353 results match your criteria Fractional Flow Reserve Management


Cost utility of fractional flow reserve-guided percutaneous coronary intervention in multivessel coronary artery disease in Brazil.

Int J Qual Health Care 2018 Dec 20. Epub 2018 Dec 20.

Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, Hall i.T., Austria.

Objective: The fractional flow reserve (FFR) versus angiography for multivessel evaluation (FAME) study has demonstrated that FFR substantially reduces major adverse cardiac events and resource utilization in coronary artery disease (CAD) patients. We aimed to assess the cost utility of FFR in percutaneous coronary interventions (PCI) from the perspective of the Brazilian Public Health System (SUS).

Design: Patient-level cost-utility analysis along the FAME study. Read More

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https://academic.oup.com/intqhc/advance-article/doi/10.1093/
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http://dx.doi.org/10.1093/intqhc/mzy240DOI Listing
December 2018
6 Reads

FFR for Complex Coronary Artery Disease Treatment Planning: New Opportunities.

Interv Cardiol 2018 Sep;13(3):126-128

St Paul's Hospital & University of British Columbia, Vancouver, British Columbia Vancouver, Canada.

Coronary computed tomography (CT) is well established for the assessment of symptomatic patients with suspected but not yet confirmed coronary artery disease with high diagnostic accuracy and risk prediction. Until recently, coronary computed tomography angiography (CTA) has played a limited role in the management of complex coronary artery disease (CAD) and in planning revascularisation strategies. With the advent of FFR, enabling anatomy and physiology with a single study and the ability to adjudicate lesion specific pressure loss, the potential of combined coronary CT angiography (CCTA) and fractional flow reserve (FFR) computed from non-invasive CT angiography (FFR) to inform treatment decision-making and help guide revascularisation has been recognised. Read More

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https://www.icrjournal.com/articles/ffrct-complex-coronary-a
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http://dx.doi.org/10.15420/icr.2018.14.3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234481PMC
September 2018
6 Reads

Management of established coronary artery disease in aircrew without myocardial infarction or revascularisation.

Heart 2019 Jan;105(Suppl 1):s25-s30

Royal Air Force Aviation Clinical Medicine Service, RAF Centre of Aviation Medicine, Bedfordshire, UK.

This paper is part of a series of expert consensus documents covering all aspects of aviation cardiology. In this manuscript, we focus on the broad aviation medicine considerations that are required to optimally manage aircrew with established coronary artery disease in those without myocardial infarction or revascularisation (both pilots and non-pilot aviation professionals). We present expert consensus opinion and associated recommendations. Read More

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http://dx.doi.org/10.1136/heartjnl-2018-313054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6256295PMC
January 2019
6 Reads

Artificial intelligence machine learning-based coronary CT fractional flow reserve (CT-FFR): Impact of iterative and filtered back projection reconstruction techniques.

J Cardiovasc Comput Tomogr 2018 Oct 26. Epub 2018 Oct 26.

Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology & Imaging Sciences, Emory University, Atlanta, GA, USA.

Background: The influence of computed tomography (CT) reconstruction algorithms on the performance of machine-learning-based CT-derived fractional flow reserve (CT-FFR) has not been investigated. CT-FFR values and processing time of two reconstruction algorithms were compared using an on-site workstation.

Methods: CT-FFR was computed on 40 coronary CT angiography (CCTA) datasets that were reconstructed with both iterative reconstruction in image space (IRIS) and filtered back-projection (FBP) algorithms. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S19345925183021
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http://dx.doi.org/10.1016/j.jcct.2018.10.026DOI Listing
October 2018
10 Reads

Impact of Pulmonary Venous Inflow on Cardiac Flow Simulations: Comparison with In Vivo 4D Flow MRI.

Ann Biomed Eng 2018 Oct 24. Epub 2018 Oct 24.

Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.

Blood flow simulations are making their way into the clinic, and much attention is given to estimation of fractional flow reserve in coronary arteries. Intracardiac blood flow simulations also show promising results, and here the flow field is expected to depend on the pulmonary venous (PV) flow rates. In the absence of in vivo measurements, the distribution of the flow from the individual PVs is often unknown and typically assumed. Read More

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http://dx.doi.org/10.1007/s10439-018-02153-5DOI Listing
October 2018
6 Reads

Functional assessment of coronary stenosis: an overview of available techniques. Is quantitative flow ratio a step to the future?

Expert Rev Cardiovasc Ther 2018 Dec 1;16(12):951-962. Epub 2018 Nov 1.

a Division of Clinical Cardiology , A.O.R.N. Sant'Anna e San Sebastiano , Caserta , Italy.

Introduction: The assessment of coronary lesions severity has always been a relevant topic in the management of the patient undergoing coronary angiography. Fractional flow reserve (FFR) has been introduced as an objective index to determine the significance of a coronary stenosis with a positive impact on clinical outcomes has been demonstrated for FFR-guided coronary interventions. However, several technical drawbacks have been pointed out in clinical practice limiting the diffusion of FFR worldwide. Read More

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http://dx.doi.org/10.1080/14779072.2018.1540303DOI Listing
December 2018
1 Read

Prognostic Value of the Residual SYNTAX Score After Functionally Complete Revascularization in ACS.

