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Freidoonimehr N, Atkins T, Marathe JA, Psaltis PJ, Arjomandi M. Evaluating the severity of tandem coronary stenoses: Insights from simulated FFR and iFR techniques. J Biomech 2025; 185:112707. [PMID: 40252338 DOI: 10.1016/j.jbiomech.2025.112707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 04/11/2025] [Accepted: 04/15/2025] [Indexed: 04/21/2025]
Abstract
The presence of coronary tandem lesions poses a significant challenge for the accurate diagnosis and management of coronary artery diseases. This study set out to provide a deeper understanding of the haemodynamic interactions between tandem obstructive coronary lesions and their impact on different haemodynamic diagnostic parameters. Using a computational fluid dynamic model, validated against in vitro laboratory experiments, we investigated the various combinations of moderate and severe stenoses interchangeably located in the proximal and distal segments of the artery. The investigation was conducted using two diagnostic parameters: one hyperaemic-based, i.e., FFR, and one rest-based, i.e., iFR, technique, both of which are commonly used to assess the physiological significance of coronary stenoses. The three main findings of this work are: (a) the recovery distance (the immediate local distance affected by the presence of stenosis) is much shorter for the rest-measured diagnostic parameter compared with the hyperaemic-measured diagnostic parameter; (b) pressure drop measurements immediately downstream of the stenotic sections overestimate the significance of stenoses, and (c) the presence of a moderate stenosis downstream of a severe stenosis increases FFR value (faster FFR recovery). These findings enhance our understanding of the diagnostic accuracy of hyperaemic-based and rest-based physiological diagnostic coronary assessments and the nuances of using these different techniques when assessing tandem coronary stenoses. This understanding can help inform tailored therapeutic approaches for the management of coronary artery disease.
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Affiliation(s)
- Navid Freidoonimehr
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Queensland 4000, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia; School of Electrical and Mechanical Engineering, The University of Adelaide, South Australia 5005, Australia.
| | - Tam Atkins
- School of Electrical and Mechanical Engineering, The University of Adelaide, South Australia 5005, Australia.
| | - Jessica A Marathe
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5005, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia 5000, Australia.
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia 5000, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia 5005, Australia; Department of Cardiology, Central Adelaide Local Health Network, Adelaide, South Australia 5000, Australia.
| | - Maziar Arjomandi
- School of Electrical and Mechanical Engineering, The University of Adelaide, South Australia 5005, Australia.
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Hoek R, de Winter RW, Peters RT, Somsen YBO, van Diemen PA, Jukema RA, Twisk JW, Verouden NJ, den Hartog AW, Raijmakers PG, Nap A, Danad I, Knaapen P. Comparison of Fractional Flow Reserve and Myocardial Perfusion Imaging in Saphenous Vein Grafts. Catheter Cardiovasc Interv 2025; 105:1365-1374. [PMID: 39991799 PMCID: PMC12057319 DOI: 10.1002/ccd.31467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 02/12/2025] [Accepted: 02/13/2025] [Indexed: 02/25/2025]
Abstract
BACKGROUND Revascularization decision-making for saphenous vein grafts (SVGs) relies on angiographic lesion severity estimation, as studies on fractional flow reserve (FFR) for detecting ischemia in SVGs are scarce. AIMS To compare FFR and quantitative coronary angiography (QCA) of SVGs against myocardial perfusion imaging (MPI) and to establish an optimal FFR threshold for SVGs. METHODS This cross-sectional registry study included symptomatic patients with prior coronary artery bypass grafting who underwent single-photon emission computed tomography, positron emission tomography, or stress perfusion cardiac magnetic resonance imaging and had FFR measurements of ≥ 1 SVGs. We matched the myocardial territory supplied by the SVGs to ischemia on MPI. The optimal FFR threshold for SVGs was determined using the Youden index. Diagnostic performance measures were calculated and compared for FFR (0.80 and the optimal threshold) and for QCA (diameter stenosis ≥ 50%). RESULTS This study included 80 patients (mean age 73 ± 7 years, 68 [85%] male) with 94 SVGs, of which 38 (40%) supplied ischemic myocardium. Areas under the curve between FFR and QCA were comparable (0.73 vs. 0.65, p = 0.181). The optimal cutoff value of FFR was 0.94. FFR ≤ 0.94 showed higher sensitivity (63%) and negative predictive value (75%) compared to FFR ≤ 0.80 (32% [p < 0.001] and 64% [p = 0.007]) and QCA (37% [p = 0.002] and 65% [p = 0.021]), but with lower specificity (75%) than FFR ≤ 0.80 (84%, p = 0.021). Positive predictive value and overall accuracy were similar across all methods. CONCLUSIONS FFR and QCA had comparable moderate diagnostic performance for detecting SVG failure determined by MPI. The optimal FFR cutoff in SVGs is higher than 0.80, resulting in higher sensitivity and negative predictive value compared to FFR ≤ 0.80 and QCA, at the expense of reduced specificity.
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Affiliation(s)
- Roel Hoek
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ruben W. de Winter
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Rens T. Peters
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Yvemarie B. O. Somsen
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Pepijn A. van Diemen
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ruurt A. Jukema
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jos W. Twisk
- Department of Epidemiology & Data ScienceAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Niels J. Verouden
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Pieter G. Raijmakers
- Department of Radiology & Nuclear Medicine, Amsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Alexander Nap
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ibrahim Danad
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
- Department of CardiologyNorthwest ClinicsAlkmaarThe Netherlands
| | - Paul Knaapen
- Department of CardiologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Kechichian A, Mizukami T, Malhotra G, Spratt JC, Ikeda K, Corradetti S, Munhoz D, Sakai K, Sonck J, Wyffels E, Bouisset F, Mahendiran T, De Bruyne B, Collet C, Wilgenhof A. Pullback pressure gradient: A paradigm shift in physiology-guided revascularization. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2025:S1553-8389(25)00214-3. [PMID: 40312199 DOI: 10.1016/j.carrev.2025.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 04/15/2025] [Accepted: 04/24/2025] [Indexed: 05/03/2025]
Abstract
Optimizing decision-making remains essential in the management of stable coronary artery disease (CAD). Recent studies of the pullback pressure gradient (PPG), a novel tool for evaluating CAD patterns, have demonstrated that the effectiveness of percutaneous coronary intervention (PCI) is strongly influenced by the baseline CAD pattern (focal vs diffuse). The capacity of PPG to predict the success of PCI provides a means to better inform decision-making, revascularization strategies and, potentially, improve clinical outcomes.
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Affiliation(s)
- Anthony Kechichian
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Takuya Mizukami
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Ganeev Malhotra
- Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - James C Spratt
- Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK; St George's, University of London, London, UK
| | - Kazumasa Ikeda
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium; Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Sara Corradetti
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | | | - Koshiro Sakai
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium; Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan; Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, NY, USA
| | - Jeroen Sonck
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium
| | - Frédéric Bouisset
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium; Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Thabo Mahendiran
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium; Lausanne University Hospital, Lausanne, Switzerland
| | | | | | - Adriaan Wilgenhof
- Cardiovascular Center Aalst, AZORG, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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Pranevičius M, Makackas D, Macas A, Petrikonis K, Šakalytė G, Pranevičius O, Benetis R. The Concept of Venous Steal: The Impact of Vascular Stenosis and Outflow Pressure Gradient on Blood Flow Diversion. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:672. [PMID: 40282963 PMCID: PMC12028601 DOI: 10.3390/medicina61040672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2025] [Revised: 03/24/2025] [Accepted: 03/29/2025] [Indexed: 04/29/2025]
Abstract
Vascular steal refers to the diversion of blood flow between collateral vessels that share a common inflow restricted by arterial stenosis. Blood is diverted from the high-pressure to the low-pressure, low-resistance system. Vascular steal is associated with anatomical bypass or vasodilation in the collateral network and is called "the arterial steal". However, we have demonstrated that in the presence of an outflow gradient (e.g., intra-extracranial), blood is shunted to a lower pressure system, a phenomenon we term "venous steal". Using Thevenin's equivalent, we generalized the concept of venous steal to apply it to any region of the vascular system with increased outflow pressure. Both arterial steal, caused by increased collateral network conductivity, and venous steal, resulting from lower collateral outflow pressure, reduce compartment perfusion. This occurs indirectly by increasing flow and the pressure gradient across the arterial stenosis, lowering the segmental compartment perfusion pressure-the difference between post-stenotic (inflow) and compartmental (outflow) pressures. Venous steal diverts blood flow from compartments with elevated pressure, such as intracranial, subendocardial, the ischemic core, and regions of focal edema due to inflammation, trauma, or external compression. In shock and low-flow states, it contributes to regional blood flow maldistribution. Treatment of venous steal addresses inflow stenosis, increased compartmental pressure and systemic loading conditions (arterial and venous pressure) to reverse venous steal malperfusion in the ischemic regions.
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Affiliation(s)
| | - Dalius Makackas
- Department of Applied Informatics, Faculty of Informatics, Kaunas University of Technology, 50254 Kaunas, Lithuania;
| | - Andrius Macas
- Department of Anesthesiology, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania;
| | - Kęstutis Petrikonis
- Department of Neurology, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania;
| | - Gintarė Šakalytė
- Institute of Cardiology, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania;
| | | | - Rimantas Benetis
- Department of Heart, Lithuanian University of Health Sciences, 50162 Kaunas, Lithuania;
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Liu W, Shi J, Shan R, Wang Y, Zhao L, Zhou H, Li W, Feng L. Pressure Guidewire Indicated for Coronary Fractional Flow Reserve Assessment: Structural Design, Deficiencies and Potential Solutions. Catheter Cardiovasc Interv 2025. [PMID: 40108763 DOI: 10.1002/ccd.31504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 03/04/2025] [Accepted: 03/08/2025] [Indexed: 03/22/2025]
Abstract
Coronary heart disease (CHD) is one of the leading causes of mortality worldwide. It is primarily caused by myocardial ischemia and hypoxia resulting from atherosclerotic plaques in the coronary arteries, leading to symptoms such as angina. The severity of CHD determines the treatment approach, which may include medication or interventional therapy. Therefore, accurately assessing the severity of myocardial ischemia is crucial for effective CHD management. In recent years, fractional flow reserve (FFR), derived from the relationship between flow and pressure, has gained widespread recognition for providing valuable information to guide coronary revascularization. Pressure guidewires equipped with pressure sensors at their tips are the most commonly used tools for clinical FFR assessment. These wires measure vessel pressure to determine the severity of coronary lesions. However, during their use, issues such as signal drift, tip breakage, core wire fractures, and coating detachment may occur. This article reviews the historical development of pressure guidewires, examines the general structure of two commonly used pressure guidewires available in the market, highlights typical issues encountered during clinical use, and proposes corresponding solutions.
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Affiliation(s)
- Wengang Liu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Jun Shi
- Department of Cardiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Rong Shan
- Department of Cardiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Yu Wang
- Department of Cardiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Liangfeng Zhao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Honglei Zhou
- Schools of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai, China
| | - Wei Li
- Schools of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai, China
| | - Liuliu Feng
- Department of Cardiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
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Chen Y, Luo D, Gao R, Wu J, Qiu X, Zou Y, Jian Y, Zhang S. The sentinels of coronary artery disease: heterogeneous monocytes. Front Immunol 2025; 16:1428978. [PMID: 40079002 PMCID: PMC11898731 DOI: 10.3389/fimmu.2025.1428978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 01/27/2025] [Indexed: 03/14/2025] Open
Abstract
Monocytes are heterogeneous immune cells that play a crucial role in the inflammatory response during atherosclerosis, influencing the progression and outcome of the disease. In the pathogenesis of atherosclerotic diseases, such as coronary artery disease (CAD), monocytes not only serve as the initial sensors of endogenous and exogenous pathogenic factors, but also function as intermediators that bridge the circulatory system and localized lesions. In the bloodstream, heterogeneous monocytes, acting as sentinels, are rapidly recruited to atherosclerotic lesions, where they exhibit a heightened capacity to respond to various pathological stimuli upon detecting signals from damaged vascular endothelial cells. Clinical studies have demonstrated that the heterogeneity of monocytes in CAD patients presents both diversity and complexity, varying across different disease subtypes and pathological stages. This review explores the heterogeneity of monocytes in CAD, focusing on alterations in monocyte subset numbers, proportions, and the expression of functional receptors, as well as their correlations with clinical features. Additionally, we propose strategies to enhance the clinical utility value of monocyte heterogeneity and outline future research directions in the field of CAD. With the widespread application of high-parameter flow cytometry and single-cell sequencing technologies, it is anticipated that a comprehensive understanding of monocyte heterogeneity in CAD will be achieved, enabling the identification of disease-specific monocyte subtypes. This could offer new opportunities for improving the diagnosis and treatment of CAD.
