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    366 results match your criteria Circulation: Cardiovascular Interventions [Journal]

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    Should We Perform an Immediate Coronary Angiogram in All Patients After Cardiac Arrest?: Insights From a Large French Registry.
    JACC Cardiovasc Interv 2018 Feb;11(3):249-256
    Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France. Electronic address:
    Objectives: This study sought to assess the relationship between an immediate invasive strategy and survival after an out-of-hospital cardiac arrest (OHCA) of presumed cardiac cause, according to prognosis evaluated on hospital arrival.

    Background: An immediate coronary angiogram (CAG) may be associated with better outcome after OHCA in neurologically preserved patients but could be futile in other cases.

    Methods: From May 2011 to May 2015, we collected data for all patients admitted in hospital after OHCA in Paris and its suburbs (France). Read More

    Dose-Dependent Cardioprotection of Moderate (32°C) Versus Mild (35°C) Therapeutic Hypothermia in Porcine Acute Myocardial Infarction.
    JACC Cardiovasc Interv 2018 Jan;11(2):195-205
    Division of Cardiovascular Medicine, Stanford University, Stanford, California; Cardiovascular Institute, Stanford University, Stanford, California.
    Objectives: The study investigated whether a dose response exists between myocardial salvage and the depth of therapeutic hypothermia.

    Background: Cardiac protection from mild hypothermia during acute myocardial infarction (AMI) has yielded equivocal clinical trial results. Rapid, deeper hypothermia may improve myocardial salvage. Read More

    Coronary Embolus: An Underappreciated Cause of Acute Coronary Syndromes.
    JACC Cardiovasc Interv 2018 Jan;11(2):172-180
    Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. Electronic address:
    Coronary embolism is the underlying cause of 3% of acute coronary syndromes but is often not considered in the differential of acute coronary syndromes. It should be suspected in the case of high thrombus burden despite a relatively normal underlying vessel or recurrent coronary thrombus. Coronary embolism may be direct (from the aortic valve or left atrial appendage), paroxysmal (from the venous circulation through a patent foramen ovale), or iatrogenic (following cardiac intervention). Read More

    Collateral Channel Size and Tortuosity Predict Retrograde Percutaneous Coronary Intervention Success for Chronic Total Occlusion.
    Circ Cardiovasc Interv 2018 Jan;11(1):e005124
    From the Department of Internal Medicine, National Taiwan University Hospital, Taipei (C.-C.H., C.-S.H., Y.-H.C., M.-S.L., C.-F.Y., H.-L.K.); and Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu (C.-K. L., S.-W.M.).
    Background: There is little evidence on how to select an interventional collateral channel (CC) in retrograde chronic total occlusion (CTO) percutaneous coronary intervention. We aimed to identify independent angiographic predictors of CC tracking and technical success in retrograde CTO percutaneous coronary intervention.

    Methods And Results: From January 2012 to December 2015, a total of 216 consecutive retrograde CTO percutaneous coronary intervention attempts by a high-volume operator in a tertiary university-affiliated hospital were enrolled. Read More

    Invasive Assessment of the Coronary Microvasculature: The Index of Microcirculatory Resistance.
    Circ Cardiovasc Interv 2017 Dec;10(12)
    From the Division of Cardiovascular Medicine, Stanford University, CA.
    Traditionally, invasive coronary physiological assessment has focused on the epicardial coronary artery. More recently, appreciation of the importance of the coronary microvasculature in determining patient outcomes has grown. Several invasive modalities for interrogating microvascular function have been proposed. Read More

    Effect of Permanent Right Internal Mammary Artery Closure on Coronary Collateral Function and Myocardial Ischemia.
    Circ Cardiovasc Interv 2017 Jun;10(6)
    From the Department of Cardiology, Bern University Hospital, Switzerland.
    Background: The objective of this study is to test the effect of permanent right internal mammary artery device closure on coronary collateral function and myocardial ischemia.

    Methods And Results: This was a prospective, open-label clinical trial in 50 patients with coronary artery disease. The primary study end point was coronary collateral flow index as obtained during a 1-minute proximal right coronary artery (RCA) and left coronary artery balloon occlusion at baseline before and at follow-up examination 6 weeks after distal right internal mammary artery device closure. Read More

    Discordance Between Fractional Flow Reserve and Coronary Flow Reserve: Insights From Intracoronary Imaging and Physiological Assessment.
    JACC Cardiovasc Interv 2017 May;10(10):999-1007
    Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Electronic address:
    Objectives: The aim of this study was to investigate the epicardial and microvascular substrates associated with discordances between fractional flow reserve (FFR) and coronary flow reserve (CFR) values.

