Martijn Meuwissen - Academia.edu (original) (raw)

Papers by Martijn Meuwissen

Research paper thumbnail of Change in Coronary Blood Flow After Percutaneous Coronary Intervention in Relation to Baseline Lesion Physiology: Results of the JUSTIFY-PCI Study

Circulation. Cardiovascular interventions, 2015

Percutaneous coronary intervention (PCI) aims to increase coronary blood flow by relieving epicar... more Percutaneous coronary intervention (PCI) aims to increase coronary blood flow by relieving epicardial obstruction. However, no study has objectively confirmed this and assessed changes in flow over different phases of the cardiac cycle. We quantified the change in resting and hyperemic flow velocity after PCI in stenoses defined physiologically by fractional flow reserve and other parameters. Seventy-five stenoses (67 patients) underwent paired flow velocity assessment before and after PCI. Flow velocity was measured over the whole cardiac cycle and the wave-free period. Mean fractional flow reserve was 0.68±0.02. Pre-PCI, hyperemic flow velocity is diminished in stenoses classed as physiologically significant compared with those classed nonsignificant (P<0.001). In significant stenoses, flow velocity over the resting wave-free period and hyperemic flow velocity did not differ statistically. After PCI, resting flow velocity over the wave-free period increased little (5.6±1.6 cm/s...

Research paper thumbnail of Prospective Assessment of the Diagnostic Accuracy of Instantaneous Wave-Free Ratio to Assess Coronary Stenosis Relevance

JACC: Cardiovascular Interventions, 2015

The purpose of this study was to assess the diagnostic accuracy of the instantaneous wave-free ra... more The purpose of this study was to assess the diagnostic accuracy of the instantaneous wave-free ratio (iFR) to characterize, outside of a pre-specified range of values, stenosis severity, as defined by fractional flow reserve (FFR) ≤0.80, in a prospective, independent, controlled, core laboratory-based environment. Studies with methodological heterogeneity have reported some discrepancies in the classification agreement between iFR and FFR. The ADVISE II (ADenosine Vasodilator Independent Stenosis Evaluation II) study was designed to overcome limitations of previous iFR versus FFR comparisons. A total of 919 intermediate coronary stenoses were investigated during baseline and hyperemia. From these, 690 pressure recordings (n = 598 patients) met core laboratory physiology criteria and are included in this report. The pre-specified iFR cut-off of 0.89 was optimal for the study and correctly classified 82.5% of the stenoses, with a sensitivity of 73.0% and specificity of 87.8% (C statistic: 0.90 [95% confidence interval (CI): 0.88 to 0.92, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001]). The proportion of stenoses properly classified by iFR outside of the pre-specified treatment (≤0.85) and deferral (≥0.94) values was 91.6% (95% CI: 88.8% to 93.9%). When combined with FFR use within these cut-offs, the percent of stenoses properly classified by such a pre-specified hybrid iFR-FFR approach was 94.2% (95% CI: 92.2% to 95.8%). The hybrid iFR-FFR approach obviated vasodilators from 65.1% (95% CI: 61.1% to 68.9%) of patients and 69.1% (95% CI: 65.5% to 72.6%) of stenoses. The ADVISE II study supports, on the basis rigorous methodology, the diagnostic value of iFR in establishing the functional significance of coronary stenoses, and highlights its complementariness with FFR when used in a hybrid iFR-FFR approach. (ADenosine Vasodilator Independent Stenosis Evaluation II-ADVISE II; NCT01740895).

Research paper thumbnail of TCT-20 Pressure-controlled Intermittent Coronary Sinus Occlusion (PICSO) in Acute ST-segment Elevation Myocardial Infarction: Final Results of the Prepare RAMSES Study

