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Herz 2020 Jun 3. Epub 2020 Jun 3.

University Heart Center Graz, Medical University Graz, Auenbruggerplatz 15, 8036, Graz, Austria.

The International Study of Comparative Health Effectiveness With Medical And Invasive Approaches (ISCHEMIA) has the potential to be a game changer in terms of the diagnostic and management approach to patients presenting with chronic coronary syndrome, suggesting that coronary revascularization may become almost like a "bail-out" strategy in the treatment of these patients. However, invasive perfusion assessment as a means of detecting the source of myocardial ischaemia at a lesion level, such as fractional flow reserve (FFR), has been validated in the past and established beyond doubt as a key diagnostic tool. The complementary role of the two approaches will be discussed here. Read More

Cureus 2020 May 1;12(5):e7908. Epub 2020 May 1.

Cardiology, Russells Hall Hospital, Dudley, GBR.

Objective To assess the diagnostic performance of CT fractional flow reserve (CT-FFR) and to assess whether its use in addition to CT coronary angiography (CTCA) changed the investigation and management of patients with suspected coronary artery disease (CAD). Method A retrospective case note review was carried out for 200 consecutive patients at Russells Hall Hospital, Dudley, United Kingdom, who had CTCA sent for Heartflow CT-FFR analysis (HeartFlow, Redwood City, CA) between January 2018 and December 2019. Results Patients with CT-FFR > 0. Read More

Cardiovasc Revasc Med 2020 Apr 15. Epub 2020 Apr 15.

Division of Cardiovascular Disease, Einstein Medical Center, Philadelphia, PA 19141, United States of America. Electronic address:

Background: Coronary intervention is routinely deferred in intermediate lesions with fractional flow reserve (FFR) ≥ 0.80. Patients with borderline FFR (0. Read More

J Cardiovasc Comput Tomogr 2020 May 1. Epub 2020 May 1.

Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA; Department of Radiology, Stanford University, Stanford, CA, USA. Electronic address:

Background: The ADVANCE registry is a large prospective study of outcomes and resource utilization in patients undergoing coronary computed tomography angiography (CCTA) and CT-based fractional flow reserve (FFR). As experience with new technologies and practices develops over time, we investigated temporal changes in the use of FFR within the ADVANCE registry.

Methods: 5083 patients with coronary artery disease (CAD) on CCTA were prospectively enrolled in the ADVANCE registry and were divided into 3 equally sized cohorts based on the temporal order of enrollment per site. Read More

JACC Cardiovasc Imaging 2020 May 8. Epub 2020 May 8.

Noninvasive Cardiovascular Imaging Section, Cardiovascular Division of Department of Medicine and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address:

Objectives: The aim of this study was to compare, using results from the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, the incremental cost-effectiveness of a stress cardiovascular magnetic resonance (CMR)-first strategy against 4 other clinical strategies for patients with stable symptoms suspicious for myocardial ischemia: 1) immediate x-ray coronary angiography (XCA) with selective fractional flow reserve for all patients; 2) single-photon emission computed tomography; 3) coronary computed tomographic angiography with selective computed tomographic fractional flow reserve; and 4) no imaging.

Background: Stress CMR perfusion imaging has established excellent diagnostic utility and prognostic value in coronary artery disease (CAD), but its cost-effectiveness in current clinical practice has not been well studied in the United States.

Methods: A decision analytic model was developed to project health care costs and lifetime quality-adjusted life years (QALYs) for symptomatic patients at presentation with a 32. Read More

Rambam Maimonides Med J 2020 Apr 29;11(2). Epub 2020 Apr 29.

Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.

An accurate functional assessment of coronary artery stenosis is pivotal in the management and clinical outcomes of patients. The hemodynamic relevance of coronary artery stenoses can be assessed using coronary flow surrogates, namely fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). This review provides an overview of these indexes, their clinical relevance, as well as a review of the literature supporting their use. Read More

Catheter Cardiovasc Interv 2020 Apr 15. Epub 2020 Apr 15.

Department of Community Health, Christian Medical College and Hospital, Vellore, India.

