scholarly journals Comparison of Resting Full-Cycle Ratio and Fractional Flow Reserve in a German Real-World Cohort

2021 ◽  
Vol 8 ◽  
Author(s):  
Hendrik Wienemann ◽  
Annika Meyer ◽  
Victor Mauri ◽  
Till Baar ◽  
Matti Adam ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Real World ◽  
Predictive Value ◽  
Gold Standard ◽  
Morphological Characteristics ◽  
Quantitative Coronary Angiography ◽  
Coronary Intervention ◽  
University Hospital ◽  
Fractional Flow ◽  
Flow Reserve

Objective: The aim of this study was to evaluate non-hyperemic resting pressure ratios (NHPRs), especially the novel “resting full-cycle ratio” (RFR; lowest pressure distal to the stenosis/aortic pressure during the entire cardiac cycle), compared to the gold standard fractional flow reserve (FFR) in a “real-world” setting.Methods: The study included patients undergoing coronary pressure wire studies at one German University Hospital. No patients were excluded based on any baseline or procedural characteristics, except for insufficient quality of traces. The diagnostic performance of four NHPRs vs. FFR ≤ 0.80 was tested. Morphological characteristics of stenoses were analyzed by quantitative coronary angiography.Results: 617 patients with 712 coronary lesions were included. RFR showed a significant correlation with FFR (r = 0.766, p < 0.01). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of RFR were 78% (95% confidence interval = 75; 81), 72% (65; 78), 81% (77; 84), 63% (57; 69), and 86% (83; 89). Relevant predictors for discordance of RFR ≤ 0.89/FFR > 0.8 were LAD lesions, peripheral artery disease, age, female sex and non-focal stenoses. Predictors for discordance of RFR > 0.89/FFR ≤ 0.8 included non-LCX lesions, percent diameter stenosis and previous percutaneous coronary intervention in the target vessel. RFR and all other NHPRs were highly correlated with each other.Conclusion: All NHPRs have a similar correlation with the gold standard FFR and may facilitate the acceptance and implementation of physiological assessments of lesion severity. However, we found ~20% discordant results between NHPRs and FFR in our “all-comers” German cohort.

Referral of patients for fractional flow reserve using quantitative flow ratio

2018 ◽  
Vol 20 (11) ◽  
pp. 1231-1238 ◽  
Author(s):  
Jeff M Smit ◽  
Gerhard Koning ◽  
Alexander R van Rosendael ◽  
Mohammed El Mahdiui ◽  
Bart J Mertens ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
Quantitative Coronary Angiography ◽  
Coronary Intervention ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Abstract Aims Quantitative flow ratio (QFR) is a recently developed technique to calculate fractional flow reserve (FFR) based on 3D quantitative coronary angiography and computational fluid dynamics, obviating the need for a pressure-wire and hyperaemia induction. QFR might be used to guide patient selection for FFR and subsequent percutaneous coronary intervention (PCI) referral in hospitals not capable to perform FFR and PCI. We aimed to investigate the feasibility to use QFR to appropriately select patients for FFR referral. Methods and results Patients who underwent invasive coronary angiography in a hospital where FFR and PCI could not be performed and were referred to our hospital for invasive FFR measurement, were included. Angiogram images from the referring hospitals were retrospectively collected for QFR analysis. Based on QFR cut-off values of 0.77 and 0.86, our patient cohort was reclassified to ‘no referral’ (QFR ≥0.86), referral for ‘FFR’ (QFR 0.78–0.85), or ‘direct PCI’ (QFR ≤0.77). In total, 290 patients were included. Overall accuracy of QFR to detect an invasive FFR of ≤0.80 was 86%. Based on a QFR cut-off value of 0.86, a 50% reduction in patient referral for FFR could be obtained, while only 5% of these patients had an invasive FFR of ≤0.80 (thus, these patients were incorrectly reclassified to the ‘no referral’ group). Furthermore, 22% of the patients that still need to be referred could undergo direct PCI, based on a QFR cut-off value of 0.77. Conclusion QFR is feasible to use for the selection of patients for FFR referral.