Journal of the American College of Cardiology, 2014

Background: Decreased LVEF at presentation during STEMI has been established as a predictor of mo... more Background: Decreased LVEF at presentation during STEMI has been established as a predictor of morbidity and mortality. Many patients have improvement in LVEF over time due to recovery of hibernating or stunned myocardium. Little data exists on the clinical and angiographic predictors of improvement in LVEF after stenting. Methods: In HORIZONS-AMI, 3,602 patients presenting with STEMI at 123 sites were randomized to heparin + a glycoprotein IIb/IIIa inhibitor (H+GPI) vs. bivalirudin, and to paclitaxel-eluting stents vs. bare metal stents. Clinical follow-up was performed for three years, including routine angiographic follow-up at 13 months in a pre-specified substudy. Results: Baseline and 13-month follow-up LVEF measurements were available in 656 patients, comprising the current study cohort. The median change [interquartile range] in LVEF from baseline to 13 months was +2.4% [-5.85%, 11.80%]. During follow-up LVEF rose or remained the same in 379 (57.8%) patients (median D +9.8% [4.30%, 16.40%]), and fell in 277 (42.2%) patients (median D -7.0% [-11.80%, -3.60%]). By multivariable analysis, independent predictors of improvement in LVEF were female sex (p¼0.002) and TIMI 3 flow after PCI (p¼0.03), while longer lesion length (p¼0.04), greater peak CKMB (p< 0.0001) and higher baseline LVEF (p< 0.0001) predicted LVEF decrease . Of note, use of drug-eluting vs. bare metal stents, bivalirudin vs. H+GPI, symptom-to-balloon time, and discharge use of beta-blockers or ACEI/ARBs were not significant predictors of LVEF improvement.

Research paper thumbnail of Fractional flow reserve as a surrogate for inducible myocardial ischaemia

Nature Reviews Cardiology, 2013

| Documentation of inducible myocardial ischaemia, related to the coronary stenosis of interest, ... more | Documentation of inducible myocardial ischaemia, related to the coronary stenosis of interest, is of increasing importance in lesion selection for percutaneous coronary intervention (PCI). Fractional flow reserve (FFR) is an easily understood, routine diagnostic modality that has become part of daily clinical practice, and is used as a surrogate technique for noninvasive assessment of myocardial ischaemia. However, the application of a single, discrete, cut-off value for FFR-guided lesion selection for PCI, and its adoption in contemporary revascularization guidelines, has limited the requirement for a thorough understanding of the physiological basis of FFR. This limitation constitutes an obstacle for the adequate use and interpretation of this technique, and also for the understanding of new and future modalities of physiological functional intracoronary testing. In this Review, we revisit the fundamental elements of coronary physiology in the absence or presence of coronary artery disease. We provide insight into three essential characteristics of FFR as a diagnostic tool in contemporary clinical practice-the theoretical framework of FFR and its associated limitations; the characteristics and role of FFR as a surrogate for noninvasively assessed myocardial ischaemia; and the requirement and associated caveats of potent vasodilatory drugs to induce maximal vasodilatation of the coronary vascular bed.

Research paper thumbnail of BASAL VERSUS HYPEREMIC CONDITIONS FOR PHYSIOLOGICAL STENOSIS SEVERITY ASSESSMENT

Research paper thumbnail of Images in cardiovascular medicine. Stent inflammation: stent footprint in restenotic tissue retrieved by directional atherectomy

Circulation, Jan 27, 2002

Research paper thumbnail of Baseline instantaneous wave-free ratio as a pressure-only estimation of underlying coronary flow reserve: results of the JUSTIFY-CFR Study (Joined Coronary Pressure and Flow Analysis to Determine Diagnostic Characteristics of Basal and Hyperemic Indices of Functional Lesion Severity-Coronary Flow...

Circulation. Cardiovascular interventions, 2014

Coronary flow reserve has extensive validation as a prognostic marker in coronary disease. Althou... more Coronary flow reserve has extensive validation as a prognostic marker in coronary disease. Although pressure-only fractional flow reserve (FFR) improves outcomes compared with angiography when guiding percutaneous coronary intervention, it disagrees with coronary flow reserve classification 30% of the time. We evaluated whether baseline instantaneous wave-free ratio (iFR) could provide an improved pressure-only estimation of underlying coronary flow reserve. Invasive pressure and flow velocity were measured in 216 stenoses from 186 patients with coronary disease. The diagnostic relationship between pressure-only indices (iFR and FFR) and coronary flow velocity reserve (CFVR) was compared using correlation coefficient and the area under the receiver operating characteristic curve. iFR showed a stronger correlation with underlying CFVR (iFR-CFVR, ρ=0.68 versus FFR-CFVR, ρ=0.50; P<0.001). iFR also agreed more closely with CFVR in stenosis classification (iFR area under the receiver ...