    Background: Discordances between FFR and CFR remain poorly characterized.

    Methods: FFR, hyperemic stenosis resistance (HSR), and intravascular ultrasound were performed as indexes of epicardial function and CFR and hyperemic microvascular resistance (HMR) as measures of microvascular function in 94 patients with moderate coronary stenosis. Read More

    Hemodynamic Measurements for the Selection of Patients With Renal Artery Stenosis: A Systematic Review.
    JACC Cardiovasc Interv 2017 May;10(10):973-985
    Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands. Electronic address:
    Interventions targeting renal artery stenoses have been shown to lower blood pressure and preserve renal function. In recent studies, the efficacy of catheter-based percutaneous transluminal renal angioplasty with stent placement has been called into question. In the identification of functional coronary lesions, hyperemic measurements have earned a place in daily practice for clinical decision making, allowing discrimination between solitary coronary lesions and diffuse microvascular disease. Read More

    Outcomes After Decompression of the Right Ventricle in Infants With Pulmonary Atresia With Intact Ventricular Septum Are Associated With Degree of Tricuspid Regurgitation: Results From the Congenital Catheterization Research Collaborative.
    Circ Cardiovasc Interv 2017 May;10(5)
    From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA (C.J.P., R.S., G.T.N., C.M., M.K.); Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia (A.C.G., D.J.G.); Department of Pediatrics, Baylor College of Medicine, Houston, TX (A.M.Q., S.A.M., H.J.); Division of Cardiology, Children's Hospital of Philadelphia, PA (N.M.); and The Heart Institute, Cincinnati Children's Hospital Medical Center, OH (W.W., L.S.R., B.H.G.).
    Background: Outcomes after right ventricle (RV) decompression in infants with pulmonary atresia with intact ventricular septum vary widely. Descriptions of outcomes are limited to small single-center studies.

    Methods And Results: Neonates undergoing RV decompression for pulmonary atresia with intact ventricular septum were included from 4 pediatric centers. Read More

    Impact of Collateral Circulation on Survival in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention With a Concomitant Chronic Total Occlusion.
    JACC Cardiovasc Interv 2017 May;10(9):906-914
    Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address:
    Objectives: This study sought to compare long-term clinical outcome in ST-segment elevation myocardial infarction (STEMI) patients with a concomitant chronic total occlusion (CTO) with well-developed versus poorly developed collaterals toward the CTO.

    Background: In STEMI patients, presence of a CTO is associated with increased morbidity and mortality. CTOs are often (partially) perfused by collateral vessels. Read More

    Cutoff Value and Long-Term Prediction of Clinical Events by FFR Measured Immediately After Implantation of a Drug-Eluting Stent in Patients With Coronary Artery Disease: 1- to 3-Year Results From the DKCRUSH VII Registry Study.
    JACC Cardiovasc Interv 2017 May 26;10(10):986-995. Epub 2017 Apr 26.
    Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. Electronic address:
    Objectives: This study aimed to investigate the cutoff of post-drug-eluting stent (DES) fractional flow reserve (FFR) for prediction of 1- to 3-year target vessel failure (TVF).

    Background: FFR immediately after a DES implantation correlates with clinical events. However, the cutoff of post-DES FFR for predicting long-term clinical events remains understudied. Read More

    Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease: A DANAMI 3-PRIMULTI Substudy (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization).
    Circ Cardiovasc Interv 2017 Apr;10(4)
    From the Department of Cardiology, Rigshospitalet, University of Copenhagen, Denmark (J.L., T.E., S.H., L. Kløvgaard, L.H., F.P., E.J., K.S., O.D.B., H.-H.T., L. Køber, D.E.H.); Department of Cardiology, Roskilde Hospital, Denmark (H.K.); Department of Cardiology, Nykoebing Falster Hospital, Denmark (P.C.); and Department of Cardiology, Aalborg University Hospital, Denmark (J.R., A.B.V., J.A., S.E.J., B.R.).
    Background: The impact of disease severity on the outcome after complete revascularization in patients with ST-segment-elevation myocardial infarction and multivessel disease is uncertain. The objective of this post hoc study was to evaluate the impact of number of diseased vessel, lesion location, and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization.