Objectives: To study the safety of stent avoidance, frequency of change in management decisions, and its cost implications while using a fractional flow reserve (FFR)-guided treatment strategy for intermediate-grade coronary artery stenosis.

Background: The impact of FFR in guiding management decisions and its cost implications has not been studied after imposition of a ceiling on stent prices by the Government of India.

Methods: In 400 patients with 477 intermediate-grade coronary lesions for whom coronary intervention was planned, functional assessment using FFR was done. Read More

Semin Nucl Med 2020 May 4;50(3):238-247. Epub 2020 Mar 4.

Turku PET Centre, University of Turku, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland.

Myocardial perfusion imaging with 15O-water positron emission tomography (PET) is a validated tool for quantitative measurement of myocardial blood flow (MBF) and myocardial flow reserve (MFR). Current scanner and software technology enable quantification of global and regional MBF in clinical PET myocardial perfusion imaging studies. Reduced stress MBF or MFR measured by 15O-water PET accurately detects hemodynamically significant coronary artery stenosis defined by intracoronary fractional flow reserve (FFR) measurement in patients with suspected obstructive coronary artery disease (CAD). Read More

G Ital Cardiol (Rome) 2020 04;21(4 Suppl 2):5S-11S

Centro Cardiologico Monzino, IRCCS, Milano - Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milano.

The increased number of patients with coronary artery disease is of great clinical relevance and carries a heavy burden on the health system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore, the ideal test should provide the correct diagnosis and appropriate information for the best patient management. Read More

Int J Cardiovasc Imaging 2020 Jul 16;36(7):1351-1362. Epub 2020 Mar 16.

Division of Cardiology, Department of Internal Medicine, University of California San Francisco-Fresno, Fresno, USA.

One of the foundations of the management of patients with suspected coronary artery disease (CAD) is to avoid unnecessary invasive coronary angiography (ICA) referrals. However, the diagnostic yield of ICA following abnormal conventional stress testing is low. The ability of ischemia testing to predict subsequent myocardial infarction and death is currently being challenged, and more than half of cardiac events among stable patients with suspected CAD occur in those with normal functional tests. Read More

Catheter Cardiovasc Interv 2020 Mar 14. Epub 2020 Mar 14.

Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.

Background: The use and clinical outcomes of fractional flow reserve (FFR)-guided revascularization in patients presenting with either stable coronary artery disease (CAD) or an acute coronary syndrome (ACS) in daily clinical practice are uncertain.

Objective: To prospectively characterize the frequency of the change in treatment plan when FFR is performed compared to the initial decision based on angiography alone and procedure-related outcomes.

Methods: We undertook a prospective, multicenter, multinational, open-label, observational study of coronary physiologic measurements during clinically indicated coronary angiography. Read More

Eur Radiol 2020 Mar 12. Epub 2020 Mar 12.

Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.

Objective: To determine the potential impact of on-site CT-derived fractional flow reserve (CT-FFR) on the diagnostic efficiency and effectiveness of coronary CT angiography (CCTA) in patients with obstructive coronary artery disease (CAD) on CCTA.

Methods: This observational cohort study included patients with suspected CAD who had been randomized to cardiac CT in the CRESCENT I and II trials. On-site CT-FFR was blindly performed in all patients with at least one ≥ 50% stenosis on CCTA and no exclusion criteria for CT-FFR. Read More

Circ Cardiovasc Interv 2020 Mar 27;13(3):e008375. Epub 2020 Feb 27.

Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston.

Background: Intraseptal anomalous aortic origin of a coronary artery is considered a benign condition. However, there have been case reports of patients with myocardial ischemia, arrhythmia, and sudden cardiac death. The purpose of this study was to determine the clinical presentation, myocardial perfusion on provocative stress testing, and management of children with anomalous aortic origin of a coronary artery with an intraseptal course in a prospective cohort. Read More

J Thorac Imaging 2020 May;35 Suppl 1:S66-S71

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

Coronary computed tomography angiography (cCTA) is a reliable and clinically proven method for the evaluation of coronary artery disease. cCTA data sets can be used to derive fractional flow reserve (FFR) as CT-FFR. This method has respectable results when compared in previous trials to invasive FFR, with the aim of detecting lesion-specific ischemia. Read More

Am Heart J 2020 04 1;222:139-146. Epub 2019 Sep 1.

Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands. Electronic address:

Background: It remains uncertain if invasive coronary physiology beyond fractional flow reserve (FFR) can refine lesion selection for revascularization or provide additional prognostic value. Coronary flow reserve (CFR) equals the ratio of hyperemic to baseline flow velocity and has a wealth of invasive and noninvasive data supporting its validity. Because of fundamental physiologic relationships, binary classification of FFR and CFR disagrees in approximately 30%-40% of cases. Read More

J Cardiothorac Surg 2020 Feb 3;15(1):32. Epub 2020 Feb 3.

Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishi Road, Xicheng District, Beijing, 100037, China.

Background: Congenital coronary-pulmonary fistulas (CPFs) are commonly unilateral; however, bilateral and multilateral fistulas are relatively rare. The steal phenomenon aroused from bilateral or multilateral CPFs, and was uncertain and seldom reported. We possess a new tool to assess the hemodynamic significance of coronary artery fistulas. Read More

J Eval Clin Pract 2020 Jan 29. Epub 2020 Jan 29.

Health Technology Assessment, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.

Rationale, Aims, And Objectives: While different imaging and treatment options are available in acute coronary syndrome (ACS) care, there is a lack of data regarding their use across Europe. We examined the diagnostic and treatment strategies in patients with known or suspected ACS as reported by physicians and identified variations in responses across European countries and geographical areas.

Method: A web-based clinician survey focusing on ACS imaging and revascularization treatments was circulated through email distribution lists and websites of European professional societies in the field of cardiology. Read More

Curr Cardiol Rep 2020 Jan 28;22(2). Epub 2020 Jan 28.

Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Purpose Of Review: The aim of this review is to provide an update on the use of positron emission tomography (PET) with myocardial blood flow (MBF) quantification for the diagnosis and management of patients with microvascular disease.

Recent Findings: It is now recognized that a large proportion of patients with classical angina and non-obstructive epicardial disease are suffering from microvascular angina. Microvascular angina shares several key features with epicardial coronary disease, including many risk factors. Read More

Curr Cardiol Rep 2020 Jan 21;22(2). Epub 2020 Jan 21.

Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.

Purpose Of Review: Our review discusses the management of post percutaneous coronary intervention angina (PPCIA) which negatively impacts 20-40% of patients and imposes a high burden on the healthcare system.

Recent Findings: Mechanisms of PPCIA include microvascular dysfunction, distal coronary vasospasm or disease, microembolization, myocardial bridge, coronary artery disease (CAD) progression, and rarely stent thrombosis or in-stent restenosis. Nitrates, beta blockers (BB), calcium channel blockers, and ranolazine are the common medical management options. Read More

G Ital Cardiol (Rome) 2020 Jan;21(1):16-24

Dipartimento di Scienze Biomediche Avanzate, Università degli Studi "Federico II", Napoli.

The presence of myocardial ischemia significantly affects prognosis of patients with coronary artery disease. The fractional flow reserve (FFR) allows interventional cardiologists to evaluate whether an equivocal coronary artery stenosis is associated or not with myocardial ischemia, and therefore deserve to be properly treated. The present article has the purpose to provide the readers with an overview about the role of FFR in the diagnosis and management of coronary artery disease, as well as the potential related controversies. Read More

Cardiovasc Revasc Med 2019 Dec 9. Epub 2019 Dec 9.

Faculty of Medicine, University of Southampton, UK; Coronary Research Group, University Hospital Southampton, Southampton, UK. Electronic address:

Background: Fractional flow reserve measurement based on computed tomography (FFR) is a novel, well validated, non-invasive method for determining the presence and extent of coronary artery disease (CAD) combined with a physiological assessment of vessel-specific ischemia in patients with chest pain. Previous studies indicate that FFR reduces the uptake of invasive angiography that shows no significant CAD, without compromising patient safety. The clinical effectiveness and economic impact of using FFR instead of other tests in the initial evaluation of patients with stable chest pain has not been tested in a randomized trial. Read More

JACC Cardiovasc Interv 2020 Jan;13(1):49-58

Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.

