Invasive Coronary Physiology for Assessing Intermediate Lesions

Fearon, William F.

doi:10.1161/circinterventions.114.001942

Cited by 21 publications

(13 citation statements)

References 73 publications

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“…In these territories, a possible coronary flow increase after PCI might be limited by responsive microvascular resistance increases. Currently, controversy exists about whether hyperemic microvascular resistance in the presence of functionally significant stenosis is equivalent to that after stenosis removal by PCI 9, 10, 26, 27, 28. Our results clearly demonstrated that microvascular resistance was affected by PCI, and its direction of change had an impact on CFR change and hyperemic coronary flow after successful PCI.…”

Section: Discussionmentioning

confidence: 50%

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Matsuda

Murai

Kanaji

et al. 2016

JAHA

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BackgroundFractional flow reserve (FFR) and coronary flow reserve (CFR) are well‐validated physiological indices; however, changes in FFR and CFR after percutaneous coronary intervention (PCI) remain elusive. We sought to evaluate these changes and to investigate whether physiological indices predict cardiac event‐free survival after PCI.Methods and ResultsPhysiological assessment of 220 stenoses from 220 patients was performed before and after PCI. The changes in FFR and CFR were studied, and factors associated with CFR change were investigated. Follow‐up data were collected to determine the predictor of cardiac events. CFR increase was found in 158 (71.8%) territories, and 62 (28.2%) presented a decrease, whereas FFR increased in all 220 (100%) territories. Pre‐ and post‐PCI percentage diameter stenoses were 57.7±11.2% and 7.48±4.79%, respectively. Post‐PCI CFR increase was associated with pre‐PCI indices including low FFR, low CFR and high microvascular resistance, and post‐PCI hyperemic coronary flow increase. Post‐PCI CFR decrease was not associated with significant post‐PCI hyperemic coronary flow increase. At a median follow‐up of 24.3 months, adverse event–free survival was significantly worse in patients with lower pre‐PCI CFR (log‐rank test λ2=7.26; P=0.007). Cox proportional hazards analysis showed that lower pre‐PCI CFR (hazard ratio 0.73; 95% CI 0.55–0.97; P=0.028) was an independent predictor of adverse cardiovascular events after PCI.Conclusions CFR decrease after PCI was not uncommon, and discordant change in FFR and CFR was associated with high pre‐PCI CFR, low pre‐PCI microvascular resistance, and no significant post‐PCI hyperemic coronary flow increase. Pre‐PCI CFR, not post‐PCI physiological indices, may help identify patients who require adjunctive management strategy after successful PCI.

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Section: Discussionmentioning

confidence: 50%

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Matsuda

Murai

Kanaji

et al. 2016

JAHA

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“…Verhoeff et al reported a decrease in MR in response to restored coronary perfusion pressure by PCI . However, Fearon et al argued that this finding might have been due to a measurement error by not taking into account the contribution of collateral flow, which is greater with functionally significant stenosis, and reported, with the use of the index of microcirculatory resistance (IMR), that PCI did not significantly affect MR .…”

Section: Introductionmentioning

confidence: 99%

Preprocedural fractional flow reserve and microvascular resistance predict increased hyperaemic coronary flow after elective percutaneous coronary intervention

Murai

Kanaji

Yonetsu

et al. 2016

Cathet Cardio Intervent

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“…Revascularization of ischemia-producing coronary lesions is widely used in management of coronary artery disease (CAD) (1). Invasive coronary angiography (CAG) continues to be the basic method for diagnosing coronary artery stenosis.…”

Section: Introductionmentioning

confidence: 99%

“…However, CAG has very limited ability to diagnose lesions responsible for inducing myocardial ischemia, and especially for lesions with intermediate diameter of stenosis (2–4). Fractional flow reserve (FFR) has become standard tool for assessment of functional significance of coronary stenosis severity in the catheterization laboratory (1–4). FFR-guided percutaneous coronary intervention (PCI) has been shown to be related to lower rate of composite endpoints of nonfatal myocardial infarction (MI), repeat revascularization, and death at 1 year, compared with angiography-guided PCI (2).…”

Section: Introductionmentioning

confidence: 99%

Prediction of fractional flow reserve with angiographic DILEMMA score

Beton

Kaya²,

Turgut

et al. 2016

Anatol J Cardiol

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Objective:Angiographic assessment of stenosis has limited predictive value for functionally significant lesions compared with fractional flow reserve (FFR). The recently developed angiographic DILEMMA score, which consists of minimal lumen diameter (MLD), lesion length (LL) and Bypass Angioplasty Revascularization Investigation (BARI) Myocardial Jeopardy Index (MJI) was found to have diagnostic value in predicting FFR ≤0.80. The present study was an investigation of prediction of FFR ≤0.80 using DILEMMA score and its relationship to resting distal coronary artery pressure/aortic pressure (Pd/Pa).Methods:Records of consecutive patients who underwent coronary angiography and FFR were retrospectively analyzed. Assessment of MLD and LL was performed using quantitative coronary angiography. BARI MJI was calculated using angiographic calculation index.Results:A total of 185 pressure wire analysis data sets from 150 patients were analyzed retrospectively. There were 82 lesions in FFR >0.80 group and 103 lesions in FFR ≤0.80 group. Negative correlation was found between FFR and DILEMMA score (r=-0.494; p<0.001), FFR and BARI-MJI (r=-0.378; p<0.001), and between FFR and LL (r=-0.314; p<0.001). Positive correlation was found between FFR and baseline Pd/Pa (r=0.713; p<0.001), and between FFR and MLD (r=0.415; p<0.001). DILEMMA score had negative correlation with resting Pd/Pa (r=-0.389; p<0.001). In receiver operating characteristic analysis for diagnosing FFR≤0.80, area under curve values of resting Pd/Pa, DILEMMA score, MLD, BARI-MJI, and LL were 0.862, 0.793, 0.780, 0.728, and 0.686, respectively.Conclusion:DILEMMA score had moderately strong correlation with FFR and good accuracy in diagnosing significant FFR, but it had weak correlation with resting Pd/Pa. (Anatol J Cardiol 2017; 17: 285-92)

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Invasive Coronary Physiology for Assessing Intermediate Lesions

Cited by 21 publications

References 73 publications

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Preprocedural fractional flow reserve and microvascular resistance predict increased hyperaemic coronary flow after elective percutaneous coronary intervention

Prediction of fractional flow reserve with angiographic DILEMMA score

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