“…However, on a practical level it must also be considered that the real unmet need is to improve risk-stratification in patients at intermediate risk of adverse events. Patients presenting with high-risk features (multiple comorbidities, haemodynamic instability, complex coronary anatomy) have already “declared” their risk category, whilst it is the majority of “intermediate risk” patients (like the patients included in our analysis) that may benefit the most from personalized and stratified medicine approaches ( 19 ).…”
Aims: Despite the prognostic value of coronary microvascular dysfunction (CMD) in patients with ST-segment-elevation myocardial infarction (STEMI), its assessment with pressure-wire-based methods remains limited due to cost, technical and procedural complexities. The non-hyperaemic angiography-derived index of microcirculatory resistance (NH IMRangio) has been shown to reliably predict microvascular injury in patients with STEMI. We investigated the prognostic potential of NH IMRangio as a pressure-wire and adenosine-free tool.Methods and Results: NH IMRangio was retrospectively derived on the infarct-related artery at completion of primary percutaneous coronary intervention (pPCI) in 262 prospectively recruited STEMI patients. Invasive pressure-wire-based assessment of the index of microcirculatory resistance (IMR) was performed. The combination of all-cause mortality, resuscitated cardiac arrest and new heart failure was the primary endpoint. NH IMRangio showed good diagnostic performance in identifying CMD (IMR > 40U); AUC 0.78 (95%CI: 0.72–0.84, p < 0.0001) with an optimal cut-off at 43U. The primary endpoint occurred in 38 (16%) patients at a median follow-up of 4.2 (2.0–6.5) years. On survival analysis, NH IMRangio > 43U (log-rank test, p < 0.001) was equivalent to an IMR > 40U(log-rank test, p = 0.02) in predicting the primary endpoint (hazard ratio comparison p = 0.91). NH IMRangio > 43U was an independent predictor of the primary endpoint (adjusted HR 2.13, 95% CI: 1.01–4.48, p = 0.047).Conclusion: NH IMRangio is prognostically equivalent to invasively measured IMR and can be a feasible alternative to IMR for risk stratification in patients presenting with STEMI.
“…However, on a practical level it must also be considered that the real unmet need is to improve risk-stratification in patients at intermediate risk of adverse events. Patients presenting with high-risk features (multiple comorbidities, haemodynamic instability, complex coronary anatomy) have already “declared” their risk category, whilst it is the majority of “intermediate risk” patients (like the patients included in our analysis) that may benefit the most from personalized and stratified medicine approaches ( 19 ).…”
Aims: Despite the prognostic value of coronary microvascular dysfunction (CMD) in patients with ST-segment-elevation myocardial infarction (STEMI), its assessment with pressure-wire-based methods remains limited due to cost, technical and procedural complexities. The non-hyperaemic angiography-derived index of microcirculatory resistance (NH IMRangio) has been shown to reliably predict microvascular injury in patients with STEMI. We investigated the prognostic potential of NH IMRangio as a pressure-wire and adenosine-free tool.Methods and Results: NH IMRangio was retrospectively derived on the infarct-related artery at completion of primary percutaneous coronary intervention (pPCI) in 262 prospectively recruited STEMI patients. Invasive pressure-wire-based assessment of the index of microcirculatory resistance (IMR) was performed. The combination of all-cause mortality, resuscitated cardiac arrest and new heart failure was the primary endpoint. NH IMRangio showed good diagnostic performance in identifying CMD (IMR > 40U); AUC 0.78 (95%CI: 0.72–0.84, p < 0.0001) with an optimal cut-off at 43U. The primary endpoint occurred in 38 (16%) patients at a median follow-up of 4.2 (2.0–6.5) years. On survival analysis, NH IMRangio > 43U (log-rank test, p < 0.001) was equivalent to an IMR > 40U(log-rank test, p = 0.02) in predicting the primary endpoint (hazard ratio comparison p = 0.91). NH IMRangio > 43U was an independent predictor of the primary endpoint (adjusted HR 2.13, 95% CI: 1.01–4.48, p = 0.047).Conclusion: NH IMRangio is prognostically equivalent to invasively measured IMR and can be a feasible alternative to IMR for risk stratification in patients presenting with STEMI.
“…Usually, power plants are connected to the electric grid via an inverter, which is used to ensure total control of the energy exchanged between the grid and renewable power plants (Casamali, de Aquino, & e Silva, 2023), (Roselyn et al, 2020). In this light, a suitable power system control is required to ensures full control of the active (P) and reactive (Q) power exchanged with the gird, high quality of the injected power with minimum current THD and maintaining the stability of the grid.…”
Section: Introductionmentioning
confidence: 99%
“…Nonlinear control methods such as adaptive input-output feedback linearization, where an adaptive input-output feedback linearization control is developed to control the active and reactive powers exchange with the grid in (Roselyn et al, 2020). The dead-beat model predictive control based direct power control strategy in order to control a three-phase grid-connected inverter is proposed in (Egea-Alvarez, Junyent-Ferré, & Gomis-Bellmunt, 2012).…”
This article proposes the development of a Hybrid Fractional Order Proportional Integral (HFOPI) controller for decoupled active (P) and reactive (Q) power control to improve grid-connected inverter performances. The proposed controller gains are numerically tuned using the isodamping feature, which is a frequently used frequency method. The system under study is a grid-connected inverter system that contains a DC source, a three-phase inverter connected to the grid through an L filter. The proposed controller HFOPI combines a Variable Gain PI (VGPI) controller work in alternative with a Fractional Order PI (FOPI) controller and a selection algorithm that organize the two controller’s interventions. The performance and robustness of the proposed HFOPI controller is examined and assessed under various scenarios such as suddenly step change in active and reactive power references and compared with the simple structure based on FOPI or PI controller. The simulation is carried out using MATLAB/Simulink. Moreover, the grid-connected inverter test bench is set up in the laboratory. Where, the experimental results are consistent with the simulation and prove that the proposed HFOPI controller provides an important amelioration in term of maximum first overshoot/undershoot, tracking settling time and lower injected current Total Harmonic Distortion (THD) compared to the simple structure based on the PI/FOPI controllers.
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