Objectives: The aim of this study was to compare optical coherence tomographic (OCT) guidance and fractional flow reserve (FFR) guidance in patients with angiographically intermediate coronary lesions (AICLs) in a single-center, prospective, 1:1 randomized trial.

Background: FFR and OCT imaging may help both in the assessment of AICLs and in percutaneous coronary intervention optimization.

Methods: Patients with AICLs were randomized to FFR or OCT imaging. Read More

JAMA Cardiol 2020 Jan 8. Epub 2020 Jan 8.

Serviço de Cardiologia, Hospital de Santa Cruz-Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal.

Importance: Approximately one-third of patients considered for coronary revascularization have diabetes, which is a major determinant of clinical outcomes, often influencing the choice of the revascularization strategy. The usefulness of fractional flow reserve (FFR) to guide treatment in this population is understudied and has been questioned.

Objective: To evaluate the usefulness and rate of major adverse cardiovascular events (MACE) of integrating FFR in management decisions for patients with diabetes who undergo coronary angiography. Read More

Am Heart J 2020 03 2;221:48-59. Epub 2019 Dec 2.

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

Microvascular and/or vasospastic anginas are relevant causes of ischemia with no obstructive coronary artery disease (INOCA) in patients after computed tomography coronary angiography (CTCA).

Objectives: Our research has 2 objectives. The first is to undertake a diagnostic study, and the second is to undertake a nested, clinical trial of stratified medicine. Read More

Crit Pathw Cardiol 2020 Mar;19(1):9-13

From the Department of Internal Medicine, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Coronary computed tomography with myocardial perfusion imaging (CCTA-MPI) provides data on coronary anatomy and perfusion and may be useful in the assessment of ischemic coronary artery disease (CAD). Management of angiographically intermediate coronary lesions is challenging, and coronary fractional flow reserve (FFR) evaluation is recommended to assess whether these lesions are functionally significant. Our aim was to evaluate the diagnostic accuracy of CCTA-MPI in patients with stable CAD and at least 1 angiographically intermediate coronary lesion submitted to FFR. Read More

Circ Cardiovasc Interv 2019 12 22;12(12):e008315. Epub 2019 Nov 22.

Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (M.M., I.X., M.O., S.G., M.N.B., E.S.B.).

Background: Management of coronary lesions with fractional flow reserve values in the gray zone (0.75-0.80) remains controversial due to conflicting data on the performance versus deferral of revascularization. Read More

Int J Cardiol 2020 02 6;300:276-281. Epub 2019 Nov 6.

Department of Emergency and Organ Transplantation, University of Bari, Italy; School of Public Health, University of Sydney, Australia; Diaverum Medical Scientific Office, Lund, Sweden.

Background: To determine diagnostic performance of non-invasive tests using invasive fractional flow reserve (FFR) as reference standard for coronary artery disease (CAD).

Methods: Medline, Embase, and citations of articles, guidelines, and reviews for studies were used to compare non-invasive tests with invasive FFR for suspected CAD published through March 2017.

Results: Seventy-seven studies met inclusion criteria. Read More

Kardiol Pol 2019 Dec 13;77(12):1123-1133. Epub 2019 Nov 13.

Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.

The new 2019 European Society of Cardiology guidelines for the diagnosis and management of chronic coronary syndromes emphasize the role of noninvasive functional imaging of myocardial ischemia in diagnosing coronary artery disease to guide decision making regarding revascularization. Cardiac magnetic resonance imaging (CMR) stands out relative to other imaging modalities given its high safety profile, absence of ionizing radiation, and its versatility in encoding various image contrasts. It also allows an assessment of myocardial function, ischemia, and viability as well as permits tissue characterization including detection of edema in a single examination. Read More

J Am Heart Assoc 2019 11 13;8(22):e012618. Epub 2019 Nov 13.

