2018
DOI: 10.1001/jamacardio.2018.0236
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Physiology-Guided Management of Serial Coronary Artery Disease

Abstract: Serial coronary artery disease is common, and physiological assessment is prone to errors. The future, whether it be in improving the interpretation of fractional flow reserve, using resting indices such as instantaneous wave-free ratio, or examining novel flow-based resistance indices, will hopefully improve our management of this common yet unresolved clinical conundrum. In the meantime, revascularisation decisions in this challenging scenario should focus on clinical presentation and physiologic evaluation … Show more

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Cited by 27 publications
(33 citation statements)
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“…A smaller spacing ratio induced a higher positive Q-value, i.e., a larger hemodynamic interference. This, in turn, causes larger errors in FFR measurements, which is consistent with current clinical speculation [11]. It is worth noting that the peak Q-values in the case of the spacing ratios of 1, 3, and 5 were located at the center of the second stenosis or further downstream, rather than the downstream of the first stenosis.…”
Section: Discussionsupporting
confidence: 83%
See 1 more Smart Citation
“…A smaller spacing ratio induced a higher positive Q-value, i.e., a larger hemodynamic interference. This, in turn, causes larger errors in FFR measurements, which is consistent with current clinical speculation [11]. It is worth noting that the peak Q-values in the case of the spacing ratios of 1, 3, and 5 were located at the center of the second stenosis or further downstream, rather than the downstream of the first stenosis.…”
Section: Discussionsupporting
confidence: 83%
“…The instantaneous wave-free ratio (iFR) has been proposed recently as an adenosine-free alternative to FFR [8,9]. The iFR outputs the distal-to-proximal pressure ratio of an single stenosis at 75% of diastolic phase, which is 2 of 14 called the wave-free period [10,11]. The vessel resistance and the interference between serial stenoses at the diastole are expected to be significantly smaller than those under the hyperemic condition [12,13].…”
Section: Introductionmentioning
confidence: 99%
“…In contrast, the PCI planning tool is a completely new application leveraging the CTA‐derived anatomical model (for vessel and lesion dimensions and diameter stenosis) and FFRCT (for assessment of lesion‐specific ischemia) (Figure ). The assessment of complex anatomy, such as serial lesions or diffuse disease, is a common challenge due to difficulties assessing the impact of individual stenosis on FFRINV . In contrast to FFRINV, the PCI planning tool enables the operator to predict the physiological outcome of any combination of interventions, recalculate the residual FFRCT values, and remove uncertainty about the interaction between multiple stenoses.…”
Section: Noninvasive Approaches To Pci Planning Using Cta and Ffrctmentioning
confidence: 99%
“…The data supporting physiology-guided revascularisation are largely derived from studies that only included vessels with single discrete lesions. The reality, particularly within elderly and diabetic populations, is that serial and diffuse CAD is common 5,85,86 . Serial CAD is important and likely to affect physiological assessment of an individual stenosis: any additional resistance proximal or distal to a stenosis will affect the trans-lesional pressure gradient at any point, with the problem further compounded by complex fluid dynamics.…”
Section: Introductionmentioning
confidence: 99%
“…Serial CAD is important and likely to affect physiological assessment of an individual stenosis: any additional resistance proximal or distal to a stenosis will affect the trans-lesional pressure gradient at any point, with the problem further compounded by complex fluid dynamics. 30,86 .…”
Section: Introductionmentioning
confidence: 99%