Predicting the Physiological Effect of Revascularization in Serially Diseased Coronary Arteries
Fractional flow reserve (FFR) is commonly used to assess the functional significance of coronary artery disease but is theoretically limited in evaluating individual stenoses in serially diseased vessels. We sought to characterize the accuracy of assessing individual stenoses in serial disease using...
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| Veröffentlicht in: | Circulation. Cardiovascular interventions 2019-02, Vol.12 (2), p.e007577-e007577 |
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| container_title | Circulation. Cardiovascular interventions |
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| creator | Modi, Bhavik N Sankaran, Sethuraman Kim, Hyun Jin Ellis, Howard Rogers, Campbell Taylor, Charles A Rajani, Ronak Perera, Divaka |
| description | Fractional flow reserve (FFR) is commonly used to assess the functional significance of coronary artery disease but is theoretically limited in evaluating individual stenoses in serially diseased vessels. We sought to characterize the accuracy of assessing individual stenoses in serial disease using invasive FFR pullback and the noninvasive equivalent, fractional flow reserve by computed tomography (FFR
). We subsequently describe and test the accuracy of a novel noninvasive FFR
-derived percutaneous coronary intervention (PCI) planning tool (FFR
) in predicting the true significance of individual stenoses.
Patients with angiographic serial coronary artery disease scheduled for PCI were enrolled and underwent prospective coronary CT angiography with conventional FFR
-derived post hoc for each vessel and stenosis (FFR
). Before PCI, the invasive hyperemic pressure-wire pullback was performed to derive the apparent FFR contribution of each stenosis (FFR
). The true FFR attributable to individual lesions (FFR
) was then measured following PCI of one of the lesions. The predictive accuracy of FFR
, FFR
, and the novel technique (FFR
) was then assessed against FFR
. From the 24 patients undergoing the protocol, 19 vessels had post hoc FFR
and FFR
calculation. When assessing the distal effect of all lesions, FFR
correlated moderately well with invasive FFR ( R=0.71; P |
| doi_str_mv | 10.1161/CIRCINTERVENTIONS.118.007577 |
| format | Article |
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). We subsequently describe and test the accuracy of a novel noninvasive FFR
-derived percutaneous coronary intervention (PCI) planning tool (FFR
) in predicting the true significance of individual stenoses.
Patients with angiographic serial coronary artery disease scheduled for PCI were enrolled and underwent prospective coronary CT angiography with conventional FFR
-derived post hoc for each vessel and stenosis (FFR
). Before PCI, the invasive hyperemic pressure-wire pullback was performed to derive the apparent FFR contribution of each stenosis (FFR
). The true FFR attributable to individual lesions (FFR
) was then measured following PCI of one of the lesions. The predictive accuracy of FFR
, FFR
, and the novel technique (FFR
) was then assessed against FFR
. From the 24 patients undergoing the protocol, 19 vessels had post hoc FFR
and FFR
calculation. When assessing the distal effect of all lesions, FFR
correlated moderately well with invasive FFR ( R=0.71; P<0.001). For lesion-specific assessment, there was significant underestimation of FFR
using FFR
(mean discrepancy, 0.06±0.05; P<0.001, representing a 42% error) and conventional trans-lesional FFR
(0.05±0.06; P<0.001, 37% error). Using FFR
, stenosis underestimation was significantly reduced to a 7% error (0.01±0.05; P<0.001).