J Am Coll Cardiol 2018 Sep;72(12):1321-1329

Division of Cardiovascular Medicine, Stanford University Medical Center and Stanford Cardiovascular Institute, Stanford, California. Electronic address:

Background: The residual SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (RSS) quantitatively assesses angiographic completeness of revascularization after percutaneous coronary intervention (PCI) and has been shown to be a predictor of events after angiography-guided PCI. In stable patients undergoing functionally complete revascularization with fractional flow reserve (FFR) guidance, RSS did not predict outcome. Whether this is also true in patients with acute coronary syndromes (ACS) is unknown. Read More

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http://dx.doi.org/10.1016/j.jacc.2018.06.069DOI Listing
September 2018
7 Reads

Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry.

Eur Heart J 2018 Nov;39(41):3701-3711

Duke University School of Medicine, 2301 Erwin Road, Durham, NC, USA.

Aims: Non-invasive assessment of stable chest pain patients is a critical determinant of resource utilization and clinical outcomes. Increasingly coronary computed tomography angiography (CCTA) with selective CCTA-derived fractional flow reserve (FFRCT) is being used. The ADVANCE Registry, is a large prospective examination of using a CCTA and FFRCT diagnostic pathway in real-world settings, with the aim of determining the impact of this pathway on decision-making, downstream invasive coronary angiography (ICA), revascularization, and major adverse cardiovascular events (MACE). Read More

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https://academic.oup.com/eurheartj/advance-article/doi/10.10
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http://dx.doi.org/10.1093/eurheartj/ehy530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215963PMC
November 2018
13 Reads

Landmark Trials in Cardiology in 2017-Celebrating 40 Years of Angioplasty.

Int J Angiol 2018 Sep 5;27(3):167-173. Epub 2018 Jul 5.

Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Cardiovascular (CV) diseases continue to be the leading cause of morbidity and mortality worldwide. Significant progress has been made in the management of coronary artery disease (CAD) and acute coronary syndrome (ACS) over the past 3 decades. The year 2017 marks 40th anniversary of the first coronary angioplasty performed by Andreas Gruentzig in the year 1977. Read More

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http://dx.doi.org/10.1055/s-0038-1661376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6103756PMC
September 2018
1 Read

Coronary CT Angiographic and Flow Reserve-Guided Management of Patients With Stable Ischemic Heart Disease.

J Am Coll Cardiol 2018 Oct 25;72(18):2123-2134. Epub 2018 Aug 25.

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

Background: Clinical outcomes following coronary computed tomography-derived fractional flow reserve (FFR) testing in clinical practice are unknown.

Objectives: This study sought to assess real-world clinical outcomes following a diagnostic strategy including first-line coronary computed tomography angiography (CTA) with selective FFR testing.

Methods: The study reviewed the results of 3,674 consecutive patients with stable chest pain evaluated with CTA and FFR testing to guide downstream management in patients with intermediate stenosis (30% to 70%). Read More

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http://dx.doi.org/10.1016/j.jacc.2018.07.043DOI Listing
October 2018
5 Reads

Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion : Implications of FFR as an Imperfect Reference Standard for Myocardial Ischemia.

Curr Cardiol Rep 2018 Jul 26;20(9):77. Epub 2018 Jul 26.

Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Centre, Meibergdreef 9, Amsterdam, The Netherlands.

Purpose Of Review: Accumulating evidence exists for the value of coronary physiology for clinical decision-making in ischemic heart disease (IHD). The most frequently used pressure-derived index to assess stenosis severity, the fractional flow reserve (FFR), has long been considered the gold standard for this purpose, despite the fact that the FFR assesses solely epicardial stenosis severity and aims to estimate coronary flow impairment in the coronary circulation. The coronary flow reserve (CFR) directly assesses coronary blood flow in the coronary circulation, including both the epicardial coronary artery and the coronary microvasculature, but is nowadays less established than FFR. Read More

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http://dx.doi.org/10.1007/s11886-018-1017-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6061210PMC
July 2018
9 Reads

Should functional assessment of lesion severity be used to guide coronary bypass?

Curr Opin Cardiol 2018 Sep;33(5):565-570

Department of Cardiovascular Surgery, Mount Sinai Heart at Mount Sinai Saint Luke's, New York City, New York, USA.

Purpose Of Review: The purpose of this article is to investigate the potential role of fractional flow reserve (FFR) to guide surgical revascularization.

Recent Findings: Coronary artery bypass is planned and executed primarily based on angiographic coronary anatomy. FFR is the most well-established tool for functional assessment of coronary lesions. Read More

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http://dx.doi.org/10.1097/HCO.0000000000000549DOI Listing
September 2018
7 Reads

Magnetic Resonance Perfusion Imaging to Guide Management of Patients With Stable Ischemic Heart Disease.

JACC Cardiovasc Imaging 2018 Jul;11(7):997-999

British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, United Kingdom.

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http://dx.doi.org/10.1016/j.jcmg.2018.05.020DOI Listing

Prospective Comparison of FFR Derived From Coronary CT Angiography With SPECT Perfusion Imaging in Stable Coronary Artery Disease: The ReASSESS Study.

JACC Cardiovasc Imaging 2018 Nov 13;11(11):1640-1650. Epub 2018 Jun 13.

Department of Cardiology, Odense University Hospital, Odense, Denmark.