Effect of the ratio of vessel-specific volume to fractional myocardial mass on fractional flow reserve

2021 ◽  
pp. 153537022110271
Author(s):  
Jincheng Liu ◽  
Bao Li ◽  
Junling Ma ◽  
Xue Wang ◽  
Liyuan Zhang ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Quantitative Coronary Angiography ◽  
Left Ventricular ◽  
Myocardial Mass ◽  
Fractional Flow ◽  
Lumen Volume ◽  
Arterial Lumen ◽  
Flow Reserve

This study aimed to examine whether the ratio of vessel-specific coronary arterial lumen volume to the fraction of myocardial mass (VR/MR) affects myocardial ischemia. We proposed a calculation method for VR/MR, and compared the ratio of total epicardial coronary arterial lumen volume to left ventricular myocardial mass (V/M) with VR/MR in predicting myocardial ischemia. VR/MR and V/M were computed using data from 205 patients with 241 stenosis vessel who underwent coronary computed tomography angiography (CTA), quantitative coronary angiography, and fractional flow reserve. The vessel-specific coronary arterial lumen volume (VR) was obtained from CTA by segmenting the coronary arterial lumen volume, while the vessel-specific fraction of myocardial mass (MR) was obtained by allometric scaling. The VR/MR was then calculated. The cut-off values of V/M (23.55 mm3/g) and VR/MR (12.98 mm3/g) were used to define equal groups of ischemic and non-ischemic patients, respectively. Using these cut-off values, the accuracy, specificity, sensitivity, positive predictive value, and negative predictive value of V/M were 60%, 76%, 45%, 57%, and 66%, and of VR/MR were 87%, 92%, 77%, 89%, and 83%, respectively. Patients have different VR/MR values in different stenotic coronary arteries. Clinically, VR/MR is a quantitative indicator of the risk of myocardial ischemia.

scholarly journals A real-world comparison of outcomes between fractional flow reserve-guided versus angiography-guided percutaneous coronary intervention

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0259662
Author(s):  
Christopher C. Y. Wong ◽  
Austin C. C. Ng ◽  
Cuneyt Ada ◽  
Vincent Chow ◽  
William F. Fearon ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Fractional Flow Reserve ◽  
Real World ◽  
Primary Outcome ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Cox Regression Analysis ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Secondary Outcomes

Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has been shown to be superior to angiography-guided PCI in randomized controlled studies. However, real-world data on the use and outcomes of FFR-guided PCI remain limited. Thus, we investigated the outcomes of patients undergoing FFR-guided PCI compared to angiography-guided PCI in a large, state-wide unselected cohort. Methods and results All patients undergoing PCI between June 2017 and June 2018 in New South Wales, Australia, were included. The cohort was stratified into the FFR-guided group when concomitant FFR was performed, and the angiography-guided group when no FFR was performed. The primary outcome was a combined endpoint of death or myocardial infarction (MI). Secondary outcomes included all-cause death, cardiovascular (CVS) death, and MI. The cohort comprised 10,304 patients, of which 542 (5%) underwent FFR-guided PCI. During a mean follow-up of 12±4 months, the FFR-guided PCI group had reduced occurrence of the primary outcome (hazard ratio [HR] 0.34, 95% confidence intervals [CI] 0.20–0.56, P<0.001), all-cause death (HR 0.18, 95% CI 0.07–0.47, P = 0.001), CVS death (HR 0.21, 95% CI 0.07–0.66, P = 0.01), and MI (HR 0.46, 95% CI 0.25–0.84, P = 0.01) compared to the angiography-guided PCI group. Multivariable Cox regression analysis showed FFR-guidance to be an independent predictor of the primary outcome (HR 0.45, 95% CI 0.27–0.75, P = 0.002), all-cause death (HR 0.22, 95% CI 0.08–0.59, P = 0.003), and CVS death (HR 0.27, 95% CI 0.09–0.83, P = 0.02). Conclusions In this real-world study of patients undergoing PCI, FFR-guidance was associated with lower rates of the primary outcome of death or MI, as well as the secondary outcomes of all-cause death and CVS death.

