Fractional Flow Reserve of Infarct-Related Arteries Identifies Reversible Defects on Noninvasive Myocardial Perfusion Imaging Early After Myocardial Infarction

Samady, Habib; Lepper, W.; Powers, Eric R.; Wei, Kevin; Ragosta, Michael; Bishop, G. G.; Sarembock, Ian J.; Gimple, Lawrence W.; Watson, Denny D.; Beller, George A.; Barringhaus, Kurt G.

doi:10.1016/j.jacc.2006.01.065

Cited by 86 publications

(49 citation statements)

References 17 publications

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“…Fractional flow reserve correlates well with SPECT, 6 and the FAME trial confirms what nuclear cardiologists have been preaching for decades: ischemia-producing lesions have a poor prognosis and lesions that do not induce ischemia have a favorable prognosis, and should not undergo revascularization. This is a culmination of a long trail of critically important science in the area for the past 25 years.…”

Section: Anatomy Vs Physiology: a Gold Standard With Feet Of Clay?supporting

confidence: 54%

Chronic kidney disease, SPECT, and coronary angiography: “head of gold and feet of clay?”

Williams

2009

Journal of Nuclear Cardiology

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Section: Anatomy Vs Physiology: a Gold Standard With Feet Of Clay?supporting

confidence: 54%

Chronic kidney disease, SPECT, and coronary angiography: “head of gold and feet of clay?”

Williams

2009

Journal of Nuclear Cardiology

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“…In the literature, different FFR cut-off values, ranging from 0.72 to 0.8, have been used (Pijls et al, 1996;De Bruyne et al, 2001;Samady et al, 2006;De Bruyne and Sarma, 2008;Petraco et al, 2013). In this study the cut-off value was set to 0.78.…”

Section: Patient Classificationmentioning

confidence: 99%

“…In the literature (Pijls et al, 1996;De Bruyne et al, 2001;Samady et al, 2006;De Bruyne and Sarma, 2008;Petraco et al, 2013), different cut-off values on the FFR have been used to separate patients with functionally significant stenosis from those without it. These values range from 0.72 to 0.8.…”

Section: The Effect Of Ffr Cut-off Valuesmentioning

confidence: 99%

Deep learning analysis of the myocardium in coronary CT angiography for identification of patients with functionally significant coronary artery stenosis

Zreik

Leßmann

Hamersvelt

et al. 2018

Medical Image Analysis

172

124

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In patients with coronary artery stenoses of intermediate severity, the functional significance needs to be determined. Fractional flow reserve (FFR) measurement, performed during invasive coronary angiography (ICA), is most often used in clinical practice. To reduce the number of ICA procedures, we present a method for automatic identification of patients with functionally significant coronary artery stenoses, employing deep learning analysis of the left ventricle (LV) myocardium in rest coronary CT angiography (CCTA).The study includes consecutively acquired CCTA scans of 166 patients who underwent invasive FFR measurements. To identify patients with a functionally significant coronary artery stenosis, analysis is performed in several stages. First, the LV myocardium is segmented using a multiscale convolutional neural network (CNN). To characterize the segmented LV myocardium, it is subsequently encoded using unsupervised convolutional autoencoder (CAE). As ischemic changes are expected to appear locally, the LV myocardium is divided into a number of spatially connected clusters, and statistics of the encodings are computed as features. Thereafter, patients are classified according to the presence of functionally significant stenosis using an SVM classifier based on the extracted features.Quantitative evaluation of LV myocardium segmentation in 20 images resulted in an average Dice coefficient of 0.91 and an average mean absolute distance between the segmented and reference LV boundaries of 0.7 mm. Twenty CCTA images were used to train the LV myocardium encoder. Classification of patients was evaluated in the remaining 126 CCTA scans in 50 10-fold cross-validation experiments and resulted in an area under the receiver operating characteristic curve of 0.74 ± 0.02. At sensitivity levels 0.60, 0.70 and 0.80, the corresponding specificity was 0.77, 0.71 and 0.59, respectively.The results demonstrate that automatic analysis of the LV myocardium in a single CCTA scan acquired at rest, without assessment of the anatomy of the coronary arteries, can be used to identify patients with functionally significant coronary artery stenosis. This might reduce the number of patients undergoing unnecessary invasive FFR measurements.

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“…In another study, FFR measurements were compared with SPECT 4 d after myocardial infarction. The optimal FFR for discriminating inducible ischemia also was 0.78 (27). Usui et al compared the reliability of FFR in infarct-related and non-infarct-related artery stenoses.…”

Section: The Ffr Cutoff After Myocardial Infarctionmentioning

confidence: 99%

Microvascular Function in Viable Myocardium After Chronic Infarction Does Not Influence Fractional Flow Reserve Measurements

Marques¹,

Knaapen

Boellaard

et al. 2007

Journal of Nuclear Medicine

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Fractional flow reserve (FFR) is an index of coronary stenosis severity. FFR is the ratio of hyperemic myocardial flow in the stenotic area to maximal flow in that same territory without stenosis and can be measured with a pressure wire. In patients with prior infarction, measuring FFR in infarct-related arteries may be different for 2 reasons: a smaller mass of viable myocardium depending on the stenotic infarct-related artery and greater microvascular resistance in the infarcted area than in the reference area. When microvascular resistance does not differ between the infarcted and the reference areas, FFR should equal relative flow reserve (RFR). RFR is the ratio of myocardial blood flow in the stenotic area to blood flow in a normally perfused reference area, at maximal hyperemia. H 2 15 O PET measures myocardial flow within only the viable areas of an infarct and can be used to measure RFR. The present study assessed in patients with chronic myocardial infarction whether microvascular resistance in the infarct is different from that in the reference area. Therefore, the correlation between FFR and RFR using H 2 15 O PET was studied. Methods: In the catheterization laboratory, FFR was measured in the infarct-related artery and a reference coronary artery. The H 2 15 O PET study and FFR measurements were performed on the same day in 22 patients. Results: In 27 patients, the mean interval between the PET study and infarction was 3.3 y. Most patients had an anterior infarction, and the mean ejection fraction was 44%. The mean FFR and RFR values were 0.75 6 0.16 and 0.74 6 0.18, respectively. A significant correlation (r 5 0.81; P , 0.0001) was found between FFR and RFR. The linear regression line was close to the line of identity. Conclusion: In patients with chronic myocardial infarction and a reduced ejection fraction, a good correlation was found between FFR measurements in the infarct-related artery and RFR. Because the linear regression line between FFR and RFR was close to the line of identity, one can conclude that microvascular resistance in the viable myocardium does not differ from that in the reference area.

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Fractional Flow Reserve of Infarct-Related Arteries Identifies Reversible Defects on Noninvasive Myocardial Perfusion Imaging Early After Myocardial Infarction

Abstract: Fractional flow reserve of the IRA accurately identifies reversibility on noninvasive imaging early after MI. These findings support the utility of FFR early after MI.

Cited by 86 publications

References 17 publications

Chronic kidney disease, SPECT, and coronary angiography: “head of gold and feet of clay?”

Chronic kidney disease, SPECT, and coronary angiography: “head of gold and feet of clay?”

Deep learning analysis of the myocardium in coronary CT angiography for identification of patients with functionally significant coronary artery stenosis

Microvascular Function in Viable Myocardium After Chronic Infarction Does Not Influence Fractional Flow Reserve Measurements

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