The Impact of Coronary Physiology on Contemporary Clinical Decision Making

Kogame, Norihiro; Ono, Masafumi; Kawashima, Hideyuki; Tomaniak, Mariusz; Hara, Hironori; Leipsic, Jonathan; Andreini, Daniele; Collet, Carlos; Patel, Manesh R.; Tu, Shengxian; Xu, Bo; Bourantas, Christos V.; Lerman, Amir; Piek, Jan J.; Davies, Justin E.; Escaned, Javier; Wijns, William; Onuma, Yoshinobu; Serruys, Patrick W.

doi:10.1016/j.jcin.2020.04.040

Cited by 80 publications

(66 citation statements)

References 113 publications

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“…Compared to the traditional coronary angiogram, quantitative flow ratio (QFR) has become a popular tool to more accurately evaluate the functional severity of coronary artery stenosis based on three-dimensional quantitative angiography and fluid dynamics algorithms (17). The QFR measurement does not require the use of pressure-wires, hyperemia induction, or reconstruction of all side branches, compared to fractional flow reserve (FFR) (18). Moreover, in terms of diagnosing functional coronary artery stenosis, QFR is highly consistent with FFR, the gold standard for evaluating functional stenosis of coronary arteries (18).…”

Section: Introductionmentioning

confidence: 99%

“…The QFR measurement does not require the use of pressure-wires, hyperemia induction, or reconstruction of all side branches, compared to fractional flow reserve (FFR) (18). Moreover, in terms of diagnosing functional coronary artery stenosis, QFR is highly consistent with FFR, the gold standard for evaluating functional stenosis of coronary arteries (18). Although the association between HRV, inflammation, and the severity of coronary angiographic stenosis has been confirmed (12,19), there remains no literature providing any evidence that HRV and inflammation are correlated with the severity of functional coronary artery stenosis as detected by QFR.…”

Section: Introductionmentioning

confidence: 99%

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Novel Insights Into the Interaction Between the Autonomic Nervous System and Inflammation on Coronary Physiology: A Quantitative Flow Ratio Study

Wang

Liu

Chen

et al. 2021

Front. Cardiovasc. Med.

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Background: Heart rate variability (HRV) was proposed as a noninvasive biomarker to stratify the risk of cardiovascular disease. However, it remains to be determined if HRV can be used as a surrogate for coronary artery physiology as analyzed by quantitative flow ratio (QFR) in patients with new-onset unstable angina pectoris (UAP).Methods: A total of 129 consecutive patients with new-onset UAP who underwent 24-h long-range 12-channel electrocardiography from June 2020 to December 2020 were included in this study. HRV, coronary angiography, and QFR information was retrieved from patient medical records, the severity of coronary lesions was evaluated using the Gensini score (GS), and total atherosclerotic burden was assessed using the three-vessel contrast QFR (3V-cQFR) calculated as the sum of cQFR in three vessels.Results: Multivariate logistic analysis showed that low-frequency power (LF) and high-sensitivity C-reactive protein (hs-CRP) were directly correlated with functional ischemia of target vessel, which were inversely correlated with total atherosclerotic burden as assessed by 3V-cQFR. Moreover, incorporation of the increase in LF into the existing model that uses clinical risk factors, GS, and hs-CRP significantly increased the discriminatory ability for evaluating coronary artery physiology of target vessel.Conclusions: LF and hs-CRP are independently associated with functional ischemia in patients with new-onset UAP. The relative increase of LF and hs-CRP could add value to the use of classical cardiovascular risk factors to predict the functional severity of coronary artery stenosis. Our results suggest a potential association between the autonomic nervous system, inflammation, and coronary artery physiology.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Novel Insights Into the Interaction Between the Autonomic Nervous System and Inflammation on Coronary Physiology: A Quantitative Flow Ratio Study

Wang

Liu

Chen

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

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“…Previous studies have shown good agreement between measured values of QFR and FFR ( 10 , 11 ), and QFR has a clear cutoff value for the diagnosis of coronary functional stenosis and demonstrates excellent reproducibility ( 11 , 12 ). It has also been shown that QFR has high predictive value for prognosis ( 13 , 14 ). Nevertheless, there is no evidence to date of the effects of immunity and inflammation on coronary physiology as detected by QFR in patients with CAD.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Immunoinflammation and Coronary Physiology Evaluated by Quantitative Flow Ratio in Patients With Coronary Artery Disease

Liu

Chen

et al. 2021

Front. Cardiovasc. Med.