Division of Cardiology Department of Medicine University of Verona Italy.

Background Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation is uncertain. Fractional flow reserve (FFR) has never been clinically validated in aortic stenosis. The study aim was to analyze the clinical outcome of FFR-guided revascularization in patients undergoing transcatheter aortic valve implantation. Read More

Vasc Health Risk Manag 2019 28;15:375-384. Epub 2019 Aug 28.

Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

Background: Survivors of myocardial infarction (MI) are at high risk of new major adverse cardiovascular events (MACE). Coronary flow reserve (CFR) is a strong and independent predictor of MACE. Understanding the prevalence of impaired CFR in this patient group and identifying risk markers for impaired CFR are important steps in the development of personalized and targeted treatment for high-risk individuals with prior MI. Read More

Clin Res Cardiol 2020 Jun 2;109(6):746-754. Epub 2019 Nov 2.

Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.

Objectives: To determine the true prevalence of CAD in AS patients, to detect changes of the hemodynamic significance of coronary lesions following TAVI, to explore to what extent FFR-positive CAD might influence outcome and finally to develop a management algorithm for this patient subset.

Methods: From May 2016 to March 2018, diagnostic coronary angiography was performed in 246 patients before TAVI. In the presence of coronary lesions with a diameter stenosis ≥ 50%, FFR was measured. Read More

Zhong Nan Da Xue Xue Bao Yi Xue Ban 2019 Sep;44(9):1078-1082

Department of Cardiology, Haikou Hospital Affiliated to Xiangya School of Medicine, Central South University, Haikou 570100, China.

The evaluation of coronary artery ischemia is of great significance in the diagnosis and treatment of coronary heart disease. In recent years, fractional flow reserve derived from computed tomographic angiography (FFRct) has been used to evaluate the diagnosis of coronary artery specific ischemia, which enriches the clinical management of patients with coronary artery disease. A number of studies have confirmed that FFRct has reliable diagnostic performance compared with invasive fraction flow reserve (FFR). Read More

Curr Opin Cardiol 2020 Jan;35(1):42-51

Coronary Anomalies Program, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.

Purpose Of Review: To report what is known and unknown regarding coronary anomalies in children, particularly anomalous aortic origin of a coronary artery, efforts undertaken to answer several questions regarding evaluation and management of this challenging young population, and where the future is heading.

Recent Findings: Patients with anomalous aortic origin of a coronary artery (AAOCA) present as an incidental finding at least half of the time, advanced imaging is essential to define anatomic characteristics of this lesion, assessment of myocardial perfusion with stress cardiac magnetic resonance imaging is feasible and contributes to risk stratification, certain patient populations require invasive assessment of coronary flow with measurement of fractional flow reserve, and surgical intervention can be safely performed through long-term data on impact to prevent sudden events is lacking.

Summary: Optimal risk stratification in AAOCA is yet to be defined, though substantial strides are being made with a standardized approach to the evaluation and management of these patients. Read More

Int J Cardiovasc Imaging 2020 Feb 9;36(2):179-185. Epub 2019 Oct 9.

Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.

Paclitaxel-coated balloon (PCB) treatment guided by fractional flow reserve (FFR) is safe and effective for de novo coronary lesions. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR in de novo lesion treatment with PCB. Baseline, post-balloon and 9-month angiographical parameters were obtained from 116 lesions of 104 patients. Read More

J Geriatr Cardiol 2019 Aug;16(8):656-659

Department of Cardiology, the First Medical Center of Chinese PLA General Hospital, Beijing, China.

Med Eng Phys 2019 10;72:38-48

Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.

