Measurement of Hyperemic Pullback Pressure Gradients to Characterize Patterns of Coronary Atherosclerosis

Collet, Carlos; Sonck, Jeroen; Vandeloo, Bert; Mizukami, Takuya; Roosens, Bram; Lochy, Stijn; Argacha, Jean-François; Schoors, Danny; Colaiori, Iginio; Gioia, Giuseppe Di; Kodeboina, Monika; Suzuki, Hiroshi; Veer, Marcel van ’t; Bartúnek, Jozef; Barbato, Emanuele; Cosyns, Bernard; Bruyne, Bernard De

doi:10.1016/j.jacc.2019.07.072

Cited by 177 publications

(115 citation statements)

References 32 publications

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“…Nevertheless, a facilitated interpretation of FFR-PB curves by a computer does not seem to generate a disproportionate rate of reclassifications. Indeed, VSA reclassifies vessel disease category in almost 15% of ratings whereas higher rates of reclassification were previously reported in studies using visual inspection of FFR and iFR coronary pressure-wire pullback (10,16).…”

Section: Discussionmentioning

confidence: 67%

“…The hyperemic pullback pressure gradients (PPGs) and VSA and are two different approaches aiming to standardize assessment of epicardial disease distribution based on FFR pullback curves analysis. The VSA approach proposes to perform a signal to noise analysis of the magnitude of FFR derivative (FFR') signal of the entire vessel, whereas the PPG focus its analysis on the 20 mm of vessel showing the highest variation in FFR (10). The VSA physically defines a focal disease as a FFR' signal to noise ratio of more than 200%, whereas, the PPG proposes no cut-off value to consider a disease as focally of diffusely distributed.…”

Section: Discussionmentioning

confidence: 99%

“…Although several studies proposed focal (abrupt) pattern and diffuse (gradual) patterns of FFR pullback curves, there are no clear criteria to define the physiological patterns of disease. Recently, the pressure pullback gradient (PPG) was proposed to characterize the functional pattern of coronary artery disease (10). This index analyzes the maximal variation in FFR signal over a length of 20 mm.…”

Section: Introductionmentioning

confidence: 99%

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Guiding Myocardial Revascularization by Algorithmic Interpretation of FFR Pullback Curves: A Proof of Concept Study

Argacha

Decamp

Vandeloo

et al. 2021

Front. Cardiovasc. Med.

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Background: Coronary artery disease distribution along the vessel is a main determinant of FFR improvement after PCI. Identifying focal from diffuse disease from visual inspections of coronary angiogram (CA) and FFR pullback (FFR-PB) are operator-dependent. Computer science may standardize interpretations of such curves.Methods: A virtual stenting algorithm (VSA) was developed to perform an automated FFR-PB curve analysis. A survey analysis of the evaluations of 39 vessels with intermediate disease on CA and a distal FFR <0.8, rated by 5 interventional cardiologists, was performed. Vessel disease distribution and PCI strategy were successively rated based on CA and distal FFR (CA); CA and FFR-PB curve (CA/FFR-PB); and CA and VSA (CA/VSA). Inter-rater reliability was assessed using Fleiss kappa and an agreement analysis of CA/VSA rating with both algorithmic and human evaluation (operator) was performed. We hypothesize that VSA would increase rater agreement in interpretation of epicardial disease distribution and subsequent evaluation of PCI eligibility.Results: Inter-rater reliability in vessel disease assessment by CA, CA/FFR-PB, and CA/VSA were respectively, 0.32 (95% CI: 0.17–0.47), 0.38 (95% CI: 0.23–0.53), and 0.4 (95% CI: 0.25–0.55). The raters' overall agreement in vessel disease distribution and PCI eligibility was higher with the VSA than with the operator (respectively, 67 vs. 42%, and 80 vs. 70%, both p < 0.05). Compared to CA/FFR-PB, CA/VSA induced more reclassification toward a focal disease (92 vs. 56.2%, p < 0.01) with a trend toward more reclassification as eligible for PCI (70.6 vs. 33%, p = 0.06). Change in PCI strategy did not differ between CA/FFR-PB and CA/VSA (23.6 vs. 28.5%, p = 0.38).Conclusions: VSA is a new program to facilitate and standardize the FFR pullback curves analysis. When expert reviewers integrate VSA data, their assessments are less variable which might help to standardize PCI eligibility and strategy evaluations.Clinical Trial Registration:https://www.clinicaltrials.gov/ct2/show/NCT03824600.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Guiding Myocardial Revascularization by Algorithmic Interpretation of FFR Pullback Curves: A Proof of Concept Study

Argacha

Decamp

Vandeloo

et al. 2021

Front. Cardiovasc. Med.

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“…Two predominant phenotypes of coronary artery (i.e. focal or diffuse) have been described 23,24 . In cases of focal functional CAD with lesion‐specific ischemia, PCI often results in complete functional revascularization.…”

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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“…The change in FFR CT values across a stenosis (ΔFFR CT ) represents an estimate of lesion-specific pressure loss and have been shown to discriminate a more focal phenotype of physiology and identify high risk plaques. 10,11 The ADVANCE (Assessing Diagnostic Value of Non-invasive FFR CT in Coronary Care) registry (NCT02499679) is an international multicenter prospective registry that enrolled stable patients with CAD who were investigated with CCTA and FFR CT . 7,8 More than half of patients who underwent ICA in gray-zone FFR CT value did not receive subsequent revascularization in the ADVANCE registry.…”

Section: Introductionmentioning

confidence: 99%

Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry

Takagi

Leipsic

McNamara

et al. 2022

Journal of Cardiovascular Computed Tomography

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Background: The role of change in fractional flow reserve derived from CT (FFR CT ) across coronary stenoses (ΔFFR CT ) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown. Objectives: To investigate the incremental value of ΔFFR CT in predicting early revascularization and improving efficiency of catheter laboratory utilization. Materials: Patients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Stenosis severity was assessed as per CAD-Reporting and Data System (CAD-RADS), and lesion-specific FFR CT was measured 2 cm distal to stenosis. ΔFFR CT was manually measured as the difference of FFR CT across visible stenosis.

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Measurement of Hyperemic Pullback Pressure Gradients to Characterize Patterns of Coronary Atherosclerosis

Cited by 177 publications

References 32 publications

Guiding Myocardial Revascularization by Algorithmic Interpretation of FFR Pullback Curves: A Proof of Concept Study

Guiding Myocardial Revascularization by Algorithmic Interpretation of FFR Pullback Curves: 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

Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry

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