scholarly journals Duration of myocardial early systolic lengthening for diagnosis of coronary artery disease

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000896 ◽  
Author(s):  
Masatoshi Minamisawa ◽  
Jun Koyama ◽  
Ayako Kozuka ◽  
Takashi Miura ◽  
Tatsuya Saigusa ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Fractional Flow ◽  
Cross Sectional ◽  
Significant Stenosis ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Relationship

ObjectiveMyocardial early systolic lengthening (ESL) duration is prolonged in patients with coronary artery disease (CAD). However, the relationship between the fractional flow reserve (FFR), the current gold standard for evaluating physiological myocardial ischaemia, and ESL has not been studied. The aims of this study were to investigate whether left ventricular (LV) ESL duration could identify patients with CAD, and to examine the relationship between FFR and LV ESL duration.MethodsIn this single-centre, cross-sectional, prospective study of 75 patients with suspected or known CAD, we performed two-dimensional speckle tracking echocardiography at rest on the day before coronary angiography or percutaneous coronary intervention. Apical 3 views were used to examine ESL duration, defined as time from onset of the Q wave to maximum myocardial systolic lengthening.ResultsThirty-five patients had non-significant stenosis. Forty patients with CAD underwent FFR testing: 17 had an FFR≥0.8 and 23 had an FFR<0.8. Global ESL duration was 20.9±22.2 ms in patients with non-significant stenosis, 36.4±23.2 ms in patients with FFR≥0.8 and 39.6±29.5 ms in patients with FFR<0.8 (p=0.020). However, global and regional ESL durations were not significantly correlated with FFR and demonstrated poor reproducibility.ConclusionAlthough myocardial ESL duration was significantly prolonged in patients with CAD compared with patients without CAD, ESL at rest showed poor reproducibility, and this new parameter did not predict FFR in patients with suspected CAD.

scholarly journals Placebo-Controlled Efficacy of Percutaneous Coronary Intervention for Focal and Diffuse Patterns of Stable Coronary Artery Disease

2021 ◽  
Author(s):  
Christopher A. Rajkumar ◽  
Matthew Shun-Shin ◽  
Henry Seligman ◽  
Yousif Ahmad ◽  
Takayuki Warisawa ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Stress Echocardiography ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
End Points ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Artery Disease

Background: Physiological assessment with pressure wire pullback can characterize coronary artery disease (CAD) with a focal or diffuse pattern. However, the clinical relevance of this distinction is unknown. We use data from the ORBITA trial (Objective Randomised Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) to test if the pattern of CAD predicts the placebo-controlled efficacy of percutaneous coronary intervention (PCI) on stress echocardiography ischemia and symptom end points. Methods: One hundred sixty-four patients in ORBITA underwent blinded instantaneous wave-free ratio (iFR) pullback assessment before randomization. Focal disease was defined as a ≥0.03 iFR unit drop within 15 mm, rather than over a longer distance. Analyses were performed using regression modeling. Results: In the PCI arm (n=85), 48 were focal and 37 were diffuse. In the placebo arm (n=79), 35 were focal and 44 were diffuse. Focal stenoses were associated with significantly lower fractional flow reserve (FFR) and iFR values than diffusely diseased vessels (mean FFR and iFR, focal 0.60±0.15 and 0.65±0.24, diffuse 0.78±0.10 and 0.88±0.08, respectively, P <0.0001). With adjustment for this difference, PCI for focal stenoses resulted in significantly greater reduction in stress echo ischemia than PCI for diffuse disease ( P <0.05). The effect of PCI on between-arm pre-randomization adjusted exercise time was 9.32 seconds (95% CI, −17.1 to 35.7 seconds; P =0.487). When stratified for pattern of disease, there was no detectable difference between focal and diffuse CAD ( P interaction=0.700). PCI improved Seattle Angina Questionnaire angina frequency score and freedom from angina more than placebo ( P =0.034; P =0.0035). However, there was no evidence of interaction between the physiological pattern of CAD and these effects ( P interaction=0.436; P interaction=0.908). Conclusions: PCI achieved significantly greater reduction of stress echocardiography ischemia in focal compared with diffuse CAD. However, for symptom end points, no such difference was observed. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02062593.

scholarly journals The Relationship between Fractional Flow Reserve, Platelet Reactivity and Platelet Leukocyte Complexes in Stable Coronary Artery Disease

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e83198 ◽  
Author(s):  
Jan-Willem E. M. Sels ◽  
Bert Rutten ◽  
Thijs C. van Holten ◽  
Marieke A. K. Hillaert ◽  
Johannes Waltenberger ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Platelet Reactivity ◽  
Stable Coronary Artery Disease ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Relationship

Percutaneous coronary intervention in stable coronary artery disease

2014 ◽  
Vol 155 (49) ◽  
pp. 1952-1959
Author(s):  
Zsolt Piróth
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Artery Disease

Percutaneous coronary intervention is a well-established symptomatic therapy of stable coronary artery disease. Using a literature search with special emphasis on the newly-published FAME 2 trial data, the author wanted to explore why percutaneous coronary intervention fails to reduce mortality and myocardial infarction in stable coronary artery disease, as opposed to surgical revascularisation. In the FAME 2 trial, fractional flow reserve-guided percutaneous coronary intervention with second generation drug eluting stents showed a significant reduction in the primary composite endpoint of 2-year mortality, myocardial infarction and unplanned hospitalization with urgent revascularisation as compared to medical therapy alone. In addition, landmark analysis showed that after 8 days, mortality and myocardial infarction were significantly reduced. The author concludes that percutaneous coronary intervention involving fractional flow reserve guidance and modern stents offers symptomatic, as well as prognostic benefit. Orv. Hetil., 2014, 155(49), 1952–1959.

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