Objectives: This study sought to compare the per-patient diagnostic performance of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFR) with that of single-photon emission computed tomography (SPECT), using a fractional flow reserve (FFR) value of ≤0.80 as the reference for diagnosing at least 1 hemodynamically significant stenosis in a head-to-head comparison of patients with intermediate coronary stenosis as determined by coronary CTA.

Background: No previous study has prospectively compared the diagnostic performance of FFR and myocardial perfusion imaging by SPECT in symptomatic patients with intermediate range coronary artery disease (CAD). Read More

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http://dx.doi.org/10.1016/j.jcmg.2018.05.004DOI Listing
November 2018
18 Reads

Interventional Cardio-Oncology: Adding a New Dimension to the Cardio-Oncology Field.

Front Cardiovasc Med 2018 17;5:48. Epub 2018 May 17.

Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.

The management of cardiovascular disease in patients with active cancer presents a unique challenge in interventional cardiology. Cancer patients often suffer from significant comorbidities such as thrombocytopenia and coagulopathic and/or hypercoagulable states, which complicates invasive evaluation and can specifically be associated with an increased risk for vascular access complications. Furthermore, anticancer therapies cause injury to the vascular endothelium as well as the myocardium. Read More

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http://dx.doi.org/10.3389/fcvm.2018.00048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5967297PMC
May 2018
2 Reads

The performance of non-invasive tests to rule-in and rule-out significant coronary artery stenosis in patients with stable angina: a meta-analysis focused on post-test disease probability.

Eur Heart J 2018 Sep;39(35):3322-3330

The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, University College Hospital Galway, Newcastle Rd, Galway, Ireland.

Aims: To determine the ranges of pre-test probability (PTP) of coronary artery disease (CAD) in which stress electrocardiogram (ECG), stress echocardiography, coronary computed tomography angiography (CCTA), single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance (CMR) can reclassify patients into a post-test probability that defines (>85%) or excludes (<15%) anatomically (defined by visual evaluation of invasive coronary angiography [ICA]) and functionally (defined by a fractional flow reserve [FFR] ≤0.8) significant CAD.

Methods And Results: A broad search in electronic databases until August 2017 was performed. Read More

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http://dx.doi.org/10.1093/eurheartj/ehy267DOI Listing
September 2018
12 Reads
1 Citation
15.203 Impact Factor

Five-Year Outcomes with PCI Guided by Fractional Flow Reserve.

N Engl J Med 2018 07 22;379(3):250-259. Epub 2018 May 22.

From the Cardiovascular Center Aalst, Onze-Lieve-Vrouw Clinic, Aalst, Belgium (P.X., S.F., E.B., G.G.T., B.D.B.); the Department of Cardiology, Catharina Hospital, and the Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven (N.H.J.P., P.A.L.T.), and Isala Klinieken, Zwolle (J.-H.D.) - all in the Netherlands; Stanford University Medical Center and Palo Alto Veterans Affairs (VA) Health Care Systems, Stanford, CA (W.F.F.); Rigshospitalet University Hospital, Copenhagen (T.E.); Klinikum der Universität München-Campus-Innenstadt, Munich (S.K.), Heart Center Leipzig, Leipzig (A.L.), and Heart Center Dresden, Dresden (A.L.) - all in Germany; the Cardiovascular Hospital, Lyon, France (G.R.); Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary (G.G.T., Z.P.); Karolinska Institutet at Södersjukhuset, Stockholm (N.W.), and Örebro University Hospital, Örebro (O.F.) - both in Sweden; Masaryk University and University Hospital, Brno (P.K.), and Na Homolce Hospital, Prague (M.M.) - both in the Czech Republic; Clinical Center Kragujevac, Kragujevac, Serbia (N.J.); Atlanta VA Medical Center, Decatur (K.M.), and Emory University School of Medicine, Atlanta (H.S.) - both in Georgia; Tulane University Heart and Vascular Institute, New Orleans (A.I.); Golden Jubilee National Hospital, Glasgow, United Kingdom (K.O.); Cardiology Unit, Azienda Ospedalieria Universitaria di Ferrara, Ferrara, and Maria Cecilia Hospital, Gruppo Villa Maria Care and Research, Cotignola - both in Italy (G.C.); Clinical Trials Unit Bern, University of Bern, Bern, Switzerland (M.R.); and the Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto (P.J.).

Background: We hypothesized that fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) would be superior to medical therapy as initial treatment in patients with stable coronary artery disease.

Methods: Among 1220 patients with angiographically significant stenoses, those in whom at least one stenosis was hemodynamically significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus medical therapy or to medical therapy alone. Read More

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http://www.nejm.org/doi/10.1056/NEJMoa1803538
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http://dx.doi.org/10.1056/NEJMoa1803538DOI Listing
July 2018
12 Reads

Appropriate use of noninvasive ischemia testing to guide revascularization decision making following acute ST elevation myocardial infarction in Latin American countries: Results from an expert panel meeting of the International Atomic Energy Agency.

Rev Esp Med Nucl Imagen Mol 2018 Jul - Aug;37(4):237-243. Epub 2018 May 31.

International Atomic Energy Agency, Viena, Austria.

