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Eur Radiol 2019 Mar 18. Epub 2019 Mar 18.

School of Basic Medical Science, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, Southern Medical University, Guangzhou, Guangdong, China.

Background: We aimed to compare the performance of FFR and FFR in assessing the functional significance of coronary artery stenosis in patients suffering from coronary artery disease with stable angina.

Method: A total of 101 stable coronary heart disease (CAD) patients with 181 lesions were recruited. FFR and FFR were compared using invasive fractional flow reserve (FFR) as a reference standard. Read More

Curr Cardiol Rep 2019 Mar 7;21(4):25. Epub 2019 Mar 7.

Section of Cardiology, Department of Internal Medicine, Harlem Hospital Center/Columbia University, New York, NY, USA.

Purpose Of Review: Just over four decades ago, the management of coronary artery disease (CAD) witnessed a major breakthrough with the advent of minimally invasive treatment modalities like angioplasty followed by coronary stenting. Dr. Andreas Gruentzig pioneered this field in 1977 by adding a balloon to the Dotter catheter. Read More

Cardiovasc Revasc Med 2019 Jan 17. Epub 2019 Jan 17.

Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA. Electronic address:

Background: Fractional flow reserve derived from computed tomography (FFRct) has shown higher accuracy for detection of significant coronary artery disease (CAD) compared to coronary computed tomography angiography (CCTA). The performance of a combined comprehensive qualitative interpretation of both CCTA and FFRct in patient management is unknown. We aimed to explore the clinical application of this combined approach. Read More

J Coll Physicians Surg Pak 2019 Mar;29(3):268-273

Department of Cardiology, Heart Center, Chongqing Three Gorges Central Hospital, Wanzhou, Chongqing, 404000, China.

Among the sick patients suffering from non-ST segment elevation acute coronary syndrome (NSTEACS), the accuracy of fractional flow reserve (FFR)-directed percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is still ambiguous. Studies were obtained from PubMed, Embase, Wanfang Data, and Cochrane Library electronic statistics from their initiation up to April 2018, to explore the differences between the FFR-directed approach and the coronary angiography (CA)/stress perfusion scintigraphy (SPS)-directed approach in the outcomes of NSTACS patients. Odds ratio was determined for individual studies, quality assessments, heterogeneity, and publishing bias analyses. Read More

Open Heart 2019 13;6(1):e000934. Epub 2019 Jan 13.

Department of Interventional Cardiology, Royal Papworth Hospital, Cambridge, UK.

Background: The utility of fractional flow reserve (FFR) to guide revascularisation in the management of acute coronary syndrome (ACS) remains unclear.

Objective: This study aims to compare the clinical outcomes of patients following FFR-guided revascularisation for either ACS or stable angina (SA) and in particular focuses on the outcome of those with deferred revascularisation after FFR.

Methods: A meta-analysis of existing literature was performed. Read More

SAGE Open Med Case Rep 2019 16;7:2050313X18823380. Epub 2019 Jan 16.

Heart & Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.

Background: Myocardial bridge is defined as a segment of a coronary artery that takes an intramyocardial course. The presence of myocardial bridge has been observed in as many as 40%-80% of cases on autopsy, angiographically from 0.5% to 16. Read More

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

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

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

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

Am J Case Rep 2018 Nov 2;19:1306-1310. Epub 2018 Nov 2.

Division of Cardiovascular Medicine, Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA.

BACKGROUND Non-atherosclerotic causes of ST-segment elevation myocardial infarction (STEMI) are uncommon, and there are few case reports of acute myocardial infarction secondary to coronary artery embolism. CASE REPORT A 66-year-old man presented with shortness of breath and leg swelling. Diagnoses of congestive heart failure and atrial fibrillation were made. Read More

Ann Biomed Eng 2019 Feb 24;47(2):413-424. 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

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

Arq Bras Cardiol 2018 Oct 21;111(4):542-550. Epub 2018 Sep 21.

Department of Cardiology, Coimbra Universitary Hospital Center, Coimbra - Portugal.

Background: There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR).

Objectives: To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR.

Methods: We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. Read More

J Cardiovasc Comput Tomogr 2018 Nov - Dec;12(6):480-492. Epub 2018 Sep 14.

Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA. Electronic address:

Background: Fractional flow reserve (FFR)-derived from computed tomography angiography (CTA; FFRCT) and invasive FFR (FFRINV) are used to assess the need for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). The optimal location for measuring FFR and the impact of measurement location have not been well defined.

Methods: 930 patients (age 60. Read More

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

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

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

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

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

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

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.

Int J Cardiol 2018 Nov 8;270:107-112. Epub 2018 Jun 8.

Division of Cardiology, Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Corso A. M. Dogliotti, 14, 10126 Torino, Italy.

Background: FFR-guided coronary intervention is recommended for patients with intermediate stenoses. However, concerns exist with this approach in anatomically prognostic disease.

Methods: In this prospective, multicentre study, we consecutively enrolled patients found to have FFR negative lesions in anatomically significant sites: left main; proximal LAD; last remaining patent vessel; and multiple vessels with concomitant impaired left ventricular systolic function (EF < 40%). Read More

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

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

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

Rev Port Cardiol 2018 06 24;37(6):511-520. Epub 2018 May 24.

Serviço de Cardiologia, Hospital Universitário de Santa Maria, CHLN, CAML, CCUL, Faculdade de Medicina de Lisboa, Portugal.

Introduction And Objective: Assessment of coronary lesions by the instantaneous wave free ratio (iFR) has generated significant debate. We aimed to assess the diagnostic performance of iFR and its impact on the decision to use fractional flow reserve (FFR) and on procedural characteristics.

Methods: In this single-center registry of patients undergoing functional assessment of coronary lesions, FFR was used as a reference for assessing the diagnostic performance of iFR. Read More

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

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

Heart Lung Circ 2019 Apr 19;28(4):e51-e53. 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

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

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

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

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

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

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

Curr Atheroscler Rep 2018 03 2;20(3):16. Epub 2018 Mar 2.

Department of Cardiology, New York-Presbyterian Hospital and Weill Cornell Medicine, 1305 York Avenue, WGC-8, New York, NY, 10021, USA.

Purpose Of Review: Ischemic heart disease is a leading cause of morbidity and mortality for women and men around the world. However, traditional cardiovascular risk factors do not fully capture cardiac risk in women. This review summarizes sex-based differences in the clinical presentation, pathophysiology, and risk assessment of ischemic heart disease. Read More

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

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

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

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

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

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

JAMA Intern Med 2018 02;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

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

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

Circulation 2017 12;136(24):2393-2394

Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Circulation 2017 12;136(24):2392

Department of Cardiology, Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China.

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