Utility of the fractional flow reserve in the evaluation of angiographically moderate in-stent restenosis (original) (raw)
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Global Journal of Health Science, 2015
Measuring fractional flow reserve (FFR) in percutaneous coronary intervention (PCI) has predictive value for PCI outcome. We decided to examine the utility of pre-and post-stenting FFR as a predictor of 6-month stent restenosis as well as MACE (major adverse cardiac events). Pre-and post-stenting FFR values were measured for 60 PCI patients. Within 6 months after stenting, all patients were followed for assessment of cardiac MACE including myocardial infarction, unstable angina, or positive exercise test. Stent restenosis was also assessed. Cutoff values for pre-and post-stenting FFR measurements were considered respectively as 0.65 and 0.92.Stent restenosis was detected in 4 patients (6.6%). All 4 patients (100%) with restenosis had pre-stenting FFR of < 0.65, while only 26 of 56 patients without restenosis (46.4%) had pre-stenting FFR value of < 0.65 (P = 0.039). Mean pre-stenting FFR in patients with restenosis was significantly lower than in those without restenosis (0.25 ± 0.01 vs. 0.53 ± 0.03, P = 0.022). Although stent restenosis was higher in patients with post-stenting FFR of < 0.92 (2 cases, 9.5%) than in those with FFR value of ≥ 0.92 (2 cases, 5.1%), the difference was not statistically (P = 0.510). Pre-stenting FFR, the use of longer stents, and history of diabetes mellitus can predict stent restenosis, but the value of post-stenting FFR for predicting restenosis was not explicit.
The American Journal of Cardiology, 2011
Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ؎ 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r ؍ ؊0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r ؍ ؊0.56, p ؍ 0.12). Although most lesions (89%) with a %DS of >70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR >0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate-or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.
AsiaIntervention, 2020
Aims: Prediction of post-intervention fractional flow reserve (FFR) in a diffuse or sequential coronary lesion is difficult due to complex haemodynamic interactions between individual stenoses. Furthermore, the existence of a residual intra-stent pressure gradient makes the prediction difficult. We developed an equation predicting the post-intervention FFR in a diffuse/sequential lesion by considering intra-stent FFR gradient. The present study aims to validate the equation in an in vitro model and in clinical data. Methods and results: In the in vitro experiment, three sequential coronary stenoses were made with a collateral flow. The correlation coefficient of the predicted FFR and the actual post-intervention FFR was 0.99, and the absolute difference was 0.008±0.006 (n=50). In the clinical data analysis, the correlation coefficient was 0.41, and the absolute difference was 0.06±0.05 (n=67). We applied a fixed value of intra-stent FFR gradient and a collateral flow index so that the equation can be used in clinical practice. The correlation coefficient became 0.28 and the absolute difference became 0.06±0.06. Conclusions: In clinical practice, prediction of post-intervention FFR in a diffuse/sequential lesion is difficult even when residual intra-stent pressure gradient is considered.
Journal of Pharmacy & Pharmacognosy Research, 2022
Context: The decision to perform an intervention on a narrowed coronary artery depends on the ischemia caused by the stenosis. The indication for intervention usually applies to cases with ≥70% stenosis of vascular diameter because of the risk of myocardial ischemia. Aims: To define the efficacy of fractional flow reserve (FFR) measurement in the evaluation of coronary artery stenosis. Methods: This prospective study was conducted on patients with intermediate coronary artery stenosis who underwent quantitative coronary angiography after coronary computed tomography angiography. Results: The study population consisted of 46 men and 26 women with a mean age of 66.0 ± 12.9 years. FFR was significantly correlated with the grade of angina pectoris (r =-0.387; p<0.01) and showed a negative correlation with percentage diameter stenosis (r =-0.241, p<0.05) and a positive correlation with the minimal lumen diameter (MLD; r = 0.377, p<0.05). The cutoff value to predict positive FFR was >55.62% diameter stenosis and MLD ≤ 1.08 mm. FFR ≤ 0.80 indicating intervention and FFR > 0.80 indicating medical therapy were observed in 56.9% and 43.1% of the cases, respectively. No major cardiac complications occurred during 12 months of follow-up in both groups. Conclusions: FFR measurements for intermediate stenosis of the coronary artery should be used to evaluate the possibility of myocardial ischaemia. If FFR is not available, a cutoff point of >55.62% diameter stenosis or MLD ≤ 1.08 mm can be used to predict the FFR results.