    Methods And Results: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete Revascularization), we randomized 627 ST-segment-elevation myocardial infarction patients to fractional flow reserve-guided complete revascularization or infarct-related percutaneous coronary intervention only. Read More

    Saline-Induced Coronary Hyperemia: Mechanisms and Effects on Left Ventricular Function.
    Circ Cardiovasc Interv 2017 Apr;10(4)
    From the Cardiovascular Center Aalst, Belgium (B.D.B., J.A., P.X., A.F., Y.M., M. Penicka, V.F., M. Pellicano, E.B.); Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (M. Pellicano, E.B.); University Heart Centre Graz, Austria (G.T.); Experimental Cardiology, Thoraxcenter, Erasmus University Rotterdam, The Netherlands (D.J.D.); Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands (N.H.J.P.); and Department of Biomedical Engineering, Eindhoven University of Technology, The Netherlands (N.H.J.P.).
    Background: During thermodilution-based assessment of volumetric coronary blood flow, we observed that intracoronary infusion of saline increased coronary flow. This study aims to quantify the extent and unravel the mechanisms of saline-induced hyperemia.

    Methods And Results: Thirty-three patients were studied; in 24 patients, intracoronary Doppler flow velocity measurements were performed at rest, after intracoronary adenosine, and during increasing infusion rates of saline at room temperature through a dedicated catheter with 4 lateral side holes. Read More

    Diagnostic Performance of Resting and Hyperemic Invasive Physiological Indices to Define Myocardial Ischemia: Validation WithN-Ammonia Positron Emission Tomography.
    JACC Cardiovasc Interv 2017 Apr 29;10(8):751-760. Epub 2017 Mar 29.
    Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea. Electronic address:
    Objectives: The authors sought to compare the diagnostic performance of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and resting distal coronary artery pressure/aortic pressure (Pd/Pa) usingN-ammonia positron emission tomography (PET).

    Background: The diagnostic performance of invasive physiological indices was reported to be different according to the reference to define the presence of myocardial ischemia.

    Methods: A total of 115 consecutive patients with left anterior descending artery stenosis who underwent bothN-ammonia PET and invasive physiological measurement were included. Read More

    Effect of Coronary Anatomy and Hydrostatic Pressure on Intracoronary Indices of Stenosis Severity.
    JACC Cardiovasc Interv 2017 Apr 29;10(8):764-773. Epub 2017 Mar 29.
    Department of Cardiology, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Germany.
    Objectives: The authors sought to analyze height differences within the coronary artery tree in patients in a supine position and to quantify the impact of hydrostatic pressure on intracoronary pressure measurements in vitro.

    Background: Although pressure equalization of the pressure sensor and the systemic pressure at the catheter tip is mandatory in intracoronary pressure measurements, subsequent measurements may be influenced by hydrostatic pressure related to the coronary anatomy in the supine position. Outlining and quantifying this phenomenon is important to interpret routine and pullback pressure measurements within the coronary tree. Read More

    Programmatic Approach to Management of Tetralogy of Fallot With Major Aortopulmonary Collateral Arteries: A 15-Year Experience With 458 Patients.
    Circ Cardiovasc Interv 2017 Apr;10(4)
    From the Departments of Pediatrics (H.B.-H., A.B., B.H., M.L., R.A., A.K., C.A.A., S.B.P., A.S., L.F.P., D.B.M.), Anesthesia (L.D., L.W.-F.), and Cardiothoracic Surgery (F.L.H., D.B.M.), Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, CA.
    Background: Tetralogy of Fallot with major aortopulmonary collateral arteries is a complex and heterogeneous condition. Our institutional approach to this lesion emphasizes early complete repair with the incorporation of all lung segments and extensive lobar and segmental pulmonary artery reconstruction.

    Methods And Results: We reviewed all patients who underwent surgical intervention for tetralogy of Fallot and major aortopulmonary collateral arteries at Lucile Packard Children's Hospital Stanford (LPCHS) since November 2001. Read More

    Coronary Collaterals Function and Clinical Outcome Between Patients With Acute and Chronic Total Occlusion.
    JACC Cardiovasc Interv 2017 Mar;10(6):585-593
    Department of Cardiology, Kyungpook National University Hospital, Daegu, Republic of Korea. Electronic address:
    Objectives: This study sought to demonstrate how changes in the collateral function and its clinical significance before and after percutaneous coronary interventions (PCIs) are compared between patients with acute coronary syndrome and total or nearly total occlusions (ATOs) and chronic total occlusions (CTOs).

    Background: The functional relevance of the collateral circulation in patients with ATOs and CTOs has not been fully investigated.

