cFFR provides diagnostic performance superior to that of Pd/Pa or iFR for predicting FFR. For clinical scenarios or health care systems in which adenosine is contraindicated or prohibitively expensive, cFFR offers a universal technique to simplify invasive coronary physiological assessments. Yet FFR remains the reference standard for diagnostic certainty as even cFFR reached only ∼85% agreement.

Index of microcirculatory resistance, a new index representing microvascular integrity, is a reliable early on-site determinant of myocardial viability and LV recovery after primary stenting for AMI.

This study included patients from 2 consecutive prospective trials at Stanford University Medical Center between 2002 and 2014. The aim of the first study was to evaluate the role of cytomegalovirus in the development of CAV (1 PO1-AI50153). The second study evaluated the role of the angiotensin-converting enzyme inhibitor ramipril in the development of CAV (5 R01 HL093475-02; ClinicalTrials.gov number NCT01078363). Patients were included if they were >18 years old, received their first cardiac transplantation, survived >1 year, and were willing and able to provide informed written consent. All patients underwent a baseline coronary angiogram with measurement of FFR, coronary flow reserve (CFR), and IMR and performance of IVUS of the left anterior descending artery (LAD) within 8 weeks and 1 year after transplantation. The study protocols were approved by the Stanford University Institutional Review Board on Human Subjects Research, and informed consent was obtained from all patients before enrollment. Immunosuppressive RegimenAll patients received standard immunosuppressive therapy, including induction therapy with daclizumab, an anti-interleukin-2 monoclonal antibody, OKT3, or antithymocyte globulin. Corticosteroid therapy Background-The aim of this study is to determine the prognostic value of invasively assessing coronary physiology early after heart transplantation. Methods and Results-Seventy-four cardiac transplant recipients had fractional flow reserve, coronary flow reserve, index of microcirculatory resistance (IMR), and intravascular ultrasound performed down the left anterior descending coronary artery soon after (baseline) and 1 year after heart transplantation. The primary end point was the cumulative survival free of death or retransplantation at a mean follow-up of 4.5±3.5 years. The cumulative event-free survival was significantly lower in patients with a fractional flow reserve <0.90 at baseline (42% versus 79%; P=0.01) or an IMR ≥20 measured 1 year after heart transplantation (39% versus 69%; P=0.03). Patients in whom IMR decreased or did not change from baseline to 1 year had higher event-free survival compared with patients with an increase in IMR (66% versus 36%; P=0.03). Fractional flow reserve <0.90 at baseline (hazard ratio, 0.13; 95% confidence interval, 0.02-0.81; P=0.03), IMR ≥20 at 1 year (hazard ratio, 3.93; 95% confidence interval, 1.08-14.27; P=0.04), and rejection during the first year (hazard ratio, 6.00; 95% confidence interval, 1.56-23.09; P=0.009) were independent predictors of death/retransplantation, whereas intravascular ultrasound parameters were not. Conclusions-Invasive measures of coronary physiology (fractional flow reserve and IMR) determined early after heart transplantation are significant predictors of late death or retransplantation.

When IVUS parameters are used to determine the functional significance of lesions in patients with intermediate coronary artery stenoses, different criteria should be used according to lesion location. In segments or vessels with anatomic variations, IVUS cannot be used for functional assessment of a stenosis. (Comparison of Fractional Flow Reserve and Intravascular Ultrasound; NCT01133015).

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IVUS parameters representing severity and extent of atheromatous plaque correlated with functional significance in LAD lesions with intermediate stenosis.

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