Research paper thumbnail of Role of fractional and coronary flow reserve in clinical decision making in intermediate coronary lesions

Interventional Cardiology, 2009

Adequate patient selection for percutaneous coronary intervention is of the greatest importance i... more Adequate patient selection for percutaneous coronary intervention is of the greatest importance in order to minimize early and late complications. Therefore, objective evidence for myocardial ischemia is mandatory for the management of patients with coronary artery ...

Research paper thumbnail of Increased hyperaemic coronary microvascular resistance adds to the presence of myocardial ischaemia

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2014

It has been argued that hyperaemic microvascular resistance (HMR), defined as the ratio of mean d... more It has been argued that hyperaemic microvascular resistance (HMR), defined as the ratio of mean distal coronary pressure to flow velocity, is overestimated in the presence of a coronary stenosis compared to actual microvascular resistance (MR), due to neglecting collateral flow. We aimed to test the hypothesis that HMR allows accurate identification of microvascular functional abnormalities by evaluating the association between high or low HMR and the presence of myocardial ischaemia on non-invasive stress testing. Myocardial perfusion scintigraphy was performed in 228 patients, with 299 lesions to identify reversible myocardial ischaemia. Intracoronary distal pressure and flow velocity were assessed during adenosine-induced hyperaemia (20-40 µg, intracoronary) to determine hyperaemic stenosis resistance (HSR) and HMR. HMR >1.9 mmHg/cm/s was defined as high. The diagnostic odds ratio (OR) for myocardial ischaemia for lesions associated with high compared to low HMR was 2.6 (95% c...

Research paper thumbnail of Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity

Circulation. Cardiovascular interventions, 2014

Discordance between fractional flow reserve (FFR) and coronary flow velocity reserve (CFVR) may r... more Discordance between fractional flow reserve (FFR) and coronary flow velocity reserve (CFVR) may reflect important coronary pathophysiology but usually remains unnoticed in clinical practice. We evaluated the physiological basis and clinical outcome associated with FFR/CFVR discordance. We studied 157 intermediate coronary stenoses in 157 patients, evaluated by FFR and CFVR between April 1997 and September 2006 in which revascularization was deferred. Long-term follow-up was performed to document the occurrence of major adverse cardiac events: cardiac death, myocardial infarction, or target vessel revascularization. Discordance between FFR and CFVR occurred in 31% and 37% of stenoses at the 0.75, and 0.80 FFR cut-off value, respectively, and was characterized by microvascular resistances during basal and hyperemic conditions. Follow-up duration amounted to 11.7 years (Q1-Q3, 9.9-13.3 years). Compared with concordant normal results of FFR and CFVR, a normal FFR with an abnormal CFVR w...

Research paper thumbnail of Catheterization, Council on Clinical Cardiology Association Committee on Diagnostic and Interventional Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Physiological Assessment of Coronary Artery Disease in the Cardiac

With advances in technology, the physiological assessment of coronary artery disease in patients ... more With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care. (Circulation. 2006;114:1321-1341.)

Research paper thumbnail of The additional value of C-reactive protein in patients with intermediate coronary lesions and a normal fractional flow reserve

Journal of the American College of Cardiology, 2003

Research paper thumbnail of Fractional flow reserve, absolute and relative coronary blood flow velocity reserve in relation to the results of technetium-99m sestambi single-photon emission computed tomography in patients with two-vessel coronary artery disease

Journal of the American College of Cardiology, 2001

We sought to perform a direct comparison between perfusion scintigraphic results and intracoronar... more We sought to perform a direct comparison between perfusion scintigraphic results and intracoronary-derived hemodynamic variables (fractional flow reserve [FFR]; absolute and relative coronary flow velocity reserve [CFVR and rCFVR, respectively]) in patients with two-vessel disease. BACKGROUND There is limited information on the diagnostic accuracy of intracoronary-derived variables (CFVR, FFR and rCFVR) in patients with multivessel disease.

