Implementing Coronary Computed Tomography Angiography in the Catheterization Laboratory

Collet, Carlos; Sonck, Jeroen; Leipsic, Jonathon; Monizzi, Giovanni; Buytaert, Dimitri; Kitslaar, Pieter H.; Andreini, Daniele; Bruyne, Bernard De

doi:10.1016/j.jcmg.2020.07.048

Cited by 42 publications

(20 citation statements)

References 35 publications

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“…QFR, on the other hand, does not require wiring or drug infusion and, after adequate training, the analysis can be performed in around 5 min [1,4]. Another interesting avenue is represented by the development of a computed tomography-derived FFR-based interactive planner which has the potential to improve non-invasively diagnostic and therapeutic interventions [9,10]. The present post hoc analysis of the HAWKEYE trial utilized pre-PCI QFR virtual pullback for the identification of the functional pattern of CAD.…”

Section: Discussionmentioning

confidence: 99%

Angio-Based Fractional Flow Reserve, Functional Pattern of Coronary Artery Disease, and Prediction of Percutaneous Coronary Intervention Result: a Proof-of-Concept Study

Biscaglia

Uretsky

Tebaldi

et al. 2021

Cardiovasc Drugs Ther

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Purpose Wire-based coronary physiology pullback performed before percutaneous coronary intervention (PCI) discriminates coronary artery disease (CAD) distribution and extent, and is able to predict functional PCI result. No research investigated if quantitative flow ratio (QFR)–based physiology assessment is able to provide similar information. Methods In 111 patients (120 vessels) treated with PCI, QFR was measured both before and after PCI. Pre-PCI QFR trace was used to discriminate functional patterns of CAD (focal, serial lesions, diffuse disease, combination). Functional CAD patterns were identified analyzing changes in the QFR virtual pullback trace (qualitative method) or after computation of the QFR virtual pullback index (QVPindex) (quantitative method). QVPindex calculation was based on the maximal QFR drop over 20 mm and the length of epicardial coronary segment with QFR most relevant drop. Then, the ability of the different functional patterns of CAD to predict post-PCI QFR value was tested. Results By qualitative method, 51 (43%), 20 (17%), 15 (12%), and 34 (28%) vessels were classified as focal, serial focal lesions, diffuse disease, and combination, respectively. QVPindex values >0.71 and ≤0.51 predicted focal and diffuse patterns, respectively. Suboptimal PCI result (post-PCI QFR value ≤0.89) was present in 22 (18%) vessels. Its occurrence differed across functional patterns of CAD (focal 8% vs. serial lesions 15% vs. diffuse disease 33% vs. combination 29%, p=0.03). Similarly, QVPindex was correlated with post-PCI QFR value (r=0.62, 95% CI 0.50–0.72). Conclusion Our results suggest that functional patterns of CAD based on pre-PCI QFR trace can predict the functional outcome after PCI. Clinical Trial Registration ClinicalTrials.gov, number NCT02811796. Date of registration: June 23, 2016.

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Section: Discussionmentioning

confidence: 99%

Angio-Based Fractional Flow Reserve, Functional Pattern of Coronary Artery Disease, and Prediction of Percutaneous Coronary Intervention Result: a Proof-of-Concept Study

Biscaglia

Uretsky

Tebaldi

et al. 2021

Cardiovasc Drugs Ther

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“…Furthermore, the FFR CT Planner is based on coronary CTA, a modality which is increasingly used to evaluate patients with suspected coronary artery disease in the non‐invasive setting. Therefore, this novel tool may increase the use of coronary CTA for planning percutaneous revascularization procedures 20 …”

Section: Discussionmentioning

confidence: 99%

Rationale and design of the precise percutaneous coronary intervention plan (P3) study: Prospective evaluation of a virtual computed tomography‐based percutaneous intervention planner

