Comparison of resting and adenosine-free pressure indices with adenosine-induced hyperemic fractional flow reserve in intermediate coronary lesions

Raja, Deep Chandh; Subban, Vijayakumar; Mathew, Rony; Abdullakutty, Jabir; Joseph, Jo; George, Jimmy; Chandra, Subash; Livingston, Nandhini; Nair, Shyam G.; Janakiraman, Ezhilan; Kalidoss, Latchumanadhas; Mullasari, Ajit S.

doi:10.1016/j.ihj.2018.11.016

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Por esse motivo, utilizaram-se figuras autoexplicativas e pouca descrição textual, buscando-se ilustrações sobre manifestações clínicas e sinais de deterioração precoce da condição clínica, a fim de que o leitor se identifique com elas e possa utilizá-las para mostrar aos cuidadores e profissionais da saúde como tem se sentido (Navidian, et al, 2015;Wingham, et al, 2015;Kessing, et al, 2014;Liu, et al, 2014;Wu, et al, 2017;Li & Shun, 2016;Chang, et al, 2017;Motal, Pimenta & Fitch, 2009). Além disso, a maioria dos pacientes também pode apresentar comprometimento cognitivo, cuja possível causa é a hipoperfusão cerebral (Raja, et al, 2019). Sendo assim, optou-se por priorizar ilustrações e linguagem simples e clara, que fossem de fácil compreensão.…”

Section: Resultsunclassified

Construção de tecnologia educativa digital para o autocuidado em insuficiência cardíaca

Xavier

Figueiredo

Canuso

2020

RSD

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O objetivo do estudo foi construir uma tecnologia educativa digital para orientar o autocuidado a pacientes portadores de insuficiência cardíaca e seus cuidadores. Para tanto, a metodologia compõe-se de duas etapas: 1) Revisão Integrativa de Literatura; 2) Elaboração da tecnologia educativa a partir do instrumento denominado “Plain-Language Checklist for Creating and Reviewing Your Materials/2013”. Como resultado da Revisão destacaram-se as seguintes categorias: o próprio autocuidado como dificultador, o impacto de cuidadores na qualidade de vida, coping/enfrentamento focado, letramento, transtornos de humor, fadiga e dispneia. Estratégias e orientações para enfrentar essas dificuldades foram incluídas na tecnologia criada, a qual resultou em 41 páginas. Por fim, conclui-se que portadores de insuficiência cardíaca e seus cuidadores necessitam de informações sobre a patologia, uma vez que isso pode aumentar a qualidade de vida, diminuir quadros de exacerbação e reospitalizações. Na vigência da pandemia por Corona vírus, acredita-se que a tecnologia criada poderá auxiliar no gerenciamento do autocuidado, evitando exposição desnecessária a serviços de saúde ou alertando para manifestações clínicas que mereçam atendimento presencial, evitando-se que o receio em adquirir COVID-19 em uma unidade hospitalar seja um obstáculo para que os pacientes descompensados busquem atendimento.

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Section: Resultsunclassified

Construção de tecnologia educativa digital para o autocuidado em insuficiência cardíaca

Xavier

Figueiredo

Canuso

2020

RSD

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“…In another study, Alfredo Fede et al [28] included more than 50 patients with borderline lesions and there was close agreement between the FFR and the IFR (R = 0.83, P < 0.0001). Deep Chandh Raja et al [29] found that IFR correlated with FFR in all the subgroups and across all the vessels, without any influence for the heart rate or blood pressure on the correlation with FFR. Also, there are some meta-analysis studies that addressed this point and clarified this concordance.…”

Section: Median 60mentioning

confidence: 95%

Myocardial perfusion imaging by single-photon emission tomography (MPI SPECT) versus Instantaneous wave-free ratio (IFR) for assessment of functional significance of intermediate coronary artery lesions

