Fractional Flow Reserve to Guide Coronary Revascularization

Pijls, Nico H.J.

doi:10.1253/circj.cj-13-0161

Cited by 85 publications

(44 citation statements)

References 29 publications

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“…26 Theoretically, a pressure gradient across the stenosis is related to viscous friction, separation, and turbulence. 27 Therefore, qualitative lesion characteristics, such as lipid-rich plaques with TCFA and microstructures, may affect FFR by producing greater flow resistance and causing energy loss of fluid. As contrasted with the association between coronary vulnerable plaque features, especially TCFA and lipid volume index, and physiological severity determined by FFR, the prevalence of macrophage accumulation showed no graded propensity according to FFR tertiles.…”

Section: Patients' Characteristics Angiographic Data and Ffr Valuesmentioning

confidence: 99%

Prevalence of Thin-Cap Fibroatheroma in Relation to the Severity of Anatomical and Physiological Stenosis

Usui

Yonetsu

Murai

et al. 2017

Circ J

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Background:The relationship between the features of morphologically unstable plaque and physiological lesion severity remains elusive. We aimed to investigate this relationship using optical coherence tomography (OCT)-derived high-risk plaque characteristics and fractional flow reserve (FFR) as the degree of anatomical and physiological stenosis severity. Methods and Results:We investigated 286 de novo intermediate and severe coronary lesions in 248 patients who underwent OCT and FFR examinations. Lesions were divided into tertiles based on either FFR or quantitative coronary angiographic diameter stenosis (QCA-%DS). The OCT findings were compared among the tertiles of FFR and QCA-%DS. FFR and QCA tertiles were defined as follows: FFR-T1 (FFR <0.74), FFR-T2 (0.74≤FFR≤0.81), and FFR-T3 (FFR >0.81); and QCA-T1 (%DS ≥61%), QCA-T2 (51%≤%DS<61%), and QCA-T3 (%DS <51%). The prevalence of thin-cap fibroatheroma (TCFA) was significantly greater in FFR-T1 (20.0%) than in FFR-T2 and FFR-T3 (7.0%, P=0.03 and 7.7%, P=0.04, respectively), although no significant differences were observed among the QCA tertiles.Conclusions: Physiological severity of coronary stenosis evaluated by FFR correlated with plaque instability in terms of TCFA. Preferable clinical outcomes for lesions with negative FFR based on the existing clinical evidence might be attributable to less likelihood of TCFA.

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Section: Patients' Characteristics Angiographic Data and Ffr Valuesmentioning

confidence: 99%

Prevalence of Thin-Cap Fibroatheroma in Relation to the Severity of Anatomical and Physiological Stenosis

Usui

Yonetsu

Murai

et al. 2017

Circ J

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“…10 FFR as a concept requires stable and minimal microvascular resistance for pressure measurements to equate to flow. In clinical practice this is most commonly achieved using adenosine; if maximal hyperemia is not achieved, there is potential for the pressure ratio calculated not to be the true FFR.…”

Section: Ffrmentioning

confidence: 99%

Advances in Coronary Physiology

Nijjer

Sen

Petraco

et al. 2015

Circ J

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Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting. (Circ J 2015; 79: 1172 -1184

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“…In other words, the indication for percutaneous coronary intervention (PCI) in such cases, will be established taking into consideration the anatomical distribution of the ischemic territory, the severity of the ischemia occurred during stress tests, the patient's adherence to antiplatelet therapy, especially if the patients have a high risk for ischemia, such as diabetics, subjects with left-main lesions or diffuse coronary atherosclerotic involvement, as well as individuals with previous thrombotic events. [19][20][21][22] Studies have shown that there are several special circumstances in which the use of FFR requires caution in interpretation, either due to lesions that have a vital risk, or due to interpretation errors that may occur. Such circumstances are listed below: a) Evaluation of the functional significance of anterograde and retrograde collateral vessels, to determine which lesion should be re-vascularized (stent or balloon angioplasty) for reducing the ischemic myocardial mass.…”

Section: Determination Of Fractional Flow Reserve (Ffr)mentioning

confidence: 99%

Invasive FFR — Current Applications and New Developments

Chițu¹,

Raț²,

Opincariu

et al. 2016

Journal of Interdisciplinary Medicine

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Myocardial ischemia caused by coronary atherosclerosis is the main cause of cardiovascular mortality, which is the first cause of death in developed countries. Inducible myocardial ischemia is a negative prognostic factor for coronary artery disease patients, and it represents a major risk stratification marker for predicting mortality. The evolution of these patients depends largely on the extension of the ischemic myocardial mass and the severity of the inducible ischemia. Most patients do not show angiographically significant coronary stenosis. Therefore, such patients do not undergo coronary revascularization therapies, even though they present functional stenoses that trigger myocardial ischemia under stress conditions, which subsequently lead to a high risk for major adverse cardiovascular events. We performed a review that aims to pinpoint invasive techniques used for evaluating the functional impact of a coronary lesion that is considered non-significant upon angiographic examination, but which triggers episodes of myocardial ischemia under stress conditions, and to describe the functional markers that show the highest specificity for predicting ischemic risk, in order to recommend invasive coronary revascularization.Keywords: invasive fractional flow reserve, inducible myocardial ischemia, functional significance of coronary stenosis REVIEWCARDIOLOGY // IMAGING

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Fractional Flow Reserve to Guide Coronary Revascularization

Cited by 85 publications

References 29 publications

Prevalence of Thin-Cap Fibroatheroma in Relation to the Severity of Anatomical and Physiological Stenosis

Prevalence of Thin-Cap Fibroatheroma in Relation to the Severity of Anatomical and Physiological Stenosis

Advances in Coronary Physiology

Invasive FFR — Current Applications and New Developments

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