scholarly journals Fractional Flow Reserve in Choosing the Tactics of Interventional Treatment of Multilevel Coronary Artery Lesions

2021 ◽  
pp. 26-29
Author(s):  
Andrii Yu. Gavrylyshyn ◽  
Sergii V. Salo ◽  
Olena V. Levchyshyna ◽  
Andrii K. Logutov ◽  
Vasyl V. Lazoryshynets
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
Stable Coronary Artery Disease ◽  
Interventional Treatment ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease

When choosing tactics for the treatment of patients with stable coronary artery disease, invasive coronary angiography remains the gold standard for diagnosis and is a crucial method in choosing tactics and volume of revascularization. However, in the presence of borderline (>50-70%), multilevel lesions of the coronary artery, there is a need for additional assessment of the physiological significance of each stenosis. The aim. To develop an algorithm to optimize the use of fractional flow reserve (FFR) measurement in interventional treatment of borderline (>50-70%), multilevel lesions of coronary arteries, to show the safety of “functional revascula­ rization” in comparison with traditional angiography. Materials and methods. The study included 32 patients who were treated at the National Amosov Institute of Cardiovascular Surgery in the period from 2017 to 2021 (the vast majority were men – 25 patients (67%) and 7 (33%) women) aged 60.3±8.3 years who had >50-75% multilevel lesions of one of the main coronary arteries according to selective invasive coronary angiography. The patients were divided into two groups: 1) Angiographic group (n = 17, 53%), where the volume and tactics of revascularization were determined only by angiography (maximum complete anatomical revascularization); 2) Functional group (n=15, 47%) (combination of angiography data and FFR measurement, the so-called “functional revascularization”). Conclusions. An effective and safe algorithm for measuring FFR in multilevel lesions (reducing the number of implanted stents) is shown.

scholarly journals Real world utilization of CT derived fractional flow reserve in stable angina from contemporary practice: impact on downstream utilization of invasive coronary angiogram and clinical decision making

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ray ◽  
K Green ◽  
A Shamsi ◽  
A Mahmood ◽  
A Hatrick ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
Severe Disease ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Flow Reserve ◽  
Artery Disease

Abstract   Background/Introduction - Fractional flow reserve (FFR), a pressure wire-based index used during coronary angiography to assess the severity of potential coronary stenosis, is considered as the reference standard for evaluating the severity of stenosis in coronary artery disease (CAD). Recently, computed tomography angiography-derived fractional flow reserve (FFRct) has been recommended for evaluating functional severity of stenoses as it improves diagnostic accuracy and reduces the need for invasive coronary angiography. Purpose To determine whether non-invasive FFRct predicts severity of coronary artery disease and whether its addition improves efficiency of proceeding to revascularisation and invasive coronary angiography (ICA) compared to coronary computed tomography angiography (CTA) without FFR. Methods This observational retrospective single center study included two cohorts of patients who presented in a District General Hospital in UK. The first group consisted of all patients who underwent coronary CTA for chest pain from January 2013 to December 2014. The second cohort consisted of all patients who proceeded to have measurement of FFRct from April 2018 to June 2019 after routine coronary CTA for chest pain. The two groups showed similar demographics. FFRct was analysed using the software HeartFlow. We determined the agreement of FFRct (positive if <0.80) with stenosis on CTA and ICA (positive if >50% left main or >70% other coronary artery) and whether it correlated with need for revascularisation. We also assessed if adding FFRct <0.80 improved efficiency of referral to ICA, defined as decreased diagnosis of mild or moderate stenosis (<70%) and higher yield of severe disease (>70%). The two cohorts were compared to determine the above specific end-points. Results In the first cohort, data was collected for 915 patients. 240 (26.2%) of these patients proceeded to ICA, which showed severe disease in 31 (3.3%) patients needing revascularisation. In the second cohort of patients, 824 patients underwent coronary CTA and 201 (24.4%) proceeded to have FFRct measurements. 99 (49%) of these patients had a negative FFR and 65 (32%) patients had a positive result (<0.80). There was agreement between FFRct and invasive coronary angiography/stress echo in 44 (77%) patients, with regards to severity /revascularisation. The need for ICA was significantly reduced if coronary CTA and FFRct were both done (240/915; 26.2% vs 54/824; 6.5%: p value <0.00001). Conclusion Reserving ICA for patients with a positive FFRct (<0.80) could reduce the number of ICA after coronary CTA and augment the number of ICA leading to revascularisation. Use of FFRct as a gatekeeper to ICA will improve appropriate selection of patients referred and this in-turn will reduce the burden of complications associated with invasive procedures, reduce costs and ensure better utilization of Cath-lab resources. Funding Acknowledgement Type of funding source: None

scholarly journals Fractional Flow Reserve in the Diagnosis of Ischemic Heart Disease in a Patient with Coronary Artery Ectasia

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 17
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Lukasz Kuzma ◽  
Hanna Bachorzewska-Gajewska ◽  
Slawomir Dobrzycki
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Connective Tissue Diseases ◽  
Heart Team ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Retrosternal Pain ◽  
Artery Disease

Coronary artery ectasias (CAE) are diffuse dilatations of coronary artery segments with a diameter 1.5 times greater than the largest adjacent normal segment of the vessel. They are found in 0.3–5.0% of coronary angiography. Risk factors for CAE include atherosclerosis, previous percutaneous coronary interventions, arterial inflammation and connective tissue diseases. The diagnosis of CEA in a patient is a considerable diagnostic and therapeutic problem due to the unfavorable prognosis and the lack of guidelines. We present a case of a 69-year-old male patient with a history of retrosternal pain admitted to the clinic for the diagnosis of coronary artery disease. In coronary angiography, numerous ectases of the main coronary arteries and atherosclerotic lesions causing border stenosis of the left anterior descending (LAD), diagonal (2D) and marginal branch (OM). The heart team decided to assess the significance of the changes with the fractional flow reserve (FFR). The FFR was performed and haemodynamically insignificant stenoses of the ectatically dilated coronary arteries were found. The patient was qualified for conservative treatment.

Sign in / Sign up

Export Citation Format

Share Document