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Affiliation(s)
- Yanyu Chen
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daya Luo
- School of Basic Medical Sciences, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Renzhuo Gao
- Queen Mary College, School of Medicine, Nanchang University, Nanchang, China
| | - Jinjing Wu
- School of Basic Medical Sciences, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xingpeng Qiu
- School of Basic Medical Sciences, Nanchang University, Nanchang, China
| | - Yang Zou
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yingchao Jian
- Department of Radiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Shuhua Zhang
- Jiangxi Cardiovascular Research Institute, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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Andersen BK, Holm NR, Mogensen LJH, Maillard L, Råmunddal T, Erriquez A, Christiansen EH, Escaned J, Of The Favor Iii Europe Study Team OB. Coronary revascularisation deferral based on quantitative flow ratio or fractional flow reserve: a post hoc analysis of the FAVOR III Europe trial. EUROINTERVENTION 2025; 21:e161-e170. [PMID: 39750037 PMCID: PMC11776405 DOI: 10.4244/eij-d-24-01001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 12/10/2024] [Indexed: 01/04/2025]
Abstract
BACKGROUND Safe deferral of revascularisation is a key aspect of physiology-guided percutaneous coronary intervention (PCI). While recent evidence gathered in the FAVOR III Europe trial showed that quantitative flow ratio (QFR) guidance did not meet non-inferiority to fractional flow reserve (FFR) guidance, it remains unknown if QFR might have a specific value in revascularisation deferral. AIMS We aimed to evaluate the safety of coronary revascularisation deferral based on QFR as compared with FFR. METHODS Patients randomised in the FAVOR III trial in whom PCI was deferred in at least one coronary artery, based on QFR or FFR>0.80, were included in the present substudy. The primary outcome was the 1-year rate of major adverse cardiac events (MACE), with results reported for two subsets of deferred patients: (1) any study lesion deferral and (2) complete study lesion deferral. RESULTS A total of 523 patients (55.2%) in the QFR group and 599 patients (65.3%) in the FFR group had at least one coronary revascularisation deferral. Of these, 433 patients (82.8%) and 511 (85.3%) patients, respectively, had complete study lesion deferral. In the "complete study lesion deferral" patient group, the occurrence of MACE was significantly higher in QFR-deferred patients as compared with FFR-deferred patients (24 [5.6%] vs 14 [2.8%], adjusted hazard ratio [HR] 2.07, 95% confidence interval [CI]: 1.07-4.03; p=0.03). In the subgroup of "any study lesion deferral", the MACE rate was 5.6% vs 3.6% (QFR vs FFR), adjusted HR 1.55, 95% CI: 0.88-2.73; p=0.13. CONCLUSIONS QFR-based deferral of coronary artery revascularisation resulted in a higher incidence of 1-year MACE as compared with FFR-based deferral.
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Affiliation(s)
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone J H Mogensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Luc Maillard
- GCS ES Axium Rambot, Clinique Axium, Aix-en-Provence, France
| | - Truls Råmunddal
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy
| | | | - Javier Escaned
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain and Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Wang A, Zhang H, Xie B, Gao Z, Dong Y, Peng C, Liu X. Main Coronary Flow Calculation With the Assistance of Physiological Side Branch Flow. IEEE Trans Biomed Eng 2025; 72:747-759. [PMID: 39348255 DOI: 10.1109/tbme.2024.3469289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
OBJECTIVE Fractional flow reserve (FFR) derived from coronary angiography, referred to as ICA-FFR, is a less-invasive alternative for invasive FFR measurement based on computational fluid dynamics. Blood flow into side branches influences the accuracy of ICA-FFR. However, properly compensating for side branch flow in ICA-FFR analysis is challenging. In this study, we proposed a physiological side branch flow model to comprehensively compensate side branch flow for ICA-FFR analysis with no need for reconstructing side branch geometry. METHODOLOGY the physiological side branch flow model employed a reduced-order model to calculate the pressure distribution in vessel segments. The main coronary artery (without side branches) was delineated and divided based on bifurcation nodes. The model compensates for flow to invisible side branches within each segment and flow to visible side branches at each bifurcation node. Lastly, ICA-FFR based on physiological side branch flow model (ICA-FFR) was calculated from a single angiographic view. Functional stenosis is defined by FFR 0.80. RESULT Our study involved 223 vessels from 172 patients. Using invasive FFR as a reference, the Pearson correlation coefficient of ICA-FFR was 0.93. ICA-FFR showed a high AUC (AUC = 0.96) and accuracy (91.9) in predicting functional stenosis. CONCLUSION The proposed model accurately compensates for flow to side branches without their geometry in ICA-FFR analysis. ICA-FFR analysis exhibits high feasibility and diagnostic performance in identifying functional stenosis.
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Hung Y, Xuan H, Ren Q, Huang J, Yu S, Tse Y, Zhang J, Gu W, Guo R, Leung CK, Yiu K. Prognostic Implication of Computational Angiography-Derived Fractional Flow Reserve in Patients With Nonobstructive Coronary Artery Disease. J Am Heart Assoc 2025; 14:e036717. [PMID: 39719430 PMCID: PMC12054502 DOI: 10.1161/jaha.124.036717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 10/28/2024] [Indexed: 12/26/2024]
Abstract
BACKGROUND Risk stratification of patients with symptomatic nonobstructive coronary artery disease remains uncertain. Our study assessed the clinical value of single-vessel, multivessel, and 3-vessel computational angiography-derived fractional flow reserve (caFFR) measurement in patients with nonobstructive coronary artery disease. METHODS AND RESULTS We enrolled patients with ≤50% stenosis with a caFFR value ≥0.8 in all 3 coronary arteries on coronary angiography. The sum of caFFR values in the 3 vessels was computed for each patient. Patient stratification was based on the median value of the following criteria: single-vessel analysis, multivessel analysis, and 3-vessel analysis. The primary end point of this study was major adverse cardiac events at 5 years, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization. A total of 490 patients were included. The 5-year major adverse cardiac event rates in single-vessel analysis were statistically insignificant between low- and high-caFFR groups (left anterior descending artery [P=0.163]; left circumflex artery [P=0.797]; right coronary artery [P=0.127]). In multivessel analysis, patients in the multiple-vessel low-caFFR group (with 2-3 vessels lower than median value of all coronary arteries) showed an increased risk of 5-year major adverse cardiac events compared with patients in the single-vessel low-caFFR group (0-1 vessel) (hazard ratio [HR], 2.648 [95% CI, 1.141-6.145]; P=0.023). In 3-vessel analysis, patients in the low 3-vessel caFFR group demonstrated a greater 5-year major adverse cardiac event risk than the high 3-vessel caFFR group (HR, 2.43 [95% CI, 1.087-5.433]; P=0.031). CONCLUSIONS We demonstrated that both multiple-vessel and 3-vessel caFFR measurements serve as valuable prognostic indicators for risk assessment in patients with nonobstructive coronary artery disease.
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Affiliation(s)
- Yik‐Ming Hung
- Division of Cardiology, Department of MedicineThe University of Hong Kong—Shen Zhen HospitalShen ZhenChina
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Hao‐Chen Xuan
- Division of Cardiology, Department of MedicineThe University of Hong Kong—Shen Zhen HospitalShen ZhenChina
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Qing‐Wen Ren
- Division of Cardiology, Department of MedicineThe University of Hong Kong—Shen Zhen HospitalShen ZhenChina
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Jia‐Yi Huang
- Division of Cardiology, Department of MedicineThe University of Hong Kong—Shen Zhen HospitalShen ZhenChina
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Si‐Yeung Yu
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Yi‐Kei Tse
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Jing‐Nan Zhang
- Division of Cardiology, Department of MedicineThe University of Hong Kong—Shen Zhen HospitalShen ZhenChina
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Wen‐Li Gu
- Division of Cardiology, Department of MedicineThe University of Hong Kong—Shen Zhen HospitalShen ZhenChina
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Ran Guo
- Division of Cardiology, Department of MedicineThe University of Hong Kong—Shen Zhen HospitalShen ZhenChina
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Calvin Ka‐Lam Leung
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
| | - Kai‐Hang Yiu
- Division of Cardiology, Department of MedicineThe University of Hong Kong—Shen Zhen HospitalShen ZhenChina
- Division of Cardiology, Department of Medicine, The University of Hong KongQueen Mary HospitalHong Kong
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Yoneyama S, Hoyano M, Ozaki K, Ikegami R, Kubota N, Okubo T, Yanagawa T, Kurokawa T, Akiyama T, Washiyama Y, Kashimura T, Inomata T. Pd/Pa fluctuation with continuous ATP administration indicates inaccurate FFR measurement caused by insufficient hyperemia. Heart Vessels 2025; 40:8-15. [PMID: 38981910 DOI: 10.1007/s00380-024-02438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
Continuous intravenous adenosine triphosphate (ATP) administration is the standard method for inducing maximal hyperemia in fractional flow reserve (FFR) measurements. Several cases have demonstrated fluctuations in the ratio of mean distal coronary pressure to mean arterial pressure (Pd/Pa) value during ATP infusion, which raised our suspicions of FFR value inaccuracy. This study aimed to investigate our hypothesis that Pd/Pa fluctuations may indicate inaccurate FFR measurements caused by insufficient hyperemia. We examined 57 consecutive patients with angiographically intermediate coronary lesions who underwent fractional flow reverse (FFR) measurements in our hospital between November 2016 and September 2018. Pd/Pa was measured after continuous ATP administration (150 μg/kg/min) via a peripheral forearm vein for 5 min (FFRA); and we analyzed the FFR value variation in the final 20 s of the 5 min, defining 'Fluctuation' as variation range > 0.03. Then, 2 mg of nicorandil was administered into the coronary artery during continued ATP infusion, and the Pd/Pa was remeasured (FFRA+N). Fluctuations were observed in 23 of 57 patients. The cases demonstrating discrepancies of > 0.05 between FFRA and FFRA+N were observed more frequently in the fluctuation group than in the non-fluctuation group (12/23 vs. 1/34; p < 0.0001). The discrepancy between FFRA and FFRA+N values was smaller in the non-fluctuation group (mean difference ± SD; -0.00026 ± 0.04636 vs. 0.02608 ± 0.1316). Pd/Pa fluctuation with continuous ATP administration could indicate inaccurate FFR measurements caused by incomplete hyperemia. Additional vasodilator administration may achieve further hyperemia when Pd/Pa fluctuations are observed.
