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Eur J Prev Cardiol 2021 Apr 30. Epub 2021 Apr 30.

1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 114 Vas. Sofias Avenue, 11527, Athens, Greece.

Current cardiovascular risk stratification by use of clinical risk score systems or plasma biomarkers is good but less than satisfactory in identifying patients at residual risk for coronary events. Recent clinical evidence puts now further emphasis on the role of coronary anatomy assessment by coronary computed tomography angiography (CCTA) for the management of patients with stable ischaemic heart disease. Available computed tomography (CT) technology allows the quantification of plaque burden, identification of high-risk plaques, or the functional assessment of coronary lesions for ischaemia detection and revascularization for refractory angina symptoms. Read More

Curr Opin Cardiol 2021 Apr 28. Epub 2021 Apr 28.

John Ochsner Heart and Vascular Institute, Ochsner Medical Center, New Orleans, Louisiana Pennsylvania Hospital of the University of Pennsylvania Health System, Philadelphia, Pennsylvania Ochsner Medical Center, New Orleans, Louisiana, USA.

Purpose Of Review: In the present comprehensive review, we describe the pathophysiology, indications, and evidence for both renal artery stenting and renal artery denervation. We also discuss the procedural techniques, risks, benefits, and future directions of renal intervention in the management of hypertension (HTN).

Recent Findings: Hemodynamic confirmation of lesion severity in severe renal artery stenosis is a resting or hyperemic translesional systolic gradient >20, resting or hyperemic mean translesional gradient >10 and/or renal fractional flow reserve <0. Read More

Kyobu Geka 2021 Mar;74(3):224-227

Department of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan.

A 71-year-old woman was referred to our hospital for mitral valve repair and coronary artery bypass grafting (CABG). Conventional coronary artery angiography showed stenosis in the right coronary artery (RCA) and two diagonal branches, whereas transthoracic echocardiography (TTE) showed diffuse hypokinesis and mild-to-moderate mitral valve regurgitation. Fractional flow reserve derived from computed tomography (FFRct) demonstrated two additional lesions in the coronary artery at the left anterior descending artery (LAD) and the high lateral (HL) branch. Read More

Eur Heart J 2021 Apr 5. Epub 2021 Apr 5.

The Lambe Institute for Translational Medicine and Curam, National University of Ireland, University Road, Galway H91 TK3, Ireland.

Percutaneous coronary intervention (PCI) guided by coronary physiology provides symptomatic benefit and improves patient outcomes. Nevertheless, over one-fourth of patients still experience recurrent angina or major adverse cardiac events following the index procedure. Coronary angiography, the current workhorse for evaluating PCI efficacy, has limited ability to identify suboptimal PCI results. Read More

J Am Heart Assoc 2021 Apr 17;10(7):e018593. Epub 2021 Mar 17.

Cardiology Department Bichat-Claude-Bernard HospitalAssistance Publique-Hôpitaux de Paris Paris France.

Background With the emergence of coronary computed tomography (CT) angiography, anomalous aortic origin of a coronary artery (ANOCOR) is more frequently diagnosed. Fractional flow reserve derived from CT (FFRCT) is a noninvasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features of anatomical and functional evaluation derived from CT could help for the management of patients with ANOCOR. Read More

Circ Rep 2020 Jun 5;2(7):364-371. Epub 2020 Jun 5.

Department of Cardiovascular Medicine, Wakayama Medical University Wakayama Japan.

Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR) is an established tool for identifying lesion-specific ischemia that is now approved for use by the Japanese insurance system. However, current clinical reimbursement is strictly limited to institutions with designated appropriate use criteria (AUC). This study assessed differences in physicians' behavior (e. Read More

Eur Radiol 2021 Feb 25. Epub 2021 Feb 25.

Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, 30-32 Ngan Shing St., Sha Tin, Hong Kong, SAR, China.

Objective: This study aims to investigate the safety and feasibility of using a deep learning algorithm to calculate computed tomography angiography-based fractional flow reserve (DL-FFRCT) as an alternative to invasive coronary angiography (ICA) in the selection of patients for coronary intervention.