Research paper thumbnail of Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease

Journal of the American College of Cardiology, 2002

Research paper thumbnail of AGE AND ONE-YEAR MORTALITY AFTER ST ELEVATION MYOCARDIAL INFARCTION TREATED WITH PRIMARY PERCUTANEOUS INTERVENTION

Journal of the American College of Cardiology, 2010

Category: PCI -Acute MI Background: Older age has been identiied as an important risk factor afte... more Category: PCI -Acute MI Background: Older age has been identiied as an important risk factor after ST Elevation Myocardial Infarction (STEMI) in the thrombolytic era. Currently, the relationship between older age and mortality after contemporary primary percutaneous coronary intervention (pPCI) remains largely unexplored.

Research paper thumbnail of MULTIVESSEL VERSUS CULPRIT-ONLY PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH MULTIVESSEL DISEASE AND ST-ELEVATION MYOCARDIAL INFARCTION COMPLICATED WITH CARDIOGENIC SHOCK

Journal of the American College of Cardiology, 2010

Category: PCI -Acute MI Background: Multivessel disease (MVD) is present in the majority of ST El... more Category: PCI -Acute MI Background: Multivessel disease (MVD) is present in the majority of ST Elevation Myocardial Infarction (STEMI) patients with cardiogenic shock (CS). We investigated the effect of multivessel primary percutaneous coronary intervention (PCI) versus culpritvessel-only PCI on 1-year mortality in patients with MVD and STEMI complicated with CS.

Research paper thumbnail of THE PERFORMANCE OF BASELINE HAEMODYNAMIC INDICES OF CORONARY DISEASE SEVERITY IN THE DEFER AND FAME STUDIES: AN ESTIMATED AGREEMENT OF STENOSES CLASSIFICATION WITH FRACTIONAL FLOW RESERVE

Journal of the American College of Cardiology, 2013

Background: Recently, two invasive, vasodilator-free indices of coronary disease severity, the in... more Background: Recently, two invasive, vasodilator-free indices of coronary disease severity, the instantaneous wave-Free Ratio (iFR) and Baseline Stenosis Resistance (BSR) index, have been proposed as alternatives to fractional flow reserve (FFR). However, outcome studies on BSR and iFR are still lacking. In this study, we estimate iFR and BSR diagnostic performance in the populations of FAME and DEFER studies, landmark trials which have demonstrated the prognostic benefit of physiology-guided coronary revascularisation.

Research paper thumbnail of BASAL STENOSIS RESISTANCE INDEX AND INSTANTANEOUS WAVE–FREE RATIO HAVE THE SAME DIAGNOSTIC PERFORMANCE AS FRACTIONAL FLOW RESERVE TO DETECT MYOCARDIAL ISCHEMIA USING MYOCARDIAL PERFUSION IMAGING

Journal of the American College of Cardiology, 2013

Background: Despite its clinical beneit, adoption of fractional low reserve (FFR)-guided revascul... more Background: Despite its clinical beneit, adoption of fractional low reserve (FFR)-guided revascularization remains limited, partly due to the prerequisite for vasodilator administration. Basal stenosis resistance index (BSR) and instantaneous wave-free ratio (iFR) are vasodilator-free indices of functional lesion severity which have been proposed as an alternative to FFR. In absence of a direct comparison of iFR and BSR, we sought to determine an iFR cut-off value for myocardial ischemia on non-invasive imaging, and to compare its agreement with BSR and FFR.

Research paper thumbnail of FRACTIONAL FLOW RESERVE IS UNLIKELY TO BE ABNORMAL IN THE PRESENCE OF HIGH MICROVASCULAR RESISTANCE

Journal of the American College of Cardiology, 2014

Research paper thumbnail of Multiple Biomarkers at Admission Significantly Improve the Prediction of Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction

Journal of the American College of Cardiology, 2011

We investigated whether multiple biomarkers improve prognostication in ST-segment elevation myoca... more We investigated whether multiple biomarkers improve prognostication in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention.