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Affiliation(s)
- Shintaro Yoneyama
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Makoto Hoyano
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Kazuyuki Ozaki
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Ryutaro Ikegami
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Naoki Kubota
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takeshi Okubo
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takao Yanagawa
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takakuni Kurokawa
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takumi Akiyama
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Yuzo Washiyama
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takeshi Kashimura
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachidori, Chuo-ku, Niigata, 951-8510, Japan
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11
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Nannini G, Saitta S, Mariani L, Maragna R, Baggiano A, Mushtaq S, Pontone G, Redaelli A. An automated and time-efficient framework for simulation of coronary blood flow under steady and pulsatile conditions. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 257:108415. [PMID: 39270532 DOI: 10.1016/j.cmpb.2024.108415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/01/2024] [Accepted: 09/05/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND AND OBJECTIVE Invasive fractional flow reserve (FFR) measurement is the gold standard method for coronary artery disease (CAD) diagnosis. FFR-CT exploits computational fluid dynamics (CFD) for non-invasive evaluation of FFR, simulating coronary flow in virtual geometries reconstructed from computed tomography (CT), but suffers from cost-intensive computing process and uncertainties in the definition of patient specific boundary conditions (BCs). In this work, we investigated the use of time-averaged steady BCs, compared to pulsatile to reduce the computational time and deployed a self-adjusting method for the tuning of BCs to patient-specific clinical data. METHODS 133 coronary arteries were reconstructed form CT images of patients suffering from CAD. For each vessel, invasive FFR was measured. After segmentation, the geometries were prepared for CFD simulation by clipping the outlets and discretizing into tetrahedral mesh. Steady BCs were defined in two steps: (i) rest BCs were extrapolated from clinical and image-derived data; (ii) hyperemic BCs were computed from resting conditions. Flow rate was iteratively adjusted during the simulation, until patient's aortic pressure was matched. Pulsatile BCs were defined exploiting the convergence values of steady BCs. After CFD simulation, lesion-specific hemodynamic indexes were computed and compared between group of patients for which surgery was indicated and not. The whole pipeline was implemented as a straightforward process, in which each single step is performed automatically. RESULTS Steady and pulsatile FFR-CT yielded a strong correlation (r = 0.988, p < 0.001) and correlated with invasive FFR (r = 0.797, p < 0.001). The per-point difference between the pressure and FFR-CT field predicted by the two methods was below 1 % and 2 %, respectively. Both approaches exhibited a good diagnostic performance: accuracy was 0.860 and 0.864, the AUC was 0.923 and 0.912, for steady and pulsatile case, respectively. The computational time required by steady BCs CFD was approximatively 30-folds lower than pulsatile case. CONCLUSIONS This work shows the feasibility of using steady BCs CFD for computing the FFR-CT in coronary arteries, as well as its computational and diagnostic performance within a fully automated pipeline.
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Affiliation(s)
- Guido Nannini
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy.
| | - Simone Saitta
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Luca Mariani
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Riccardo Maragna
- Department of Perioperative Cardiology and Cardiovascular Imaging D, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging D, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging D, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging D, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
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12
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Bigler MR, Stark AW, Shiri I, Illi J, Siepe M, Caobelli F, Giannopoulos AA, Buechel RR, Haeberlin A, Obrist D, Räber L, Gräni C. Noninvasive anatomical assessment for ruling out hemodynamically relevant coronary artery anomalies in adults - A comparison of coronary-CT to invasive coronary angiography: The NARCO study design. Contemp Clin Trials Commun 2024; 42:101394. [PMID: 39634517 PMCID: PMC11616572 DOI: 10.1016/j.conctc.2024.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 09/23/2024] [Accepted: 11/17/2024] [Indexed: 12/07/2024] Open
Abstract
Background Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital heart disease, potentially leading to myocardial ischemia and adverse cardiac events. As the sole presence of AAOCA does not always imply a revascularization, a detailed anatomical and functional analysis is crucial for clinical decision-making. Currently, invasive coronary angiography is the gold-standard method for a thorough hemodynamic assessment of AAOCA. However, due to its invasive nature, the development of noninvasive diagnostic alternatives is desired. Methods In the NARCO trial, patients with AAOCA will undergo coronary computed tomography angiography (CCTA) to assess anatomical high-risk features followed by a vessel-based (i.e. invasive measurement with fractional flow reserve and intravascular imaging under a dobutamine-volume challenge) and a myocardium-based (i.e. nuclear imaging) ischemia testing. Comparison of noninvasive and invasive imaging will be performed. Additionally, explorative analysis of post-processing advanced computational fluid dynamics (CFD) and 3D printing will be performed to unravel the pathophysiologic mechanism of myocardial ischemia in AAOCA. Aims Our primary aim is to define characteristics of anatomical high-risk features (using CCTA) to rule out noninvasively hemodynamically relevant anomalous vessels in AAOCA patients. The secondary aim is to investigate the underlying pathophysiology of AAOCA-related hemodynamic relevance using advanced techniques such as CFD and 3D printing. Conclusions The NARCO trial will help to optimize AAOCA patient selection for revascularization by improving risk stratification and ruling out hemodynamic relevance noninvasively and, therefore, preventing unnecessary downstream testing and/or costly interventions in patients with AAOCA.
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Affiliation(s)
- Marius R. Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W. Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joel Illi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Siepe
- Centre for Congenital Heart Disease, Department of Cardiovascular Surgery, Inselspital, Bern, Switzerland
| | - Federico Caobelli
- University Clinic of Nuclear Medicine, Inselspital, Bern University Hospital, Switzerland
| | - Andreas A. Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Ronny R. Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, 8091, Zurich, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, 3008, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bennett J, Chandrasekhar S, Woods E, McLean P, Newman N, Montelaro B, Hassan Virk HU, Alam M, Sharma SK, Jned H, Khawaja M, Krittanawong C. Contemporary Functional Coronary Angiography: An Update. Future Cardiol 2024; 20:755-778. [PMID: 39445463 PMCID: PMC11622791 DOI: 10.1080/14796678.2024.2416817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 10/11/2024] [Indexed: 10/25/2024] Open
Abstract
Functional coronary angiography (FCA) is a novel modality for assessing the physiology of coronary lesions, going beyond anatomical visualization by traditional coronary angiography. FCA incorporates indices like fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), which utilize pressure measurements across coronary stenoses to evaluate hemodynamic impacts and to guide revascularization strategies. In this review, we present traditional and evolving modalities and uses of FCA. We will also evaluate the existing evidence and discuss the applicability of FCA in various clinical scenarios. Finally, we provide insight into emerging evidence, current challenges, and future directions in FCA.
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Affiliation(s)
- Josiah Bennett
- Department of Internal Medicine, Emory University, Atlanta, GA30322, USA
| | | | - Edward Woods
- Department of Internal Medicine, Emory University, Atlanta, GA30322, USA
| | - Patrick McLean
- Department of Internal Medicine, Emory University, Atlanta, GA30322, USA
| | - Noah Newman
- Department of Internal Medicine, Emory University, Atlanta, GA30322, USA
| | - Brett Montelaro
- Department of Internal Medicine, Emory University, Atlanta, GA30322, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH44106, USA
| | - Mahboob Alam
- Department of Cardiology, The Texas Heart Institute, Baylor College of Medicine, Houston, TX77030, USA
| | - Samin K Sharma
- Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai Hospital, New York, NY10029, USA
| | - Hani Jned
- John Sealy Distinguished Centennial Chair in Cardiology, Chief, Division of Cardiology, University of Texas Medical Branch, Galveston, TX77555, USA
| | - Muzamil Khawaja
- Division of Cardiology, Emory University, Atlanta, GA30322, USA
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health & NYU School of Medicine, New York, NY10016, USA
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14
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Lugo-Gavidia LM, Alcocer-Gamba MA, Martinez-Cervantes A. Challenges and Advances in Interventional Cardiology for Coronary Artery Disease Management. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1323. [PMID: 39202606 PMCID: PMC11356482 DOI: 10.3390/medicina60081323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 07/31/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024]
Abstract
The development of percutaneous coronary intervention (PCI) has been one of the greatest advances in cardiology and has changed clinical practice for patients with coronary artery disease (CAD). Despite continuous improvements in operators' experience, techniques, and the development of new-generation devices, significant challenges remain in improving the efficacy of PCI, including calcification, bifurcation, multivascular disease, stent restenosis, and stent thrombosis, among others. The present review aims to provide an overview of the current status of knowledge of endovascular revascularization in CAD, including relevant trials, therapeutic strategies, and new technologies addressing particular scenarios that can impact the prognosis of this vulnerable population.
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Affiliation(s)
- Leslie Marisol Lugo-Gavidia
- Mexican Academic Consortium for Clinical Data Acquisition SC, Sinaloa 80230, Mexico
- Dobney Hypertension Centre, Medical School, University of Western Australia, Perth 6000, Australia
| | - Marco Antonio Alcocer-Gamba
- Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro 76180, Mexico
- Instituto de Corazón de Querétaro, Santiago de Querétaro 76180, Mexico
- Centro de Estudios Clínicos de Querétaro, Santiago de Querétaro 76180, Mexico
| | - Araceli Martinez-Cervantes
- Facultad de Medicina, Universidad Autónoma de Querétaro, Santiago de Querétaro 76180, Mexico
- Centro de Estudios Clínicos de Querétaro, Santiago de Querétaro 76180, Mexico
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15
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El Hajj M, Hadid B, Rosenzveig A, Hadid S, Frishman WH, Aronow WS. Managing the Intricacies of Coronary Revascularization: A Close Look at the Complete Versus Culprit-Only Approach and its Implications in Elderly Patients. Cardiol Rev 2024:00045415-990000000-00293. [PMID: 38970477 DOI: 10.1097/crd.0000000000000752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
Coronary heart disease is the leading cause of mortality in the United States, and data indicates that 805,000 Americans will face a new or recurrent myocardial infarction (MI) attack every year. Frailty, a conceptual syndrome categorized by a functional decline that occurs with aging, has been linked to adverse health outcomes in cardiovascular disease and all cardiac-related procedures in general. It is therefore reasonable to deliberate that more conservative medical therapy or medical management should be considered in the frail population when managing acute coronary syndrome. This course of action has, in fact, been documented in clinical practice. However, the recent Functional Assessment in Elderly MI Patients with Multivessel Disease trial, in which all subjects were 75 years of age or above, indicated that the more invasive complete revascularization approach may be favorable over incomplete or culprit-only revascularization in patients with acute MI. In this review, we will discuss coronary heart disease and review guidelines and procedures for culprit lesion identification, including electrocardiogram procedures, coronary angiography, intravascular ultrasound, fractional flow reserve, and instantaneous fractional flow reserve. We then discuss the concept of complete vs culprit-only/incomplete coronary revascularization and staging. Following this, we will delve into recent trials discussing complete vs culprit-only revascularization, emphasizing the insights gleaned from this latest trial within this special frailty cohort which warrants special consideration.
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Affiliation(s)
- Mahmoud El Hajj
- From the Department of Internal Medicine, Montefiore St. Luke's Cornwall Hospital, Newburgh, NY
| | - Bana Hadid
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Akiva Rosenzveig
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Somar Hadid
- Department of Medicine, New York Medical College, Valhalla, NY
| | - William H Frishman
- Department of Medicine, New York Medical College, Valhalla, NY
- Department of Medicine, Westchester Medical Center, Valhalla, NY
- Department of Cardiology, Westchester Medical Center, Valhalla, NY
| | - Wilbert S Aronow
- Department of Medicine, New York Medical College, Valhalla, NY
- Department of Medicine, Westchester Medical Center, Valhalla, NY
- Department of Cardiology, Westchester Medical Center, Valhalla, NY
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16
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Lucca A, Fraccarollo L, Fossan FE, Bråten AT, Pozzi S, Vergara C, Müller LO. Impact of Pressure Guidewire on Model-Based FFR Prediction. Cardiovasc Eng Technol 2024; 15:251-263. [PMID: 38438691 PMCID: PMC11239750 DOI: 10.1007/s13239-024-00710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/02/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Fractional Flow Reserve (FFR) is used to characterize the functional significance of coronary artery stenoses. FFR is assessed under hyperemic conditions by invasive measurements of trans-stenotic pressure thanks to the insertion of a pressure guidewire across the coronary stenosis during catheterization. In order to overcome the potential risk related to the invasive procedure and to reduce the associated high costs, three-dimensional blood flow simulations that incorporate clinical imaging and patient-specific characteristics have been proposed. PURPOSE Most CCTA-derived FFR models neglect the potential influence of the guidewire on computed flow and pressure. Here we aim to quantify the impact of taking into account the presence of the guidewire in model-based FFR prediction. METHODS We adopt a CCTA-derived FFR model and perform simulations with and without the guidewire for 18 patients with suspected stable CAD. RESULTS Presented results show that the presence of the guidewire leads to a tendency to predict a lower FFR value. The FFR reduction is prominent in cases of severe stenoses, while the influence of the guidewire is less pronounced in cases of moderate stenoses. CONCLUSION From a clinical decision-making point of view, including of the pressure guidewire is potentially relevant only for intermediate stenosis cases.