    Methods: The pressure-derived collateral pressure index (CPI), myocardial fractional flow reserve (FFRmyo), and coronary fractional flow reserve (FFRcor) at maximum hyperemia induced by intravenous adenosine were evaluated in occluded vessels at baseline, after the PCI, and at 1 year in 23 ATO and 74 CTO patients. Read More

    The Role of Post-Resuscitation Electrocardiogram in Patients With ST-Segment Changes in the Immediate Post-Cardiac Arrest Period.
    JACC Cardiovasc Interv 2017 Mar;10(5):451-459
    Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul, Korea. Electronic address:
    Objectives: The authors aimed to evaluate the role of post-resuscitation electrocardiogram (ECG) in patients showing significant ST-segment changes on the initial ECG and to provide useful diagnostic indicators for physicians to determine in which out-of-hospital cardiac arrest (OHCA) patients brain computed tomography (CT) should be performed before emergency coronary angiography.

    Background: The usefulness of immediate brain CT and ECG for all resuscitated patients with nontraumatic OHCA remains controversial.

    Methods: Between January 2010 and December 2014, 1,088 consecutive adult nontraumatic patients with return of spontaneous circulation who visited the emergency department of 3 tertiary care hospitals were enrolled. Read More

    Identification of Coronary Artery Side Branch Supplying Myocardial Mass That May Benefit From Revascularization.
    JACC Cardiovasc Interv 2017 Mar 1;10(6):571-581. Epub 2017 Mar 1.
    Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Emergency Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address:
    Objectives: The authors sought to identify whether a coronary side branch (SB) is supplying a myocardial mass that may benefit from revascularization.

    Background: The amount of subtending myocardium and physiological stenosis is frequently different between the main vessel (MV) and SB.

    Methods: In this multicenter registry, 482 patients who underwent coronary computed tomography angiography and fractional flow reserve (FFR) measurement were enrolled. Read More

    Invasive Assessment of the Coronary Microcirculation in Reperfused ST-Segment-Elevation Myocardial Infarction Patients: Where Do We Stand?
    Circ Cardiovasc Interv 2017 Mar;10(3)
    From the Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, United Kingdom (H.B., D.J.H.); The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, United Kingdom (H.B., D.J.H.); Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore (H.B., N.F., D.J.H.); National Heart Research Institute Singapore, National Heart Centre Singapore (H.B., N.F., J.W.T., D.J.H.); National University Heart Centre, Singapore (A.F.L.); Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Çapa, Turkey (M.S.); Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (D.J.H.); and Yong Loo Lin School of Medicine, National University Singapore (D.J.H.).
    For patients presenting with an acute ST-segment-elevation myocardial infarction, the most effective therapy for reducing myocardial infarct size and preserving left ventricular systolic function is primary percutaneous coronary intervention (PPCI). However, mortality and morbidity remain significant. This is partly attributed to the development of microvascular obstruction, which occurs in around 50% of ST-segment-elevation myocardial infarction patients post-PPCI, and it is associated with adverse left ventricular remodeling and worse clinical outcomes. Read More

    Management of No-Reflow Phenomenon in the Catheterization Laboratory.
    JACC Cardiovasc Interv 2017 Feb;10(3):215-223
    Huntington Medical Research Institute, Pasadena, California; Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California.
    At the conclusion of a primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, and after the cardiologist makes certain that there is no residual stenosis following stenting, assessment of coronary flow becomes the top priority. The presence of no-reflow is a serious prognostic sign. No-reflow can result in poor healing of the infarct and adverse left ventricular remodeling, increasing the risk for major adverse cardiac events, including congestive heart failure and death. Read More

    Wound Blush Obtainment Is the Most Important Angiographic Endpoint for Wound Healing.
    JACC Cardiovasc Interv 2017 Jan;10(2):188-194
    Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan.
    Objectives: This study aimed to assess the optimal angiographic endpoint of endovascular therapy (EVT) for wound healing.

    Background: Several reports have demonstrated acceptable patency and limb salvage rates following infrapopliteal interventions for the treatment of critical limb ischemia (CLI). However, the optimal angiographic endpoint of EVT remains unclear. Read More

    INNOVATION Study (Impact of Immediate Stent Implantation Versus Deferred Stent Implantation on Infarct Size and Microvascular Perfusion in Patients With ST-Segment-Elevation Myocardial Infarction).
    Circ Cardiovasc Interv 2016 Dec;9(12)
    From the Division of Cardiology, Department of Internal Medicine (J.S.K., H.J.L., R.K.C., Y.J.C., J.S.P., T.H.K., H.-J.J., Y.M.R.) and Division of Radiology (Y.M.K.), Sejong General Hospital, Bucheon, Korea; and Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University School of Medicine, Seoul (C.W.Y., S.J.H., J.H.P., H.J.J., S.-A.C., D.-S.L.).
    Background: The aim of this study was to assess whether deferred stenting (DS) reduces infarct size and microvascular obstruction (MVO) compared with immediate stenting (IS) in primary percutaneous coronary intervention for ST-segment-elevation myocardial infarction.