Materials And Methods: Patients (N = 296) with symptomatic coronary artery disease identified by coronary computed tomography angiography (CTA) with stenosis over 50% were retrospectively enrolled from a single centre in this study. ICA-guided interventions were performed in patients at admission, and DL-FFRCT was conducted retrospectively. Read More

EuroIntervention 2021 Feb;16(14):1131-1133

Hospital General ISSSTE Querétaro - Autonomous University of Querétaro, Santiago de Querétaro, México.

Front Cardiovasc Med 2020 21;7:591326. Epub 2021 Jan 21.

Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Coronary artery anomalies (CAA) represent a heterogeneous group of congenital disorders of the arterial coronary circulation, defined by an anomalous origin of the coronary ostium and/or vessel course. Of particular interest are anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). The interarterial variants (with the anomalous vessel situated between the great arteries) are historically called "malignant," based on an anticipated higher risk for myocardial ischemia and sudden cardiac death (SCD), especially affecting young patients during strenuous physical activity. Read More

Heart 2021 May 8;107(10):783-789. Epub 2021 Jan 8.

Mathematical Modellling in Medicine, Department of Infection Immunity and Cardiovascular Disease, The Medical School, University of Sheffield, Sheffield, UK

The role of 'stand-alone' coronary angiography (CAG) in the management of patients with chronic coronary syndromes is the subject of debate, with arguments for its replacement with CT angiography on the one hand and its confinement to the interventional cardiac catheter laboratory on the other. Nevertheless, it remains the standard of care in most centres. Recently, computational methods have been developed in which the laws of fluid dynamics can be applied to angiographic images to yield 'virtual' (computed) measures of blood flow, such as fractional flow reserve. Read More

Eur Radiol 2021 Jan 6. Epub 2021 Jan 6.

Department of Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, XuHui District, Shanghai, 200032, China.

Objectives: To compare the diagnostic power of separately integrating on-site computed tomography (CT)-derived fractional flow reserve (CT-FFR) and static CT stress myocardial perfusion (CTP) with coronary computed tomography angiography (CCTA) in detecting patients with flow-limiting CAD. The flow-limiting stenosis was defined as obstructive (≥ 50%) stenosis by invasive coronary angiography (ICA) with a corresponding perfusion deficit on stress single photon emission computed tomography (SPECT/MPI).

Methods: Forty-eight patients (74 vessels) were enrolled who underwent research-indicated combined CTA-CTP (320-row CT scanner, temporal resolution 137 ms) and SPECT/MPI prior to conventional coronary angiography. Read More

BMC Cardiovasc Disord 2020 12 14;20(1):523. Epub 2020 Dec 14.

Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.

Background: To explore the clinical benefits of revascularization in patients with different levels of left ventricular ejection fraction (LVEF) from the perspective of quantitative flow ratio (QFR).

Methods: Patients who underwent successful percutaneous coronary intervention (PCI) and one-year angiographic follow-up were retrospectively screened and computed by QFR analysis. Based on their LVEF, 301 eligible patients were classified into reduced LVEF (≤ 50%, n = 48) and normal LVEF (> 50%, n = 253) groups. Read More

JAMA Netw Open 2020 12 1;3(12):e2028312. Epub 2020 Dec 1.

Cardiovascular Imaging Research Center, Massachusetts General Hospital, Harvard Medical School, Boston.

Importance: Both noninvasive anatomic and functional testing strategies are now routinely used as initial workup in patients with low-risk stable chest pain (SCP).

Objective: To determine whether anatomic approaches (ie, coronary computed tomography angiography [CTA] and coronary CTA supplemented with noninvasive fractional flow reserve [FFRCT], performed in patients with 30% to 69% stenosis) are cost-effective compared with functional testing for the assessment of low-risk SCP.

Design, Setting, And Participants: This cost-effectiveness analysis used an individual-based Markov microsimulation model for low-risk SCP. Read More

J Clin Med 2020 Dec 3;9(12). Epub 2020 Dec 3.

Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy.

In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes in high risk patients with known coronary artery disease (CAD). Calcium detection is commonly expressed through the coronary artery calcium score (CACS), but further research is warranted to confirm the powerness of a CACS-only strategy in both diagnosis and prognosis assessment. Read More

J Am Heart Assoc 2020 12 7;9(24):e017729. Epub 2020 Dec 7.