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Affiliation(s)
- Alessia Lucca
- Department of Mathematics, University of Trento, Via Sommarive, 14, 38123, Trento, Italy.
| | | | - Fredrik E Fossan
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders T Bråten
- Department of Cardiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Silvia Pozzi
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Christian Vergara
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Lucas O Müller
- Department of Mathematics, University of Trento, Via Sommarive, 14, 38123, Trento, Italy
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17
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Li L, Yang B, Dmytriw AA, Li Y, Gong H, Bai X, Zhang C, Chen J, Dong J, Wang Y, Gao P, Wang T, Luo J, Xu X, Feng Y, Zhang X, Yang R, Ma Y, Jiao L. Correlations between intravascular pressure gradients and cerebral blood flow in patients with symptomatic, medically refractory, anterior circulation artery stenosis: an exploratory study. J Neurointerv Surg 2024; 16:608-614. [PMID: 37402573 DOI: 10.1136/jnis-2023-020144] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Fractional flow reserve is widely used in coronary disease management, with a threshold of 0.80. However, similar thresholds are unclear in functional assessment of intracranial atherosclerotic stenosis (ICAS). OBJECTIVE To investigate the potential threshold values in functional assessment of ICAS by studying the relation between pressure-derived indexes and perfusion parameters derived from arterial spin labeling (ASL). METHODS Patients were consecutively screened between June 2019 and December 2020. The translesional gradient indices were measured by pressure guidewire under resting-state conditions and recorded as mean distal/proximal pressure ratios (Pd/Pa) and translesional pressure difference (Pa-Pd). Preoperative and postoperative cerebral blood flow (CBF) bilaterally and the relative cerebral blood flow ratio (rCBF) were measured and recorded by ASL imaging. Patients were defined as having reversible hemodynamic insufficiency only if the preoperative rCBF was <0.9 and the postoperative rCBF≥0.9. Preoperative and postoperative Pd/Pa or Pa-Pd values of those patients were used to calculate the threshold. RESULTS Twenty-five patients (19 men, 6 women) with a mean age of 56.7±9.4 years were analyzed. Seventeen patients (68%) had lesions at the M1 segment of the middle cerebral artery, eight patients (32%) had lesions in the intracranial internal carotid artery. In 14 of the 25 patients, the preoperative rCBF was <0.9 and the postoperative rCBF≥0.9. Cut-off values of Pd/Pa=0.81 and Pa-Pd=8 mm Hg were suggested to be associated with hemodynamic insufficiency. CONCLUSIONS In a highly selected subgroup with ICAS, cut-off values of translesional pressure gradients (Pd/Pa=0.81 or Pa-Pd=8 mm Hg) were preliminarily established, which may facilitate clinical decision-making in the management of ICAS.
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Affiliation(s)
- Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neuroradiology and Neurointervention, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yanling Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, Beijing, China
| | - Haozhi Gong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Chao Zhang
- Neuroendovascular Program, Beijing Escope Technology Inc, Beijing, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Jia Dong
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Peng Gao
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xin Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
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18
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Cai L, Zhong Q, Xu J, Huang Y, Gao H. A lumped parameter model for evaluating coronary artery blood supply capacity. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:5838-5862. [PMID: 38872561 DOI: 10.3934/mbe.2024258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The coronary artery constitutes a vital vascular system that sustains cardiac function, with its primary role being the conveyance of indispensable nutrients to the myocardial tissue. When coronary artery disease occurs, it will affect the blood supply of the heart and induce myocardial ischemia. Therefore, it is of great significance to numerically simulate the coronary artery and evaluate its blood supply capacity. In this article, the coronary artery lumped parameter model was derived based on the relationship between circuit system parameters and cardiovascular system parameters, and the blood supply capacity of the coronary artery in healthy and stenosis states was studied. The aortic root pressure calculated by the aortic valve fluid-structure interaction (AV FSI) simulator was employed as the inlet boundary condition. To emulate the physiological phenomenon of sudden pressure drops resulting from an abrupt reduction in blood vessel radius, a head loss model was connected at the coronary artery's entrance. For each coronary artery outlet, the symmetric structured tree model was appended to simulate the terminal impedance of the missing downstream coronary arteries. The particle swarm optimization (PSO) algorithm was used to optimize the blood flow viscous resistance, blood flow inertia, and vascular compliance of the coronary artery model. In the stenosis states, the relative flow and fractional flow reserve (FFR) calculated by numerical simulation corresponded to the published literature data. It was anticipated that the proposed model can be readily adapted for clinical application, serving as a valuable reference for diagnosing and treating patients.
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Affiliation(s)
- Li Cai
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
| | - Qian Zhong
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
| | - Juan Xu
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
| | - Yuan Huang
- Department of Mathematics, University of Cambridge, Cambridge CB2 1TN, UK
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, Glasgow G12 8QQ, UK
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Taylor DJ, Saxton H, Halliday I, Newman T, Feher J, Gosling R, Narracott AJ, van Kemenade D, Van't Veer M, Tonino PAL, Rochette M, Hose DR, Gunn JP, Morris PD. Evaluation of models of sequestration flow in coronary arteries-Physiology versus anatomy? Comput Biol Med 2024; 173:108299. [PMID: 38537564 DOI: 10.1016/j.compbiomed.2024.108299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/08/2024] [Accepted: 03/12/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Myocardial ischaemia results from insufficient coronary blood flow. Computed virtual fractional flow reserve (vFFR) allows quantification of proportional flow loss without the need for invasive pressure-wire testing. In the current study, we describe a novel, conductivity model of side branch flow, referred to as 'leak'. This leak model is a function of taper and local pressure, the latter of which may change radically when focal disease is present. This builds upon previous techniques, which either ignore side branch flow, or rely purely on anatomical factors. This study aimed to describe a new, conductivity model of side branch flow and compare this with established anatomical models. METHODS AND RESULTS The novel technique was used to quantify vFFR, distal absolute flow (Qd) and microvascular resistance (CMVR) in 325 idealised 1D models of coronary arteries, modelled from invasive clinical data. Outputs were compared to an established anatomical model of flow. The conductivity model correlated and agreed with the reference model for vFFR (r = 0.895, p < 0.0001; +0.02, 95% CI 0.00 to + 0.22), Qd (r = 0.959, p < 0.0001; -5.2 mL/min, 95% CI -52.2 to +13.0) and CMVR (r = 0.624, p < 0.0001; +50 Woods Units, 95% CI -325 to +2549). CONCLUSION Agreement between the two techniques was closest for vFFR, with greater proportional differences seen for Qd and CMVR. The conductivity function assumes vessel taper was optimised for the healthy state and that CMVR was not affected by local disease. The latter may be addressed with further refinement of the technique or inferred from complementary image data. The conductivity technique may represent a refinement of current techniques for modelling coronary side-branch flow. Further work is needed to validate the technique against invasive clinical data.
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Affiliation(s)
- Daniel J Taylor
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom.
| | - Harry Saxton
- Materials & Engineering Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Ian Halliday
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Tom Newman
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | | | - Rebecca Gosling
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Andrew J Narracott
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Denise van Kemenade
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marcel Van't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | | | - D Rodney Hose
- Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Julian P Gunn
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Paul D Morris
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom; Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
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20
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Park J, Seo B, Jeong Y, Park I. A Review of Recent Advancements in Sensor-Integrated Medical Tools. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307427. [PMID: 38460177 PMCID: PMC11132050 DOI: 10.1002/advs.202307427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/26/2023] [Indexed: 03/11/2024]
Abstract
A medical tool is a general instrument intended for use in the prevention, diagnosis, and treatment of diseases in humans or other animals. Nowadays, sensors are widely employed in medical tools to analyze or quantify disease-related parameters for the diagnosis and monitoring of patients' diseases. Recent explosive advancements in sensor technologies have extended the integration and application of sensors in medical tools by providing more versatile in vivo sensing capabilities. These unique sensing capabilities, especially for medical tools for surgery or medical treatment, are getting more attention owing to the rapid growth of minimally invasive surgery. In this review, recent advancements in sensor-integrated medical tools are presented, and their necessity, use, and examples are comprehensively introduced. Specifically, medical tools often utilized for medical surgery or treatment, for example, medical needles, catheters, robotic surgery, sutures, endoscopes, and tubes, are covered, and in-depth discussions about the working mechanism used for each sensor-integrated medical tool are provided.
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Affiliation(s)
- Jaeho Park
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
| | - Bokyung Seo
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
| | - Yongrok Jeong
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
- Radioisotope Research DivisionKorea Atomic Energy Research Institute (KAERI)Daejeon34057South Korea
| | - Inkyu Park
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
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21
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Zsarnoczay E, Pinos D, Schoepf UJ, Fink N, O'Doherty J, Gnasso C, Griffith J, Vecsey-Nagy M, Suranyi P, Maurovich-Horvat P, Emrich T, Varga-Szemes A. Intra-individual comparison of coronary CT angiography-based FFR between energy-integrating and photon-counting detector CT systems. Int J Cardiol 2024; 399:131684. [PMID: 38151162 DOI: 10.1016/j.ijcard.2023.131684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-based fractional flow reserve (CT-FFR) allows for noninvasive determination of the functional severity of anatomic lesions in patients with coronary artery disease. The aim of this study was to intra-individually compare CT-FFR between photon-counting detector (PCD) and conventional energy-integrating detector (EID) CT systems. METHODS In this single-center prospective study, subjects who underwent clinically indicated CCTA on an EID-CT system were recruited for a research CCTA on PCD-CT within 30 days. Image reconstruction settings were matched as closely as possible between EID-CT (Bv36 kernel, iterative reconstruction strength level 3, slice thickness 0.5 mm) and PCD-CT (Bv36 kernel, quantum iterative reconstruction level 3, virtual monoenergetic level 55 keV, slice thickness 0.6 mm). CT-FFR was measured semi-automatically using a prototype on-site machine learning algorithm by two readers. CT-FFR analysis was performed per-patient and per-vessel, and a CT-FFR ≤ 0.75 was considered hemodynamically significant. RESULTS A total of 22 patients (63.3 ± 9.2 years; 7 women) were included. Median time between EID-CT and PCD-CT was 5.5 days. Comparison of CT-FFR values showed no significant difference and strong agreement between EID-CT and PCD-CT in the per-vessel analysis (0.88 [0.74-0.94] vs. 0.87 [0.76-0.93], P = 0.096, mean bias 0.02, limits of agreement [LoA] -0.14/0.19, r = 0.83, ICC = 0.92), and in the per-patient analysis (0.81 [0.60-0.86] vs. 0.76 [0.64-0.86], P = 0.768, mean bias 0.02, LoA -0.15/0.19, r = 0.90, ICC = 0.93). All included patients were classified into the same category (CT-FFR > 0.75 vs ≤0.75) with both CT systems. CONCLUSIONS CT-FFR evaluation is feasible with PCD-CT and it shows a strong agreement with EID-CT-based evaluation when images are similarly reconstructed.
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Affiliation(s)
- Emese Zsarnoczay
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Daniel Pinos
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Nicola Fink
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jim O'Doherty
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Siemens Medical Solutions USA Inc, Malvern, USA
| | - Chiara Gnasso
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Joseph Griffith
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Milán Vecsey-Nagy
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pal Suranyi
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA; Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany; German Centre for Cardiovascular Research, Partner site Rhine-Main, Mainz, Germany.