2019

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Background: The aim of our work was to compare the myocardial perfusion imaging by single-photon emission tomography (MPI-SPECT) as a non-invasive, relatively non-expensive test versus the instantaneous wave-free ratio (IFR) for the evaluation of functional significance of the borderline coronary artery lesions in the view of results of fractional flow reserve (FFR) which is considered the gold standard reference test. Results: Our study was conducted in the Cardiology Department. It included 50 patients with borderline coronary artery lesions; they underwent physiological evaluation by stress/rest myocardial perfusion imaging using followed by an invasive physiological assessment by Instantaneous wave-free ratio (IFR) and Fractional flow reserve (FFR). Finally, the results of both SPECT MPI and IFR were compared to FFR as a gold standard reference. There was a strong (kappa = 0.754) significant (P value < 0.001) agreement between the MPI results and FFR results and the overall agreement was 88%. The sensitivity of the MPI was 81.8%, the specificity was 92.9%, the positive predictive value was 90%, the negative predictive value was 86.7%, the positive likelihood ratio was 11.45, and the negative likelihood ratio was 0.20. There was a strong (kappa = 0.918) significant (P value < 0.001) agreement between the IFR results and FFR results and the overall agreement was 96%. The sensitivity of the IFR was 90.9%, the specificity was 100%, the positive predictive value was 100 %, the negative predictive value was 93.3%, and the negative likelihood ratio was 0.09. Conclusions: The instantaneous wave-free ratio (IFR) may be a valid alternative to fractional flow reserve to assess the functional significance of intermediate coronary lesions. The myocardial perfusion imaging may be an alternative, non-invasive, relatively non-expensive test for the evaluation of the physiological significance of intermediate coronary lesions.

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“…However, further validation is needed for adenosine-free indices to be commonly used in clinical practice. [34] Cost-effectiveness of FFR…”

Section: Clinical Evidence Related To the Benefits Of Ffr In Cadmentioning

confidence: 99%

Coronary Physiology in the Management of CAD Patients: Position Paper Regarding the Current Scenario in India

Kasturi,

Kaur,

Narang

et al. 2023

WJCD

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Fractional flow reserve (FFR), a physiology-based diagnostic method, has emerged as an important decision-making tool in determining the borderline or intermediate coronary lesions requiring revascularization. As per the guidelines recommended by European and American cardiology associations, functional assessment of indeterminate lesions is to be considered strongly prior to PCI. However, in India, FFR continues to be a much-underutilized tool due to limited facilities, and many times, physicians are reluctant to advise FFR because of its time-consuming nature with additional cost implications of simple diagnostic tests. Notably, for stenoses ranging between 50% -70% where the choice between revascularization and medication becomes ambiguous, FFR provides invaluable insight. Without such guidance, there is a risk of improper decisions and strategies while planning revascularization procedures, which might adversely influence clinical outcomes, escalation of the cost due to unnecessary procedures, and prolonged hospitalization as a result of simple vs complex procedures. Landmark studies have validated the efficacy of FFR in enhancing outcomes in coronary artery disease (CAD) patients, especially when paired with a coronary angiogram. This combination provides robust evidence of the functional significance of stenosis in stable CAD. Additionally, non-hyperemic pressure ratio indices correlate well with conventional FFR. Hence, adopting FFR-guided management can have transformative effects on the clinical and economic facets of treating severe CAD with intermediary lesions in Indian settings.

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Comparison of resting and adenosine-free pressure indices with adenosine-induced hyperemic fractional flow reserve in intermediate coronary lesions

Cited by 3 publications

References 18 publications

Construção de tecnologia educativa digital para o autocuidado em insuficiência cardíaca

Construção de tecnologia educativa digital para o autocuidado em insuficiência cardíaca

Myocardial perfusion imaging by single-photon emission tomography (MPI SPECT) versus Instantaneous wave-free ratio (IFR) for assessment of functional significance of intermediate coronary artery lesions

Coronary Physiology in the Management of CAD Patients: Position Paper Regarding the Current Scenario in India

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