The aim of this position paper is to provide a brief overview of the current status of cardiovascular modelling and of the processes required and some of the challenges to be addressed to see wider exploitation in both personal health management and clinical practice. In most branches of engineering the concept of the digital twin, informed by extensive and continuous monitoring and coupled with robust data assimilation and simulation techniques, is gaining traction: the Gartner Group listed it as one of the top ten digital trends in 2018. The cardiovascular modelling community is starting to develop a much more systematic approach to the combination of physics, mathematics, control theory, artificial intelligence, machine learning, computer science and advanced engineering methodology, as well as working more closely with the clinical community to better understand and exploit physiological measurements, and indeed to develop jointly better measurement protocols informed by model-based understanding. Read More

J Am Coll Cardiol 2019 09;74(10):1420-1421

Int J Cardiol 2019 10;293:60

Heart Center, Amsterdam UMC, location AMC, Amsterdam, the Netherlands. Electronic address:

Int J Cardiol 2019 10;293:52

Miedzyleski Specialist Hospital in Warsaw, Poland; III Clinic of Internal Disease and Cardiology, Medical University of Warsaw, Poland.

JACC Cardiovasc Imaging 2020 Apr 14;13(4):994-1004. Epub 2019 Aug 14.

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

Objectives: This study was designed to compare head-to-head fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFR) and cardiac magnetic resonance (CMR) stress perfusion imaging for prediction of standard-of-care-guided coronary revascularization in patients with stable chest pain and obstructive coronary artery disease by coronary CTA.

Background: FFR is a novel modality for noninvasive functional testing. The clinical utility of FFR compared to CMR stress perfusion imaging in symptomatic patients with coronary artery disease is unknown. Read More

Eur Heart J 2020 May;41(17):1665-1672

Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.

Aims: Fractional flow reserve (FFR) has never been investigated in patients with reduced ejection fraction and associated coronary artery disease (CAD). We evaluated the impact of FFR on the management strategies of these patients and related outcomes.

Methods And Results: From 2002 to 2010, all consecutive patients with left ventricular ejection fraction (LVEF) ≤50% undergoing coronary angiography with ≥1 intermediate coronary stenosis [diameter stenosis (DS)% 50-70%] treated based on angiography (Angiography-guided group) or according to FFR (FFR-guided group) were screened for inclusion. Read More

J Cardiovasc Med (Hagerstown) 2019 Nov;20(11):762-767

Fondazione IRCCS Policlinico San Matteo, Pavia.

Aims: Although the benefits of percutaneous coronary interventions (PCIs) in patients with stable chronic ischemic heart disease (SIHD) are controversial, a large number of PCIs are currently performed in SIHD patients, frequently after coronary angiography (ad-hoc procedures), without the use of fractional flow reserve (FFR) to identify patients most likely to benefit from PCI.

Methods: Assessment of regional variations in PCI for SIHD performed in Italy in 2017 and correlation of the regional number of PCI per million inhabitants with the use of FFR were performed using the data reported in the registry of the Italian Society of Interventional Cardiology (SICI-GISE) registry for the year 2017.

Results: PCI for SIHD accounted for 44. Read More

J Cardiovasc Comput Tomogr 2019 Sep - Oct;13(5):242-247. Epub 2019 Jul 17.

BHF Centre for Cardiovascular Science, University of Edinburgh, 47 Little France Crescent, Edinburgh, United Kingdom. Electronic address:

Despite decades of research and major innovations in technology, cardiovascular disease remains the leading cause of death globally. Our understanding of major cardiovascular events and their prevention is centred around the atherosclerotic plaque and the processes that ultimately lead to acute plaque rupture. Recent advances in hybrid imaging technology allow the combination of high spatial resolution and anatomical detail with molecular assessments of disease activity. Read More

Radiology 2019 09 23;292(3):597-605. Epub 2019 Jul 23.

From the Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Via C. Parea 4, 20138 Milan, Italy (G.P., A.B., A.D.T., L.F., M.G., G.M., D.A.); Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, England (J.R.W.); Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy (A.I.G.); Duke University School of Medicine, Durham, NC (M.P., L.H.K.); Department of Cardiology, Stanford University School of Medicine, Stanford, Calif (K.N.); Wakayama Medical University, Wakayama, Japan (T.A.); HeartFlow, Redwood City, Calif (C.R.); Department of Cardiology, Aarhus University Hospital, Aarhus Skejby, Denmark (B.L.N.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.B.); William Beaumont Hospital, Royal Oak, Mich (G.L.R., K.C.); Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif (D.B.); Liverpool Heart and Chest Hospital, Liverpool, England (T.F.); and Department of Radiology, University of British Columbia, Vancouver, Canada (J.L.).

Background Coronary artery fractional flow reserve (FFR) derived from CT angiography (FFT) enables functional assessment of coronary stenosis. Prior clinical trials showed 13%-33% of coronary CT angiography studies had insufficient quality for quantitative analysis with FFR Purpose To determine the rejection rate of FFR analysis and to determine factors associated with technically unsuccessful calculation of FFR Materials and Methods Prospectively acquired coronary CT angiography scans submitted as part of the Assessing Diagnostic Value of Noninvasive FFR in Coronary Care (ADVANCE) registry (: NCT02499679) and coronary CT angiography series submitted for clinical analysis were included. The primary outcome was the FFR rejection rate (defined as an inability to perform quantitative analysis with FFR). Read More

G Ital Cardiol (Rome) 2019 Jul-Aug;20(7):417-428

Dipartimento di Imaging Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milano.

The increased number of patients with coronary artery disease (CAD) is of great clinical relevance and involves a large burden of the healthcare system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore, the ideal test would provide the correct diagnosis and actionable information. Read More

J Am Coll Cardiol 2019 07;74(3):362-372

Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address:

About one-half of transcatheter aortic valve replacement (TAVR) candidates have coronary artery disease (CAD), and controversial results have been reported regarding the effect of the presence and severity of CAD on clinical outcomes post-TAVR. In addition to coronary angiography, promising data has been recently reported on both the use of computed tomography angiography and the functional invasive assessment of coronary lesions in the work-up pre-TAVR. While waiting for the results of ongoing randomized trials, percutaneous revascularization of significant coronary lesions has been the routine strategy in TAVR candidates with CAD. Read More

Angiology 2020 Jan 17;71(1):48-55. Epub 2019 Jul 17.

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China.

We searched PubMed, EMBASE, Cochrane Library, and Web of Science for studies using fractional flow reserve (FFR) to determine whether revascularization should be performed or deferred for patients with coronary stenosis and grey zone FFR. Meta-analysis was performed using the generic inverse variance method, and hazard ratios (HR) were synthesized with a random-effects model. Of 2766 records, 7 nonrandomized studies including 2683 patients were selected. Read More

Future Cardiol 2019 09 10;15(5):323-327. Epub 2019 Jul 10.

Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.

Circ Cardiovasc Interv 2019 07 5;12(7):e007813. Epub 2019 Jul 5.

Department of Cardiology, Royal North Shore Hospital, Sydney, Australia (U.K.A., M.R.W., R.B.).

Concurrent coronary artery disease in a vessel remote from a chronic total occlusion (CTO) is common and presents a management dilemma. While the use of adjunctive coronary physiology to guide revascularization is now commonplace in the catheterization laboratory, the presence of a CTO provides a unique and specific situation whereby the physiological assessment is more complex and relies on theoretical assumptions. Broadly, the physiological assessment of a CTO relies on assessing the function and regression of collaterals, the assessment of the microcirculation, the impact of collateral steal as well as assessing the severity of a lesion in the donor vessel (the vessel supplying the majority of collaterals to the CTO). Read More

J Cardiovasc Comput Tomogr 2020 Mar - Apr;14(2):185-194. Epub 2019 Jun 13.

University of Chicago Medical Center, Chicago, IL, USA. Electronic address:

Computed tomography coronary angiography (CTCA) is a widely accepted non-invasive technique for the accurate detection of coronary artery disease (CAD), but comes with a notable limitation stemming from its limited capacity to define the physiologic significance of a given lesion This hampered ability for functional assessment of coronary stenosis may lead to additional testing in an effort to delineate whether ischemia is truly present. An important technique that can overcome this pitfall of CTCA has emerged in the form of stress CT myocardial perfusion (CTP) imaging, which provides the functional assessment necessary, thereby complementing the anatomic information provided by CTCA. The combination of CTCA and CTP permits a single exam to simultaneously detect coronary stenosis and categorize its hemodynamic significance. Read More