Angiographic severity does not correlate with fractional flow reserve in heavily calcified coronary arteries

Johnson, Paul M.; Madamanchi, Chaitanya; Sharalaya, Zarina; Iqbal, Zahra; Gehi, Anil K.; Kaul, Prashant; Stouffer, George A.

doi:10.1002/ccd.26635

Cited by 9 publications

(10 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In an observational study including 200 patients with intermediate coronary lesion, the correlation between angiographic severity and FFR value decreased as lesion calcification increased (none or mild calcification: R 2 = 0.24; moderate calcification: R 2 = 0.11; severe calcification: R 2 = 0.02). [17] These findings may be associated with decreased coronary artery distensibility due to the presence of coronary artery calcium. There have been several studies which investigated the relationship between defined morphological features from virtual histology-IVUS and FFR, with inconsistent results.…”

Section: Functional Assessment Of Calcified Lesionmentioning

confidence: 99%

The Value of Intracoronary Imaging and Coronary Physiology When Treating Calcified Lesions

et al. 2019

View full text Add to dashboard Cite

Heavily calcified coronary artery lesions hinder the delivery of devices and limit stent expansion, resulting in low procedural success and poor clinical outcomes driven by an increase in restenosis and stent thrombosis. Intracoronary imaging provides a more precise assessment of lesions and is a critical step when deciding whether the lesion needs to be prepared with atherectomy devices. Physiological assessment of lesion significance is an important consideration to avoid unnecessary stenting. This article summarises the current data on the value of intracoronary imaging and functional assessment for coronary calcified lesions and suggests a treatment strategy based on the findings of intracoronary imaging findings.

show abstract

Section: Functional Assessment Of Calcified Lesionmentioning

confidence: 99%

The Value of Intracoronary Imaging and Coronary Physiology When Treating Calcified Lesions

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Während die Spezifität und Sensitivität der FFR-Messung bei nicht oder nur moderat kalzifizierten Koronarien in der FAME-Studie eindrucksvoll bewiesen wurde, haben Vergleiche an Patienten mit schwer kalzifizierten Gefäßen gezeigt, dass bei intermediären Stenosen keine Assoziation zwischen dem angiografischen Schweregrad (gemessen durch quantitative Koronarangiografie, QCA) und der hämodynamischen Signifikanz (gemessen mittels FFR) besteht [8].…”

Section: Kalzifikationenunclassified

Der invasive Ischämienachweis – Fraktionelle Flussreserve (FFR) und Instantaneous Wave Free Ratio (iFR)

Baumanns

Dahl

2017

Nuklearmediziner

View full text Add to dashboard Cite

Zusammenfassung Die Bestimmung der fraktionellen Flussreserve (FFR) unter Bedingungen der maximalen Hyper?mie ? induziert mit Adenosin ? im gemessenen koronaren Versorgungsgebiet ist eine einfache und valide Methode zur h?modynamischen Quantifizierung von Koronarstenosen und damit derzeit der Goldstandard zur Therapie-Entscheidung f?r den invasiv t?tigen Kardiologen. Ein Wert?0,80 stellt eine klare, auch prognostische, Indikation f?r eine Intervention dar. Bei Werten>0,80 sollte, unter prognostischen Aspekten, auf eine Revaskularisation verzichtet werden. Die Evaluation von Stenosen mit der ? Adenosin-freien ? instantaneous wave free ratio (iFR) ist ebenfalls m?glich bei Patienten, die aufgrund von Kontraindikationen kein Adenosin erhalten d?rfen. Aufgrund der geringen diagnostischen Genauigkeit in den aktuellen Studien ist ihr routinem??iger Einsatz zurzeit aber limitiert.

