Background: Little large-scale data is available about the long-term (beyond 3 years) clinical outcomes after fractional flow reserve (FFR)–based deferral of revascularization in clinical practice. We sought to assess the 5-year outcomes after deferral of revascularization based on FFR. Methods: The J-CONFIRM registry (Long-Term Outcomes of Japanese Patients With Deferral of Coronary Intervention Based on Fractional Flow Reserve in Multicenter Registry) prospectively enrolled 1263 patients with 1447 lesions in whom revascularization was deferred based on FFR from 28 Japanese centers. The primary study end point was the cumulative 5-year incidence of target vessel failure (TVF), including cardiac death, target vessel–related myocardial infarction, and clinically driven target vessel revascularization. Results: Five-year follow-up was completed in 92.2% of patients. The 5-year TVF rate was 11.6% in deferred lesions, mainly driven by clinically driven target vessel revascularization (9.8%). Cardiac death and target vessel–related myocardial infarction were 1.9% and 0.95%, respectively. Cumulative 5-year incidence of TVF was similar between the FFR 0.75 to 0.80 and 0.81 to 0.85 groups even after adjustment for baseline characteristics (12.2% versus 13.0%, inverse probability–weighted hazard ratio, 0.86 [95% CI, 0.46–1.60]; P =0.63). Compared with the almost normal FFR (0.86–1.00) group, the significant (<0.75) and borderline (0.75–0.85) FFR groups showed a higher incidence of TVF at 5 years (29.9% versus 12.8% versus 8.6%, P <0.001). Independent predictors of the 5-year TVF were hemodialysis, FFR value, left main coronary artery lesion, prior percutaneous coronary intervention, and male sex. Conclusions: The 5-year TVF rate was 11.6% in deferred lesions, mainly driven by clinically driven target vessel revascularization. Notably, cardiac death and target vessel–related myocardial infarction rarely occurred during the follow-up. Our findings highlight the long-term safety of FFR-based deferral of revascularization in patients with chronic coronary syndrome. REGISTRATION: URL: https://www.umin.ac.jp/ctr ; Unique identifier: UMIN000014473.

B-type natriuretic peptide (Bnp) secretion is stimulated by cardiac dysfunction. However, it is unclear how finely myocardial ischaemia contributes to BNP secretion and whether increases in BNP secretion contribute to coronary vasodilation. this study investigated the direct interaction between plasma Bnp levels and cardiac ischaemia using the baseline distal-to-aortic pressure ratio (pd/pa). We examined the baseline Pd/Pa and fractional flow reserve (FFR) in 167 patients with intermediate coronary stenosis. the plasma Bnp level appeared to be associated with the baseline pd/pa in the study population, and this association appeared to become clear only in patients with an ffR ≤ 0.80. To examine the effect of the baseline pd/pa on the Bnp level in these patients, structural equation modeling (SeM) was performed. The baseline Pd/Pa significantly affected the BNP level (β: −0.37, p = 0.003) and the left ventricular ejection fraction (β: 0.43, p = 0.001). To examine the role of BNP in coronary vasodilation, we proposed another path model using a novel value obtained by dividing the ffR by the baseline pd/ Pa (FFR/baseline Pd/Pa) as an index of the hyperaemic response. The BNP level significantly affected the ffR/baseline pd/pa (β: 0.48, p = 0.037). This study demonstrated that BNP finely responded to an exacerbation of cardiac ischaemia and that increases in BNP secretion effectively ameliorated coronary vasoconstriction.B-type natriuretic peptide (BNP) is secreted mainly by the ventricles in heart failure, whereas normal atria secrete A-type natriuretic peptide (ANP) as well as BNP 1-5 . ANP and BNP have a wide range of biological effects; for instance, they induce vasodilation and natriuresis and inhibit the renin-angiotensin aldosterone system (RAAS) and the sympathetic nervous system 6,7 . Plasma BNP is elevated in heart failure caused by various heart diseases, including ischaemic heart disease (IHD) 8-10 .Previous reports have shown that myocardial hypoxia associated with a reduction in coronary blood flow increases cardiac BNP expression 11 . Moreover, the BNP level is elevated during early ischaemia, and an elevated BNP level is a significant risk factor for poor short-term and long-term prognoses 12 . Increases in the plasma BNP level are considered a compensatory response of the heart to ischaemia, because several reports have shown that BNP has a vasodilatory effect on the coronary artery system in humans 13,14 . However, it is still unclear how finely myocardial ischaemia itself contributes to BNP secretion and whether increases in BNP secretion actually induce vasodilation as a counter-adaptation. A precise analysis of the relationship between cardiac ischaemia and BNP secretion is the remaining action assignment.Coronary artery pressure wires are widely used in the clinic to assess the degree of coronary stenosis-induced myocardial ischaemia 15,16 . Pressure wires can be used to measure the fractional flow reserve (FFR), which requires the induction of maximal hyperaemia by drug administration, and the ...

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Background: Pulmonary vein (PV) stenosis after atrial fibrillation (AF) ablation is rare; however, it remains a serious complication. PV angioplasty is reportedly an effective therapy; however, a dedicated device for PV angioplasty has not been developed, and the detailed procedural methods remain undetermined. This study describes the symptoms, indications, treatment strategies, and long-term outcomes for PV stenosis after AF ablation. Methods and Results:This study retrospectively analyzed 7 patients with PV stenosis after catheter ablation for AF and who had undergone PV angioplasty at our hospital during 2015-2021. PV stenosis occurred in the left superior (5 patients) and left inferior (2 patients) PV. Six patients had hemoptysis, chest pain, and dyspnea. Seven de novo lesions were treated using balloon angioplasty (BA) (3 patients), a bare metal stent (BMS) (3 patients), and a drug-coated balloon (DCB) (1 patient). The restenosis rate was 42.9% (n=3; 2 patients in the BA group and 1 patient in the DCB group). The repeat treatment rate was 28.6% (2 patients in the BA group). Stenting was performed as repeat treatment. One patient with subsequent repeat restenosis development underwent BA. Ten PV angioplasties were performed; there were no major complications. Conclusions:Regarding PV angioplasty after ablation therapy for AF, stenting showed superior long-term PV patency than BA alone; therefore, it should be considered as a standard first-line approach.

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