Fractional Flow Reserve Assessed by Pressure Wire and Proper Stent Deployment
2012
Background There are different methods for assessing the results of coronary intervention, some are morphological and the others are physiological. Myocardial fractional flow reserve (FFR myo) is a lesion specific index relating maximum myocardial blood flow in the presence of stenosis to its normal value if there is no stenosis. Objective The aim of our study is to assess the results of coronary stenting before and after post-stenting balloon dilatation by measuring myocardial fractional flow reserve using intracoronary pressure wire measurements. Methods FFR myo and quantitative coronary angiography (QCA) were obtained before PCI, after stent placement and after post-stenting balloon dilatation in 60 patients (LAD in 38 patients, RCA in 18 patients and LCX in 4 patients). FFR myo was calculated as the ratio of Pd/Pa during intracoronary adenosine (50 micg and 20 micg in the left and right coronary artery respectively) induced maximum hyperemia, where Pd represents mean distal coronary pressure measured by pressure wire and Pa represents mean aortic pressure measured by guiding catheter. Results The percent diameter stenosis decreased significantly after coronary stenting than baseline values (76%±14% diameter stenosis in baseline values vs15%±11% after stenting, p <0.05). Post-stenting balloon dilatation produced non-significant more reduction in the percent diameter stenosis (6%±4% with P value >0.05). FFR myo after PCI was significantly higher than that at baseline conditions before intervention (0.48±0.18 at baseline versus 0.89±0.09 after stenting, p <0.05). There was significant increase in FFR myo after post-stenting balloon dilatation (0.94±0.05 versus 0.89±0.09). Conclusions Assessment of coronary stenting by measuring myocardial fractional flow reserve by pressure wire is a valid and useful technique. Post-stenting Balloon dilatation produced non-significant trend towards better lumen diameter by Quantitative coronary angiography but with significant increase in Myocardial fractional flow reserve assessed by pressure wire.
Circulation: Cardiovascular Imaging, 2013
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Circulation: Cardiovascular Interventions
O n the basis of robust scientific 1,2 and clinical outcome data derived from large randomized controlled trials and registries, 3-18 fractional flow reserve (FFR) has become the standard for clinical decision making about percutaneous coronary revascularization. FFR has a Class I indication with a level of evidence A in stable patients to identify hemodynamically significant coronary lesions when evidence of ischemia is not available. 19 Recent prospective outcome data, obtained in medically treated patients, indicated a risk continuum for FFR values from 0 to 1, where the lower the FFR the higher the long-term event rate. 18,20 However, it is still unclear whether a similar correlation is maintained after revascularization because the clinical value of FFR to evaluate the results of percutaneous coronary intervention (PCI) has not been prospectively investigated in the drug-eluting stent (DES) era.
Circulation: Cardiovascular Imaging, 2013
Background— Fractional flow reserve derived from computed tomography angiography (FFR CT ) is a noninvasive method for diagnosis of ischemic coronary lesions. To date, the diagnostic performance of FFR CT for lesions of intermediate stenosis severity remains unexamined. Methods and Results— Among 407 vessels from 252 patients at 17 centers who underwent CT, FFR CT , invasive coronary angiography, and invasive FFR, we identified 150 vessels of intermediate stenosis by CT, defined as 30% to 69% stenosis. FFR CT , FFR, and CT were interpreted in blinded fashion by independent core laboratories. FFR CT and FFR ≤0.80 were considered hemodynamically significant, whereas CT stenosis ≥50% was considered obstructive. Diagnostic performance of FFR CT versus CT was assessed for accuracy, sensitivity, specificity, positive predictive values, and negative predictive values. Area under the receiver operating characteristic curve and net reclassification improvement were evaluated. For lesions of ...
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 2005
Fractional flow reserve (FFR) is correlated with angiographic and intravascular ultrasound assessments of stent placement. Post-stenting FFR has been described as a good predictor of clinical events after 6 months. To evaluate the feasibility and clinical impact of targeting an FFR > 0.95 via incremental in-stent inflation pressures. In this multicenter prospective study, 100 consecutive patients underwent FFR measurement at baseline, after balloon predilatation, and after stenting with 4-atm inflation pressure increments from 8 to 20 atmospheres. Inflations were stopped when FFR increased above 0.95 and angiographic stenosis was less than 20%. FFR > 0.95 was achieved in 81% of cases; this FFR target was reached at 8 atm in 47% of patients, 12 atm in 16 %, 16 atm in 15%, and 20 atm in 3%. Fifty percent of patients with adequate angiographic result had an FFR less than 0.95 and needed further higher inflations. FFR was correlated with residual stenosis when the total procedure ...
JACC. Cardiovascular imaging, 2018
The aims of the present study were: 1) to investigate the contribution of the extent of luminal stenosis and other lesion composition-related factors in predicting invasive fractional flow reserve (FFR); and 2) to explore the distribution of various combinations of morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR. In patients with stable ischemic heart disease, FFR-guided revascularization, as compared with medical therapy alone, is reported to improve outcomes. Because morphological characteristics are the basis of plaque rupture and acute coronary events, a relationship between FFR and lesion characteristics may exist. This is a subanalysis of NXT (HeartFlowNXT: HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography), a prospective, multicenter study of 254 patients (age 64 ± 10 years, 64% male) with suspected stable ischemic heart disease; coronary computed tomography angiography including plaque morph...