Research paper thumbnail of Change in Coronary Blood Flow After Percutaneous Coronary Intervention in Relation to Baseline Lesion Physiology: Results of the JUSTIFY-PCI Study

Circulation. Cardiovascular interventions, 2015

Percutaneous coronary intervention (PCI) aims to increase coronary blood flow by relieving epicar... more Percutaneous coronary intervention (PCI) aims to increase coronary blood flow by relieving epicardial obstruction. However, no study has objectively confirmed this and assessed changes in flow over different phases of the cardiac cycle. We quantified the change in resting and hyperemic flow velocity after PCI in stenoses defined physiologically by fractional flow reserve and other parameters. Seventy-five stenoses (67 patients) underwent paired flow velocity assessment before and after PCI. Flow velocity was measured over the whole cardiac cycle and the wave-free period. Mean fractional flow reserve was 0.68±0.02. Pre-PCI, hyperemic flow velocity is diminished in stenoses classed as physiologically significant compared with those classed nonsignificant (P<0.001). In significant stenoses, flow velocity over the resting wave-free period and hyperemic flow velocity did not differ statistically. After PCI, resting flow velocity over the wave-free period increased little (5.6±1.6 cm/s...

Research paper thumbnail of Prospective Assessment of the Diagnostic Accuracy of Instantaneous Wave-Free Ratio to Assess Coronary Stenosis Relevance

JACC: Cardiovascular Interventions, 2015

The purpose of this study was to assess the diagnostic accuracy of the instantaneous wave-free ra... more The purpose of this study was to assess the diagnostic accuracy of the instantaneous wave-free ratio (iFR) to characterize, outside of a pre-specified range of values, stenosis severity, as defined by fractional flow reserve (FFR) ≤0.80, in a prospective, independent, controlled, core laboratory-based environment. Studies with methodological heterogeneity have reported some discrepancies in the classification agreement between iFR and FFR. The ADVISE II (ADenosine Vasodilator Independent Stenosis Evaluation II) study was designed to overcome limitations of previous iFR versus FFR comparisons. A total of 919 intermediate coronary stenoses were investigated during baseline and hyperemia. From these, 690 pressure recordings (n = 598 patients) met core laboratory physiology criteria and are included in this report. The pre-specified iFR cut-off of 0.89 was optimal for the study and correctly classified 82.5% of the stenoses, with a sensitivity of 73.0% and specificity of 87.8% (C statistic: 0.90 [95% confidence interval (CI): 0.88 to 0.92, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001]). The proportion of stenoses properly classified by iFR outside of the pre-specified treatment (≤0.85) and deferral (≥0.94) values was 91.6% (95% CI: 88.8% to 93.9%). When combined with FFR use within these cut-offs, the percent of stenoses properly classified by such a pre-specified hybrid iFR-FFR approach was 94.2% (95% CI: 92.2% to 95.8%). The hybrid iFR-FFR approach obviated vasodilators from 65.1% (95% CI: 61.1% to 68.9%) of patients and 69.1% (95% CI: 65.5% to 72.6%) of stenoses. The ADVISE II study supports, on the basis rigorous methodology, the diagnostic value of iFR in establishing the functional significance of coronary stenoses, and highlights its complementariness with FFR when used in a hybrid iFR-FFR approach. (ADenosine Vasodilator Independent Stenosis Evaluation II-ADVISE II; NCT01740895).

Research paper thumbnail of TCT-20 Pressure-controlled Intermittent Coronary Sinus Occlusion (PICSO) in Acute ST-segment Elevation Myocardial Infarction: Final Results of the Prepare RAMSES Study

