow reserve (FFR) to guide revascularization decisions has become routine. We investigated whether the preoperative FFR measurement of coronary lesions is associated with anastomosis function 6 months after surgical revascularization using a multiarterial grafting strategy. Methods and results In this prospective double-blind study, 67 patients were enrolled from two institutions in Europe and Canada. From these patients, 199 coronary lesions were assessed visually and with FFR at the time of the preoperative angiogram. All patients received coronary revascularization using multiple arterial grafts. A post-operative 6-month angiogram was performed to assess anastomosis functionality using a described angiographic method. The primary outcome was the association between preoperative FFR values and anastomosis function 6 months after surgery. Preoperative FFR was significantly associated with 6-months anastomotic function for all conduits and for all targets (P  <  0.001). An FFR value of ≤0.78 was associated with an anastomotic occlusion rate of 3%. Conclusion We found a significant association between the preoperative FFR measurement of the target vessel and the anastomotic functionality at 6 months, with a cut-off of 0.78. Integration of FFR measurement into the preoperative diagnostic workup before multiarterial coronary surgical revascularization leads to improved anastomotic graft function. Clinical Trials. gov Identifier NCT02527044.

Functional assessment of myocardial ischemia by intracoronary electrocardiogram

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.R Bigler ◽  
F Praz ◽  
G.C.M Siontis ◽  
M Stoller ◽  
R Grossenbacher ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Primary Study ◽  
Coronary Perfusion ◽  
Funding Source ◽  
Maximal Heart Rate ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
St Segment ◽  
Coronary Lesions

Abstract Background In patients with chronic coronary syndrome (CCS), percutaneous coronary intervention (PCI) targets hemodynamically significant stenoses, i.e., those thought to cause ischemia. The hemodynamic severity of a coronary stenosis increases with its tightness and with the myocardial mass of viable myocardium downstream of the stenosis. Besides the structural angiographic approach, assessment of functional relevance by pressure measurements (fractional flow reserve, FFR; instantaneous wave-free ratio, iFR) is recommended. However, visual angiographic assessment continues to dominate the treatment decisions for intermediate coronary lesions. Conversely, intracoronary ECG (icECG) potentially provides an inexpensive, sensitive and direct measure of myocardial ischemia. Purpose The goal of this study was to test the accuracy of intracoronary ECG during pharmacologic inotropic stress to determine coronary lesion severity in comparison to established physiologic indices (FFR/iFR) as well as with quantitatively determined percent diameter stenosis (%S) using biplane coronary angiography. Method This was a prospective, open-label study in patients with CCS. The primary study end point was the maximal change in icECG ST-segment shift during pharmacologic inotropic stress induced by dobutamine plus atropine obtained within 1 minute after the point of maximal heart rate (estimated by the formula 220 - age). IcECG was acquired by attaching an alligator clamp to the angioplasty guidewire positioned downstream of a stenosis. For the pressure-derived ratios, i.e. FFR and iFR, the coronary perfusion pressure downstream of a lesion as well as the aortic pressure were continuously recorded. Results One hundred patients were included in the study. Pearson-Correlation coefficient was significant between icECG and all three comparators (%S p&lt;0.001, iFR p&lt;0.001, FFR p&lt;0.001). Using the FFR threshold of 0.80 defining coronary hemodynamic significance, ROC-analysis of the absolute icECG ST-segment shift showed an area under the curve (AUC) of 0.708±0.053 (p=0.0001, n=100, FFR&lt;0.80 n=41). AUC for iFR was 0.919±0.030 (p&lt;0.0001), for percent diameter stenosis it was 0.867±0.036 (p&lt;0.0001). Conclusions During pharmacologic inotropic stress, intracoronary ECG ST-segment shift provides specific evidence for regional myocardial ischemia irrespective of the etiology and thus, provides an additional (patho-)physiologic information for decision making in borderline coronary lesions. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Swiss Heart Foundation

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