Nagumo

Collet

Nørgaard

et al. 2021

Clinical Cardiology

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Introduction Fractional flow reserve (FFR) measured after percutaneous coronary intervention (PCI) has been identified as a surrogate marker for vessel related adverse events. FFR can be derived from standard coronary computed tomography angiography (CTA). Moreover, the FFR derived from coronary CTA (FFRCT) Planner is a tool that simulates PCI providing modeled FFRCT values after stenosis opening. Aim To validate the accuracy of the FFRCT Planner in predicting FFR after PCI with invasive FFR as a reference standard. Methods Prospective, international and multicenter study of patients with chronic coronary syndromes undergoing PCI. Patients will undergo coronary CTA with FFRCT prior to PCI. Combined morphological and functional evaluations with motorized FFR hyperemic pullbacks, and optical coherence tomography (OCT) will be performed before and after PCI. The FFRCT Planner will be applied by an independent core laboratory blinded to invasive data, replicating the invasive procedure. The primary objective is to assess the agreement between the predicted FFRCT post‐PCI derived from the Planner and invasive FFR. A total of 127 patients will be included in the study. Results Patient enrollment started in February 2019. Until December 2020, 100 patients have been included. Mean age was 64.1 ± 9.03, 76% were males and 24% diabetics. The target vessels for PCI were LAD 83%, LCX 6%, and RCA 11%. The final results are expected in 2021. Conclusion This study will determine the accuracy and precision of the FFRCT Planner to predict post‐PCI FFR in patients with chronic coronary syndromes undergoing percutaneous revascularization.

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“…In the specific field of CTO, CT-MPI seems particularly useful, by combining anatomical information on lesion characteristics from CCTA with the presence and extension of ischemia from perfusion assessment and demonstrated high and similar diagnostic performance vs. other non-invasive stress tests to identify flow-limiting coronary lesions at invasive FFR ( 62 – 64 ). Finally, some group of researchers are developing a dedicated tool for a full, real-time integration of anatomical (calcium and atherosclerosis) and functional (FFRCT) CCTA-derived information into the cath lab for the guidance of PCI ( 65 ).…”

Section: Imaging Modalitiesmentioning

confidence: 99%

The Role of Multimodality Imaging for Percutaneous Coronary Intervention in Patients With Chronic Total Occlusions

Melotti

Belmonte

Gigante

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPercutaneous coronary intervention (PCI) of Chronic total occlusions (CTOs) has been traditionally considered a challenging procedure, with a lower success rate and a higher incidence of complications compared to non-CTO-PCI. An accurate and comprehensive evaluation of potential candidates for CTO-PCI is of great importance. Indeed, assessment of myocardial viability, left ventricular function, individual risk profile and coronary lesion complexity as well as detection of inducible ischemia are key information that should be integrated for a shared treatment decision and interventional strategy planning. In this regard, multimodality imaging can provide combined data that can be very useful for the decision-making algorithm and for planning percutaneous CTO recanalization.AimsThe purpose of this article is to appraise the value and limitations of several non-invasive imaging tools to provide relevant information about the anatomical characteristics and functional impact of CTOs that may be useful for the pre-procedural assessment and follow-up of candidates for CTO-PCI. They include echocardiography, coronary computed tomography angiography (CCTA), nuclear imaging, and cardiac magnetic resonance (CMR). As an example, CCTA can accurately delineate CTO location and length, distal coronary bed, vessel tortuosity and calcifications that can predict PCI success, whereas stress CMR, nuclear imaging and stress-CT can provide functional evaluation in terms of myocardial ischemia and viability and perfusion defect extension.

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Implementing Coronary Computed Tomography Angiography in the Catheterization Laboratory

Cited by 42 publications

References 35 publications

Angio-Based Fractional Flow Reserve, Functional Pattern of Coronary Artery Disease, and Prediction of Percutaneous Coronary Intervention Result: a Proof-of-Concept Study

Angio-Based Fractional Flow Reserve, Functional Pattern of Coronary Artery Disease, and Prediction of Percutaneous Coronary Intervention Result: a Proof-of-Concept Study

Rationale and design of the precise percutaneous coronary intervention plan (P3) study: Prospective evaluation of a virtual computed tomography‐based percutaneous intervention planner

The Role of Multimodality Imaging for Percutaneous Coronary Intervention in Patients With Chronic Total Occlusions

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