Effective Radiation Dose, Time, and Contrast Medium to Measure Fractional Flow Reserve

Ntalianis, Argyrios; Trana, Catalina; Müller, Olivier; Mangiacapra, Fabio; Peace, Aaron; Backer, Carina De; Block, Liesbeth de; Wyffels, Eric; Bartúnek, Jozef; Vanderheyden, Marc; Heyse, Alex; Durme, Frederic Van; Driessche, Luc Van; Jans, Jo De; Heyndrickx, Guy R.; Wijns, William; Barbato, Emanuele; Bruyne, Bernard De

doi:10.1016/j.jcin.2010.06.006

Cited by 44 publications

(23 citation statements)

References 20 publications

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“…Of these 83 patients, 66 underwent PCI before the CMR. Of the 21 by guest on May 9, 2018 http://circinterventions.ahajournals.org/ Downloaded from patients studied before coronary angiography, 8 patients underwent PCI and 1 patient went on to have coronary artery bypass graft. The mean time interval between the CMR and FFR for this group was 6.6±3.7 days.…”

Section: Resultsmentioning

confidence: 99%

“…13 In some patients with NSTEMI, the natural history may involve intermittent coronary occlusion (eg, because of vasopasm and thrombus burden), but typically, the occlusion is transient. Furthermore, microvascular injury may also be transient such that initial measurements of FFR may be artificially elevated, but after stabilization of the coronary microcirculation, FFR reflects the true hemodynamic effect by guest on May 9, 2018 http://circinterventions.ahajournals.org/ Downloaded from FFR vs MRI in NSTEMI of the coronary stenosis. In our study, FFR was restricted by protocol to coronary arteries with normal flow, and in the case of chronic total occlusions or severely obstructed arteries, an FFR value of 0.5 was assigned.…”

Section: Culprit Arteriesmentioning

confidence: 99%

“…Potvin et al 9 demonstrated that in 201 unselected patients presenting to the catheter laboratory, the use of an FFR threshold of ≤0.75 was safe to allow deferral of stenting. However, only 21% of patients had a recent STEMI/NSTEMI, and the use of FFR was not by guest on May 9, 2018 http://circinterventions.ahajournals.org/ Downloaded from FFR vs MRI in NSTEMI randomized or blinded. Thus, although helpful, these studies were in relatively stable patients and not powered to detect any effect of FFR-guided management on health outcomes or to determine the clinical utility of FFR or optimal cutoff in patients with ACS.…”

Section: Current Evidence For Benefit Of Ffr In Acsmentioning

confidence: 99%

“…They demonstrated no difference in outcome between patients who had revascularization deferred on the basis of FFR compared with those who underwent angiographically guided revascularization. In addition, Ntalianis et al 27 evaluated the assessment of nonculprit stenoses in 26 patients with an acute NSTEMI (within 72 hours) and 126 patients with STEMI and showed that FFR values in the nonculprit vessel were unchanged when measured again ≈5 weeks later. Thus, the use of FFR to evaluate nonculprit stenoses has been shown to be reasonably accurate and reproducible in different NSTEMI populations, including from this analysis also.…”

Section: Current Evidence For Benefit Of Ffr In Acsmentioning

confidence: 99%

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Assessment of Fractional Flow Reserve in Patients With Recent Non–ST-Segment–Elevation Myocardial Infarction

Layland

Rauhalammi

Watkins

et al. 2015

Circ: Cardiovascular Interventions

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F ractional flow reserve (FFR) has an established role in guiding percutaneous coronary intervention (PCI) in stable coronary artery disease (CAD). In this setting, the use of FFR has been associated with improved long-term outcomes and reduced healthcare costs compared with angiographic-based strategies.1 Rates of urgent revascularization are reduced whenBackground-The use of fractional flow reserve (FFR) in acute coronary syndromes is controversial. The British Heart Foundation Fractional Flow Reserve Versus Angiography in Guiding Management to Optimize Outcomes in Non-STElevation Myocardial Infarction (FAMOUS-NSTEMI) study (NCT01764334) has recently demonstrated the safety and feasibility of FFR measurement in patients with non-ST-segment-elevation myocardial infarction. We report the findings of the cardiac magnetic resonance (CMR) substudy to assess the diagnostic accuracy of FFR compared with 3.0-T stress CMR perfusion. Methods and Results-One hundred six patients with non-ST-segment-elevation myocardial infarction who had been referred for early invasive management were included from 2 centers. FFR was measured in all major patent epicardial coronary arteries with a visual stenosis estimated at ≥30%, and if percutaneous coronary intervention was performed, an FFR assessment was repeated. Myocardial perfusion was assessed with stress perfusion CMR at 3 T. The mean age was 56.7±9.8 years; 82.6% were men. Mean time from FFR evaluation to CMR was 6.1±3.1 days. The mean±SD left ventricular ejection fraction was 58.2±9.1%. Mean infarct size was 5.4±7.1%, and mean troponin concentration was 5.2±9.2 μg/L. There were 34 fixed and 160 inducible perfusion defects. There was a negative correlation between the number of segments with a perfusion abnormality and FFR (r=−0.77; P<0.0001). The overall sensitivity, specificity, positive predictive value, and negative predictive value for an FFR of ≤0.8 were 91.4%, 92.2%, 76%, and 97%, respectively. Diagnostic accuracy was 92%. The positive and negative predictive values of FFR for flow-limiting coronary artery disease (FFR≤0.8) in patients with non-ST-segment-elevation myocardial infarction (n=21) who underwent perfusion CMR before invasive angiography were 92% and 93%, respectively. Receiver operating characteristic analysis indicated that the optimal cutoff value of FFR for demonstrating reversible ischemia on CMR was ≤0.805 (area under the receiver operating characteristic curve, 0.94 [0.9-0.99]; P<0.0001). Conclusions-FFR in patients with recent non-ST-segment-elevation myocardial infarction showed high concordance with myocardial perfusion in matched territories as revealed by 3.0-T stress perfusion CMR. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422.

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Section: Resultsmentioning

confidence: 99%

Section: Culprit Arteriesmentioning

confidence: 99%

Section: Current Evidence For Benefit Of Ffr In Acsmentioning

confidence: 99%

Section: Current Evidence For Benefit Of Ffr In Acsmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of Fractional Flow Reserve in Patients With Recent Non–ST-Segment–Elevation Myocardial Infarction

Layland

Rauhalammi

Watkins

et al. 2015

Circ: Cardiovascular Interventions

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“…As an alternative, hemodynamically significant stenoses can be easily identified by applying pressure-derived fractional flow reserve measurements at the end of the initial invasive procedure. 3 For measuring up to 3 additional stenoses, the fractional flow reserve approach requires the use of an additional 50 mL contrast, prolongs the catheterization by 9 minutes, and adds 4 mSv of patient exposure (one third of the exposure required for a nuclear stress test). Most important, the team will be encouraged to develop strategies that reduce bleeding complications and the domino effects that are associated with such complications in terms of worsening outcomes but also increased radiation exposure.…”

Section: Moving Forwardmentioning

confidence: 99%