Coronary artery disease evaluation by coronary angiography and intracoronary imaging compared to Fractional Flow Reserve: anatomical-functional mismatch.

Adjedj, Julien

doi:10.14744/anatoljcardiol.2018.42949

Cited by 6 publications

(7 citation statements)

References 51 publications

(66 reference statements)

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“…Nevertheless, as established by numerous studies, it is well-documented that the relationship between the degree of coronary artery stenosis and myocardial ischemia is intricate and multifaceted. 17 , 18 Results of a study trial by Tonino et al 19 showed that 20% of the coronary arteries with over 70% stenosis had no functional ischemia. Park et al 4 showed that more than half of the coronary arteries with over 50% stenosis had an FFR value above 0.80.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Functional Coronary Artery Ischemia: A Gender-Specific Predictive Model

Li,

2023

RMHP

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Objective The objective of this study was to explore factors that impact functional coronary artery ischemia (FCAI) and develop a gender-specific prognostic model that could serve as a benchmark for predicting FCAI in clinical practice. Methods A cumulative total of 330 patients were enrolled comprising 634 main and branch coronary, consisting of 179 men (359 coronary arteries) and 151 women (275 coronary arteries). Based on the computed tomography-fractional flow reserve (CT-FFR), the coronary arteries of male and female patients were classified into the non-ischemic group (CT-FFR ≥ 0.80) and the ischemic group (CT-FFR < 0.80). We screened for factors related to the CT-FFR values of the coronary arteries in male and female patients and developed corresponding gender-specific models. Results In male patients, the correlation between FCAI and several indicators, including white blood cell (WBC) count, left anterior descending artery (LAD) lesions, pericoronary fat attenuation index (FAI), and the degree of coronary artery stenosis, was found to be statistically significant. A predictive model was developed using these factors, yielding an area under the curve (AUC) value of 0.812, with a P value of < 0.001 and a 95% confidence interval (CI) ranging from 0.767 to 0.857. This model demonstrated superior predictive capability compared to any individual indicators mentioned above. Significant correlations with FCAI were observed in female patients for hemoglobin (Hb), systolic blood pressure (SBP), FAI, and the degree of coronary artery stenosis. The predictive model, derived from these factors, exhibited robust performance with an area under the curve (AUC) value of 0.818, a P value of < 0.001, and a 95% confidence interval (CI) ranging from 0.764 to 0.872. Conclusion Gender disparities exist in the factors affecting FCAI, underscoring the need for a gender-specific predictive model to enhance the precision of FCAI prediction.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Functional Coronary Artery Ischemia: A Gender-Specific Predictive Model

Li,

2023

RMHP

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“…Patients requiring an FFR assessment often have diffuse atherosclerosis other than that at the site with minimal lumen diameter, which progressively decreases coronary pressure 28,29 . Unlike twodimensional angiographic projection images, FFR reflects the totality of the physiological effects of patient characteristics, lesion characteristics, microvascular function, amount of myocardial mass subtended by the coronary artery stenosis, and hyperemia 3,7,11,12,[30][31][32] . Consistent with prior studies 3,12 , non-LAD location and minimal luminal diameter were associated with an anatomical-functional mismatch.…”

Section: Anatomical-functional Mismatch and Overestimation Of Ffr By ...mentioning

confidence: 99%

“…Diameter stenosis (DS) of > 50% on invasive coronary angiography is deemed anatomically significant 1 . Coronary angiography alone, however, has limited ability to differentiate functionally significant lesions 2 – 7 . Pressure wire-derived fractional flow reserve (FFR) has emerged as the gold standard for assessing the functional impact of stenotic lesions, and a vessel with an FFR value ≤ 0.80 is considered to have functionally significant stenosis 2 , 8 – 11 .…”

