scholarly journals Anatomical Assessment vs. Pullback REsting full-cycle rAtio (RFR) Measurement for Evaluation of Focal and Diffuse CoronarY Disease: Rationale and Design of the “READY Register”

2021 ◽  
Vol 8 ◽  
Author(s):  
Zsolt Kőszegi ◽  
Balázs Berta ◽  
Gábor G. Tóth ◽  
Balázs Tar ◽  
Áron Üveges ◽  
...  
Keyword(s):  
Coronary Disease ◽  
Coronary Stenosis ◽  
Clinical Decision Making ◽  
Microvascular Disease ◽  
Segment Length ◽  
Focal Lesion ◽  
Poor Correlation ◽  
Fractional Flow ◽  
Local Pressure ◽  
Flow Reserve

Background: The morphology and functional severity of coronary stenosis show poor correlation. However, in clinical practice, the visual assessment of the invasive coronary angiography is still the most common means for evaluating coronary disease. The fractional flow reserve (FFR), the coronary flow reserve (CFR), and the resting full-cycle ratio (RFR) are established indices to determine the hemodynamic significance of a coronary stenosis.Design/Methods: The READY register (NCT04857762) is a prospective, multicentre register of patients who underwent invasive intracoronary FFR and RFR measurement. The main aim of the registry is to compare the visual estimate of coronary lesions and the functional severity of the stenosis assessed by FFR, as well as the RFR pullback. Characterizations of the coronary vessel for predominantly focal, diffuse, or mixed type disease according to visual vs. RFR pullback determination will be compared. The secondary endpoint of the study is a composite of major adverse cardiac events, including death, myocardial infarction, and repeat coronary revascularization at 1 year. These endpoints will be compared in patients with non-ischemic FFR in the subgroup of cases where the local pressure drop indicates a focal lesion according to the definition of ΔRFR > 0.05 (for <25 mm segment length) and in the subgroup without significant ΔRFR. In case of an FFR value above 0.80, an extended physiological analysis is planned to diagnose or exclude microvascular disease using the CFR/FFR index. This includes novel flow dynamic modeling for CFR calculation (CFRp−3D).Conclusion: The READY register will define the effect of RFR measurement on visual estimation-based clinical decision-making. It can identify a prognostic value of ΔRFR during RFR pullback, and it would also explore the frequency of microvascular disease in the patient population with FFR > 0.80.Clinical Trial Registration:ClinicalTrials.gov (NCT04857762).

Epicardial coronary stenosis severity and myocardial perfusion

2020 ◽  
pp. 12-16
Keyword(s):  
Myocardial Perfusion ◽  
Myocardial Ischemia ◽  
Coronary Disease ◽  
Myocardial Perfusion Reserve ◽  
Pharmacological Intervention ◽  
Fractional Flow ◽  
Perfusion Reserve ◽  
Flow Reserve ◽  
Stenosis Severity ◽  
Microvascular Resistance

Patients suspected of having epicardial coronary disease are often investigated with noninvasive myocardial ischemia tests to establish a diagnosis and guide management. However, the relationship between myocardial ischemia and coronary stenoses is affected by multiple factors, and there is marked biological variation between patients. The ischemic cascade represents the temporal sequence of pathophysiological events that occur after interruption of myocardial oxygen delivery. The earliest part of the cascade is examined via perfusion imaging, and fractional flow reserve (FFR) is a corresponding index which is specific to the coronary artery. Whereas FFR has come to be regarded a clinical reference standard against which other newer invasive and noninvasive tests are validated, the diagnostic FFR threshold for detecting ischemia was established against a combination of noninvasive ischemia tests that assessed different stages of the ischemic cascade. Moreover, the validity of invasive pressure-derived indices of stenosis severity are contingent on the assumption that pressure is proportional to flow if microvascular resistance is constant, a condition induced by pharmacological intervention or by examining specific segments of the cardiac cycle. Furthermore, myocardial perfusion reserve depends on dynamic modulation of microvascular resistance, and dysfunction of the microvasculature can lead to ischemia even in the absence of epicardial coronary disease.

scholarly journals A Computational Analysis of the Influence of a Pressure Wire in Evaluating Coronary Stenosis

Fluids ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. 165
Author(s):  
Jie Yi ◽  
Fang-Bao Tian ◽  
Anne Simmons ◽  
Tracie Barber
Keyword(s):  
Coronary Stenosis ◽  
Severe Case ◽  
Patient Specific ◽  
Fractional Flow ◽  
Ideal Model ◽  
Coronary Pressure ◽  
Flow Reserve ◽  
Pressure Wire ◽  
Physical Presence ◽  
The Difference