    Methods And Results: From February 2013 to August 2015, 114 patients (mean age: 69 years) were randomized into the following 2 groups: DS with an intention to stent 3 to 7 days later or IS after primary reperfusion in 2 centers. The primary and secondary end points were infarct size and the incidence of MVO, respectively, assessed by cardiac magnetic resonance imaging at 30 days after primary reperfusion. Read More

    The IMPACT Study (Influence of Sensor-Equipped Microcatheters on Coronary Hemodynamics and the Accuracy of Physiological Indices of Functional Stenosis Severity).
    Circ Cardiovasc Interv 2016 Dec;9(12)
    From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.).
    Background: The Navvus pressure sensor-equipped microcatheter allows to measure functional stenosis severity over a work-horse guidewire and is used as a more feasible alternative to regular sensor-equipped wires. However, Navvus is larger in diameter than contemporary sensor-equipped guidewires and may, thereby, influence functional measurements. The present study evaluates the hemodynamic influence of the Navvus microcatheter. Read More

    Acquired Aseptic Intracardiac Shunts Following Transcatheter Aortic Valve Replacement: A Systematic Review.
    JACC Cardiovasc Interv 2016 Dec 23;9(24):2527-2538. Epub 2016 Nov 23.
    Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain.
    Objectives: The aim of this study was to describe the incidence, mechanisms, features, and management of aseptic intracardiac shunts (AICS).

    Background: AICS following transcatheter aortic valve replacement (TAVR) are an uncommon and barely described complication.

    Methods: A systematic review was performed of all published cases of AICS following TAVR, and the incidence, predictors, main features, management, and related outcomes were analyzed. Read More

    The Influence of Lesion Location on the Diagnostic Accuracy of Adenosine-Free Coronary Pressure Wire Measurements.
    JACC Cardiovasc Interv 2016 Dec 9;9(23):2390-2399. Epub 2016 Nov 9.
    Stanford University Medical Center, Stanford, California; Stanford Cardiovascular Institute, Stanford, California. Electronic address:
    Objectives: This work compares the diagnostic performance of adenosine-free coronary pressure wire indices based on lesion location.

    Background: Several adenosine-free coronary pressure wire indices have been proposed to assess the functional significance of coronary artery lesions; however, there is a theoretical concern that lesion location and the mass of perfused myocardium may affect diagnostic performance.

    Methods: A total of 763 patients were prospectively enrolled from 12 institutions. Read More

    Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post-Cardiac Arrest in a Porcine Model.
    JACC Cardiovasc Interv 2016 Dec 9;9(23):2403-2412. Epub 2016 Nov 9.
    University of Arizona Sarver Heart Center, Tucson, Arizona; University of Basel, Basel, Switzerland.
    Objectives: The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest.

    Background: Cohort studies have shown that 1 in 4 post-cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. Read More

    Discordance Between Resting and Hyperemic Indices of Coronary Stenosis Severity: The VERIFY 2 Study (A Comparative Study of Resting Coronary Pressure Gradient, Instantaneous Wave-Free Ratio and Fractional Flow Reserve in an Unselected Population Referred for Invasive Angiography).
    Circ Cardiovasc Interv 2016 Nov;9(11)
    From the University of Glasgow, United Kingdom (B.H., K.G.O., C.B., P.M., M.B.M., H.E., M.C.P., P.R., R.G., M.M.L., S.H., S.W.); Cardiology Department, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (B.H., K.G.O., C.B., J.M.); and The Weatherhead PET Imaging Center, Houston, TX (N.J.).
    Background: Distal coronary to aortic pressure ratio (Pd/Pa) and instantaneous wave-free ratio (iFR) are indices of functional significance of a coronary stenosis measured without hyperemia. It has been suggested that iFR has superior diagnostic accuracy to Pd/Pa when compared with fractional flow reserve (FFR).We hypothesized that in comparison with FFR, revascularization decisions based on either binary cutoff values for iFR and Pd/Pa or hybrid strategies incorporating iFR or Pd/Pa will result in similar levels of disagreement. Read More

    Functional Assessment of Coronary Artery Disease in Patients Undergoing Transcatheter Aortic Valve Implantation: Influence of Pressure Overload on the Evaluation of Lesions Severity.
    Circ Cardiovasc Interv 2016 Nov;9(11)
    From the Division of Cardiology, Department of Medicine, School of Medicine (G.P., R.S., C.Z., A.P., A.G., A.R., V.F., C.V., F.R.) and Department of Anesthesia and Intensive Care (L.G.), University of Verona, Italy.
    Background: Aortic valve stenosis may influence fractional flow reserve (FFR) of concomitant coronary artery disease by causing hypertrophy and reducing the vasodilatory reserve of the coronary circulation. We sought to investigate whether FFR values might change after valve replacement.