Cardiovascular Center Aalst Aalst Belgium.

Background Global fractional flow reserve (FFR) (ie, the sum of the FFR values in the 3 major coronary arteries) is a physiologic correlate of global atherosclerotic burden. The objective of the present study was to investigate the value of global FFR in predicting long-term clinical outcome of patients with stable coronary artery disease but no ischemia-inducing stenosis. Methods and Results We studied major adverse cardiovascular events (MACEs: all-cause death, myocardial infarction, and any revascularization) after 5 years in 1122 patients without significant stenosis (all FFR >0. Read More

JAMA 2020 12;324(23):2406-2414

Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Importance: Fractional flow reserve (FFR) is an invasive measurement used to assess the potential of a coronary stenosis to induce myocardial ischemia and guide decisions for percutaneous coronary intervention (PCI). It is not known whether established FFR thresholds for PCI are adhered to in routine interventional practice and whether adherence to these thresholds is associated with better clinical outcomes.

Objective: To assess the adherence to evidence-based FFR thresholds for PCI and its association with clinical outcomes. Read More

EuroIntervention 2021 Jan;16(13):1070-1078

Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.

Aims: Angina and no obstructive coronary artery disease (ANOCA) is common. A potential cause of angina in this patient population is a myocardial bridge (MB). We aimed to study the anatomical and haemodynamic characteristics of an MB in patients with ANOCA. Read More

Radiol Med 2020 Nov 12;125(11):1135-1147. Epub 2020 Oct 12.

SDN IRCCS, Naples, Italy.

In the past decades, coronary computed tomography angiography (CCTA) has become a powerful tool in the management of coronary artery disease. The diagnostic and prognostic value of CCTA has been extensively demonstrated in both large observational studies and clinical trials among stable chest pain patients. The quantification of coronary artery calcium score (CACS) is a well-established predictor of cardiovascular morbidity and mortality in asymptomatic subjects. Read More

J Cardiovasc Comput Tomogr 2021 Mar-Apr;15(2):121-128. Epub 2020 Sep 23.

Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. Electronic address:

Background: CT coronary angiography (CTA) with Fractional Flow Reserve as determined by CT (FFR) is a safe alternative to invasive coronary angiography. A negative FFR has been shown to have low cardiac event rates compared to those with a positive FFR. However, the clinical utility of FFR according to age is not known. Read More

World Allergy Organ J 2020 Oct 30;13(10):100466. Epub 2020 Sep 30.

Hospital Quirónsalud Bizkaia, Erandio, Bilbao, Spain.

Medical devices provide people with some health benefits in terms of diagnosis, prevention, treatment, and monitoring of disease processes. Different medical specialties use varieties of medical devices more or less specific for them. Allergology is an interdisciplinary field of medical science and teaches that allergic reactions are of systemic nature but can express themselves at the level of different organs across the life cycle of an individual. Read More

JAMA Netw Open 2020 09 1;3(9):e2018162. Epub 2020 Sep 1.

Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.

Importance: The prognostic value of pre-percutaneous coronary intervention (PCI) fractional flow reserve (FFR) may be associated with the post-PCI FFR and their interaction. To correctly interpret the prognostic value of pre-PCI FFR, it is essential to understand to what extent the association of pre-PCI FFR with clinical outcomes is explained by post-PCI FFR.

Objective: To investigate the extent to which post-PCI FFR mediates the association of pre-PCI FFR with vessel-related outcomes using an international, multicenter collaboration registry. Read More

Cardiovasc Res 2021 Apr;117(5):1284-1294

C2VN, INSERM, INRAE, Aix-Marseille University, Campus Santé Timone, Faculté de Pharmacie, 27 Bd Jean Moulin, F-13005 Marseille, France.

Adenosine is an endogenous nucleoside that plays a major role in the physiology and physiopathology of the coronary artery system, mainly by activating its A2A receptors (A2AR). Adenosine is released by myocardial, endothelial, and immune cells during hypoxia, ischaemia, or inflammation, each condition being present in coronary artery disease (CAD). While activation of A2AR improves coronary blood circulation and leads to anti-inflammatory effects, down-regulation of A2AR has many deleterious effects during CAD. Read More

Future Cardiol 2020 Sep 21. Epub 2020 Sep 21.

Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.

Computed tomography coronary angiography is emerging as the preferred diagnostic tool for patients with chest pain. Additional knowledge of the extent and distribution of myocardial ischemia enables tailored patient management. Computed tomography-derived fractional flow reserve (FFR) employs computed tomography coronary angiography raw data processed via complex computational fluid dynamics and produces a surrogate of the invasive fractional flow reserve (FFR) thus delivering anatomical and physiological assessment in a single test. Read More

Radiol Med 2020 Nov 15;125(11):1024-1039. Epub 2020 Sep 15.

Radiology Department, Azienda Ospedaliero Universitaria "Ospedali Riuniti", 60126, Ancona, Italy.

Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose reduction over the last decade was obtained, with the beginning of the sub-mSv era in CTCA. The main technical basis to obtain a radiation dose reduction in CTCA is the use of a low tube voltage, the adoption of a prospective electrocardiogram-triggering spiral protocol and the application of the tube current modulation with the iterative reconstruction technique. Read More

JACC Cardiovasc Imaging 2020 12 26;13(12):2588-2590. Epub 2020 Aug 26.

University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom; Royal Papworth Hospital, Cambridge, United Kingdom.

JACC Cardiovasc Imaging 2020 12 26;13(12):2576-2587. Epub 2020 Aug 26.

Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.

Objectives: This study is to determine the management and clinical outcomes of patients investigated with coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR) according to sex.

Background: Women are underdiagnosed with conventional ischemia testing, have lower rates of obstructive coronary artery disease (CAD) at invasive coronary angiography (ICA), yet higher mortality compared to men. Whether FFR improves sex-based patient management decisions compared to CCTA alone is unknown. Read More

Curr Opin Cardiol 2020 11;35(6):712-719

Division of Cardiovascular Medicine, Brigham & Women's Hospital, Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA.

Purpose Of Review: Management of patients with coronary artery disease (CAD) has been based on identification of a coronary obstruction causing ischemia and performing a revascularization procedure to reduce that ischemia, with the goal of thereby preventing subsequent major adverse cardiac events (MACEs) in that vascular territory. Recent investigations demonstrate that preemptive percutaneous coronary intervention (PCI) of nonculprit coronary lesions (NCLs) that may not cause ischemia in patients with ST-segment elevation myocardial infarction (STEMI) reduces MACE. In this review, we focus on preemptive PCI, discuss its mechanistic benefits and speculate on its potential value for other coronary syndromes. Read More

Circ Cardiovasc Imaging 2020 07 13;13(7):e000053. Epub 2020 Jul 13.

A substantial proportion of patients with acute myocardial infarction develop clinical heart failure, which remains a common and major healthcare burden. It has been shown that in patients with chronic coronary artery disease, ischemic episodes lead to a global pattern of cardiomyocyte remodeling and dedifferentiation, hallmarked by myolysis, glycogen accumulation, and alteration of structural proteins. These changes, in conjunction with an impaired global coronary reserve, may eventually become irreversible and result in ischemic cardiomyopathy. Read More

JACC Cardiovasc Interv 2020 08;13(16):1920-1933

Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea. Electronic address:

Objectives: This study sought to investigate the prognostic implications of post-percutaneous coronary intervention (PCI) nonhyperemic pressure ratios compared with that of post-PCI fractional flow reserve (FFR).

Background: FFR measured after PCI has been shown to possess prognostic implications. However, the prognostic value of post-PCI nonhyperemic pressure ratios has not yet been clarified. Read More

JACC Cardiovasc Interv 2020 08;13(16):1907-1916

Department of Cariology, Keimyung University Dongsan Hospital, Daegu, Korea. Electronic address:

Objectives: The aim of this study was to evaluate the clinical and anatomical features to predict the long-term outcomes in patients with fractional flow reserve (FFR)-guided deferred lesions, verified by intravascular ultrasound (IVUS).

Background: Deferral of nonsignificant lesion by FFR is associated with a low risk of clinical events. However, the impact of combined information on clinical and anatomical factors is not well known. Read More