Across Latin American and Caribbean countries, cardiovascular disease and especially ischemic heart disease is currently the main cause of death both in men and in women. For most Latin American and Caribbean countries, public and community health efforts aim to define care strategies which are both clinically and cost effective and promote primary and secondary prevention, resulting in improved patient outcomes. The optimal approach to deal with acute events such as ST-elevation myocardial infarction (STEMI) is a matter of controversy; however, there is an expanding role for assessing residual ischemic burden in STEMI patients following primary percutaneous coronary intervention. Read More

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http://dx.doi.org/10.1016/j.remn.2018.01.005DOI Listing

Is Fractional Flow Reserve Useful in Assessing Coronary Artery Fistula: A Case-Based Discussion and Review.

Heart Lung Circ 2018 Apr 19. Epub 2018 Apr 19.

Division of Cardiology, Department of Medicine, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada. Electronic address:

We present two cases where fractional flow reserve (FFR) was utilised to guide management of coronary artery fistula (CAF), an approach advocated in recent case studies. CAF is a coronary anomaly that may present with a variety of syndromes though is frequently asymptomatic. When to exclude the fistula (surgically or percutaneously) is not always clear. Read More

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http://dx.doi.org/10.1016/j.hlc.2018.04.281DOI Listing
April 2018
1 Read

Coronary microvascular dysfunction in patients with stable coronary artery disease: The CE-MARC 2 coronary physiology sub-study.

Int J Cardiol 2018 Sep 19;266:7-14. Epub 2018 Apr 19.

British Heart Foundation (BHF) Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK. Electronic address:

Background: In patients with angina undergoing invasive management, no obstructive coronary artery disease (NOCAD) is a common finding, and angina may persist following percutaneous coronary intervention (PCI). Coronary microvascular dysfunction may be relevant. We aimed to assess the proportion of patients presenting with suspected CAD who had coronary microvascular dysfunction. Read More

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http://dx.doi.org/10.1016/j.ijcard.2018.04.061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008494PMC
September 2018
6 Reads

Prognostic implication of thermodilution coronary flow reserve in patients with indeterminate pressure-bounded coronary flow reserve.

Int J Cardiol 2018 06;261:24-27

Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; Institute on Aging, Seoul National University, Seoul, Republic of Korea. Electronic address:

Background: Recently, the concept of pressure-bounded coronary flow reserve (PB-CFR) has been introduced. However, using pressure-only data, a substantial proportion of patients could not be classified into high or low PB-CFR and remained as indeterminate PB-CFR. The current study evaluated the prognostic implication of thermodilution-based CFR (thermo-CFR) in patients with indeterminate PB-CFR. Read More

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http://dx.doi.org/10.1016/j.ijcard.2018.02.008DOI Listing
June 2018
2 Reads

Impact of cardiac hybrid imaging-guided patient management on clinical long-term outcome.

Int J Cardiol 2018 06;261:218-222

Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.

Background: Although randomized trials have provided evidence for invasive fractional flow reserve to guide revascularization, evidence for non-invasive imaging is less well established. The present study investigated whether hybrid coronary computed tomography (CCTA)/single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) can identify patients who benefit from early revascularization compared to medical therapy.

Methods: This retrospective study consists of 414 patients referred for evaluation of known or suspected coronary artery disease (CAD) with CCTA/SPECT hybrid imaging. Read More

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http://dx.doi.org/10.1016/j.ijcard.2018.01.118DOI Listing
June 2018
4 Reads

Stability of 2 mg/mL Adenosine Solution in Polyvinyl Chloride and Polyolefin Infusion Bags.

Hosp Pharm 2018 Apr 30;53(2):73-74. Epub 2017 Nov 30.

Wegmans School of Pharmacy, Rochester, NY, USA.

Adenosine is a potent endogenous mediator of vasodilation. Compounded sterile solutions of adenosine are used in cardiac catheterization lab to perform stress tests on the heart. These tests are used to determine the fractional flow reserve (FFR) and are commonly used in the management and diagnosis of cardiovascular conditions. Read More

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http://dx.doi.org/10.1177/0018578717742516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5863881PMC

Physiology-Guided Management of Serial Coronary Artery Disease: A Review.

JAMA Cardiol 2018 May;3(5):432-438

Cardiovascular Division, St Thomas' Hospital Campus, King's College London, England.

Importance: Ischemia-guided revascularization is the cornerstone of contemporary management of coronary artery disease and has evolved from noninvasive functional evaluation to real-time assessment with invasive physiological indices during diagnostic catheterization. However, serial/diffuse disease is common, and revascularization decisions often need to be made about individual lesions within the same vessel. It is unclear whether current physiological techniques, such as fractional flow reserve, can be reliably used to discern the individual contribution of lesions within a serially diseased vessel with erroneous measurements, potentially leading to suboptimal revascularization decisions. Read More

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http://dx.doi.org/10.1001/jamacardio.2018.0236DOI Listing
May 2018
1 Read

Anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), fractional flow reserve- and intravascular ultrasound-guided management in adult patients.

Catheter Cardiovasc Interv 2018 Mar 9. Epub 2018 Mar 9.

Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, CX, 3584, The Netherlands.

Objectives: To describe the use of fractional flow reserve (FFR) and intravascular ultrasound (IVUS) in the evaluation of patients with anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS).

