Evolving Routine Standards in Invasive Hemodynamic Assessment of Coronary Stenosis

Tebaldi, Matteo; Biscaglia, Simone; Fineschi, Massimo; Musumeci, Giuseppe; Marchese, Alfredo; Leone, Antonio Maria; Rossi, Marco; Stefanini, Giulio G.; Maione, AntonGiulio; Menozzi, Alberto; Tarantino, Fabio; Lodolini, Veronica; Gallo, Francesco; Barbato, Emanuele; Tarantini, Giuseppe; Campo, Gianluca

doi:10.1016/j.jcin.2018.04.037

Cited by 88 publications

(61 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some of the alleged causes for low adoption of FFR such as side effects, increased procedure time, and costs associated with use of hyperemia‐inducing agents were addressed by the arrival of instantaneous wave‐free ratio (iFR) to clinical practice . It is anticipated that the confidence in visual assessment, costs of pressure guidewires, and the inherent risks of intracoronary instrumentation will remain obstacles for a universal use of iFR and future pressure wire based nonhyperemic indices . Computer tomography‐based FFR (CT‐FFR) calculation has demonstrated its value as a wire‐free alternative of functional stenosis evaluation in selected patients, but its widespread use is hampered by limited availability of this technique and the inability to perform ad hoc measurements in the catheterization laboratory …”

Section: Introductionmentioning

confidence: 99%

“…4,5 It is anticipated that the confidence in visual assessment, costs of pressure guidewires, and the inherent risks of intracoronary instrumentation will remain obstacles for a universal use of iFR and future pressure wire based nonhyperemic indices. 6 Computer tomography-based FFR (CT-FFR) calculation has demonstrated its value as a wire-free alternative of functional stenosis evaluation in selected patients, but its widespread use is hampered by limited availability of this technique and the inability to perform ad hoc measurements in the catheterization laboratory. 7,8 To improve access to functional lesion evaluation during invasive coronary angiography, quantitative flow ratio (QFR) based on threedimensional reconstruction of coronary arteries and application of mathematical equations was recently developed.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Westra

Campo

et al. 2019

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Objectives We aimed to provide robust performance estimates for quantitative flow ratio (QFR) in assessment of intermediary coronary lesions. Background Angiography‐based functional lesion assessment by QFR may appear as a cost saving and safe approach to expand the use of physiology‐guided percutaneous coronary interventions. QFR was proven feasible and showed good diagnostic performance in mid‐sized off‐line and on‐line studies with fractional flow reserve (FFR) as reference standard. Methods We performed a collaborative individual patient‐data meta‐analysis of all available prospective studies with paired assessment of QFR and FFR using the CE‐marked QFR application. The main outcome was agreement of QFR and FFR using a two‐step analysis strategy with a multilevel mixed model accounting for study and center level variation. Results Of 16 studies identified, four studies had prospective enrollment and provided patient level data reaching a total of 819 patients and 969 vessels with paired FFR and QFR: FAVOR Pilot (n = 73); WIFI II (n = 170); FAVOR II China (n = 304) and FAVOR II Europe‐Japan (n = 272). We found an overall agreement (mean difference 0.009 ± 0.068, I2 = 39.6) of QFR with FFR. The diagnostic performance was sensitivity 84% (95%CI: 77–90, I2 = 70.1), specificity 88% (95%CI: 84–91, I2 = 60.1); positive predictive value 80% (95%CI: 76–85, I2 = 33.4), and negative predictive value 95% (95%CI: 93–96, I2 = 75.9). Conclusions Diagnostic performance of QFR was good with FFR as reference in this meta‐analysis of high quality studies. QFR could provide an easy, safe, and cost‐effective solution for functional evaluation of coronary artery stenosis.

show abstract

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Westra

Campo

et al. 2019

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

show abstract

“…A recent study assessing coronary artery height variations using CT coronary angiograms has been conducted recently in a group composed predominantly of transcutaneous aortic valve implantation (TAVI) patients [5]. Hydrostatic pressure effects were then confirmed using an in vitro model.…”

Section: Discussionmentioning

confidence: 99%

“…Despite strong evidence for its use, FFR remains underutilized [5]. Avoiding confounding factors when using pressure-based indices is crucial in accurate stenosis assessment.…”

