Background The correlation between angiographic or intravascular ultrasound （IVUS） variables and fractional flow reserve （FFR） in patients with single left anterior descending artery （LAD） lesion has not been st...Background The correlation between angiographic or intravascular ultrasound （IVUS） variables and fractional flow reserve （FFR） in patients with single left anterior descending artery （LAD） lesion has not been studied. The current study aimed at determining the best cutoff value of angiographic and IVUS parameters for defining FFR 〈0.80 in patients with LAD lesion. Methods Quantitative coronary analysis, IVUS and FFR measurements were undergone in 169 patients with single LAD lesion, The best angiographic and IVUS cutoff value and their predictive value for FFR 〈0.80 were compared using area under the receiver-operator characteristic curve （AUC） in overall patients or in subgroups stratified by lesion sites. Results FFR 〈0.80 was found in 99 lesions （58.6%）. Minimal lumen area （MLA）, and plaque burden （PB） were two predictors of FFR 〈0.80. Lesion length had less value in predicting FFR 〈0.80. The cutoff value of PB and MLA for FFR 〈0.80 was 75.4% and 3.03 mm2. MLA and PB had similar high diagnostic value for proximal （cutoff value 3.04 mm2 and 76.5%） and distal LAD lesion （2.82 mm2 and 80.6%）. Combination of MLA （2.82 mm2） and PB （80.6%） had increased diagnostic value for distal LAD lesion. Conclusions MLA and plaque burden had equivalent diagnostic value for FFR 〈0.80 when lesion localized in LAD. The predictive value of combination of MLA and plaque burden for distal LAD lesion was strengthened.展开更多
Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiolo...Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis.FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy,deferring unnecessary procedures for lesions with a FFR>0.8,improving patients'management and clinical outcome.Post intervention,an optimal FFR>0.9 post stenting should be reached and>0.8 post drug eluting balloons.Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89.They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated.FFR remains the gold standard reference for invasive assessment of ischemia.We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio.We conclude introducing a hybrid approach to intermediate lesions(DFR 0.85-0.95)potentially maximizing clinical decision from all measurements.展开更多
New non-and less-invasive techniques have been developed to overcome the procedural and operator related burden of the fractional flow reserve(FFR)for the assessment of potentially significant stenosis in the coronary...New non-and less-invasive techniques have been developed to overcome the procedural and operator related burden of the fractional flow reserve(FFR)for the assessment of potentially significant stenosis in the coronary arteries.Virtual FFR-techniques can obviate the need for the additional flow or pressure wires as used for FFR measurements.This review provides an overview of the developments and validation of the virtual FFR-algorithms,states the challenges,discusses the upcoming clinical trials,and postulates the future role of virtual FFR in the clinical practice.展开更多
文摘Background The correlation between angiographic or intravascular ultrasound （IVUS） variables and fractional flow reserve （FFR） in patients with single left anterior descending artery （LAD） lesion has not been studied. The current study aimed at determining the best cutoff value of angiographic and IVUS parameters for defining FFR 〈0.80 in patients with LAD lesion. Methods Quantitative coronary analysis, IVUS and FFR measurements were undergone in 169 patients with single LAD lesion, The best angiographic and IVUS cutoff value and their predictive value for FFR 〈0.80 were compared using area under the receiver-operator characteristic curve （AUC） in overall patients or in subgroups stratified by lesion sites. Results FFR 〈0.80 was found in 99 lesions （58.6%）. Minimal lumen area （MLA）, and plaque burden （PB） were two predictors of FFR 〈0.80. Lesion length had less value in predicting FFR 〈0.80. The cutoff value of PB and MLA for FFR 〈0.80 was 75.4% and 3.03 mm2. MLA and PB had similar high diagnostic value for proximal （cutoff value 3.04 mm2 and 76.5%） and distal LAD lesion （2.82 mm2 and 80.6%）. Combination of MLA （2.82 mm2） and PB （80.6%） had increased diagnostic value for distal LAD lesion. Conclusions MLA and plaque burden had equivalent diagnostic value for FFR 〈0.80 when lesion localized in LAD. The predictive value of combination of MLA and plaque burden for distal LAD lesion was strengthened.
文摘Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis.FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy,deferring unnecessary procedures for lesions with a FFR>0.8,improving patients'management and clinical outcome.Post intervention,an optimal FFR>0.9 post stenting should be reached and>0.8 post drug eluting balloons.Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89.They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated.FFR remains the gold standard reference for invasive assessment of ischemia.We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio.We conclude introducing a hybrid approach to intermediate lesions(DFR 0.85-0.95)potentially maximizing clinical decision from all measurements.
文摘New non-and less-invasive techniques have been developed to overcome the procedural and operator related burden of the fractional flow reserve(FFR)for the assessment of potentially significant stenosis in the coronary arteries.Virtual FFR-techniques can obviate the need for the additional flow or pressure wires as used for FFR measurements.This review provides an overview of the developments and validation of the virtual FFR-algorithms,states the challenges,discusses the upcoming clinical trials,and postulates the future role of virtual FFR in the clinical practice.