Background: ACAOS of the right and left coronary are rare, but may lead to symptoms and impose a risk for sudden cardiac death, depending on several anatomical features. Assessment and risk estimation is challenging in (nonathlete) adults, especially if they present without symptoms or with atypical complaints. Read More

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http://dx.doi.org/10.1002/ccd.27578DOI Listing
March 2018
13 Reads

Impact of Routine Invasive Physiology at Time of Angiography in Patients With Multivessel Coronary Artery Disease on Reclassification of Revascularization Strategy: Results From the DEFINE REAL Study.

JACC Cardiovasc Interv 2018 02;11(4):354-365

Department of Cardiovascular Sciences, Policlinico Umberto I Roma, Rome, Italy. Electronic address:

Objectives: This study sought to prospectively assess the impact of routine invasive physiology at the time of angiography on reclassification of therapeutic management of multivessel disease (MVD) patients, and to assess how implementation of instantaneous wave-free ratio (iFR) alters the process.

Background: Routine invasive physiology in intermediate coronary lesions at the time of diagnostic angiography, primarily in patients with single-vessel disease and using fractional flow reserve (FFR), reclassifies coronary revascularization management in 26% to 44% of patients. The role of invasive physiology in patients with MVD is unclear. Read More

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http://dx.doi.org/10.1016/j.jcin.2017.11.030DOI Listing
February 2018
14 Reads

Design and Rationale of the RIPCORD 2 Trial (Does Routine Pressure Wire Assessment Influence Management Strategy at Coronary Angiography for Diagnosis of Chest Pain?): A Randomized Controlled Trial to Compare Routine Pressure Wire Assessment With Conventional Angiography in the Management of Patients With Coronary Artery Disease.

Circ Cardiovasc Qual Outcomes 2018 Feb;11(2):e004191

From the Institute of Cardiovascular Medicine and Science, London, United Kingdom (M.E., R.S., I.K.); Liverpool Heart and Chest Hospital NHS Foundation Trust, United Kingdom (M.E., R.S., I.K.); Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, United Kingdom (Z.N., N.C.); and Faculty of Medicine, University of Southampton, United Kingdom (N.C.).

Background: Investigation of anginal chest pain has traditionally involved either assessment of the coronary anatomy by angiography or noninvasive testing for reversible ischemia. Invasive pressure wire assessment at the time of angiography offers information on both anatomy and physiology. Fractional flow reserve-guided percutaneous coronary intervention is associated with lower resource utilization and improved clinical outcome compared with angiographic guidance alone. Read More

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https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.117.004
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http://dx.doi.org/10.1161/CIRCOUTCOMES.117.004191DOI Listing
February 2018
5 Reads

Quantitative Flow Ratio Identifies Nonculprit Coronary Lesions Requiring Revascularization in Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Disease.

Circ Cardiovasc Interv 2018 Feb;11(2):e006023

From the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy (G.S., M.T., S.B., A.E., G.P., A.B., R.F., G.C.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W.); University Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., M.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (A.M.L., C.T.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (A.P.); Bolognini Hospital, Seriate (BG), Italy (A.I.); Cardiologia Interventistica, A.O. Sant'Anna e San Sebastiano, Caserta, Italy (D.D.G.); Maria Cecilia Hospital, GVM Care and Research, E.S: Health Science Foundation, Cotignola, Italy (R.F., G.C.); Department of Radiology, Leiden University Medical Center, the Netherlands (J.H.C.R.); and University Hospital of Bern, Inselspital, Switzerland (M.V.).

Background: The nonculprit lesion (NCL) management in ST-segment-elevation myocardial infarction patients with multivessel disease is debated. We sought to assess whether quantitative flow ratio (QFR), a noninvasive tool to identify potentially flow-limiting lesions, may be reliable in this scenario.

Methods And Results: The present proof-of-concept study is based on a 3-step process: (1) identification of the QFR reproducibility in NCLs assessment (cohort A, n=31); (2) prospective validation of QFR diagnostic accuracy in respect to fractional flow reserve (cohort B, n=45); and (3) investigation of long-term clinical outcomes of NCLs stratified according to QFR (cohort C, n=110). Read More

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https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.11
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http://dx.doi.org/10.1161/CIRCINTERVENTIONS.117.006023DOI Listing
February 2018
28 Reads

Is heart rate response a reliable marker of adenosine-induced coronary hyperemia?

Int J Cardiovasc Imaging 2018 Jul 14;34(7):1117-1125. Epub 2018 Feb 14.

NIHR Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, St Thomas' Campus, King's College London, London, UK.

Introduction Growing evidence supports ischemia-guided management of chest pain, with invasive and non-invasive tests reliant upon achieving adenosine-induced coronary hyperemia (defined as increased blood flow to an organ's perfusion bed). In the non-invasive setting, surrogate markers of hyperemia, such as increases in heart rate, are often used, despite not being formally validated. We tested whether heart rate and other non-invasive indices are reliable markers of coronary hyperemia. Read More

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http://dx.doi.org/10.1007/s10554-018-1309-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280851PMC
July 2018
26 Reads
2.320 Impact Factor

Coronary Flow Reserve in Non-Infarcted Myocardium Predicts Long-Term Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention.

Yonsei Med J 2018 Mar;59(2):252-257

Department of Cardiology, the Forth Affiliated Hospital of Harbin Medical University, Harbin, China.