Journal of the American College of Cardiology, 2014

Background: Decreased LVEF at presentation during STEMI has been established as a predictor of mo... more Background: Decreased LVEF at presentation during STEMI has been established as a predictor of morbidity and mortality. Many patients have improvement in LVEF over time due to recovery of hibernating or stunned myocardium. Little data exists on the clinical and angiographic predictors of improvement in LVEF after stenting. Methods: In HORIZONS-AMI, 3,602 patients presenting with STEMI at 123 sites were randomized to heparin + a glycoprotein IIb/IIIa inhibitor (H+GPI) vs. bivalirudin, and to paclitaxel-eluting stents vs. bare metal stents. Clinical follow-up was performed for three years, including routine angiographic follow-up at 13 months in a pre-specified substudy. Results: Baseline and 13-month follow-up LVEF measurements were available in 656 patients, comprising the current study cohort. The median change [interquartile range] in LVEF from baseline to 13 months was +2.4% [-5.85%, 11.80%]. During follow-up LVEF rose or remained the same in 379 (57.8%) patients (median D +9.8% [4.30%, 16.40%]), and fell in 277 (42.2%) patients (median D -7.0% [-11.80%, -3.60%]). By multivariable analysis, independent predictors of improvement in LVEF were female sex (p¼0.002) and TIMI 3 flow after PCI (p¼0.03), while longer lesion length (p¼0.04), greater peak CKMB (p< 0.0001) and higher baseline LVEF (p< 0.0001) predicted LVEF decrease . Of note, use of drug-eluting vs. bare metal stents, bivalirudin vs. H+GPI, symptom-to-balloon time, and discharge use of beta-blockers or ACEI/ARBs were not significant predictors of LVEF improvement.

Research paper thumbnail of Fractional flow reserve as a surrogate for inducible myocardial ischaemia

Nature Reviews Cardiology, 2013

| Documentation of inducible myocardial ischaemia, related to the coronary stenosis of interest, ... more | Documentation of inducible myocardial ischaemia, related to the coronary stenosis of interest, is of increasing importance in lesion selection for percutaneous coronary intervention (PCI). Fractional flow reserve (FFR) is an easily understood, routine diagnostic modality that has become part of daily clinical practice, and is used as a surrogate technique for noninvasive assessment of myocardial ischaemia. However, the application of a single, discrete, cut-off value for FFR-guided lesion selection for PCI, and its adoption in contemporary revascularization guidelines, has limited the requirement for a thorough understanding of the physiological basis of FFR. This limitation constitutes an obstacle for the adequate use and interpretation of this technique, and also for the understanding of new and future modalities of physiological functional intracoronary testing. In this Review, we revisit the fundamental elements of coronary physiology in the absence or presence of coronary artery disease. We provide insight into three essential characteristics of FFR as a diagnostic tool in contemporary clinical practice-the theoretical framework of FFR and its associated limitations; the characteristics and role of FFR as a surrogate for noninvasively assessed myocardial ischaemia; and the requirement and associated caveats of potent vasodilatory drugs to induce maximal vasodilatation of the coronary vascular bed.

Research paper thumbnail of BASAL VERSUS HYPEREMIC CONDITIONS FOR PHYSIOLOGICAL STENOSIS SEVERITY ASSESSMENT

Research paper thumbnail of Images in cardiovascular medicine. Stent inflammation: stent footprint in restenotic tissue retrieved by directional atherectomy

Circulation, Jan 27, 2002

Research paper thumbnail of Baseline instantaneous wave-free ratio as a pressure-only estimation of underlying coronary flow reserve: results of the JUSTIFY-CFR Study (Joined Coronary Pressure and Flow Analysis to Determine Diagnostic Characteristics of Basal and Hyperemic Indices of Functional Lesion Severity-Coronary Flow...

Circulation. Cardiovascular interventions, 2014

Coronary flow reserve has extensive validation as a prognostic marker in coronary disease. Althou... more Coronary flow reserve has extensive validation as a prognostic marker in coronary disease. Although pressure-only fractional flow reserve (FFR) improves outcomes compared with angiography when guiding percutaneous coronary intervention, it disagrees with coronary flow reserve classification 30% of the time. We evaluated whether baseline instantaneous wave-free ratio (iFR) could provide an improved pressure-only estimation of underlying coronary flow reserve. Invasive pressure and flow velocity were measured in 216 stenoses from 186 patients with coronary disease. The diagnostic relationship between pressure-only indices (iFR and FFR) and coronary flow velocity reserve (CFVR) was compared using correlation coefficient and the area under the receiver operating characteristic curve. iFR showed a stronger correlation with underlying CFVR (iFR-CFVR, ρ=0.68 versus FFR-CFVR, ρ=0.50; P<0.001). iFR also agreed more closely with CFVR in stenosis classification (iFR area under the receiver ...