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, USA
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22
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Nijjer SS. Using Physiology Pullback for Percutaneous Coronary Intervention Guidance: Is this the Future? Cardiol Clin 2024; 42:41-53. [PMID: 37949539 DOI: 10.1016/j.ccl.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Modern coronary intervention requires integration of angiographic, physiologic, and intravascular imaging. This article describes the use and techniques needed to understand coronary physiology pullback data and how use it to make revascularization decisions. The article describes instantaneous wave-free ratio, fractional flow reserve, and the data that support their use and how they differ when used in tandem disease. Common practical mistakes and errors are discussed together with a brief review of the limited published research data.
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Affiliation(s)
- Sukhjinder Singh Nijjer
- Department of Cardiology, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom. https://twitter.com/SukhNijjer
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23
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Fawaz S, Cook CM. Understanding the Basis for Hyperemic and Nonhyperemic Coronary Pressure Assessment. Cardiol Clin 2024; 42:1-11. [PMID: 37949531 DOI: 10.1016/j.ccl.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Despite the now routine integration of invasive physiologic systems into coronary catheter laboratories worldwide, it remains critical that all operators maintain a sound understanding of the fundamental physiologic basis for coronary pressure assessment. More specifically, performing operators should be well informed regarding the basis for hyperemic (ie, fractional flow reserve) and nonhyperemic (ie, instantaneous wave-free ratio and other nonhyperemic pressure ratio) coronary pressure assessment. In this article, we provide readers a comprehensive history charting the inception, development, and validation of hyperemic and nonhyperemic coronary pressure assessment.
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Affiliation(s)
- Samer Fawaz
- Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon SS16 5NL, United Kingdom; Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, United Kingdom
| | - Christopher M Cook
- Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon SS16 5NL, United Kingdom; Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, United Kingdom.
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24
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Arefinia F, Aria M, Rabiei R, Hosseini A, Ghaemian A, Roshanpoor A. Non-invasive fractional flow reserve estimation using deep learning on intermediate left anterior descending coronary artery lesion angiography images. Sci Rep 2024; 14:1818. [PMID: 38245614 PMCID: PMC10799954 DOI: 10.1038/s41598-024-52360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/17/2024] [Indexed: 01/22/2024] Open
Abstract
This study aimed to design an end-to-end deep learning model for estimating the value of fractional flow reserve (FFR) using angiography images to classify left anterior descending (LAD) branch angiography images with average stenosis between 50 and 70% into two categories: FFR > 80 and FFR ≤ 80. In this study 3625 images were extracted from 41 patients' angiography films. Nine pre-trained convolutional neural networks (CNN), including DenseNet121, InceptionResNetV2, VGG16, VGG19, ResNet50V2, Xception, MobileNetV3Large, DenseNet201, and DenseNet169, were used to extract the features of images. DenseNet169 indicated higher performance compared to other networks. AUC, Accuracy, Sensitivity, Specificity, Precision, and F1-score of the proposed DenseNet169 network were 0.81, 0.81, 0.86, 0.75, 0.82, and 0.84, respectively. The deep learning-based method proposed in this study can non-invasively and consistently estimate FFR from angiographic images, offering significant clinical potential for diagnosing and treating coronary artery disease by combining anatomical and physiological parameters.
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Affiliation(s)
- Farhad Arefinia
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrad Aria
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Rabiei
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Azamossadat Hosseini
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Ghaemian
- Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Arash Roshanpoor
- Department of Computer, Yadegar-e-Imam Khomeini (RAH), Islamic Azad University, Janat-Abad Branch, Tehran, Iran
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25
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Diana F, Peschillo S, Requena M, Romano DG, Frauenfelder G, de Dios Lascuevas M, Hernandez D, Ribó M, Tomasello A, Romoli M. Correlation between intravascular pressure gradients and ultrasound velocities in carotid artery stenosis: An exploratory study. Interv Neuroradiol 2023:15910199231224007. [PMID: 38155483 DOI: 10.1177/15910199231224007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Grading of carotid stenosis is routinely performed with non-invasive techniques, such as carotid ultrasound (CUS) and computerized tomography angiography (CTA), which have limitations in grading definition. Moreover, the actual hemodynamic impact of a stenosis remains poorly defined. Preliminary studies explored the application of the resting full-cycle ratio (RFR), measured with pressure wire (PW), but the correlation between RFR and morphological/hemodynamic parameters is still undefined. This study aims to test the correlation between RFR and CUS-CTA-DSA based degree of stenosis, to define the suitability of RFR as carotid stenosis index. METHODS We included patients with symptomatic carotid stenosis receiving carotid artery stenting (CAS), between November 2022 and May 2023. We performed CUS and PW measurements before and after stenting, at four different sites (trans-lesion, distal cervical, petrous and supraclinoid internal carotid artery [ICA] segments). We compared CUS and PW parameters by Pearson's or Spearman test for continuous variables. RESULTS Among 15 patients included the mean stenosis degree was 81.3%. Trans-lesion RFR was significantly higher than other sites (0.72 ± 0.2 trans-lesion vs. 0.69 ± 0.18 distal cervical ICA vs. 0.66 ± 0.2 petrous ICA vs. 0.6 ± 0.2 intracranial ICA, p < 0.05). All RFR values significantly increased after treatment; the highest relative increase was registered at stenosis site (0.72 ± 0.2 pre-stent vs. 1.01 ± 0.1 post-stent, p < 0.01). Trans-lesion RFR was significantly associated with the CTA and DSA stenosis degree and CUS measurements. CONCLUSIONS Pressure wire in carotid artery stenosis seems safe and suitable. Resting full-cycle ratio has a significant correlation with CUS values and stenosis degree and might be used as carotid stenosis index during CAS.
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Affiliation(s)
- Francesco Diana
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Simone Peschillo
- Unicamillus International University of Health Sciences, Rome, Italy
| | - Manuel Requena
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Daniele G Romano
- Interventional Neuroradiology, San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giulia Frauenfelder
- Interventional Neuroradiology, San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Marta de Dios Lascuevas
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - David Hernandez
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Marc Ribó
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
- Stroke Unit, Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Tomasello
- Interventional Neuroradiology, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- Stroke Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
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26
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Elbadawi A, Sedhom R, Ghoweba M, Etewa AM, Kayani W, Rahman F. Contemporary Use of Coronary Physiology in Cardiology. Cardiol Ther 2023; 12:589-614. [PMID: 37668939 DOI: 10.1007/s40119-023-00329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023] Open
Abstract
Coronary angiography has a limited ability to predict the functional significance of intermediate coronary lesions. Hence, physiological assessment of coronary lesions, via fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), has been introduced to determine their functional significance. An accumulating body of evidence has consolidated the role of physiology-guided revascularization, particularly among patients with stable ischemic heart disease. The use of FFR or iFR to guide decision-making in patients with stable ischemic heart disease and intermediate coronary lesions received a class I recommendation from major societal guidelines. Nevertheless, the role of coronary physiology testing is less clear among certain patients' groups, including patients with serial coronary lesions, acute coronary syndromes, aortic stenosis, heart failure, as well as post-percutaneous coronary interventions. In this review, we aimed to discuss the utility and clinical evidence of coronary physiology (mainly FFR and iFR), with emphasis on those specific patient groups.
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Affiliation(s)
- Ayman Elbadawi
- Division of Cardiology, Christus Good Shepherd, 707 East Marshall Avenue, Longview, TX, 75604, USA.
| | - Ramy Sedhom
- Department of Internal Medicine, Einstein Medical Centre, Philadelphia, PA, USA
| | - Mohamed Ghoweba
- Department of Internal Medicine, Christus Good Shepherd, Longview, TX, 75601, USA
| | | | - Waleed Kayani
- Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Faisal Rahman
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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27
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Gräni C, Bigler MR, Kwong RY. Noninvasive Multimodality Imaging for the Assessment of Anomalous Coronary Artery. Curr Cardiol Rep 2023; 25:1233-1246. [PMID: 37851270 DOI: 10.1007/s11886-023-01948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/19/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE OF REVIEW Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital coronary anomaly with the potential to cause myocardial ischemia and adverse cardiac events. The presence of AAOCA anatomy itself does not necessarily implicate a need for revascularization. Therefore, the purpose of this review is to assess how noninvasive comprehensive anatomic- and physiologic evaluation may guide patient management. RECENT FINDINGS The assessment of AAOCA includes an accurate description of the anomalous origin/vessel course including anatomical high-risk features such as a slit-like ostium, proximal narrowing, elliptic vessel shape, acute take-off angle, intramural course, and possible concomitant coronary atherosclerosis and hemodynamics. Various cardiac imaging modalities offer unique advantages and capabilities in visualizing these anatomical and functional aspects of AAOCA. This review explored the role of noninvasive multimodality imaging in the characterization of AAOCA by highlighting the strengths, limitations, and potential applications of the current different cardiac imaging methods, with a focus on the pathophysiology of myocardial ischemia and stress testing protocols.
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Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marius R Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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28
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Sciagrà R, Linguanti F. All that glisters is not gold: the elusive difference between statistics and pathophysiology. J Nucl Cardiol 2023; 30:2003-2005. [PMID: 37142880 DOI: 10.1007/s12350-023-03268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/06/2023]
Affiliation(s)
- Roberto Sciagrà
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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29
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Mushtaq S, Gigante C, Conte E, Capovilla TM, Sonck J, Tanzilli A, Barbato E, Monizzi G, Belmonte M, De Bruyne B, Bartorelli AL, Schillaci M, Marchetti D, Carerj ML, Pontone G, Collet C, Andreini D. Preoperative angiography-derived fractional flow reserve may predict coronary artery bypass grafting occlusion and disease progression. J Cardiovasc Med (Hagerstown) 2023; 24:651-658. [PMID: 37605957 DOI: 10.2459/jcm.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
BACKGROUND Graft occlusion after coronary artery bypass grafting (CABG) has been associated with competitive flow of native coronary arteries. OBJECTIVES To assess with coronary computed tomography angiography (CCTA) graft occlusion and coronary artery disease (CAD) progression of native vessels after CABG and their relationship with angiography-derived vessel fractional flow reserve (vFFR) performed before surgery. METHODS Between 2006 and 2018, serial vFFR analyses were obtained before CABG in each major native coronary vessel from two institutions. All patients underwent follow-up CCTA. RESULTS In 171 consecutive patients, serial preoperative angiograms were suitable for vFFR analysis of 298 grafted and 59 nongrafted vessels. Median time between CABG and CCTA was 2.1 years. Preoperative vFFR was assessed in 131 left anterior descending artery (LAD), 132 left circumflex artery (LCX) and 94 right coronary aretry (RCA) and was less than 0.80 in 255 of 298 bypassed vessels. Graft occlusion was observed at CCTA in 28 of 298 grafts. The median preoperative vFFR value of native coronaries was higher in occluded compared with patent grafts (0.75 vs. 0.60, P < 0.001) and was associated with graft. The best vFFR cut-off to predict graft occlusion was 0.67. Progression of CAD was higher in grafted than in nongrafted vessels (89.6 vs. 47.5%, P < 0.001). Pre-CABG vFFR predicted disease progression of grafted native vessels (AUC = 0.83). CONCLUSION Preoperative vFFR derived from invasive coronary angiography was able to predict graft occlusion and CAD progression of grafted coronary arteries.
