Invasive “in the cath-lab” assessment of myocardial ischemia in patients with coronary artery disease: When does the gold standard not apply?

Benenati, Stefano; Maria, Giovanni Luigi De; Scarsini, Roberto; Porto, Italo

doi:10.1016/j.carrev.2018.01.005

Cited by 25 publications

(37 citation statements)

References 84 publications

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“…It has been demonstrated that acute coronary syndrome, cardiac hypertrophy, and severe aortic stenosis could attenuate the hyperemic response of the microcirculation to adenosine. 16 Accordingly, it is likely the prevalence (and possibly mechanism) of FFR/iFR discordance may be different in these selected populations.…”

Section: Discussionmentioning

confidence: 98%

Physiological Pattern of Disease Assessed by Pressure-Wire Pullback Has an Influence on Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance

Warisawa

Cook

Howard

et al. 2019

Circ: Cardiovascular Interventions

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Section: Discussionmentioning

confidence: 98%

Physiological Pattern of Disease Assessed by Pressure-Wire Pullback Has an Influence on Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance

Warisawa

Cook

Howard

et al. 2019

Circ: Cardiovascular Interventions

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“…However, its cost, availability, vasodilator need [10,61], and poor hemodynamic correlation [50,66] makes its use for physiological assessment meet the current guideline indicators in only 50% of the cases [19]. FFR importance is questioned [66] as well as hyperemia is suggested not to be essential to the correct diagnose [7]. Recent evidences affirm that the use of non-invasive techniques reaching similar results are promising to replace the invasive FFR [7].…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

“…FFR importance is questioned [66] as well as hyperemia is suggested not to be essential to the correct diagnose [7]. Recent evidences affirm that the use of non-invasive techniques reaching similar results are promising to replace the invasive FFR [7].…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

Functional Coronary Artery Assessment: a Systematic Literature Review

Freitas

Nienow

Costa

et al. 2021

Wien Klin Wochenschr

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Cardiovascular diseases represent the number one cause of death in the world, including the most common disorders in the heart's health, namely coronary artery disease (CAD). CAD is mainly caused by fat accumulated in the arteries' internal walls, creating an atherosclerotic plaque that impacts the blood flow functional behavior. Anatomical plaque characteristics are essential but not sufficient for a complete functional assessment of CAD. In fact, plaque analysis and visual inspection alone have proven insufficient to determine the lesion severity and hemodynamic repercussion. Furthermore, the fractional flow reserve (FFR) exam, which is considered the gold standard for stenosis functional impair determination, is invasive and contains several limitations. Such a panorama evidences the need for new techniques applied to image exams to improve CAD functional assessment. In this article, we perform a systematic literature review on emerging methods determining CAD significance, thus delivering a unique base for comparing these methods, qualitatively and quantitatively. Our goal is to guide further studies with evidence from the most promising methods, highlighting the benefits from both areas. We summarize benchmarks,

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“…The accuracy of FFR relies on the achievement of maximal hyperemia, which is normally obtained in the catheterization laboratory with the intravenous or intracoronary administration of vasodilatatory agents, such as adenosine. The complex interplay between the stenotic valve, elevated left ventricular end-diastolic pressure, left ventricular hypertrophy and the associated negative remodelling of the coronary microcirculation may blunt the response to adenosine and the achievement of maximal hyperaemia [25][26][27][28][29]. These factors may theoretically reduce the reliability of FFR in AS, causing a possible underestimation of the true ischemic significance of a given coronary obstruction.…”

Section: Invasive Physiological Assessmentmentioning

confidence: 99%

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

Marin

Scarsini

Kotronias

et al. 2021

JCM

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Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve stenosis and subsequent impact on blood flow. The prognostic role of CAD in patients undergoing TAVI is being still debated and the benefits and the best timing of PCI in this context are currently under evaluation. Additionally, PCI in the setting of advanced AS poses some technical challenges, due to the complex anatomy, risk of hemodynamic instability, and the increased risk of bleeding complications. This review aims to provide a comprehensive synthesis of the available literature on myocardial revascularization in patients with severe AS undergoing TAVI. This work can assist the Heart Team in individualizing decisions about myocardial revascularization, taking into account available diagnostic tools as well as the risks and benefits.

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Invasive “in the cath-lab” assessment of myocardial ischemia in patients with coronary artery disease: When does the gold standard not apply?

Cited by 25 publications

References 84 publications

Physiological Pattern of Disease Assessed by Pressure-Wire Pullback Has an Influence on Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance

Physiological Pattern of Disease Assessed by Pressure-Wire Pullback Has an Influence on Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance

Functional Coronary Artery Assessment: a Systematic Literature Review

Aortic Valve Disease and Associated Complex CAD: The Interventional Approach

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