Purpose: Coronary flow reserve (CFR) is recognized as an indicator of myocardial perfusion. The aim of this study was to assess the relationship between CFR in the non-infarcted myocardium and the incidence of major adverse cardiac events (MACEs).

Materials And Methods: 100 consecutive patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were enrolled in the present study, and divided into MACE and non-MACE groups according to the incidence of 12-month MACEs. Read More

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http://dx.doi.org/10.3349/ymj.2018.59.2.252DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823827PMC
March 2018
7 Reads

Incidence and predictors of lesion-specific ischemia by FFR: Learnings from the international ADVANCE registry.

J Cardiovasc Comput Tomogr 2018 Mar - Apr;12(2):95-100. Epub 2018 Feb 2.

Wakayama Medical University, Wakayama, Japan.

Background: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry. Read More

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http://dx.doi.org/10.1016/j.jcct.2018.01.008DOI Listing
August 2018
9 Reads

Comparison of Physician Visual Assessment With Quantitative Coronary Angiography in Assessment of Stenosis Severity in China.

JAMA Intern Med 2018 Feb;178(2):239-247

National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease and Division of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

Importance: Although physician visual assessment (PVA) of stenosis severity is a standard clinical practice to support decisions for coronary revascularization, there are concerns about its accuracy.

Objective: To compare PVA with quantitative coronary angiography (QCA) as a means of assessing stenosis severity among patients undergoing percutaneous coronary intervention (PCI) in China.

Design, Setting, And Participants: A cross-sectional study (2012-2013) of a random subset of 1295 patients from the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Prospective PCI Study was carried out. Read More

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http://dx.doi.org/10.1001/jamainternmed.2017.7821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5838612PMC
February 2018
13 Reads

Hybrid Imaging in Ischemic Heart Disease.

Rev Esp Cardiol (Engl Ed) 2018 May 10;71(5):382-390. Epub 2018 Jan 10.

Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland. Electronic address:

Hybrid imaging for ischemic heart disease refers to the fusion of information from a single or usually from multiple cardiovascular imaging modalities enabling synergistic assessment of the presence, the extent, and the severity of coronary atherosclerotic disease along with the hemodynamic significance of lesions and/or with evaluation of the myocardial function. A combination of coronary computed tomography angiography with myocardial perfusion imaging, such as single-photon emission computed tomography and positron emission tomography, has been adopted in several centers and implemented in international coronary artery disease management guidelines. Interest has increased in novel hybrid methods including coronary computed tomography angiography-derived fractional flow reserve and computed tomography perfusion and these techniques hold promise for the imminent diagnostic and management approaches of patients with coronary artery disease. Read More

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http://dx.doi.org/10.1016/j.rec.2017.11.023DOI Listing
May 2018
2 Reads

Fractional flow reserve computed tomography in the evaluation of coronary artery disease.

Cardiovasc Diagn Ther 2017 Oct;7(5):463-474

St Paul's Hospital, Vancouver, Canada.

Amongst patients with suspected obstructive coronary artery disease (CAD), less than a third of patients have obstructive disease on invasive coronary angiography (ICA) and fewer still have flow-limiting obstructive disease as determined by invasive fractional flow reserve (FFR). FFR is a powerful tool in guiding revascularization of flow-limiting lesions which in turn improves clinical outcome in those with haemodynamically significant obstructive disease. However FFR is infrequently performed due to the cost, time and patient discomfort the procedure entails. Read More

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http://cdt.amegroups.com/article/view/13694/17295
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http://dx.doi.org/10.21037/cdt.2017.01.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716947PMC
October 2017
3 Reads

Diagnostic performance of an acoustic-based system for coronary artery disease risk stratification.

Heart 2018 06 9;104(11):928-935. Epub 2017 Nov 9.

Department of Cardiology, Hospital Unit West, Herning, Denmark.

Objective: Diagnosing coronary artery disease (CAD) continues to require substantial healthcare resources. Acoustic analysis of transcutaneous heart sounds of cardiac movement and intracoronary turbulence due to obstructive coronary disease could potentially change this. The aim of this study was thus to test the diagnostic accuracy of a new portable acoustic device for detection of CAD. Read More

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http://dx.doi.org/10.1136/heartjnl-2017-311944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5969347PMC
June 2018
15 Reads

Coronary Computed Tomographic Angiography-Derived Fractional Flow Reserve for Therapeutic Decision Making.

Am J Cardiol 2017 Dec 19;120(12):2121-2127. Epub 2017 Sep 19.

Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address:

This study investigated the performance of coronary computed tomography angiography (cCTA) with cCTA-derived fractional flow reserve (CT-FFR) compared with invasive coronary angiography (ICA) with fractional flow reserve (FFR) for therapeutic decision making in patients with suspected coronary artery disease (CAD). Seventy-four patients (62 ± 11 years, 62% men) with at least 1 coronary stenosis of ≥50% on clinically indicated dual-source cCTA, who had subsequently undergone ICA with FFR measurement, were retrospectively evaluated. CT-FFR values were computed using an on-site machine-learning algorithm to assess the functional significance of CAD. Read More

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http://dx.doi.org/10.1016/j.amjcard.2017.08.034DOI Listing
December 2017
19 Reads

SMARTool: A tool for clinical decision support for the management of patients with coronary artery disease based on modeling of atherosclerotic plaque process.

