Fractional Flow Reserve and Coronary Bifurcation Anatomy

Tu, Shengxian; Echavarría‐Pinto, Mauro; Birgelen, Clemens von; Holm, Niels Ramsing; Pyxaras, Stylianos A.; Kumsārs, Indulis; Lam, Ming Kai; Valkenburg, Ilona; Tóth, Gábor G.; Li, Yingguang; Escaned, Javier; Wijns, William; Reiber, Johan H. C.

doi:10.1016/j.jcin.2014.12.232

Cited by 57 publications

(28 citation statements)

References 20 publications

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“…Bifurcation lesions with side-branches ≥2 mm, as addressed in our present study, were also examined in the Z-SEAside and the SEAside studies [9, 25]. Recently, advanced, user-friendly three-dimensional reconstruction and analysis software for bifurcation lesions has become available [41], but such software was not available at the time of angiographic analysis of the TWENTE trial.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

et al. 2016

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The objective of this study is to assess 3-year clinical outcome of patients with true bifurcation lesions (TBLs) versus non-true bifurcation lesions (non-TBLs) following treatment with second-generation drug-eluting stents (DES). TBLs are characterized by the obstruction of both main vessel and side-branch. Limited data are available on long-term clinical outcome following TBL treatment with newer-generation DES. We performed an explorative sub-study of the randomized TWENTE trial among 287 patients who had bifurcated target lesions with side-branches ≥2.0 mm. Patients were categorized into TBL (Medina classes: 1.1.1; 1.0.1; 0.1.1) versus non-TBL to compare long-term clinical outcome. A total of 116 (40.4 %) patients had TBL, while 171 (59.6 %) had non-TBL only. Target-lesion revascularization rates were similar (3.5 vs. 3.5 %; p = 1.0), and definite-or-probable stent thrombosis rates were low (both <1.0 %). The target-vessel myocardial infarction (MI) rate was 11.3 versus 5.3 % (p = 0.06), mostly driven by (periprocedural) MI ≤48 h from PCI. All-cause mortality and cardiac death rates were 8.7 versus 3.5 % (p = 0.06) and 3.5 versus 1.2 % (p = 0.22), respectively. The 3-year major adverse cardiac event rate for patients with TBL versus non-TBL was 20.0 versus 11.7 % (p = 0.05). At 1-, 2-, and 3-year follow-up, 6.5, 13.0, and 11.0 % of patients reported chest pain at less than or equal moderate physical effort, respectively, without any between-group difference. Patients treated with second-generation DES for TBL had somewhat higher adverse event rates than patients with non-TBL, but dissimilarities did not reach statistical significance. Up to 3-year follow-up, the vast majority of patients of both groups remained free from chest pain.

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Section: Discussionmentioning

confidence: 99%

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

et al. 2016

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“…Then, using the local site network for QFR and AMR calculation, the data were transferred to the AngioPlus system (Pulse Medical Imaging Technology, Shanghai, China). Patients were excluded if QFR or AMR could not be calculated because of 1 the poor quality of angiographic images and 2 the presence of severe vascular curvature and overlap 7,13 …”

Section: Methodsmentioning

confidence: 99%

“…Subsequently, the analysis frame should have good contrast fill‐in and complete exposure of the lumen contour, with automatic delineation of the lumen boundaries of both the studied vessel and major side branches. Based on the Murray bifurcation fractal law, the reference vessel diameter was reconstructed, considering the step‐down phenomenon across bifurcations 13 . Finally, based on the fluid dynamic equations with the abovementioned hyperemic flow as the boundary condition, the pressure drop was calculated 14 .…”

Section: Methodsmentioning

confidence: 99%

Application of AMR in evaluating microvascular dysfunction after ST‐elevation myocardial infarction

Wang,

Wu,

Yang

et al. 2023

Clinical Cardiology

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BackgroundA guidewire‐free angiography‐derived microcirculatory resistance (AMR) derived from Quantitative flow ratio (QFR) exhibits good diagnostic accuracy for assessing coronary microvascular dysfunction (CMD), but there are no relevant studies supporting the specific application of AMR in patients with ST‐elevation myocardial infarction (STEMI). The study aims to evaluate CMD in patients with STEMI using the AMR index.MethodsThis study included patients with STEMI who underwent percutaneous coronary intervention (PCI) from June 1, 2020 to September 28, 2021. All patients were divided into two groups: the CMD (n = 215) and non‐CMD (n = 291) groups. After matching, there were 382 patients in both groups.1‐year follow‐up major adverse cardiac events (MACEs) were evaluated.ResultsAfter matching, the primary endpoint was achieved in 41 patients (10.7%), with 27 and 14 patients in the CMD and non‐CMD groups, respectively (HR 1.954 [95% CI 1.025–3.726]; 14.1% versus 7.3%, p = .042). Subgroup analysis revealed that 18 patients (4.7%) were readmitted for heart failure, with 15 and 3 in the CMD and non‐CMD groups, respectively (HR 5.082 [95% CI 1.471–17.554]; 7.9% versus 1.6%, p = .010). Post‐PCI AMR ≥ 250 was significantly associated with a higher risk of the primary endpoint and was its independent predictor (HR 2.265 [95% CI 1.136–4.515], p = .020).ConclusionThe retrospective use of AMR with a cutoff value of ≥250 after PCI in patients with STEMI can predict a significant difference in the 1‐year MACE rates when compared with a propensity score‐matched group with normal AMR.

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“…In contrast, 3D-QCA was proposed to overcome some inherited limitations in 2D-QCA, such as out-of-plane magnification and foreshortening, which has a better ability to evaluate the geometric characteristics of the lesion 35. Tu et al36 also used 3D-QCA to evaluate the stenosis severity of bifurcation lesions (Fig. 2).…”

Section: Imaging In Coronary Interventionmentioning

confidence: 99%

“…The diameter stenosis function (bottom) was generated on the basis of the arterial and reference core diameter functions and was expressed as percent diameter stenosis at each location. The image is used with permission from Tu et al36…”

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The Chinese Experience of Imaging in Cardiac Intervention

Liu

Yang

Chen

2022

Journal of Thoracic Imaging

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Recent scientific and technological advances have greatly contributed to the development of medical imaging that could enable specific functions. It has become the primary focus of cardiac intervention in preoperative assessment, intraoperative guidance, and postoperative follow-up. This review provides a contemporary overview of the Chinese experience of imaging in cardiac intervention in recent years.

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Fractional Flow Reserve and Coronary Bifurcation Anatomy

Cited by 57 publications

References 20 publications

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial

Application of AMR in evaluating microvascular dysfunction after ST‐elevation myocardial infarction

The Chinese Experience of Imaging in Cardiac Intervention

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