Contrast Fractional Flow Reserve (cFFR): A pragmatic response to the call for simplification of invasive functional assessment

Leone, Antonio Maria; Pepe, Francesca; Arioti, Manfredi; Crea, Filippo

doi:10.1016/j.ijcard.2018.04.048

Cited by 8 publications

(7 citation statements)

References 56 publications

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“…In this section, we discuss the results based on the search strategy presented in the previous section. and usability of each kind of exam [41,59,60,63]. In all cases, they were compared with at least one of the gold standard techniques or with outcome.…”

Section: Resultsmentioning

confidence: 99%

“…iFR is suggested to moderate stenoses [10,30,55] and multi-vessel lesion [30], having lower cost once it does not need hyperemia induction [30]. iFR is also an option for intermediate LMS lesions [6], which has been also challenged in small validation [41]. Finally, CCTA has limited positive predictive value, mainly in calcified lesions [58], causing additional costs repeating exams [58].…”

Section: Figmentioning

confidence: 99%

“…iFR is a good option in countries where Adenosine is expensive and/or other vasodilators are not available [1,18]. iFR presents a good correlation between 0.8 and 0.94 for severe or low-grade stenosis [9,22,29,41,59], but a poor correlation in moderate cases [9,22,59].…”

Section: Gq4 -What Is the Taxonomy For The Functional Assessment In Coronary Arteries?mentioning

confidence: 99%

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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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Section: Resultsmentioning

confidence: 99%

Section: Figmentioning

confidence: 99%

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Functional Coronary Artery Assessment: a Systematic Literature Review

Freitas

Nienow

Costa

et al. 2021

Wien Klin Wochenschr

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“…Several studies have demonstrated that contrast-FFR measured during submaximal hyperemia is a novel index and a feasible measurement method that accurately predicts the functional significance of intermediate coronary artery stenosis assessed by FFR 14, 15. The RINASCI study had shown a strong correlation between contrast FFR and adenosine FFR ( r = 0.94, p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

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

Raja

Subban

Mathew

et al. 2019

Indian Heart Journal

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ObjectiveFractional flow reserve (FFR) using adenosine has been the gold standard in the functional assessment of intermediate coronary stenoses in the catheterization laboratory. We aim to study the correlation of adenosine-free indices such as whole cycle Pd/Pa [the ratio of mean distal coronary pressure (Pd) to the mean pressure observed in the aorta (Pa)], instantaneous wave-free ratio (iFR), and contrast-induced submaximal hyperemia (cFFR) with FFR.MethodsThis multicenter, prospective, observational study included patients with stable angina or acute coronary syndrome (>48 h since onset) with discrete intermediate coronary lesions (40–70% diameter stenosis). All patients underwent assessment of whole cycle Pd/Pa, iFR, cFFR, and FFR. We then evaluated the correlation of these indices with FFR and assessed the diagnostic efficiencies of them against FFR ≤0.80.ResultsOf the 103 patients from three different centers, 83 lesions were included for analysis. The correlation coefficient (r value) of whole cycle Pd/Pa, iFR, and cFFR in relation to FFR were +0.84, +0.77, and +0.70 (all p values < 0.001), respectively, and the c-statistic against FFR ≤0.80 were 0.92 (0.86–0.98), 0.89(0.81–0.97), and 0.91 (0.85–0.97) (all p values < 0.001), respectively. The best cut-off values identified by receiver–operator characteristic curve for whole cycle Pd/Pa, iFR, and cFFR were 0.94, 0.90, and 0.88, respectively, for an FFR ≤0.80. By the concept of “adenosine-free zone” (iFR = 0.86–0.93), 59% lesions in this study would not require adenosine.ConclusionAll the three adenosine-free indices had good correlation with FFR. There is no difference in the diagnostic accuracies among the indices in functional evaluation of discrete intermediate coronary stenoses. However, further validation is needed before adoption of adenosine-free pressure parameters into clinical practice.

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“…В опит да се избегнат по-трудоемките, изискващи медикаментозна хиперемия методи, някои автори предлагат определянето на коронарния резерв (независимо FFR или CFR), използвайки хиперемията, предизвикана от контрастното вещество от самата коронарография. Според тях, това прави анализът по-бърз, по-евтин и без страничните явления от медикаментите (Leone, 2018;Mazniczka, 2019). Авторите откриват добра корелация със стандартния FFR и заключават, че в немалък процент cFFR би могъл да даде представа за хемодинамичната значимост на стенозата (Johnson, 2016).…”

Section: контрастен Ffr (Contrast Ffr -Cffr)unclassified

Invasive methods for coronary reserve measurement

Gatzov¹

2021

ICF

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During the last years, following numerous trials, the need of functional assessment of stenoses before myocardial revascularization has been established. This came to replace the subjective approach based on the so-called “oculo-stenotic” reflex of the operator. Numerous methods for coronary reserve (CR) estimation as a measure of functional significance of the lesion, have been introduced in the practice. Those methods are noninvasive and invasive. A part of them are based on the measurement of coronary flow velocity before and after hyperemic medication, other are based on the difference of arterial pressure before and after the coronary stenosis. They are divided to such with or without hyperemic medication. During the last years in the diagnostic have been used methods for functional estimation of the lesions based only on standard coronary angiography or even computerized tomography (CT). The aim of this article is to present a review of modern invasive methods for coronary reserve measurement.

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Contrast Fractional Flow Reserve (cFFR): A pragmatic response to the call for simplification of invasive functional assessment

Cited by 8 publications

References 56 publications

Functional Coronary Artery Assessment: a Systematic Literature Review

Functional Coronary Artery Assessment: a Systematic Literature Review

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

Invasive methods for coronary reserve measurement

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