Research paper thumbnail of Role of fractional and coronary flow reserve in clinical decision making in intermediate coronary lesions

Interventional Cardiology, 2009

Adequate patient selection for percutaneous coronary intervention is of the greatest importance i... more Adequate patient selection for percutaneous coronary intervention is of the greatest importance in order to minimize early and late complications. Therefore, objective evidence for myocardial ischemia is mandatory for the management of patients with coronary artery ...

Research paper thumbnail of Increased hyperaemic coronary microvascular resistance adds to the presence of myocardial ischaemia

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2014

It has been argued that hyperaemic microvascular resistance (HMR), defined as the ratio of mean d... more It has been argued that hyperaemic microvascular resistance (HMR), defined as the ratio of mean distal coronary pressure to flow velocity, is overestimated in the presence of a coronary stenosis compared to actual microvascular resistance (MR), due to neglecting collateral flow. We aimed to test the hypothesis that HMR allows accurate identification of microvascular functional abnormalities by evaluating the association between high or low HMR and the presence of myocardial ischaemia on non-invasive stress testing. Myocardial perfusion scintigraphy was performed in 228 patients, with 299 lesions to identify reversible myocardial ischaemia. Intracoronary distal pressure and flow velocity were assessed during adenosine-induced hyperaemia (20-40 µg, intracoronary) to determine hyperaemic stenosis resistance (HSR) and HMR. HMR >1.9 mmHg/cm/s was defined as high. The diagnostic odds ratio (OR) for myocardial ischaemia for lesions associated with high compared to low HMR was 2.6 (95% c...

Research paper thumbnail of Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity

Circulation. Cardiovascular interventions, 2014

Discordance between fractional flow reserve (FFR) and coronary flow velocity reserve (CFVR) may r... more Discordance between fractional flow reserve (FFR) and coronary flow velocity reserve (CFVR) may reflect important coronary pathophysiology but usually remains unnoticed in clinical practice. We evaluated the physiological basis and clinical outcome associated with FFR/CFVR discordance. We studied 157 intermediate coronary stenoses in 157 patients, evaluated by FFR and CFVR between April 1997 and September 2006 in which revascularization was deferred. Long-term follow-up was performed to document the occurrence of major adverse cardiac events: cardiac death, myocardial infarction, or target vessel revascularization. Discordance between FFR and CFVR occurred in 31% and 37% of stenoses at the 0.75, and 0.80 FFR cut-off value, respectively, and was characterized by microvascular resistances during basal and hyperemic conditions. Follow-up duration amounted to 11.7 years (Q1-Q3, 9.9-13.3 years). Compared with concordant normal results of FFR and CFVR, a normal FFR with an abnormal CFVR w...

Research paper thumbnail of Catheterization, Council on Clinical Cardiology Association Committee on Diagnostic and Interventional Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Physiological Assessment of Coronary Artery Disease in the Cardiac

With advances in technology, the physiological assessment of coronary artery disease in patients ... more With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care. (Circulation. 2006;114:1321-1341.)

Research paper thumbnail of The additional value of C-reactive protein in patients with intermediate coronary lesions and a normal fractional flow reserve

Journal of the American College of Cardiology, 2003

Research paper thumbnail of Fractional flow reserve, absolute and relative coronary blood flow velocity reserve in relation to the results of technetium-99m sestambi single-photon emission computed tomography in patients with two-vessel coronary artery disease

Journal of the American College of Cardiology, 2001

We sought to perform a direct comparison between perfusion scintigraphic results and intracoronar... more We sought to perform a direct comparison between perfusion scintigraphic results and intracoronary-derived hemodynamic variables (fractional flow reserve [FFR]; absolute and relative coronary flow velocity reserve [CFVR and rCFVR, respectively]) in patients with two-vessel disease. BACKGROUND There is limited information on the diagnostic accuracy of intracoronary-derived variables (CFVR, FFR and rCFVR) in patients with multivessel disease.

