scholarly journals Validation of pressure gradient and peripheral fractional flow reserve measured by a pressure wire for diagnosis of iliofemoral artery disease with intermediate stenosis

2015 ◽  
pp. 467 ◽  
Author(s):  
Naotaka Murata ◽  
Hideaki Aihara ◽  
Yoshimitu Soga ◽  
Yusuke Tomoi ◽  
Seiichi Hiramori ◽  
...  
Keyword(s):  
Pressure Gradient ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Pressure Wire ◽  
Artery Disease

scholarly journals Novel Indices of Coronary Physiology

2020 ◽  
Vol 13 (4) ◽  
Author(s):  
Giovanni Luigi De Maria ◽  
Hector M. Garcia-Garcia ◽  
Roberto Scarsini ◽  
Alexandre Hideo-Kajita ◽  
Nieves Gonzalo López ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Special Focus ◽  
Fractional Flow ◽  
Procedural Cost ◽  
Flow Reserve ◽  
Pressure Wire ◽  
Pros And Cons ◽  
Artery Disease ◽  
Development Alternatives ◽  
Near Future

Fractional flow reserve is the current invasive gold standard for assessing the ischemic potential of an angiographically intermediate coronary stenosis. Procedural cost and time, the need for coronary vessel instrumentation, and the need to administer adenosine to achieve maximal hyperemia remain integral components of invasive fractional flow reserve. The number of new alternatives to fractional flow reserve has proliferated over the last ten years using techniques ranging from alternative pressure wire metrics to anatomic simulation via angiography or intravascular imaging. This review article provides a critical description of the currently available or under-development alternatives to fractional flow reserve with a special focus on the available evidence, pros, and cons for each with a view towards their clinical application in the near future for the functional assessment of coronary artery disease.

scholarly journals Resistance to Flow of Arterial Y-Grafts 6 Months After Coronary Artery Bypass Surgery

Circulation ◽  
2005 ◽  
Vol 112 (9_supplement) ◽  
Author(s):  
David Glineur ◽  
Philippe Noirhomme ◽  
Jim Reisch ◽  
Gebrine El Khoury ◽  
Parla Astarci ◽  
...  
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Pressure Gradient ◽  
Fractional Flow Reserve ◽  
Artery Bypass ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Pressure Wire ◽  
Flow Demand ◽  
Minimal Resistance

Background— The use of both internal thoracic arteries (ITAs) as a Y-graft configuration has been proposed as a technique allowing complete arterial revascularization. Controversy remains, however, about the capacity of this Y-graft configuration to provide sufficient blood flow to the whole left coronary system and about possible steal phenomenon occurring during periods of maximal myocardial blood flow demand. Methods and Results— To evaluate graft conductance 6 months after Y-graft revascularization of the left coronary system with both ITAs, 11 consecutive patients were studied during cardiac catheterization. In all of the cases, the left ITA had been connected to the left anterior descending coronary artery (LAD) territory (mean, 1.3 anastomoses), and the free right ITA was anastomosed proximally to the left ITA and distally to the left circumflex (LCX) territory (mean, 1.9 anastomoses). Pressure and fractional flow reserve (FFR) were recorded using a 0.014-inch pressure wire advanced distally in the left ITA main stem close to the proximal anastomosis of the free right ITA (ITA-stem) and in the distal part of each ITA branch at the site of their implantation to the LAD (ITA-LAD) or LCX (ITA-LCX) system. At each of these sites, the pressure gradient between aorta and the graft was measured in basal condition and during maximal hyperemia induced by intragraft bolus injection of 40 μg of adenosine. In basal conditions, the pressure gradient was minimal between the aorta and the ITA-stem (2±2 mm Hg), the ITA-LAD (3±3 mm Hg), and the ITA-LCX (3±2 mm Hg; P value was not significant versus ITA-LAD). During maximal hyperemia, the pressure gradient increased to 7±2 mm Hg in the ITA-stem, to 9±5 mm Hg in the ITA-LAD, and to 9±3 in the ITA-LCX ( P value not significant versus ITA-LAD). The fractional flow reserve was 0.93±0.03 in the ITA-stem, 0.91±0.04 in the ITA-LAD, and 0.91±0.03 in the ITA-LCX. Conclusions— A Y-graft configuration with a free right ITA attached to a pedicled left ITA allows an adequate revascularization of the whole left coronary system with an even distribution of perfusion pressure in both distal branches and minimal resistance to maximal blood flow.

scholarly journals Prognostic value of per-vessel treatment adherence in stable coronary artery disease based on novel computational pressure-flow dynamics derived fractional flow reserve

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C K L Leung ◽  
L Y Lam ◽  
K Y Li ◽  
A S Y Yu ◽  
M Z Wu ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Fractional Flow Reserve ◽  
Coronary Vessels ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Group 3 ◽  
Group 2 ◽  
Artery Disease ◽  
Adherence Group ◽  
Group 1

Abstract Background Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index developed to evaluate the extent of myocardial ischemia in patients with coronary artery disease (CAD), which eliminates the need of invasive pressure guidewire and hyperaemic stimulus in conventional fractional flow reserve (FFR) measurement. Studies have shown improved clinical outcomes associated with adherence to functional myocardial ischemia assessment when deciding to perform percutaneous coronary intervention (PCI) at a per-patient level. However, the clinical significance of such treatment adherence at a per-vessel level remains uncertain. Methods A total of 928 patients (mean age 66.2±10.5, male 72.7%) with stable CAD were included in this study. The caFFR of all three major coronary vessels were obtained for every patient, and the FFR threshold of 0.8 was adopted as the threshold for caFFR to indicate functionally significant artery stenosis which warrants PCI, and vice versa. Based on the caFFR of each major coronary vessel and whether PCI was performed to the respective vessel, patients were stratified into 0–1 vessel with treatment adherence group (group 1) (n=105), 2 vessels with treatment adherence group (group 2) (n=338), and 3 vessels with treatment adherence group (group 3) (n=485). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction and any subsequent revascularization. Results The severity of CAD based on SYNTAX score assessment was 18.6±10.2 in group 1, 14.6±8.9 in group 2, and 11.5±9.9 in group 3 (P<0.001). The rates of MACE at 3 years were significantly different across groups 1, 2 and 3 (17.1% vs. 12.1% vs. 7.4%; P=0.004). With reference to group 3, the risk of MACE at 3 years was increased in group 2 (adjusted hazard ratio [HR]=1.597; 95% confidence interval [CI]=1.020–2.501; P=0.041), and further increased in group 1 (adjusted HR=1.933; 95% CI=1.081–3.457; P=0.026). Conclusion In stable CAD patients, the risk of MACE is incremental when fewer major coronary vessels are treated with adherence to caFFR threshold of 0.8. Per-vessel treatment adherence significantly affects clinical outcomes in terms of MACE. FUNDunding Acknowledgement Type of funding sources: None.

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