    Methods And Results: The functional relevance of 133 coronary lesions was assessed by FFR in 54 patients with severe aortic valve stenosis before and after transcatheter aortic valve implantation (TAVI) during the same procedure. Read More

    Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography: The International Multicenter FAVOR Pilot Study.
    JACC Cardiovasc Interv 2016 Oct;9(19):2024-2035
    Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland.
    Objectives: The aim of this prospective multicenter study was to identify the optimal approach for simple and fast fractional flow reserve (FFR) computation from radiographic coronary angiography, called quantitative flow ratio (QFR).

    Background: A novel, rapid computation of QFR pullbacks from 3-dimensional quantitative coronary angiography was developed recently.

    Methods: QFR was derived from 3 flow models with: 1) fixed empiric hyperemic flow velocity (fixed-flow QFR [fQFR]); 2) modeled hyperemic flow velocity derived from angiography without drug-induced hyperemia (contrast-flow QFR [cQFR]); and 3) measured hyperemic flow velocity derived from angiography during adenosine-induced hyperemia (adenosine-flow QFR [aQFR]). Read More

    Does Residual Thrombus After Aspiration Thrombectomy Affect the Outcome of Primary PCI in Patients With ST-Segment Elevation Myocardial Infarction?: An Optical Coherence Tomography Study.
    JACC Cardiovasc Interv 2016 Oct;9(19):2002-2011
    Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea. Electronic address:
    Objectives: The aim of this study was to evaluate if residual thrombus burden after aspiration thrombectomy affects the outcomes of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction (STEMI).

    Background: Recent studies failed to show clinical benefit of aspiration thrombectomy in STEMI patients. This might be due to insufficient removal of thrombus at the culprit lesion. Read More

    Prevention of Radial Artery Occlusion After Transradial Catheterization: The PROPHET-II Randomized Trial.
    JACC Cardiovasc Interv 2016 Oct;9(19):1992-1999
    Apex Heart Institute, Ahmedabad, India.
    Objectives: The study sought to evaluate whether prophylactic ipsilateral ulnar artery compression during radial artery hemostasis could reduce the risk of radial artery occlusion (RAO).

    Background: RAO after transradial access (TRA) is a structural complication of TRA. It limits future ipsilateral TRA and may cause transient pain. Read More

    Elimination of Transcoarctation Pressure Gradients Has No Impact on Left Ventricular Function or Aortic Shear Stress After Intervention in Patients With Mild Coarctation.
    JACC Cardiovasc Interv 2016 Sep;9(18):1953-65
    Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
    Objectives: This study sought to investigate the impact of transcatheter intervention on left ventricular function and aortic hemodynamics in patients with mild coarctation of the aorta (COA).

    Background: The optimal method and timing of transcatheter intervention for COA remains unclear, especially when the severity of COA is mild (peak-to-peak transcoarctation pressure gradient <20 mm Hg). Debate rages regarding the risk/benefit ratio of intervention versus long-term effects of persistent minimal gradient in this heterogeneous population with differing blood pressures, ventricular function, and peripheral perfusion. Read More

    Percutaneous Intervention to Treat Platypnea-Orthodeoxia Syndrome: The Toronto Experience.
    JACC Cardiovasc Interv 2016 Sep;9(18):1928-38
    Peter Munk Cardiac Centre and Toronto Congenital Cardiac Centre for Adults, Toronto General Hospital, University Health Network. Electronic address:
    Objectives: This study reviewed a series of patients treated with transcatheter closure of septal defect to treat platypnea-orthodeoxia syndrome, with specific attention to septal characteristics and device choice.

