Coronary artery disease (CAD) is currently the leading cause of death globally, and the prevalence of this disease is growing more rapidly in the Asia-Pacific region than in Western countries. Although the use of metal coronary stents has rapidly increased thanks to the advancement of safety and efficacy of newer generation drug eluting stent (DES), patients are still negatively affected by some the inherent limitations of this type of treatment, such as stent thrombosis or restenosis, including neoatherosclerosis, and the obligatory use of dual antiplatelet therapy (DAPT) with unknown optimal duration. Drug-coated balloon (DCB) treatment is based on a leave-nothing-behind concept and therefore it is not limited by stent thrombosis and long-term DAPT; it directly delivers an anti-proliferative drug which is coated on a balloon after improving coronary blood flow. At present, DCB treatment is recommended as the first-line treatment option in metal stent-related restenosis linked to DES and bare metal stent. For de novo coronary lesions, the application of DCB treatment is extended further, for conditions such as small vessel disease, bifurcation lesions, and chronic total occlusion lesions, and others. Recently, several reports have suggested that fractional flow reserve guided DCB application was safe for larger coronary artery lesions and showed good long-term outcomes. Therefore, the aim of these recommendations of the consensus group was to provide adequate guidelines for patients with CAD based on objective evidence, and to extend the application of DCB to a wider variety of coronary diseases and guide their most effective and correct use in actual clinical practice.
ASD sizing by MRI using bFFE and phase-contrast protocols correlated well with TEE estimations. PC-MRI provided additional information on ASD shapes and proximity to adjacent structures.
SummaryST-elevation myocardial infarction (STEMI) in situs inversus dextrocardia is a rare combination and poses many challenges in terms of diagnosis and management. These include the early detection of dextrocardia as well as the interpretation of the ECG. In addition, percutaneous coronary intervention could be challenging in the setting of dextrocardia because of diffi culty in cannulating the coronary arteries, selection of catheters, catheter manipulation, image acquisition and interpretation.
Background and Objectives: The aims of this study were (1) to examine the diagnostic accuracy of resting time-averaged distal coronary pressure (Pd) to mean aortic pressure (Pa) ratio to predict hyperemic fractional flow reserve (FFR) and (2) to identify a resting Pd/Pa value that can preclude the need for hyperemic FFR assessed with use of a monorail pressure catheter.
Methods: A total of 191 stenoses were assessed. After exclusions, 157 FFR data sets from 103 patients were analyzed.
Results: Resting Pd/Pa showed poor agreement with hyperemic FFR (r=0.619, P<0.001). The receiver operating characteristic curve for resting Pd/Pa with reference to hyperemic FFR of 0.80 or less showed an area under the curve of 0.800 (95% confidence interval 0.732–0.868, P<0.001), with the greatest diagnostic accuracy of 74.5% for resting Pd/Pa of less than 0.85. Resting Pd/Pa of 0.96 or greater had a sensitivity of 100% and a negative predictive value of 100%, and resting Pd/Pa of 0.82 or less had a specificity of 98.9% and a positive predictive value of 94.1% to predict abnormal FFR of 0.80 or less. These results were consistent regardless of the vessels studied, the location of lesions, and the severity of stenosis.
Conclusions: Resting Pd/Pa showed poor agreement with hyperemic FFR assessed with use of a monorail pressure microcatheter. However, resting Pd/Pa of 0.96 or greater had excellent sensitivity and negative predictive value to predict normal hyperemic FFR, and resting Pd/Pa of 0.82 or less had excellent specificity and positive predictive value to predict abnormal hyperemic FFR.
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