Section: Introductionmentioning

confidence: 99%

“…It is well known that the anatomical and functional significance of coronary lesions does not always match 2 – 4 . Previous studies have identified clinical and pathophysiological factors associated with anatomically significant but functionally non-significant lesions (anatomical–functional mismatch) 3 – 7 , 12 .…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have identified clinical and pathophysiological factors associated with anatomically significant but functionally non-significant lesions (anatomical-functional mismatch) [3][4][5][6][7]12 .…”

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confidence: 99%

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Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch

Matsumoto

Masaki

Higuchi

et al. 2022

Sci Rep

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Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical–functional mismatch) and its influence on reclassification of functional significance. Distal-to-aortic pressure ratio (Pd/Pa) was measured using adenosine (Pd/PaADN) and papaverine (Pd/PaPAP) in 326 patients (326 vessels). The overestimation of FFR was calculated as Pd/PaADN–Pd/PaPAP. The anatomical–functional mismatch was defined as diameter stenosis > 50% and Pd/PaADN > 0.80. Reclassification was indicated by Pd/PaADN > 0.80 and Pd/PaPAP ≤ 0.80. The mismatch (n = 72) had a greater overestimation of FFR than the non-mismatch (n = 99): median 0.02 (interquartile range 0.01–0.05) versus 0.01 (0.00–0.04), p = 0.014. Multivariable analysis identified the overestimation of FFR (p = 0.003), minimal luminal diameter (p = 0.001), and non-left anterior descending artery (LAD) location (p < 0.001) as determinants of the mismatch. Reclassification was indicated in 29% of the mismatch and was more frequent in the LAD than in the non-LAD (52% vs. 20%, p = 0.005). The overestimation of FFR is an independent determinant of anatomical−functional mismatch. Anatomical−functional mismatch, specifically in the LAD, may suggest a false-negative result.

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Management of Anxiety in Coronary Artery Bypass Grafting Patients: The influence of Chair Aerobics and Nadisodhana Pranayama A Pilot Randomized Clinical Trial

Ashok

GOPALAKRISHNAN

2022

Preprint

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Background Anxiety is a primary concern affecting the prognosis of CABG patients. Relieving anxiety is thus a component of management in patients with CABG. Also, patients with bypass surgery express compromise in exercise tolerance. We use two feasible and cost-effective treatment techniques to know the improvement in symptoms of anxiety and exercise tolerance. Objective To evaluate the efficacy of chair aerobics and pranayama on anxiety in patients who underwent CABG. We hypothesized that there would be an improvement in anxiety in CABG patients after receiving the interventions. Methods In a total of 21 screened, 16 met eligibility requirements. These were randomized into two, group A and group B. Group A is treated with progressive chair aerobics, and group B with nadisodhana pranayama. Both groups were given standardised cardiac rehabilitation techniques. The duration was fifteen minutes of activity along with phase 1 cardiac rehabilitation. The treatment session was given once a day in the morning. The intervention starts from the post-operative day 3 to post-operative day 7. The anxiety is measured by the tool “hospital anxiety and depression scale”. The exercise capacity of the patient was measured by a 6-minute walk test. Heart rate is estimated to know the somatic and physiologic components of anxiety. Took all the outcome measures before the surgery and on post-operative day 7 by a blinded outcome assessor. Results: The results showed that the improvement in the p-value of HADS anxiety, depression, and heart rate of both groups is less than 0.05. The 6-minute walk test showed better improvement in the chair aerobics group with a p-value less than 005. Registration: The trial is prospectively registered in CTRI. The trial registration number is CTRI/2021/09/037008.

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Coronary artery disease evaluation by coronary angiography and intracoronary imaging compared to Fractional Flow Reserve: anatomical-functional mismatch.

Cited by 6 publications

References 51 publications

Factors Influencing Functional Coronary Artery Ischemia: A Gender-Specific Predictive Model

Factors Influencing Functional Coronary Artery Ischemia: A Gender-Specific Predictive Model

Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch

Management of Anxiety in Coronary Artery Bypass Grafting Patients: The influence of Chair Aerobics and Nadisodhana Pranayama A Pilot Randomized Clinical Trial

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