    Background: Platypnea-orthodeoxia syndrome is an uncommon condition characterized by positional dyspnea and hypoxemia due to intracardiac right-to-left shunting through a patent foramen ovale (PFO), an atrial septal defect, or pulmonary arteriovenous malformations. Percutaneous closure of such defects is the treatment of choice. Read More

    Contemporary Approach to Coronary Bifurcation Lesion Treatment.
    JACC Cardiovasc Interv 2016 Sep;9(18):1861-78
    Ramsay-Générale de Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy and Hôpital Privé Claude Galien, Quincy, France. Electronic address:
    Coronary bifurcations are frequent and account for approximately 20% of all percutaneous coronary interventions. Nonetheless, they remain one of the most challenging lesion subsets in interventional cardiology in terms of a lower procedural success rate and increased rates of long-term adverse cardiac events. Provisional side branch stenting should be the default approach in the majority of cases and we propose easily applicable and reproducible stepwise techniques associated with low risk of failure and complications. Read More

    Coronary Plaque Characteristics Associated With Reduced TIMI (Thrombolysis in Myocardial Infarction) Flow Grade in Patients With ST-Segment-Elevation Myocardial Infarction: A Combined Optical Coherence Tomography and Intravascular Ultrasound Study.
    Circ Cardiovasc Interv 2016 Sep;9(9)
    From the Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan (T.H., M.Y., T.Y., H.Y., F.N., K.O.); Cardiology Division (T.H., T.S., L.X., E.Y., K.B., J.D., I.-K.J.) and Biostatistics Center (H.L.), Massachusetts General Hospital and Harvard Medical School, Boston; and Division of Cardiology, Kyung Hee University, Seoul, Republic of Korea (I.-K.J.).
    Background: Previous studies reported that reduced TIMI (Thrombolysis in Myocardial Infarction) flow grade before procedure was associated with worse clinical outcomes in patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention. The aim of this study was to identify specific morphological characteristics of the culprit plaque associated with poor TIMI flow grade at baseline in patients with ST-segment-elevation myocardial infarction using both optical coherence tomography and intravascular ultrasound.

    Methods And Results: A total of 111 ST-segment-elevation myocardial infarction patients who underwent percutaneous coronary intervention within 24 hours of symptom onset were included. Read More

    Predictors for Successful Endovascular Intervention in Chronic Carotid Artery Total Occlusion.
    JACC Cardiovasc Interv 2016 Sep;9(17):1825-32
    Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address:
    Objectives: This study sought to determine predictors for successful endovascular treatment in patients with chronic carotid artery occlusion (CAO).

    Background: Endovascular recanalization in patients with chronic CAO has been reported to be feasible, but technically challenging.

    Methods: Endovascular attempts in 138 consecutive chronic CAO patients with impaired ipsilateral hemisphere perfusion were reviewed. Read More

    Diastolic Backward-Traveling Decompression (Suction) Wave Correlates With Simultaneously Acquired Indices of Diastolic Function and Is Reduced in Left Ventricular Stunning.
    Circ Cardiovasc Interv 2016 Sep;9(9)
    From the Department of Cardiology, Papworth Hospital, Cambridge, United Kingdom (A.L., M.O., N.E.J.W., S.P.H.); Department of Medical Physics and Clinical Engineering, Addenbrooke's Hospital, Cambridge, United Kingdom (P.A.W.); and International Centre for Circulatory Health, Imperial College, London, United Kingdom (S.S.N., J.E.D.).
    Background: Wave intensity analysis can distinguish proximal (propulsion) and distal (suction) influences on coronary blood flow and is purported to reflect myocardial performance and microvascular function. Quantifying the amplitude of the peak, backwards expansion wave (BEW) may have clinical utility. However, simultaneously acquired wave intensity analysis and left ventricular (LV) pressure-volume loop data, confirming the origin and effect of myocardial function on the BEW in humans, have not been previously reported. Read More

    Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery.
    Circ Cardiovasc Interv 2016 Aug;9(8)
    From the Department of Electrical Engineering, Sejong University, Seoul, Korea (J.H., J.L., G.K., S.L.); Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea (J.-S.K., D.-H.S., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.); Cardiovascular Research Institute (J.-S.K., D.-H.S., B.-K.K., Y.-G.K., D.C., Y.J., M.-K.H.) and Severance Biomedical Science Institute (Y.J., M.-K.H.), Yonsei University College of Medicine, Seoul, Korea; and Department of Mechanical Engineering, Yonsei University, Seoul, Korea (J.S.L.).
    Background: Intravascular optical coherence tomography (OCT) imaging provides limited information on the functional assessment of coronary stenosis. We evaluated a new approach to OCT image-based computation modeling, which can be used to estimate the fractional flow reserve (FFR) in patients with intermediate coronary stenosis.

    Methods And Results: Ninety-two patients with intermediate diameter stenosis in the left anterior descending artery underwent both FFR measurement with pressure wires and OCT examination. Read More

    Physiological Severity of Coronary Artery Stenosis Depends on the Amount of Myocardial Mass Subtended by the Coronary Artery.
    JACC Cardiovasc Interv 2016 Aug 13;9(15):1548-60. Epub 2016 Jul 13.
    Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. Electronic address:
    Objectives: This study investigated the role of fractional myocardial mass (FMM), a vessel-specific myocardial mass, in the evaluation of physiological severity of stenosis. Using computed tomography angiography, the study investigated fractional myocardial mass, a concept of myocardial mass subtended by specific vessel, which could reduce anatomical-physiological mismatch.