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Affiliation(s)
| | | | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples
| | | | | | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
| | - Matteo Schillaci
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Davide Marchetti
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- University of Milan, Milan
| | - Maria Ludovica Carerj
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Diagnostic and Interventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, 'G. Martino' University Hospital Messina, Messina
| | - Gianluca Pontone
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Biomedical and Clinical Sciences
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Yang G, Li L, Peng X, Tang G, Zheng N, Zhao Y, Li H, Zhang H, Sun F, Ai H. Accuracy and Reproducibility of Coronary Angiography-Derived Fractional Flow Reserve in the Assessment of Coronary Lesion Severity. Int J Gen Med 2023; 16:3805-3814. [PMID: 37662502 PMCID: PMC10473419 DOI: 10.2147/ijgm.s413991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose Coronary angiography-derived fractional flow reserve (caFFR) is a novel computational flow dynamics (CFD)-derived assessment of coronary vessel flow with good diagnostic performance. Herein, we performed a retrospective study to evaluate the reproducibility of caFFR findings between observers and investigate the diagnostic performance of caFFR for coronary stenosis defined as FFR ≤0.80, especially in the grey zone (0.75≤caFFR ≤0.80). Patients and Methods A total of 150 patients (167 coronary vessels) underwent caFFR (with FlashAngio used for calculation of flow variables) and subsequent invasive fractional flow reserve (FFR) measurements. Outcomes, including reproducibility, were compared for vessels in and outside the grey zone. Results The correlation of caFFR findings was good between the two laboratories (r = 0.723, p<0.001). The AUC of ROC were both high for caFFR-CoreLab1 and caFFR-CoreLab2 (0.975 and 0.883). The diagnostic accuracy, sensitivity, specificity, and negative and positive predictive values were not significantly different between the two laboratories (p>0.05). caFFR had a strong correlation with measures to FFR (r=0.911, p<0.001). There was no systematic difference between caFFR and FFR on Bland-Altman analysis in and outside the grey zone. There was no difference in diagnostic accuracy between the grey and non-grey zones in the prediction of FFR ≤0.80 (p=0.09). Conclusion The inter-observer reproducibility for caFFR was high, and the diagnostic accuracy of caFFR was good compared to that of FFR.
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Affiliation(s)
- Guojian Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Le Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Xi Peng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Guodong Tang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Naixin Zheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Ying Zhao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Huiping Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Fucheng Sun
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
| | - Hu Ai
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China
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Soh MS, Kim H, Kang MG, Lee HJ, Lee SD, Hwang SJ, Hwang JY, Kim K, Park JR, Kim HR, Tahk SJ, Yoon MH, Lim HS, Koh JS. Impact of height difference between coronary ostium and location of intracoronary pressure sensor on fractional flow reserve measurements. PLoS One 2023; 18:e0289646. [PMID: 37616282 PMCID: PMC10449150 DOI: 10.1371/journal.pone.0289646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND During fractional flow reserve (FFR) measurements, distal coronary pressure (Pd) can be influenced by hydrostatic pressure changes resulting from the height difference (HD) between the coronary ostium and the location of the distal pressure sensor. AIMS We investigated the effect of aortocoronary HD on the FFR measurements in each coronary artery. METHODS In this retrospective cohort study, we analyzed 257 patients who underwent FFR measurements and coronary computed tomography (CCTA) within a year. Using CCTA, we measured HD as the vertical distance between the coronary ostium and a matched point of the distal coronary pressure sensor identified on coronary angiography. RESULTS The location of the Pd sensor was higher than the coronary ostium in the left anterior descending artery (LAD) (-4.64 ± 1.15 cm) and lower than the coronary ostium in the left circumflex artery (LCX) (2.54 ± 1.05 cm) and right coronary artery (RCA) (2.03 ± 1.28 cm). The corrected FFR values by HD were higher in the LAD (0.78 ± 0.09 to 0.82 ± 0.09, P<0.01) and lower in the LCX and RCA than the original FFR values (0.87 ± 0.07 to 0.85 ± 0.08, P<0.01; 0.87 ± 0.10 to 0.86 ± 0.10, P<0.01, respectively). Using an FFR cut-off value of 0.8, the concordance rates between the FFR and corrected FFR values were 77.8%, 95.2%, and 100% in the LAD, LCX, and RCA, respectively. CONCLUSION HD between the coronary ostium and the distal coronary pressure sensor may affect FFR measurements and FFR-guided treatment decisions for coronary artery disease.
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Affiliation(s)
- Moon-Seung Soh
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hangyul Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Min Gyu Kang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hyo Jin Lee
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seung Do Lee
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seok-Jae Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin-Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Kyehwan Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jeong-Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hye-Ree Kim
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Myeong-Ho Yoon
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin-Sin Koh
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
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Yu L, Guo W, He W, Qin W, Zeng M, Wang S. A novel method for calculating CTFFR based on the flow ratio between stenotic coronary and healthy coronary. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107469. [PMID: 36921466 DOI: 10.1016/j.cmpb.2023.107469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Epicardial coronary stenosis may lead to myocardial ischaemia, and the resulting obstructive coronary artery disease is one of the leading causes of death. CT-derived fractional flow reserve (CT-FFR) has been clinically shown to be an effective method for the noninvasive assessment of coronary artery stenosis. However, this method has the problem that the measurement result is affected by the selected measurement position. OBJECTIVES This study was to obtain a novel flow-based approach to coronary CTFFR (CTQFFR), which was not affected by the measurement location. METHODS This study established healthy-assumed coronary arteries based on narrowed coronary arteries. Based on the assumption that the microvascular resistance remains unchanged in the short term after coronary stenosis treatment, the blood flow in the stenotic coronary artery and the healthy-assumed coronary artery was obtained by numerical simulation, and the CTQFFR based on the blood flow ratio was calculated. The functional relationship between CTQFFR and FFR was fitted by the results of 20 cases. RESULTS In this study, the functional relationship between CTQFFR and FFR was fitted by a quadratic curve, and the variance was 0.8744; the functional relationship between CTQFFR and pressure-based approach to coronary CTFFR (CTPFFR) was fitted by a primary curve, and the variance was 0.9971. There was coronary artery growth in all 20 cases. Preliminary validation results using 10 cases showed 100% accuracy in determining whether coronary artery stenosis required for clinical intervention. The relative error of the coefficient with the results proposed in a previous study was 0.316%. CONCLUSION This study proposes a new method for calculating coronary CTFFR, namely, coronary CTQFFR, which is the flow ratio between stenotic coronary and healthy-assumed coronary. This method solves the problem that the downstream CTFFR of coronary stenosis is related to the selected location, which effectively improves the CTFFR at the critical value (CTFFR= 0.8) near reliability. Preliminary research results show that the method obtained in this study has a high accuracy for determining whether there is significant coronary stenosis. However, large multi-centre validation for the feasibility of this method was necessary in our future work.
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Affiliation(s)
- Long Yu
- Department of aeronautics and astronautics, Fudan University, Shanghai, China
| | - Weifeng Guo
- Depratment of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei He
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang Qin
- Department of aeronautics and astronautics, Fudan University, Shanghai, China
| | - Mengsu Zeng
- Depratment of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of aeronautics and astronautics, Fudan University, Shanghai, China; Institute of Biomedical Engineering Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China; Yiwu Research Institute, Fudan University, Yiwu, Zhejiang Province, China.
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Boutaleb AM, Ghafari C, Ungureanu C, Carlier S. Fractional flow reserve and non-hyperemic indices: Essential tools for percutaneous coronary interventions. World J Clin Cases 2023; 11:2123-2139. [PMID: 37122527 PMCID: PMC10131021 DOI: 10.12998/wjcc.v11.i10.2123] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact. Fractional flow reserve (FFR) received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis. FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy, deferring unnecessary procedures for lesions with a FFR > 0.8, improving patients' management and clinical outcome. Post intervention, an optimal FFR > 0.9 post stenting should be reached and > 0.8 post drug eluting balloons. Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89. They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated. FFR remains the gold standard reference for invasive assessment of ischemia. We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio. We conclude introducing a hybrid approach to intermediate lesions (DFR 0.85-0.95) potentially maximizing clinical decision from all measurements.
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Affiliation(s)
- Amine Mamoun Boutaleb
- Department of Cardiology, Ibn Rochd University Hospital, Casablanca 20230, Casablanca, Morocco
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, Mons 7000, Belgium
| | - Chadi Ghafari
- Department of Cardiology, University of Mons, Mons 7000, Belgium
| | - Claudiu Ungureanu
- Department of Cardiology, University of Mons, Mons 7000, Belgium
- Catheterization Unit, Jolimont Hospital, La Louvière 7100, Belgium, Belgium
| | - Stéphane Carlier
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, Mons 7000, Belgium
- Department of Cardiology, University of Mons, Mons 7000, Belgium
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34
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de Oliveira Laterza Ribeiro M, Correia VM, Herling de Oliveira LL, Soares PR, Scudeler TL. Evolving Diagnostic and Management Advances in Coronary Heart Disease. Life (Basel) 2023; 13:951. [PMID: 37109480 PMCID: PMC10143565 DOI: 10.3390/life13040951] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Despite considerable improvement in diagnostic modalities and therapeutic options over the last few decades, the global burden of ischemic heart disease is steadily rising, remaining a major cause of death worldwide. Thus, new strategies are needed to lessen cardiovascular events. Researchers in different areas such as biotechnology and tissue engineering have developed novel therapeutic strategies such as stem cells, nanotechnology, and robotic surgery, among others (3D printing and drugs). In addition, advances in bioengineering have led to the emergence of new diagnostic and prognostic techniques, such as quantitative flow ratio (QFR), and biomarkers for atherosclerosis. In this review, we explore novel diagnostic invasive and noninvasive modalities that allow a more detailed characterization of coronary disease. We delve into new technological revascularization procedures and pharmacological agents that target several residual cardiovascular risks, including inflammatory, thrombotic, and metabolic pathways.
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Affiliation(s)
| | | | | | | | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
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35
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Jin X, Gao B, Zheng J, Wu X, Zhang N, Zhu L, Zhu X, Xie J, Wang Z, Tong G, Huang J. Impact of epicardial adipose tissue volume on hemodynamically significant coronary artery disease in Chinese patients with known or suspected coronary artery disease. Front Cardiovasc Med 2023; 10:1088961. [PMID: 37025685 PMCID: PMC10071511 DOI: 10.3389/fcvm.2023.1088961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Background Epicardial adipose tissue (EAT) is directly related to coronary artery disease (CAD), but little is known about its role in hemodynamically significant CAD. Therefore, our goal is to explore the impact of EAT volume on hemodynamically significant CAD. Methods Patients who underwent coronary computed tomography angiography (CCTA) and received coronary angiography within 30 days were retrospectively included. Measurements of EAT volume and coronary artery calcium score (CACs) were performed on a semi-automatic software based on CCTA images, while quantitative flow ratio (QFR) was automatically calculated by the AngioPlus system according to coronary angiographic images. Results This study included 277 patients, 112 of whom had hemodynamically significant CAD and showed higher EAT volume. In multivariate analysis, EAT volume was independently and positively correlated with hemodynamically significant CAD [per standard deviation (SD) cm3; odds ratio (OR), 2.78; 95% confidence interval (CI), 1.86-4.15; P < 0.001], but negatively associated with QFRmin (per SD cm3; β coefficient, -0.068; 95% CI, -0.109 to -0.027; P = 0.001) after adjustment for traditional risk factors and CACs. Receiver operating characteristics curve analysis demonstrated a significant improvement in predictive value for hemodynamically significant CAD with the addition of EAT volume to obstructive CAD alone (area under the curve, 0.950 vs. 0.891; P < 0.001). Conclusion In this study, we found that EAT volume correlated substantially and positively with the existence and severity of hemodynamically significant CAD in Chinese patients with known or suspected CAD, which was independent of traditional risk factors and CACs. In combination with obstructive CAD, EAT volume significantly improved diagnostic performance for hemodynamically significant CAD, suggesting that EAT could be a reliable noninvasive indicator of hemodynamically significant CAD.