Conf Proc IEEE Eng Med Biol Soc 2017 07;2017:96-99

SMARTool aims to the development of a clinical decision support system (CDSS) for the management and stratification of patients with coronary artery disease (CAD). This will be achieved by performing computational modeling of the main processes of atherosclerotic plaque growth. More specifically, computed tomography coronary angiography (CTCA) is acquired and 3-dimensional (3D) reconstruction is performed for the arterial trees. Read More

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http://dx.doi.org/10.1109/EMBC.2017.8036771DOI Listing
July 2017
6 Reads

Comparison of Accuracy of One-Use Methods for Calculating Fractional Flow Reserve by Intravascular Optical Coherence Tomography to That Determined by the Pressure-Wire Method.

Am J Cardiol 2017 Dec 1;120(11):1920-1925. Epub 2017 Sep 1.

Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea; KI for Health Science and Technology, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea. Electronic address:

Although the identification of the hemodynamic significance of coronary lesions becomes important for revascularization strategy, the potential role of 3-dimensional high-resolution intracoronary optical coherence tomography (OCT) for predicting functional significance of coronary lesions remains unclear. We assessed the diagnostic performance of 2 computational approaches for deriving fractional flow reserve (FFR) from intravascular OCT images. We developed 2 methods to derive FFR-OCT by AFD (FFR-OCT) and FFR-OCT by CFD (FFR-OCT). Read More

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http://dx.doi.org/10.1016/j.amjcard.2017.08.010DOI Listing
December 2017
10 Reads

[FFR-Guided Revascularisation - Pros and Cons].

Dtsch Med Wochenschr 2017 Oct 18;142(21):1595-1603. Epub 2017 Oct 18.

An invasive measurement of the fractional flow reserve (FFR) allows the valuation of the individual risk for ischemic events in patients with coronary artery disease. Therefore, FFR has become a valuable tool to guide coronary revascularisations. The cut-off value ≤ 0. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-104466
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http://dx.doi.org/10.1055/s-0043-104466DOI Listing
October 2017
3 Reads

Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage.

Kidney Int 2018 02 13;93(2):501-509. Epub 2017 Oct 13.

Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA; Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts, USA.

Microvascular rarefaction is found in experimental uremia, but data from patients with chronic kidney disease (CKD) are limited. We therefore quantified absolute myocardial blood flow and coronary flow reserve (the ratio of peak to resting flow) from myocardial perfusion positron emission tomography scans at a single institution. Individuals were classified into standard CKD categories based on the estimated glomerular filtration rate. Read More

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http://dx.doi.org/10.1016/j.kint.2017.07.025DOI Listing
February 2018
22 Reads

CT coronary imaging-a fast evolving world.

Authors:
P Rajiah S Abbara

QJM 2018 Sep;111(9):595-604

From the Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA.

Computed tomography (CT) has become an important modality in the evaluation of coronary artery disease (CAD). The tremendous technological advances in CT in the last two decades has made it possible to obtain high quality images of coronary arteries with high spatial and temporal resolutions. Multiple trials have confirmed the accuracy of CT compared to invasive catheter angiography. Read More

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http://dx.doi.org/10.1093/qjmed/hcx175DOI Listing
September 2018
20 Reads

Efficacy and safety of instantaneous wave-free ratio in patients undergoing coronary revascularisation: protocol for a systematic review.

BMJ Open 2017 Sep 28;7(9):e017868. Epub 2017 Sep 28.

Chiu Hin Kwong Heart Centre, Hong Kong Baptist Hospital, Kowloon, Hong Kong.

Introduction: Effective selection of coronary lesions for revascularisation is pivotal in the management of symptoms and adverse outcomes in patients with coronary artery disease. Recently, instantaneous 'wave-free' ratio (iFR) has been proposed as a new diagnostic index for assessing the severity of coronary stenoses without the need of pharmacological vasodilation. Evidence of the effectiveness of iFR-guided revascularisation is emerging and a systematic review is warranted. Read More

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http://dx.doi.org/10.1136/bmjopen-2017-017868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5640096PMC
September 2017
17 Reads

CT myocardial perfusion imaging: ready for prime time?

Eur Radiol 2018 Mar 27;28(3):1253-1256. Epub 2017 Sep 27.

Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA.

The detection of functional coronary artery stenosis with coronary CT angiography (CCTA) is suboptimal. Additional CT myocardial perfusion imaging (CT-MPI) may be helpful to identify patients with myocardial ischaemia in whom coronary revascularization therapy would be beneficial. CT-MPI adds incremental diagnostic and prognostic value over obstructive disease on CCTA. Read More

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http://dx.doi.org/10.1007/s00330-017-5057-8DOI Listing
March 2018
40 Reads

Coronary CT Angiography Derived Fractional Flow Reserve: The Game Changer in Noninvasive Testing.

Curr Cardiol Rep 2017 09 22;19(11):112. Epub 2017 Sep 22.

Department of Radiology and Medicine, St. Paul´s Hospital, University of British Columbia, Vancouver, Canada.