Research paper thumbnail of Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease

Journal of the American College of Cardiology, 2002

Research paper thumbnail of AGE AND ONE-YEAR MORTALITY AFTER ST ELEVATION MYOCARDIAL INFARCTION TREATED WITH PRIMARY PERCUTANEOUS INTERVENTION

Journal of the American College of Cardiology, 2010

Category: PCI -Acute MI Background: Older age has been identiied as an important risk factor afte... more Category: PCI -Acute MI Background: Older age has been identiied as an important risk factor after ST Elevation Myocardial Infarction (STEMI) in the thrombolytic era. Currently, the relationship between older age and mortality after contemporary primary percutaneous coronary intervention (pPCI) remains largely unexplored.

Research paper thumbnail of MULTIVESSEL VERSUS CULPRIT-ONLY PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH MULTIVESSEL DISEASE AND ST-ELEVATION MYOCARDIAL INFARCTION COMPLICATED WITH CARDIOGENIC SHOCK

Journal of the American College of Cardiology, 2010

Category: PCI -Acute MI Background: Multivessel disease (MVD) is present in the majority of ST El... more Category: PCI -Acute MI Background: Multivessel disease (MVD) is present in the majority of ST Elevation Myocardial Infarction (STEMI) patients with cardiogenic shock (CS). We investigated the effect of multivessel primary percutaneous coronary intervention (PCI) versus culpritvessel-only PCI on 1-year mortality in patients with MVD and STEMI complicated with CS.

Research paper thumbnail of THE PERFORMANCE OF BASELINE HAEMODYNAMIC INDICES OF CORONARY DISEASE SEVERITY IN THE DEFER AND FAME STUDIES: AN ESTIMATED AGREEMENT OF STENOSES CLASSIFICATION WITH FRACTIONAL FLOW RESERVE

Journal of the American College of Cardiology, 2013

Background: Recently, two invasive, vasodilator-free indices of coronary disease severity, the in... more Background: Recently, two invasive, vasodilator-free indices of coronary disease severity, the instantaneous wave-Free Ratio (iFR) and Baseline Stenosis Resistance (BSR) index, have been proposed as alternatives to fractional flow reserve (FFR). However, outcome studies on BSR and iFR are still lacking. In this study, we estimate iFR and BSR diagnostic performance in the populations of FAME and DEFER studies, landmark trials which have demonstrated the prognostic benefit of physiology-guided coronary revascularisation.

Research paper thumbnail of BASAL STENOSIS RESISTANCE INDEX AND INSTANTANEOUS WAVE–FREE RATIO HAVE THE SAME DIAGNOSTIC PERFORMANCE AS FRACTIONAL FLOW RESERVE TO DETECT MYOCARDIAL ISCHEMIA USING MYOCARDIAL PERFUSION IMAGING

Journal of the American College of Cardiology, 2013

Background: Despite its clinical beneit, adoption of fractional low reserve (FFR)-guided revascul... more Background: Despite its clinical beneit, adoption of fractional low reserve (FFR)-guided revascularization remains limited, partly due to the prerequisite for vasodilator administration. Basal stenosis resistance index (BSR) and instantaneous wave-free ratio (iFR) are vasodilator-free indices of functional lesion severity which have been proposed as an alternative to FFR. In absence of a direct comparison of iFR and BSR, we sought to determine an iFR cut-off value for myocardial ischemia on non-invasive imaging, and to compare its agreement with BSR and FFR.

Research paper thumbnail of FRACTIONAL FLOW RESERVE IS UNLIKELY TO BE ABNORMAL IN THE PRESENCE OF HIGH MICROVASCULAR RESISTANCE

Journal of the American College of Cardiology, 2014

Research paper thumbnail of Multiple Biomarkers at Admission Significantly Improve the Prediction of Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction

Journal of the American College of Cardiology, 2011

We investigated whether multiple biomarkers improve prognostication in ST-segment elevation myoca... more We investigated whether multiple biomarkers improve prognostication in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention.