FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy.

Measurements of distal CFR after PTCA, in combination with DS%, have a predictive value, albeit modest for the short- and long-term outcomes after PTCA, and thus may be used to identify patients who will or will not benefit from additional therapy such as stent implantation.

Palmaz-Schatz stent implantation after successful balloon PTCA of chronic total occlusions improves the midterm angiographic and clinical outcome and could be the preferred treatment option in selected patients with occluded vessels.

Background: Conflicting data exist on the relation between the synchronism of cardiac contraction and ventricular function. Aim and methods: A resting radionuclide ventriculography (RNV) was performed in 380 consecutive patients to evaluate the relationship between the synchronism of cardiac contraction and ventricular function. Results: A significant, non-linear, relation was found between LVEF and intra-ventricular asynchrony or QRS, but not between interventricular asynchrony and LVEF. A linear correlation was observed between QRS and intra-ventricular or inter-ventricular asynchrony. Intra-ventricular asynchrony was identified as the major, independent, determinant of LV function. With the increase in QRS duration, a decrease in LVEF ( p b 0.001), and a worsening of either intra-ventricular ( p b 0.001) or inter-ventricular synchronism ( p b 0.05), was documented. However, 48% of patients with QRS 120-150 ms had abnormal inter-ventricular and 42% abnormal intra-ventricular synchronism, while 27% of patients with QRS N 150 ms had normal inter-ventricular and 25% normal intra-ventricular synchronism. Conclusions: Intra-ventricular asynchrony was identified as the major determinant of ventricular dysfunction. A consistent proportion of patients had asynchrony despite preserved QRS duration or normal synchronism with a QRS N 150 ms. Fourier phase analysis of RNV may detect asynchrony better than QRS. The role of RNV for detection of individual patients who may most benefit from resynchronization therapy requires additional investigations.

Background-Distal coronary flow velocity reserve (CVR) is significantly improved after a successful balloon angioplasty (PTCA). Furthermore, a postinterventional CVR Ͼ2.5 and a percent diameter stenosis (%DS) Յ35% are predictive for a low incidence of major adverse cardiac events (MACE) at 6 months of 16%. Similar results are lacking for coronary stenting. Methods and Results-In 150 patients, baseline and hyperemic coronary flow velocities were recorded with a Doppler guidewire distal to the target lesion and in an unobstructed reference artery before and after PTCA, after stenting, and at 6 months. Distal CVR and relative CVR (CVR rel ) were calculated. Logistic regression and receiver operating characteristic analyses were applied to determine prognostic cutoff values of CVR, CVR rel , %DS, and minimal lumen diameter separately and in combination to predict MACE at 6 months. After stenting, CVR (2.96Ϯ0.87 versus 2.40Ϯ0.7; Pϭ0.001), CVR rel (1.02Ϯ0.24 versus 0.81Ϯ0.24; Pϭ0.001), and minimal lumen diameter (2.98Ϯ0.56 versus 2.11Ϯ0.74 mm; Pϭ0.001) were significantly higher than after PTCA. Thirty-three patients developed MACE. A postinterventional CVR rel Ͼ0.88 was the best single predictor of MACE, with an incidence of 6.8%, whereas the combination of a CVR rel Ͼ0.88 and a %DS Յ11.2% predicted an incidence of MACE of 1.5%. Conclusions-Measurement of CVR rel and %DS after stent implantation are best suitable to predict MACE at 6 months.