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Affiliation(s)
- Xiangbo Jin
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Beibei Gao
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiamin Zheng
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xueer Wu
- Graduate School, Wenzhou Medical University, Wenzhou, China
| | - Ning Zhang
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijun Zhu
- Department of Cardiology, Ningbo Municipal Medical Center LiHuili Hospital, Ningbo, China
| | - Xinyu Zhu
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianchang Xie
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen Wang
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoxin Tong
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinyu Huang
- Department of Cardiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Fawaz S, Khan S, Simpson R, Clesham G, Cook CM, Davies JR, Karamasis GV, Keeble TR. Invasive Detection of Coronary Microvascular Dysfunction: How It Began, and Where We Are Now. Interv Cardiol 2023; 18:e07. [PMID: 37601734 PMCID: PMC10433108 DOI: 10.15420/icr.2022.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/02/2022] [Indexed: 03/17/2023] Open
Abstract
The landscape of interventional cardiology is ever evolving. Contemporary practice has shifted from a stenosis-centred approach to the total characterisation of both the epicardial and microcirculatory vessels. Microcirculatory dysfunction plays an important role in the pathophysiology of acute and chronic coronary syndromes, and characterisation of the microcirculation has important clinical consequences. Accordingly, the invasive diagnosis of microcirculatory dysfunction is becoming a key feature of the interventional cardiologist's toolkit. This review focuses on the methodology underpinning the invasive diagnosis of microvascular dysfunction and highlights the indices that have arisen from these methodologies.
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Affiliation(s)
- Samer Fawaz
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Sarosh Khan
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Rupert Simpson
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Gerald Clesham
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Christopher M Cook
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - John R Davies
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
| | - Grigoris V Karamasis
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School Athens, Greece
| | - Thomas R Keeble
- Research Department, Roding Ward, Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust Basildon, UK
- Department of Circulatory Health Research, Anglia Ruskin University Chelmsford, UK
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Taylor DJ, Feher J, Czechowicz K, Halliday I, Hose DR, Gosling R, Aubiniere-Robb L, van’t Veer M, Keulards DCJ, Tonino P, Rochette M, Gunn JP, Morris PD. Validation of a novel numerical model to predict regionalized blood flow in the coronary arteries. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:81-89. [PMID: 36974271 PMCID: PMC10039427 DOI: 10.1093/ehjdh/ztac077] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/28/2022] [Indexed: 01/04/2023]
Abstract
Aims Ischaemic heart disease results from insufficient coronary blood flow. Direct measurement of absolute flow (mL/min) is feasible, but has not entered routine clinical practice in most catheterization laboratories. Interventional cardiologists, therefore, rely on surrogate markers of flow. Recently, we described a computational fluid dynamics (CFD) method for predicting flow that differentiates inlet, side branch, and outlet flows during angiography. In the current study, we evaluate a new method that regionalizes flow along the length of the artery. Methods and results Three-dimensional coronary anatomy was reconstructed from angiograms from 20 patients with chronic coronary syndrome. All flows were computed using CFD by applying the pressure gradient to the reconstructed geometry. Side branch flow was modelled as a porous wall boundary. Side branch flow magnitude was based on morphometric scaling laws with two models: a homogeneous model with flow loss along the entire arterial length; and a regionalized model with flow proportional to local taper. Flow results were validated against invasive measurements of flow by continuous infusion thermodilution (Coroventis™, Abbott). Both methods quantified flow relative to the invasive measures: homogeneous (r 0.47, P 0.006; zero bias; 95% CI -168 to +168 mL/min); regionalized method (r 0.43, P 0.013; zero bias; 95% CI -175 to +175 mL/min). Conclusion During angiography and pressure wire assessment, coronary flow can now be regionalized and differentiated at the inlet, outlet, and side branches. The effect of epicardial disease on agreement suggests the model may be best targeted at cases with a stenosis close to side branches.
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Affiliation(s)
- Daniel J Taylor
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK
| | | | - Krzysztof Czechowicz
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Ian Halliday
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - D R Hose
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, Sheffield, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, Sheffield, UK
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Louise Aubiniere-Robb
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Marcel van’t Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | | | - Pim Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
- Department of Biomechanical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | | | - Julian P Gunn
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, Sheffield, UK
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul D Morris
- Department of Infection, Immunity and Cardiovascular Science, University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, Sheffield, UK
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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de Vos A, Jansen TPJ, van 't Veer M, Dimitriu-Leen A, Konst RE, Elias-Smale S, Paradies V, Rodwell L, van den Oord S, Smits P, van Royen N, Pijls N, Damman P. Microvascular Resistance Reserve to Assess Microvascular Dysfunction in ANOCA Patients. JACC Cardiovasc Interv 2023; 16:470-481. [PMID: 36858668 DOI: 10.1016/j.jcin.2022.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Microvascular resistance reserve (MRR) is a new index to assess coronary microvascular (dys)function, which can be easily measured invasively using continuous thermodilution. In contrast to coronary flow reserve (CFR), MRR is independent of epicardial coronary disease and hemodynamic variations. Its measurement is accurate, reproducible, and operator independent. OBJECTIVES The aim of this study was to establish the range of normal values for MRR and to determine an optimal cutoff point. METHODS In this exploratory study in 214 patients with angina and no obstructive coronary artery disease, after excluding significant epicardial disease, all physiological parameters, such as fractional flow reserve, index of microvascular resistance, CFR, absolute blood flow, absolute microvascular resistance, and MRR, were measured. On the basis of concordant positive or concordant negative results of index of microvascular resistance and CFR, subgroups of patients were defined with high probability of either normal (n = 122) or abnormal (n = 24) microcirculatory function, and MRR was studied in these groups. RESULTS Mean MRR in the "normal" group was 3.4 compared with a mean MRR of 1.9 in the "abnormal" group; these values were significantly different between the groups. MRR >2.7 ruled out coronary microvascular dysfunction (CMD) with a certainty of 96%, whereas MRR <2.1 indicated the presence of CMD with a similar high certainty of 96%. CONCLUSIONS MRR is a suitable index to distinguish the presence or absence of CMD in patients with angina and no obstructive coronary artery disease. The present data indicate that an MRR of 2.7 virtually excludes the presence of CMD, while an MRR value <2.1 confirms its presence.
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Affiliation(s)
- Annemiek de Vos
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
| | - Tijn P J Jansen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Marcel van 't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | | | - Regina E Konst
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Suzette Elias-Smale
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Laura Rodwell
- Department of Health Evidence, Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stijn van den Oord
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Pieter Smits
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nico Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Peter Damman
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Takagi H, Ihdayhid AR, Leipsic JA. Integration of fractional flow reserve derived from CT into clinical practice. J Cardiol 2023; 81:577-585. [PMID: 36805489 DOI: 10.1016/j.jjcc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 02/21/2023]
Abstract
Fractional flow reserve (FFR) is currently considered as the gold standard for revascularization decision-making in patients with stable coronary artery disease (CAD). The application of computational fluid dynamics to coronary computed tomography (CT) angiography (CCTA) enables calculation of FFR without additional testing, radiation exposure, contrast medium injection, and hyperemia (FFRCT). Although multiple diagnostic and clinical studies have enriched the scientific evidence, it is still challenging to integrate FFRCT into clinical practice. Both meticulous scientific backgrounds and precise anatomical data derived from CCTA are fundamental for FFRCT computation, and there are numerous factors impacting on FFRCT calculation and interpretation: coronary artery stenosis, calcium, atherosclerosis, luminal volume, and left ventricular myocardial mass. Further, there is a gap that clinicians using FFRCT need to recognize in interpretation of FFRCT results between diagnostic studies and clinical studies. In this review, we summarize multiple evidence related to FFRCT computation and interpretation to refine the FFRCT strategy in patients with stable CAD.
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Affiliation(s)
- Hidenobu Takagi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Curtin University, Perth, Australia
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
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A spatiotemporal analysis of the left coronary artery biomechanics using fluid-structure interaction models. Med Biol Eng Comput 2023; 61:1533-1548. [PMID: 36790640 DOI: 10.1007/s11517-023-02791-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/24/2023] [Indexed: 02/16/2023]
Abstract
Biomechanics plays a critical role in coronary artery disease development. FSI simulation is commonly used to understand the hemodynamics and mechanical environment associated with atherosclerosis pathology. To provide a comprehensive characterization of patient-specific coronary biomechanics, an analysis of FSI simulation in the spatial and temporal domains was performed. In the current study, a three-dimensional FSI model of the LAD coronary artery was built based on a patient-specific geometry using COMSOL Multiphysics. The effect of myocardial bridging was simulated. Wall shear stress and its derivatives including time-averaged wall shear stress, wall shear stress gradient, and OSI were calculated across the cardiac cycle in multiple locations. Arterial wall strain (radial, circumferential, and longitudinal) and von Mises stress were calculated. To assess perfusion, vFFR was calculated. The results demonstrated the FSI model could identify regional and transient differences in biomechanical parameters within the coronary artery. The addition of myocardial bridging caused a notable change in von Mises stress and an increase in arterial strain during systole. The analysis performed in this manner takes greater advantage of the information provided in the space and time domains and can potentially assist clinical evaluation.
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41
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Nijjer SS. Using Physiology Pullback for Percutaneous Coronary Intervention Guidance: Is this the Future? Interv Cardiol Clin 2023; 12:41-53. [PMID: 36372461 DOI: 10.1016/j.iccl.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Modern coronary intervention requires integration of angiographic, physiologic, and intravascular imaging. This article describes the use and techniques needed to understand coronary physiology pullback data and how use it to make revascularization decisions. The article describes instantaneous wave-free ratio, fractional flow reserve, and the data that support their use and how they differ when used in tandem disease. Common practical mistakes and errors are discussed together with a brief review of the limited published research data.
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Affiliation(s)
- Sukhjinder Singh Nijjer
- Department of Cardiology, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom. https://twitter.com/SukhNijjer
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Fawaz S, Cook CM. Understanding the Basis for Hyperemic and Nonhyperemic Coronary Pressure Assessment. Interv Cardiol Clin 2023; 12:1-12. [PMID: 36372454 DOI: 10.1016/j.iccl.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Despite the now routine integration of invasive physiologic systems into coronary catheter laboratories worldwide, it remains critical that all operators maintain a sound understanding of the fundamental physiologic basis for coronary pressure assessment. More specifically, performing operators should be well informed regarding the basis for hyperemic (ie, fractional flow reserve) and nonhyperemic (ie, instantaneous wave-free ratio and other nonhyperemic pressure ratio) coronary pressure assessment. In this article, we provide readers a comprehensive history charting the inception, development, and validation of hyperemic and nonhyperemic coronary pressure assessment.
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Affiliation(s)
- Samer Fawaz
- Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon SS16 5NL, United Kingdom; Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, United Kingdom
| | - Christopher M Cook
- Essex Cardiothoracic Centre, Mid and South Essex NHS Hospitals Trust, Basildon SS16 5NL, United Kingdom; Anglia Ruskin University, Chelmsford, Essex CM1 1SQ, United Kingdom.
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Fezzi S, Huang J, Lunardi M, Ding D, Ribichini FL, Tu S, Wijns W. Coronary physiology in the catheterisation laboratory: an A to Z practical guide. ASIAINTERVENTION 2022; 8:86-109. [PMID: 36798834 PMCID: PMC9890586 DOI: 10.4244/aij-d-22-00022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022]
Abstract
Coronary revascularisation, either percutaneous or surgical, aims to improve coronary flow and relieve myocardial ischaemia. The decision-making process in patients with coronary artery disease (CAD) remains largely based on invasive coronary angiography (ICA), even though until recently ICA could not assess the functional significance of coronary artery stenoses. Invasive wire-based approaches for physiological evaluations were developed to properly assess the ischaemic relevance of epicardial CAD. Fractional flow reserve (FFR) and later, instantaneous wave-free ratio (iFR), were shown to improve clinical outcomes in several patient subsets when used for coronary revascularisation guidance or deferral and for procedural optimisation of percutaneous coronary intervention (PCI) results. Despite accumulating evidence and positive guideline recommendations, the adoption of invasive physiology has remained quite low, mainly due to technical and economic issues as well as to operator-resistance to change. Coronary image-based computational physiology has been recently developed, with promising results in terms of accuracy and a reduction in computational time, costs, radiation exposure and risks for the patient. Lastly, the integration of intracoronary imaging and physiology allows for individualised PCI treatment, aiming at complete relief of ischaemia through optimised morpho-functional immediate procedural results. Instead of a conventional state-of-the-art review, this A to Z dictionary attempts to provide a practical guide for the application of coronary physiology in the catheterisation laboratory, exploring several methods, their pitfalls, and useful tips and tricks.