Purpose Of Review: To summarize the scientific basis of CT derived fractional flow reserve (FFR) and present an updated review on the evidence from clinical trials and real-world observational data RECENT FINDINGS: In prospective multicenter studies of patients with stable coronary artery disease (CAD), FFR showed high diagnostic performance. More recently, FFR has advanced to the realm of clinical utility and real-world clinical practice with emerging data showing that FFR when compared to standard care is efficient in safely reducing downstream utilization of invasive coronary angiography (ICA), and costs, as well as improving the diagnostic yield of ICA. Moreover, FFR may broaden applicability of frontline coronary CTA testing to patients with high pre-test risk of CAD. Read More

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http://dx.doi.org/10.1007/s11886-017-0923-1DOI Listing
September 2017
12 Reads

Diagnostic Value of Noninvasive Computed Tomography Perfusion Imaging and Coronary Computed Tomography Angiography for Assessing Hemodynamically Significant Native Coronary Artery Lesions.

Am J Med Sci 2017 09 12;354(3):291-298. Epub 2017 Mar 12.

Division of Cardiology, East Tennessee State University, Johnson City, Tennessee. Electronic address:

Background: The objective of this study is to determine the diagnostic performance of computed tomography perfusion (CTP) with and without computed tomography angiography (CTA) in assessment of hemodynamically significant coronary artery lesions in comparison to invasive fractional flow reserve (FFR).

Materials And Methods: PubMed and Cochrane Center Register of Controlled Trials from January 2010 searched through December 2014. Nine original studies were selected evaluating the diagnostic performance of CTP with and without CTA to invasive coronary angiography in evaluation of hemodynamic significance of coronary lesions (n = 951). Read More

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http://dx.doi.org/10.1016/j.amjms.2017.03.016DOI Listing
September 2017
14 Reads
1.515 Impact Factor

Functional assessment of lesion severity without using the pressure wire: coronary imaging and blood flow simulation.

Expert Rev Cardiovasc Ther 2017 Nov 19;15(11):863-877. Epub 2017 Sep 19.

a Second Department of Cardiology , University Hospital of Ioannina , Ioannina , Greece.

Introduction: Hemodynamic indices derived from measurements with the pressure wire (primarily fractional flow reserve [FFR]) have been established as a reliable tool for assessing coronary stenoses and improving clinical decision making. However, the use of the pressure wire constitutes a hurdle for the universal adoption of physiology-guided patient management. Technological advancements have enabled the large-scale application of blood flow simulation (computational fluid dynamics [CFD]) to medical imaging, thereby enabling the virtual assessment of coronary physiology. Read More

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http://dx.doi.org/10.1080/14779072.2017.1379899DOI Listing
November 2017
12 Reads

The Evolving Future of Instantaneous Wave-Free Ratio and Fractional Flow Reserve.

J Am Coll Cardiol 2017 Sep;70(11):1379-1402

Hammersmith Hospital, Imperial College London, London, United Kingdom.

In this review, the authors reflect upon the role of coronary physiology in the modern management of coronary artery disease. They critically appraise the scientific background of the instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR), from early experimental studies to validation studies against indexes of ischemia, to clinical trials assessing outcome. At this important juncture for the field, the authors make predictions for the future of physiological stenosis assessment, outlining developments for both iFR and FFR in new clinical domains beyond the confines of stable angina. Read More

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http://dx.doi.org/10.1016/j.jacc.2017.07.770DOI Listing
September 2017
10 Reads

Integrated Noninvasive Physiological Assessment of Coronary Circulatory Function and Impact on Cardiovascular Mortality in Patients With Stable Coronary Artery Disease.

Circulation 2017 Dec 1;136(24):2325-2336. Epub 2017 Sep 1.

Division of Cardiovascular Medicine, Department of Medicine, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.G., V.R.T., N.S.B., P.E.B., S.B.S., T.V., C.F.B., M.H., J.H., S.D., R.B., M.F.D.C.)

Background: It is suggested that the integration of maximal myocardial blood flow (MBF) and coronary flow reserve (CFR), termed coronary flow capacity, allows for comprehensive evaluation of patients with known or suspected stable coronary artery disease. Because management decisions are predicated on clinical risk, we sought to determine the independent and integrated value of maximal MBF and CFR for predicting cardiovascular death.

Methods: MBF and CFR were quantified in 4029 consecutive patients (median age 66 years, 50. Read More

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http://dx.doi.org/10.1161/CIRCULATIONAHA.117.029992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5726898PMC
December 2017
36 Reads

Severe aortic stenosis patients with preserved ejection fraction according to flow and gradient classification: Prevalence and outcomes.

Int J Cardiol 2017 Dec 30;248:211-215. Epub 2017 Aug 30.

Department of Cardiology, Ramón y Cajal University Hospital, CIBERCV, Madrid, Spain.

Background: Clinicians often encounter patients with apparently discordant echocardiographic findings, severe aortic stenosis (SAS) defined by aortic valve area (AVA) despite a low mean gradient. A new classification according to flow state and pressure gradient has been proposed. We sought to assess the prevalence, characteristics and outcomes of patients with asymptomatic SAS with preserved left-ventricular ejection fraction (LVEF) according to flow and gradient. Read More

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http://dx.doi.org/10.1016/j.ijcard.2017.06.064DOI Listing
December 2017
16 Reads