Cardiovascular disease is one of the world’s leading causes of morbidity and mortality. Fractional flow reserve (FFR) was proposed in the 1990s to more accurately evaluate the functional severity of intermediate coronary stenosis, and it is currently the gold standard in cardiac catheterization laboratories where coronary pressure and flow are routinely obtained. The clinical measurement of FFR relies on a pressure wire for the recording of pressures; however, in computational fluid dynamics studies, an FFR is frequently predicted using a wire-absent model. We aim to investigate the influence of the physical presence of a 0.014-inch (≈0.36 mm) pressure wire in the calculation of virtual FFR. Ideal and patient-specific models were simulated with the absence and presence of a pressure wire. The computed FFR reduced from 0.96 to 0.93 after inserting a wire in a 3-mm non-stenosed (pipe) ideal model. In mild stenotic cases, the difference in FFR between the wire-absent and wire-included models was slight. The overestimation in severe case was large but is of less clinical significance because, in practice, this tight lesion does not require sophisticated measurement to be considered critical. However, an absence of the pressure wire in simulations could contribute to an over-evaluation for an intermediate coronary stenosis.

P2736Hemodynamic and clinical impact in adult patients with anomalous aortic origin of the coronary artery evaluated with quantitative flow reserve

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Adjedj ◽  
F Hyafil ◽  
F Aminfar ◽  
A Farnoud ◽  
V Rubimbura ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Decision Making ◽  
Quantitative Coronary Angiography ◽  
Proximal Part ◽  
Clinical Impact ◽  
Adult Patients ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow

Abstract Background Anomalous origin of the right coronary artery (ARCA) represents the most frequent form of abnormal coronary origin and may potentially increase the risk for sudden cardiac death. Evaluation of ARCA in adult patients referred for invasive coronary angiograms (ICA) is difficult, and clinical impact is unknown. Quantitative flow reserve (QFR) is an available method able to virtually calculate fractional flow reserve using 3-dimensional quantitative coronary angiography (3D-QCA) based on ICA. Objectives To evaluate the feasibility of QFR analysis in patients with ARCA and its clinical impact. Methods Using the registry of proximal anomalous connections of coronary arteries (ANOCOR registry), a multicentric observational registry including 472 adult patients with ANOCOR between 2010 and 2013, we retrospectively performed QFR analysis from ICA and evaluated the rate of death, myocardial infarction, unplanned revascularization and hospitalization in cardiology at 5 years. Results Among 128 patients with ARCA, 41 (32%) could have QFR analysis with median clinical follow-up of 8.3 years. The mean QFR value was 0.90±0.10, and 3D-QCA analysis showed preserved lumen area despite the elliptical shape of the proximal part of the ARCA which in the worst cases appeared on ICA as a significant narrowing. The event rate was 14.6% (n=6), including three deaths (one due to cancer, one due to stroke, and one cause remains unknown), two unplanned revascularizations, and one hospitalization for heart failure at 5 years. No myocardial infarction was reported. Conclusions QFR analysis of ARCA is feasible and non-significant QFR values are associated with good clinical outcome at 5 years. QFR of ARCA could be the evaluation of choice to help in clinical decision-making during ICA, when applicable.

Abstract 14743: Usefulness of Estimated Coronary Flow Velocity Using Quantitative Flow Ratio for Intermediate Coronary Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eiji Ichimoto ◽  
Nao Konagai ◽  
Sawako Horie ◽  
Atsushi Hasegawa ◽  
Hirofumi Miyahara ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Stenosis ◽  
Coronary Flow ◽  
Flow Ratio ◽  
Operating Characteristics ◽  
Fractional Flow ◽  
Coronary Flow Velocity ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Introduction: Quantitative flow ratio (QFR) is a diagnostic modality for functional assessment for intermediate coronary stenosis without the use of pressure wire. QFR is calculated from 3-dimensional quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis. Hypothesis: We assessed the usefulness of QFR and the association with an estimated coronary flow velocity (eCFV) for intermediate coronary stenosis. Methods: A total of 100 lesions in 80 consecutive patients were assessed Fractional Flow Reserve (FFR) for intermediate coronary stenosis between January 2011 and April 2019. Of these, 97 lesions in 77 patients who underwent QFR were included in this study. Patients were classified into two groups (FFR ≤ 0.80 or FFR > 0.80). QFR and eCFV using contrast were measured by Thrombolysis in Myocardial Infarction (TIMI) frame counts. Results: There was no significant differences in target vessels (p = 0.90) and diffuse lesions (p = 0.06) between the two groups (FFR ≤ 0.80 or FFR > 0.80). Mean FFR and QFR values were 0.78 ± 0.12 and 0.77 ± 0.11, respectively. QFR had a good correlation with FFR values (r = 0.86, p < 0.0001). The diagnostic accuracy, sensitivity, and specificity on QFR ≤ 0.80 were 91.8%, 92.7% and 90.5%, respectively. The eCFV of FFR ≤ 0.80 was greater than that of FFR > 0.80 (0.19 ± 0.08 m/s vs. 0.14 ± 0.06 m/s, p<0.001). Figure showed that the eCFV correlated with FFR values (r = -0.29, p < 0.01). Moreover, the eCFV had a high area under the curve (AUC = 0.71, p < 0.01) on Receiver operating characteristics curve (ROC) analysis with FFR ≤ 0.80. Conclusions: QFR was useful for the assessment of functional stenosis severity. As eCFV was faster, FFR was lower for intermediate coronary stenosis. The eCFV had a good correlation with FFR and may become one of the evaluations for ischemia.