Section: Introductionmentioning

confidence: 99%

Coronary artery height differences and their effect on fractional flow reserve

et al. 2021

View full text Add to dashboard Cite

Background: Fractional flow reserve (FFR) uses pressure-based measurements to assess the severity of a coronary stenosis. Distal pressure (Pd) is often at a different vertical height to that of the proximal pressure (Pa). The difference in pressure between Pd and Pa due to hydrostatic pressure, may impact FFR calculation. Methods: One hundred computed tomography coronary angiographies were used to measure height differences between the coronary ostia and points in the coronary tree. Mean heights were used to calculate the hydrostatic pressure effect in each artery, using a correction factor of 0.8 2 mmHg/cm. This was tested in a simulation of intermediate coronary stenosis to give the "corrected FFR" (cFFR) and percentage of values, which crossed a threshold of 0.8. Results: The mean height from coronary ostium to distal left anterior descending (LAD) was +5.26 cm, distal circumflex (Cx)-3.35 cm, distal right coronary artery-posterior left ventricular artery (RCA-PLV)-5.74 cm and distal RCA-posterior descending artery (PDA) +1.83 cm. For LAD, correction resulted in a mean change in FFR of +0.042,-0.027 in the Cx,-0.046 in the PLV and +0.015 in the PDA. Using 200 random FFR values between 0.75 and 0.85, the resulting cFFR crossed the clinical treatment threshold of 0.8 in 43% of LAD, 27% of Cx, 47% of PLV and 15% of PDA cases. Conclusions: There are significant vertical height differences between the distal artery (Pd) and its point of normalization (Pa). This is likely to have a modest effect on FFR calculation and the results in values crossing the treatment threshold. Operators should be mindful of this phenomenon when interpreting FFR values.

show abstract

“…Although it is not an imaging modality, the physiological assessment of coronary artery disease, such as fractional flow reserve (FFR), has become one of the primary procedures to evaluate the necessity of coronary intervention [56]. In brief, it quantifies the pressure difference between the proximal and distal segments of the diseased artery in the conditions of drug-induced hyperaemia, and thus assesses the severity of the flow obstruction in the artery.…”

Section: Fractional Flow Reservementioning

confidence: 99%

The role of optical coherence tomography and other intravascular imaging modalities in cardiac allograft vasculopathy

Dyrbuś

Gąsior

Szyguła‐Jurkiewicz

et al. 2020

pwki

View full text Add to dashboard Cite

Orthotopic heart transplantation (OHT) is the standard-of-care for end-stage heart disease. Although a significant improvement in the prognosis of patients after OHT has been observed in recent years, their overall mortality remains relatively high, with a median survival of approximately 10 years after transplantation. One of the primary causes of death in patients after OHT is cardiac allograft vasculopathy (CAV), the condition developing specifically in the coronary vasculature after OHT, the pathophysiology of which is still inadequately known. It is estimated that CAV development and progression is responsible for approximately 30% of deaths within five years post-OHT. According to the International Society for Heart and Lung Transplantation (ISHLT) Nomenclature for CAV, its presence should be assessed primarily by the coronary angiography performed routinely after OHT, mostly due to its wide availability, reproducibility, and low complication rate. However, the analysis of CAV in coronary angiography has limitations, mostly concerning its-sometimes inadequate-sensitivity and specificity. Hence, there is a growing need for the introduction of more accurate methods of CAV assessment, such as intravascular imaging, which through a thorough evaluation of the arterial wall structure and thickness allows the drawbacks of routine angiography to be minimised. The aim of the article was to critically summarise the current findings derived from the analysis of CAV by optical coherence tomography, the other intravascular imaging modalities, such as intravascular ultrasound (IVUS) and IVUS-derived virtual histology, along with physiological assessment with the use of the fractional flow reserve.

show abstract

Evolving Routine Standards in Invasive Hemodynamic Assessment of Coronary Stenosis

Cited by 88 publications

References 19 publications

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Coronary artery height differences and their effect on fractional flow reserve

The role of optical coherence tomography and other intravascular imaging modalities in cardiac allograft vasculopathy

Contact Info

Product

Resources

About