AS-117 Long-Term Outcomes of Fractional Flow Reserve Guided Coronary Intervention in Consecutive ‘Real-World’ Patients

2011 ◽  
Vol 107 (8) ◽  
pp. 114A-115A
Author(s):  
Michael Liang ◽  
Damian Kelly ◽  
Aniket Puri ◽  
Suresh Perera ◽  
Madhav Menon ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Real World ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Long Term Outcomes ◽  
Flow Reserve

scholarly journals Predictive Value of Resting Pd/Pa for Fractional Flow Reserve Assessed with Monorail Pressure Microcatheter in Real-World Practice

2019 ◽  
Vol 4 (2) ◽  
pp. 113-120
Author(s):  
Keng Tat Koh ◽  
Asri Said ◽  
Khaw Chee Sin ◽  
Oon Yen Yee ◽  
Erwin Mulia ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Real World ◽  
Predictive Value ◽  
Fractional Flow ◽  
Flow Reserve

A real-world comparison of outcomes between fractional flow reserve-guided versus angiography-guided percutaneous coronary intervention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Wong ◽  
A Ng ◽  
C Ada ◽  
V Chow ◽  
W Fearon ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Fractional Flow Reserve ◽  
Primary Endpoint ◽  
Real World ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Funding Source ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary

Abstract Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has been shown to be superior to angiography-guided PCI in randomized controlled studies. However, real-world data on the use and outcomes of FFR-guided PCI remain limited. Purpose To investigate the outcomes of patients undergoing FFR-guided PCI compared to angiography-guided PCI in a large, state-wide unselected cohort. Methods All patients undergoing PCI between June 2017 and June 2018 recorded by the Centre for Health Record Linkage (CHeReL) were included in the study. The CHeReL database is one of the largest data linkage systems in Australia, capturing health data from ≥97% of all healthcare facilities in the state of New South Wales, which has a population of 7.5 million people. The PCI cohort was stratified into the FFR-guided group when a concomitant FFR procedure was performed, and the angiography-guided group when no FFR was performed. The primary endpoint was a combined endpoint of death or myocardial infarction (MI). Secondary endpoints included all-cause death, cardiovascular (CV) death, and MI. Results The cohort comprised 10,304 patients, of which 542 (5%) underwent FFR-guided PCI. There were no significant differences in age, gender, or comorbidities between the two groups. During a mean follow-up of 12±4 months, the FFR-guided PCI group had reduced occurrence of the primary endpoint (3% vs 8%, P&lt;0.001), all-cause death (1% vs 4%, P=0.001), CV death (1% vs 3%, P=0.01), and MI (2% vs 4%, P=0.01) (Figure). Multivariable Cox regression analysis demonstrated FFR-guidance to be an independent predictor of the primary endpoint (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.28–0.78, P=0.004), after adjusting for age, clinical presentation, comorbidities, and multi-vessel PCI. A sensitivity analysis was performed excluding patients that presented with acute MI, leading to a smaller cohort of 5,850 patients, of which 448 (8%) underwent FFR-guided PCI. FFR-guidance remained an independent predictor of the primary endpoint in this cohort of stable patients (HR 0.36, 95% CI 0.17–0.77, P=0.01). Conclusion In this real-world study of patients undergoing PCI, FFR-guidance was associated with improved clinical outcomes, driven by the lower hard endpoint of death or MI. The use of FFR-guided PCI remains limited worldwide, and efforts should be directed to increase adoption of this technique in future. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): National Heart Foundation of Australia Health Professional Scholarship

Deferral of coronary intervention on the basis of fractional flow reserve measurement: a real-world analysis

2008 ◽  
Vol 9 (3) ◽  
pp. 199-200
Author(s):  
T. Lockie ◽  
D. Perera ◽  
P. O'Kane ◽  
S. Hartley ◽  
S. Khan ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Real World ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve
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