scholarly journals Reliability of Instantaneous Wave-Free Ratio (iFR) for the Evaluation of Left Main Coronary Artery Lesions

2019 ◽  
Vol 8 (8) ◽  
pp. 1143 ◽  
Author(s):  
Rosa ◽  
Polimeni ◽  
Velli ◽  
Conte ◽  
Sorrentino ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Left Main Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Evaluation ◽  
Left Main ◽  
Fractional Flow ◽  
Ventricular Ejection Fraction ◽  
Flow Reserve

The assessment of the left main coronary artery (LMCA) by coronary angiography has several limitations. The fractional flow reserve (FFR) is useful for the functional evaluation of LMCA stenoses. The instantaneous wave-free ratio (iFR), a resting index, was developed to simplify functional coronary assessment. However, its performance for LMCA stenoses has yet to be explored. The iFR was measured at rest, and the FFR was measured under maximal hyperemia. We calculated that a sample size of 90 lesions would have provided 90% power at a 5% significance level to detect an Area Under the Curve (AUC) < 0.7 for the iFR to identify FFR-positive stenoses. A total of 91 measurements were performed on angiographically intermediate LMCA stenoses at three centers. The comparison between the iFR and the FFR showed a significant correlation (r = 0.67, p < 0.001). At receiver operating characteristic (ROC) analysis, the iFR revealed a good diagnostic performance when compared to the FFR (AUC = 0.84; p < 0.001). A classification agreement between the iFR and the FFR was recorded in 81% of cases. The left ventricular ejection fraction (LVEF) was an independent predictor of the discrepancy between the FFR and iFR values (p = 0.040). The present study is the first demonstrating that the assessment of LMCA stenoses with the instantaneous wave-free ratio is a reliable adenosine-free alternative to classic fractional flow reserve. If confirmed in larger populations, these findings could be of relevance for real world daily practice.

Fractional flow reserve in patients with reduced ejection fraction

2019 ◽  
Vol 41 (17) ◽  
pp. 1665-1672 ◽  
Author(s):  
Giuseppe Di Gioia ◽  
Bernard De Bruyne ◽  
Mariano Pellicano ◽  
Jozef Bartunek ◽  
Iginio Colaiori ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Ejection Fraction ◽  
Fractional Flow Reserve ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Fractional Flow ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Flow Reserve ◽  
The Impact

Abstract Aims Fractional flow reserve (FFR) has never been investigated in patients with reduced ejection fraction and associated coronary artery disease (CAD). We evaluated the impact of FFR on the management strategies of these patients and related outcomes. Methods and results From 2002 to 2010, all consecutive patients with left ventricular ejection fraction (LVEF) ≤50% undergoing coronary angiography with ≥1 intermediate coronary stenosis [diameter stenosis (DS)% 50–70%] treated based on angiography (Angiography-guided group) or according to FFR (FFR-guided group) were screened for inclusion. In the FFR-guided group, 433 patients were matched with 866 contemporary patients of the Angiography-guided group. For outcome comparison, 617 control patients with LVEF &gt;50% were included. After FFR, stenotic vessels per patient were significantly downgraded compared with the Angiography-guided group (1.43 ± 0.98 vs. 1.97 ± 0.84; P &lt; 0.001). This was associated with lower revascularization rate (52% vs. 62%; P &lt; 0.001) in the FFR-guided vs. the Angiography-guided group. All-cause death at 5 years of follow-up was significantly lower in the FFR-guided as compared with Angiography-guided group [22% vs. 31%. HR (95% CI) 0.64 (0.51–0.81); P &lt; 0.001]. Similarly, rate of major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, revascularization, and stroke) was significantly lower in the FFR-guided group [40% vs. 46% in the Angiography-guided group. HR (95% CI) 0.81 (0.67–0.97); P = 0.019]. Higher rates of death and MACCE were observed in patients with reduced LVEF compared with the control cohort. Conclusions In patients with reduced LVEF and CAD, FFR-guided revascularization was associated with lower rates of death and MACCE at 5 years as compared with the Angiography-guided strategy. This beneficial impact was observed in parallel with less coronary artery bypass grafting and more patients deferred to percutaneous coronary intervention or medical therapy.

scholarly journals Left Main Coronary Artery Thrombus Diagnosed and Managed With Coronary Computed Tomography Angiography and Fractional Flow Reserve Derived From Computed Tomography

2019 ◽  
Vol 13 ◽  
pp. 117954681989459
Author(s):  
Shone O Almeida ◽  
Nasih M Ahmed ◽  
Ronald P Karlsberg
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Computed Tomography Angiography ◽  
Left Main Coronary Artery ◽  
Coronary Computed Tomography Angiography ◽  
Left Main ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Flow Reserve

Left main coronary artery thrombus (LMCA-T) is a rare disease state and diagnosed with invasive coronary angiography (ICA). We present a case of LMCA-T diagnosed with coronary computed tomography angiography (CTA) and treated without ICA in a patient who presented to a hospital in the middle of war zone in Erbil, Iraqi Kurdistan. Coronary CTA performed 1 month later demonstrated resolution of the thrombus. Fractional flow reserve computed from computed tomography (FFR-CT; HeartFlow, Redwood City, CA) performed retrospectively confirmed that the clot was not hemodynamically significant at the time of diagnosis. This case demonstrates the diagnostic capabilities of coronary CTA and FFR-CT when ICA is not readily available.

Abstract 4470: Long Term Follow Up After Fractional Flow Reserve-guided Treatment Of ‘Moderate’ Left Main Coronary Artery Stenosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Michalis Hamilos ◽  
Thomas Cuisset ◽  
Jaydeep Sarma ◽  
Emanuele Barbato ◽  
Jozef Bartunek ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Left Main Coronary Artery ◽  
Medical Group ◽  
Left Main ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Surgical Group

Introduction: We assesed the value, in terms of long-term clinical outcome, of a fractional flow reserve (FFR)-guided treatment strategy in patients with angiographically ‘intermediate’ left main coronary artery (LMCA) stenoses. Methods: In 215 consecutive patients with an angiographically ‘intermediate’ unprotected LMCA stenosis (between 30–70%, by visual estimate), FFR measurements and off line quantitative coronary angiography (QCA) were obtained. When FFR was ≥0.80, patients were treated medically (medical group); When FFR was <0.80 coronary artery bypass grafting (CABG) was advocated (surgical group). Incidence of death, myocardial infarction and any coronary revascularisation procedure were recorded. Results: 140 patients had an FFR≥0.80 and 75 patients had an FFR<0.80. Percent diameter stenosis at QCA correlated significantly with FFR (r = −0.38, p<0.001), but a very large scatter was observed (Figure 1B ). Mean follow up duration was 35 ± 25 months. The incidence of death was 7.9 % in the medical group and 9.3 % in the surgical group. (Figure 1A , p=0.73). Conclusions : Angiography alone does not allow appropriate decision making in patients with angiographically ‘intermediate’ stenosis of the LMCA. Given the favorable outcome of an FFR-guided strategy such patients deserve FFR assessment before blindly proceeding to revascularisation. Figure 1: A Kaplan-Meier mortality curves for the 2 study groups. B Scatterplots showing the distribution of % diameter stenosis and the corresponding FFR values (filled dots indicate FFR≥0.80 and circles indicate FFR<0.80).

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