    Background: Discordance between anatomical stenosis and physiological severity is common but remains poorly understood. Read More

    Routine Fractional Flow Reserve Combined to Diagnostic Coronary Angiography as a One-Stop Procedure: Episode 3.
    Circ Cardiovasc Interv 2016 07;9(7)
    From the Department of Cardiology, University Hospital, Lille, France (E.V.B.); INSERM U1011, Lille-II-University, France (E.V.B.); Hôpital Privé d'Antony, France (P.D.); Hôpital Louis Pradel, Hospices Civils de Lyon, France (G.R.); and INSERM U1060 CARMEN, Claude Bernard University Lyon, France (G.R.).

    Impact of Routine Fractional Flow Reserve Evaluation During Coronary Angiography on Management Strategy and Clinical Outcome: One-Year Results of the POST-IT.
    Circ Cardiovasc Interv 2016 Jul;9(7)
    From the Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal (S.B.B.); Cardiology Department, Hospital Santa Cruz, CHLO, Carnaxide, Portugal (L.R.); Cardiology Department, Centro Hospitalar Vila Nova de Gaia, Portugal (L.S.); Cardiology Department, Hospital Santa Marta, Centro Hospitalar Lisboa Central, Portugal (R.R.); Cardiology Department, Hospital Garcia de Orta, Almada, Portugal (R.C.); Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Portugal (E.J.); Cardiology Department, Hospital Divino Espirito Santo, Ponta Delgada, Portugal (C.M.); Unidade de Intervenção Cardiovascular, Hospital Geral do Centro Hospitalar e Universitário de Coimbra, Portugal (M.C.); Cardiology Department, Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Portugal (E.O.); Cardiology Department, Hospital de Braga, Portugal (J.C.); Cardiology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal (J.P.); Cardiology Department, Centro Hospitalar Setúbal, Portugal (N.F.); Cardiology Department, Hospital Santo André, Centro Hospitalar Leiria-Pombal, Portugal (J.G.); Cardiology Department, Hospital Dr. Nélio Mendonça, Funchal, Portugal (B.S.); Cardiology Department, Hospital Geral Santo António, Centro Hospitalar do Porto, Portugal (J.S.); Cardiology Department, Centro Hospitalar São João, Porto, Portugal (J.S.); Cardiology Department, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal (A.R.); Cardiology Department, Centro Hospitalar Trás-os-Montes e Alto Douro, Unidade Hospitalar Vila Real, Portugal (L.S.); and Cardiology Department, Hospital Espírito Santo, Évora, Portugal (R.F.).
    Background: Penetration of fractional flow reserve (FFR) in clinical practice varies extensively, and the applicability of results from randomized trials is understudied. We describe the extent to which the information gained from routine FFR affects patient management strategy and clinical outcome.

    Methods And Results: Nonselected patients undergoing coronary angiography, in which at least 1 lesion was interrogated by FFR, were prospectively enrolled in a multicenter registry. Read More

    Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes.
    JACC Cardiovasc Interv 2016 05;9(10):1022-31
    Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Cardiology Section, Central Arkansas Veteran Affairs Health System, Little Rock, Arkansas. Electronic address:
    Objectives: This study sought to evaluate the impact of fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) on subsequent in-lab interventional management vessels that had undergone pre-PCI FFR and its prognostic value in predicting long-term (>1 year) outcomes.

    Background: Post-PCI FFR has been shown to be a predictor of intermediate-term (6 months) adverse events. However, its impact on immediate post procedure clinical decision making and long-term outcomes is not known. Read More

    Continuum of Vasodilator Stress From Rest to Contrast Medium to Adenosine Hyperemia for Fractional Flow Reserve Assessment.
    JACC Cardiovasc Interv 2016 Apr;9(8):757-767
    Stanford University Medical Center and the Palo Alto VA Health Care Systems, Stanford and Palo Alto, California.
    Objectives: This study compared the diagnostic performance with adenosine-derived fractional flow reserve (FFR) ≤0.8 of contrast-based FFR (cFFR), resting distal pressure (Pd)/aortic pressure (Pa), and the instantaneous wave-free ratio (iFR).

    Background: FFR objectively identifies lesions that benefit from medical therapy versus revascularization. Read More

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