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Background: The association between coronary physiology and immunoinflammation has not been investigated. We performed a retrospective study using quantitative flow ratio (QFR) to evaluate the interaction between immunoinflammatory biomarkers and coronary physiology.Methods: A total of 172 patients with CAD who underwent coronary arteriography (CAG) and QFR were continuously enrolled from May 2020 to February 2021. As a quantitative indicator of coronary physiology, QFR can reflect the functional severity of coronary artery stenosis. The target vessel measured by QFR was defined as that with the most severe lesions. Significant coronary anatomical stenosis was defined as 70% stenosis in the target vessel.Results: Compared with the QFR > 0.8 group, interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ were increased and CD3+ and CD4+ T lymphocyte counts were decreased in the QFR ≤ 0.8 group. In addition, patients with DS ≤ 70% had higher IL-6, IL-10, and TNF-α levels and decreased CD3+ and CD4+ T lymphocyte counts than those with DS > 70%. Logistic regression analysis indicated IL-6 to be an independent predictor of significant coronary functional and anatomic stenosis (odds ratio, 1.125; 95% CI, 1.059–1.196; P < 0.001). Receiver operating characteristic (ROC) analyses showed that IL-6 > 6.36 was predictive of QFR ≤ 0.8 of the target vessel. The combination of IL-6, IL-10 and CD4 improved the value for predicting QFR ≤ 0.8 of the target vessel (AUC, 0.737; 95% CI, 0.661–0.810).Conclusion: Among immunoinflammatory biomarkers, IL-6 was independently associated with a higher risk of QFR ≤ 0.8 of the target vessel. The combination of immunoinflammatory biomarkers was highly predictive of significant coronary functional and anatomic stenosis.

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“…Many studies showed that the prediction accuracy of FFR using DS was low (≤35%) (Park et al, 2012;Cho et al, 2014;Curzen et al, 2014). Angiography-derived FFR was invasive detection and ignored individual risk factors of patients to predict FFR (Kogame et al, 2020;Suzuki et al, 2020;Ding et al, 2021). With the development of predictive FFR technology, some studies, including case reports, have shown that other risk factors besides DS can also have a significant impact on the prediction of FFR.…”

Section: Discussionmentioning

confidence: 99%

Research on the Method of Predicting Fractional Flow Reserve Based on Multiple Independent Risk Factors

Zhang

Hou

et al. 2021

Front. Physiol.

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The use of diameter stenosis (DS), as revealed by coronary angiography, for predicting fractional flow reserve (FFR) usually results in a high error rate of detection. In this study, we investigated a method for predicting FFR in patients with coronary stenosis based on multiple independent risk factors. The aim of the study was to improve the accuracy of detection. First, we searched the existing literature to identify multiple independent risk factors and then calculated the corresponding odds ratios. The improved analytic hierarchy process (IAHP) was then used to determine the weighted value of each independent risk factor, based on the corresponding odds ratio. Next, we developed a novel method, based on the top seven independent risk factors with the highest weighted values, to predict FFR. This model was then used to predict the FFR of 253 patients with coronary stenosis, and the results were then compared with previous methods (DS alone and a simplified scoring system). In addition to DS, we identified a range of other independent risk factors, with the highest weighted values, for predicting FFR, including gender, body mass index, location of stenosis, type of coronary artery distribution, left ventricular ejection fraction, and left myocardial mass. The area under the receiver-operating characteristic curve (AUC) for the newly developed method was 84.3% (95% CI: 79.2–89.4%), which was larger than 65.3% (95% CI: 61.5–69.1%) of DS alone and 74.8% (95% CI: 68.4–81.2%) of the existing simplified scoring system. The newly developed method, based on multiple independent risk factors, effectively improves the prediction accuracy for FFR.

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The Impact of Coronary Physiology on Contemporary Clinical Decision Making

Cited by 80 publications

References 113 publications

Novel Insights Into the Interaction Between the Autonomic Nervous System and Inflammation on Coronary Physiology: A Quantitative Flow Ratio Study

Novel Insights Into the Interaction Between the Autonomic Nervous System and Inflammation on Coronary Physiology: A Quantitative Flow Ratio Study

Relationship Between Immunoinflammation and Coronary Physiology Evaluated by Quantitative Flow Ratio in Patients With Coronary Artery Disease

Research on the Method of Predicting Fractional Flow Reserve Based on Multiple Independent Risk Factors

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