show abstract

“…While numerous studies have shown that there are significant limitations in using angiography to decide hemodynamic significance, this is especially true in heavily calcified coronary arteries. There is a decreasing correlation between FFR and angiographic severity as coronary artery calcium (CAC) increases, and no correlation at all between hemodynamic significance and angiographic severity of a coronary artery lesion in severely calcified arteries 5 . A 2016 study showed that the positive predictive value (PPV) of a lesion with a stenosis of ≥ 70% being hemodynamically significant was 71% in arteries with no or minimal calcification, but only 54% in heavily calcified arteries 5 .…”

Section: Introductionmentioning

confidence: 99%

“…There is a decreasing correlation between FFR and angiographic severity as coronary artery calcium (CAC) increases, and no correlation at all between hemodynamic significance and angiographic severity of a coronary artery lesion in severely calcified arteries 5 . A 2016 study showed that the positive predictive value (PPV) of a lesion with a stenosis of ≥ 70% being hemodynamically significant was 71% in arteries with no or minimal calcification, but only 54% in heavily calcified arteries 5 . CAC is a common finding with clinical factors predisposing to CAC including age, male gender, hypertension, diabetes mellitus, and impaired renal function 6 .…”

Section: Introductionmentioning

confidence: 99%

“…CAC is a common finding with clinical factors predisposing to CAC including age, male gender, hypertension, diabetes mellitus, and impaired renal function 6 . Moderate to severe angiographic coronary artery calcification was observed in one third of patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome and in nearly half of patients with intermediate coronary lesions 5,7,8 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Resting Pd/Pa correlates with fractional flow reserve but not angiographic severity in calcified coronary arteries

Sattler

Moscona

Johnson³

et al. 2020

Cathet Cardio Intervent

Self Cite

View full text Add to dashboard Cite

Objective Study the effect of coronary artery calcium (CAC) on resting coronary physiological indices. Background Prior studies found no correlation between angiographic stenosis and fractional flow reserve (FFR) in heavily calcified arteries. Methods Two hundred consecutive patients undergoing whole‐cycle resting Pd/Pa and FFR evaluation of a single lesion of intermediate severity (40–80%) had CAC quantified based upon radiopacities at the site of the stenosis, where 0 = none or mild calcium, 1 = moderate calcium, and 2 = severe calcium. Results Mean age was 61 ± 11 years and 34% were female. The mean degree of stenosis, FFR, and resting Pd/Pa were 60 ± 12%, 0.83 ± 0.08, and 0.93 ± 0.05, respectively. Resting Pd/Pa correlated with degree of angiographic diameter stenosis (DS) as determined by quantitative coronary angiography (QCA) or visual estimation in arteries with calcium score of 0 or 1, but there was no correlation in severely calcified arteries. The diagnostic accuracy of DS ≥70% by QCA to predict hemodynamic significance was 68% with calcium scores of 0/1, but only 43% with calcium score = 2. Resting Pd/Pa was highly correlated with FFR irrespective of the degree of CAC (R2 = 0.68, p < .001) and the sensitivity of resting Pd/Pa ≤0.91 for predicting an FFR ≤0.80 was 0.67 in arteries with calcium scores of 0 or 1 and 0.69 in arteries with a calcium score of 2. Conclusions There was no correlation between angiographic stenosis and either resting Pd/Pa or FFR in heavily calcified coronary artery lesions.

show abstract

Angiographic severity does not correlate with fractional flow reserve in heavily calcified coronary arteries

Abstract: In patients with heavily calcified coronary lesions, there was no association between angiographic stenosis and hemodynamic significance and FFR is needed to determine hemodynamic significance of intermediate lesions. © 2016 Wiley Periodicals, Inc.

Cited by 9 publications

References 36 publications

The Value of Intracoronary Imaging and Coronary Physiology When Treating Calcified Lesions

The Value of Intracoronary Imaging and Coronary Physiology When Treating Calcified Lesions

Der invasive Ischämienachweis – Fraktionelle Flussreserve (FFR) und Instantaneous Wave Free Ratio (iFR)

Resting Pd/Pa correlates with fractional flow reserve but not angiographic severity in calcified coronary arteries

Contact Info

Product

Resources

About