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Affiliation(s)
- Simone Fezzi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Jiayue Huang
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Mattia Lunardi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Flavio L Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Department of Cardiology, Fujian Medical University Union Hospital, Fujian, China
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
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Stegehuis V, Westra J, Boerhout C, Sejr-Hansen M, Eftekhari A, Mejía-Renteria H, Cambero-Madera M, Van Royen N, Matsuo H, Nakayama M, Siebes M, Christiansen EH, Van de Hoef T, Piek J. Three-Dimensional Angiographic Characteristics versus Functional Stenosis Severity in Fractional and Coronary Flow Reserve Discordance: A DEFINE FLOW Sub Study. Diagnostics (Basel) 2022; 12:1770. [PMID: 35885676 PMCID: PMC9323286 DOI: 10.3390/diagnostics12071770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/07/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Coronary angiography alone is insufficient to identify lesions associated with myocardial ischemia that may benefit from revascularization. Coronary physiology parameters may improve clinical decision making in addition to coronary angiography, but the association between 2D and 3D qualitative coronary angiography (QCA) and invasive pressure and flow measurements is yet to be elucidated. METHODS We associated invasive fractional flow reserve (FFR), coronary flow reserve (CFR) and coronary flow capacity (CFC) with 2D- and 3D-QCA in 430 intermediate lesions of 366 patients. RESULTS Overall, 2D-QCA analysis resulted in less severe stenosis severity compared with 3D-QCA analysis. FFR+/CFR- lesions had similar 3D-QCA characteristics as FFR+/CFR+ lesions. In contrast, vessels with FFR-/CFR+ discordance had 3D-QCA characteristics similar to those of vessels with concordant FFR-/CFR-. Contrarily, FFR+/CFR- lesions had CFC similar to that of as FFR-/CFR- lesions. CONCLUSIONS Non-flow-limiting lesions (FFR+/CFR-) have 3D-QCA characteristics similar to those of FFR+/CFR+, but the majority are not associated with inducible myocardial ischemia as determined by invasive CFC. FFR-/CFR+ lesions have 3D-QCA characteristics similar to those of FFR-/CFR- lesions but are more frequently associated with a moderately to severely reduced CFC, illustrating the angiographic-functional mismatch in discordant lesions.
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Affiliation(s)
- Valerie Stegehuis
- Amsterdam UMC—Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands; (V.S.); (C.B.); (T.V.d.H.)
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark; (J.W.); (M.S.-H.); (A.E.); (E.C.)
| | - Coen Boerhout
- Amsterdam UMC—Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands; (V.S.); (C.B.); (T.V.d.H.)
| | - Martin Sejr-Hansen
- Department of Cardiology, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark; (J.W.); (M.S.-H.); (A.E.); (E.C.)
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark; (J.W.); (M.S.-H.); (A.E.); (E.C.)
| | - Hernan Mejía-Renteria
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | | | - Niels Van Royen
- Department of Cardiology, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands;
| | | | - Masafumi Nakayama
- Gifu Heart Center, Gifu 500-8384, Japan; (H.M.); (M.N.)
- Japan Toda Chuo General Hospital, Toda 335-0023, Japan
| | - Maria Siebes
- Amsterdam UMC—Location AMC, Department of Biomedical Engineering and Physics, 1105 AZ Amsterdam, The Netherlands;
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark; (J.W.); (M.S.-H.); (A.E.); (E.C.)
| | - Tim Van de Hoef
- Amsterdam UMC—Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands; (V.S.); (C.B.); (T.V.d.H.)
| | - Jan Piek
- Amsterdam UMC—Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands; (V.S.); (C.B.); (T.V.d.H.)
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Emfietzoglou M, Mavrogiannis MC, Samaras A, Rampidis GP, Giannakoulas G, Kampaktsis PN. The role of cardiac computed tomography in predicting adverse coronary events. Front Cardiovasc Med 2022; 9:920119. [PMID: 35911522 PMCID: PMC9334665 DOI: 10.3389/fcvm.2022.920119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiac computed tomography (CCT) is now considered a first-line diagnostic test for suspected coronary artery disease (CAD) providing a non-invasive, qualitative, and quantitative assessment of the coronary arteries and pericoronary regions. CCT assesses vascular calcification and coronary lumen narrowing, measures total plaque burden, identifies plaque composition and high-risk plaque features and can even assist with hemodynamic evaluation of coronary lesions. Recent research focuses on computing coronary endothelial shear stress, a potent modulator in the development and progression of atherosclerosis, as well as differentiating an inflammatory from a non-inflammatory pericoronary artery environment using the simple measurement of pericoronary fat attenuation index. In the present review, we discuss the role of the above in the diagnosis of coronary atherosclerosis and the prediction of adverse cardiovascular events. Additionally, we review the current limitations of cardiac computed tomography as an imaging modality and highlight how rapid technological advancements can boost its capacity in predicting cardiovascular risk and guiding clinical decision-making.
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Affiliation(s)
- Maria Emfietzoglou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Michail C. Mavrogiannis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | | | | | | | - Polydoros N. Kampaktsis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Polydoros N. Kampaktsis
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Jeremias A, Nijjer S, Davies J, DiMario C. Physiologic Assessment and Guidance in the Cardiac Catheterization Laboratory. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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47
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Clinical use of physiological lesion assessment using pressure guidewires: an expert consensus document of the Japanese association of cardiovascular intervention and therapeutics-update 2022. Cardiovasc Interv Ther 2022; 37:425-439. [PMID: 35543896 DOI: 10.1007/s12928-022-00863-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/16/2022] [Indexed: 01/10/2023]
Abstract
Fractional flow reserve and instantaneous wave-free ratio are widely accepted and recommended in Western and Japanese guidelines for appropriate percutaneous coronary intervention. There are, however, many differences in clinical situations between Japan and Western countries. Therefore, the Task Force on coronary physiology of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has proposed an expert consensus document to summarize current evidence and suggest the practical use of physiological lesion assessment in Japan.
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Structure (Epicardial Stenosis) and Function (Microvascular Dysfunction) That Influence Coronary Fractional Flow Reserve Estimation. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background. The treatment of coronary stenosis is decided by performing high risk invasive surgery to generate the fractional flow reserve diagnostics index, a ratio of distal to proximal pressures in respect of coronary atherosclerotic plaques. Non-invasive methods are a need of the times that necessitate the use of mathematical models of coronary hemodynamic physiology. This study proposes an extensible mathematical description of the coronary vasculature that provides an estimate of coronary fractional flow reserve. Methods. By adapting an existing computational model of human coronary blood flow, the effects of large vessel stenosis and microvascular disease on fractional flow reserve were quantified. Several simulations generated flow and pressure information, which was used to compute fractional flow reserve under several conditions including focal stenosis, diffuse stenosis, and microvascular disease. Sensitivity analysis was used to uncover the influence of model parameters on fractional flow reserve. The model was simulated as coupled non-linear ordinary differential equations and numerically solved using our implicit higher order method. Results. Large vessel stenosis affected fractional flow reserve. The model predicts that the presence, rather than severity, of microvascular disease affects coronary flow deleteriously. Conclusions. The model provides a computationally inexpensive instrument for future in silico coronary blood flow investigations as well as clinical-imaging decision making. A combination of focal and diffuse stenosis appears to be essential to limit coronary flow. In addition to pressure measurements in the large epicardial vessels, diagnosis of microvascular disease is essential. The independence of the index with respect to heart rate suggests that computationally inexpensive steady state simulations may provide sufficient information to reliably compute the index.
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Calculation of Intracoronary Pressure-Based Indexes with JLabChart. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The Fractional Flow Reserve (FFR) and instantaneous wave-Free Ratio (iFR) have been proposed and clinically validated to measure the pressure gradient across coronary stenoses. They provide quantitative information on stenosis severity. Both are used in coronary revascularization procedures to measure intracoronary pressure giving quantitative information to evaluate coronary diseases during angiographic procedures. We designed and implemented a tool able to acquire and measure iFR and FFR supporting the physicians studying and treating patients in interventional cardiology laboratories. We designed an extensive case study to assess the performance of the tool in (i) acquiring pressure signals from blood pressure measurement systems; (ii) calculating FFR and iFR; and (iii) filtering out extra-beats signals during realtime signal analysis phases. The tool, named JLabChart, is available online. We tested it on two sets of data for a total of 600 cycles from 201 pressure measurements performed on 65 patients, from the Interventional Cardiology Unit of Magna Graecia University. The recognition of cardiac cycles and keypoint of the pressure curve was effective in 100% of cases for proximal (aortic) pressure and in 99.2% for distal pressure. The FFR calculated by JLabChart had an excellent correlation (Rp=0.960; p<0.001) with the FFR values obtained through the commercial systems. Similar results were obtained with iFR (Rp=0.998; p<0.001). Finally, the tool measurement results were compared with a commercial tool proving JLabChart’s efficiency with real cases. It was also compared with measurements performed on synthetic vessels and stenosis designed using the Comsol commercial tool. JLabChart is able to provide reliable measurements of FFR and iFR indexes used to support decisions on interventional procedures. It represents a valuable open source support system that can be used in an interventional cardiology laboratory.
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Kumar P, Kim JS, Gordin J, Honda HM, Suh W, Lee MS, Press M, Nsair A, Aksoy O, Busuttil RW, Tobis J, Parikh RV. Fractional Flow Reserve in End-Stage Liver Disease. Am J Cardiol 2022; 166:122-126. [PMID: 34949471 DOI: 10.1016/j.amjcard.2021.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/25/2022]
Abstract
Fractional flow reserve (FFR) determines the functional significance of epicardial stenoses assuming negligible venous pressure (Pv) and microvascular resistance. However, these assumptions may be invalid in end-stage liver disease (ESLD) because of fluctuating Pv and vasodilation. Accordingly, all patients with ESLD who underwent right-sided cardiac catheterization and coronary angiography with FFR as part of their orthotopic liver transplantation evaluation between 2013 and 2018 were included in the present study. Resting mean distal coronary pressure (Pd)/mean aortic pressure (Pa), FFR, and Pv were measured. FFR accounting for Pv (FFR - Pv) was defined as (Pd - Pv)/(Pa - Pv). The hyperemic effect of adenosine was defined as resting Pd/Pa - FFR. The primary outcome was all-cause mortality at 1 year. In 42 patients with ESLD, 49 stenoses were interrogated by FFR (90% were <70% diameter stenosis). Overall, the median model for ESLD score was 16.5 (10.8 to 25.5), FFR was 0.87 (0.81 to 0.94), Pv was 8 mm Hg (4 to 14), FFR-Pv was 0.86 (0.80 to 0.94), and hyperemic effect of adenosine was 0.06 (0.02 to 0.08). FFR-Pv led to the reclassification of 1 stenosis as functionally significant. There was no significant correlation between the median model for ESLD score and the hyperemic effect of adenosine (R = 0.10). At 1 year, 13 patients had died (92% noncardiac in etiology), and patients with FFR ≤0.80 had significantly higher all-cause mortality (73% vs 17%, p = 0.001. In conclusion, in patients with ESLD who underwent orthotopic liver transplantation evaluation, Pv has minimal impact on FFR, and the hyperemic effect of adenosine is preserved. Furthermore, even in patients with the predominantly angiographically-intermediate disease, FFR ≤0.80 was an independent predictor of all-cause mortality.
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