scholarly journals Clinical use of optical coherence tomography and fractional flow reserve

2016 ◽  
Vol 73 (6) ◽  
pp. 592-598
Author(s):  
Vladimir Ivanovic ◽  
Milovan Petrovic ◽  
Milenko Cankovic ◽  
Anastazija Stojsic-Milosavljevic ◽  
Snezana Cemerlic
Keyword(s):  
Functional Analysis ◽  
Optical Coherence Tomography ◽  
Case Report ◽  
Coronary Disease ◽  
Morphological Analysis ◽  
Case Reports ◽  
Myocardial Revascularization ◽  
Fractional Flow ◽  
Stent Restenosis ◽  
Flow Reserve

Introduction. The aim of each diagnostic method is to serve as a guide in deciding about the right patient treatment. During myocardial revascularization the decision to perform revascularization is usually not easy to make, especially in case of borderline stenosis. It has been proven that it is not enough to base morphological evaluation of coronary artery vessel stenosis solely on angiography. It is necessary to include additional modern diagnostic methods for functional analysis and detailed morphological analysis using fractional flow reserve (FFR) and optical coherence tomography (OCT), respectively. Case reports. In the first case report we showed the significance of morphological analysis using OCT and proved that it was not lumen stenosis. The second and the third case reports showed the complementarity between functional analysis (FFR) and morphological analysis (OCT) of stenosis in solving a complex coronary disease. The fourth case report showed the significance of OCT in dealing with the recurrent stent restenosis. Conclusion. By these short case reports we confirmed that percutaneous coronary intervention (PCI) guided by angiography is definitely not enough in deciding about myocardial revascularization especially in patients with a complex coronary disease. In certain cases FFR and OCT procedures can be complementary methods and improve quality of revascularization, particularly in the case of recurrent in-stent restenosis.

Abstract 19177: Loss of Coronary Perfusion Efficiency in Microvascular Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Matthew Lumley ◽  
Matthew Ryan ◽  
Kaleab Asrress ◽  
Rupert Williams ◽  
Satpal Ari ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Flow ◽  
Microvascular Disease ◽  
Rate Pressure Product ◽  
Coronary Perfusion ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Wave Separation ◽  
Flow Reserve ◽  
Response To Stress

Introduction: Coronary Microvascular Disease (MVD) is associated with an unfavorable prognosis, even in the absence of significant epicardial disease. The pathophysiological basis of increased cardiac events is unclear. The aim of this study was to characterize the forces that govern myocardial perfusion at rest and during stress. Methods: Patients with chest pain syndromes requiring Fractional Flow Reserve (FFR) assessment were screened and those with a FFR>0.80 were included. MVD was defined by coronary flow reserve (CFR) < 2.0. Controls were those with CFR>2.0. Simultaneous intracoronary pressure (P d ) and flow velocity (U) recordings were made at rest and hyperemia. Microvascular Resistance (MR)= P d /U. Wave intensity = dP d /dt x dU/dt and wave separation analysis was used to identify the waves that accelerate and decelerate flow. The proportional contribution of accelerating waves was assessed as an index of coronary perfusion efficiency. Results: 39 consecutive patients were enrolled, 21 had MVD and 18 comprised controls. The groups were matched for atherosclerotic risk factors, rate-pressure-product and P d . Coronary flow velocity in MVD patients was higher at rest (21.5±6.4 vs. 14.1±4.5cms -1 , p < 0.001) but lower during hyperemia (28.3±13.0 vs. 45.1±13.1cms -1 , p < 0.001) compared to controls. While resting MR was lower in MVD (501±162 vs. 755±262 mmHg.cm -1 .s, p = 0.001), hyperemic MR was significantly lower in controls. At rest the magnitude of the accelerating waves was higher in the MVD group than controls. The percentage contribution of accelerating waves increased with hyperemia in controls but decreased in MVD patients (figure). Conclusion: MVD manifests as resting microvascular dilation as well as diminished response to stress. While the normal heart has improved efficiency during hyperemia, in MVD efficiency decreases and as a result, flow augmentation is attenuated. These processes render the myocardium more susceptible to ischemia.

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