FFR pullback and conventional FFR
significantly underestimate true stenosis contribution in serial coronary artery disease. A novel noninvasive FFR
-based PCI planner tool more accurately predicts the true FFR contribution of each stenosis in serial coronary artery disease.</description><identifier>EISSN: 1941-7632</identifier><identifier>DOI: 10.1161/CIRCINTERVENTIONS.118.007577</identifier><identifier>PMID: 30722688</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Cardiac Catheterization ; Computed Tomography Angiography ; Coronary Angiography - methods ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - physiopathology ; Coronary Artery Disease - therapy ; Coronary Stenosis - diagnostic imaging ; Coronary Stenosis - physiopathology ; Coronary Stenosis - therapy ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - physiopathology ; Female ; Fractional Flow Reserve, Myocardial ; Humans ; Male ; Middle Aged ; Models, Cardiovascular ; Patient-Specific Modeling ; Percutaneous Coronary Intervention - adverse effects ; Predictive Value of Tests ; Prospective Studies ; Reproducibility of Results ; Treatment Outcome</subject><ispartof>Circulation. Cardiovascular interventions, 2019-02, Vol.12 (2), p.e007577-e007577</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2357-5151d62ca87ce02997f71fae43aba03c1f0682ba0a1cf121617b920557b27fec3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30722688$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Modi, Bhavik N</creatorcontrib><creatorcontrib>Sankaran, Sethuraman</creatorcontrib><creatorcontrib>Kim, Hyun Jin</creatorcontrib><creatorcontrib>Ellis, Howard</creatorcontrib><creatorcontrib>Rogers, Campbell</creatorcontrib><creatorcontrib>Taylor, Charles A</creatorcontrib><creatorcontrib>Rajani, Ronak</creatorcontrib><creatorcontrib>Perera, Divaka</creatorcontrib><title>Predicting the Physiological Effect of Revascularization in Serially Diseased Coronary Arteries</title><title>Circulation. Cardiovascular interventions</title><addtitle>Circ Cardiovasc Interv</addtitle><description>Fractional flow reserve (FFR) is commonly used to assess the functional significance of coronary artery disease but is theoretically limited in evaluating individual stenoses in serially diseased vessels. We sought to characterize the accuracy of assessing individual stenoses in serial disease using invasive FFR pullback and the noninvasive equivalent, fractional flow reserve by computed tomography (FFR
). We subsequently describe and test the accuracy of a novel noninvasive FFR
-derived percutaneous coronary intervention (PCI) planning tool (FFR
) in predicting the true significance of individual stenoses.
Patients with angiographic serial coronary artery disease scheduled for PCI were enrolled and underwent prospective coronary CT angiography with conventional FFR
-derived post hoc for each vessel and stenosis (FFR
). Before PCI, the invasive hyperemic pressure-wire pullback was performed to derive the apparent FFR contribution of each stenosis (FFR
). The true FFR attributable to individual lesions (FFR
) was then measured following PCI of one of the lesions. The predictive accuracy of FFR
, FFR
, and the novel technique (FFR
) was then assessed against FFR
. From the 24 patients undergoing the protocol, 19 vessels had post hoc FFR
and FFR
calculation. When assessing the distal effect of all lesions, FFR
correlated moderately well with invasive FFR ( R=0.71; P<0.001). For lesion-specific assessment, there was significant underestimation of FFR
using FFR
(mean discrepancy, 0.06±0.05; P<0.001, representing a 42% error) and conventional trans-lesional FFR
(0.05±0.06; P<0.001, 37% error). Using FFR
, stenosis underestimation was significantly reduced to a 7% error (0.01±0.05; P<0.001).
FFR pullback and conventional FFR
significantly underestimate true stenosis contribution in serial coronary artery disease. A novel noninvasive FFR
-based PCI planner tool more accurately predicts the true FFR contribution of each stenosis in serial coronary artery disease.</description><subject>Aged</subject><subject>Cardiac Catheterization</subject><subject>Computed Tomography Angiography</subject><subject>Coronary Angiography - methods</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary Stenosis - diagnostic imaging</subject><subject>Coronary Stenosis - physiopathology</subject><subject>Coronary Stenosis - therapy</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Female</subject><subject>Fractional Flow Reserve, Myocardial</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Cardiovascular</subject><subject>Patient-Specific Modeling</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Treatment Outcome</subject><issn>1941-7632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1kFFLwzAUhYMgbk7_guTBB186k9u1aR9HrVoY29imryVNky2SNTNphfnrDahP93DPx-Xcg9A9JVNKU_pYVJuiWu7KzXu53FWr5TassykhLGHsAo1pPqMRS2MYoWvvPwgJMoUrNIoJA0izbIzqtZOtFr3u9rg_SLw-nL22xu614AaXSknRY6vwRn5xLwbDnf7mvbYd1h3eSqe5MWf8pL3kXra4sM523J3x3PXBlP4GXSpuvLz9mxP09lzuitdosXqpivkiEhAnLEpoQtsUBM-YkATynClGFZezmDecxIIqkmYQJKdCUQi_syYHkiSsARYyxhP08Hv35OznIH1fH7UX0hjeSTv4GgByklGALKB3f-jQHGVbn5w-hsj1fynxD4pWZnA</recordid><startdate>201902</startdate><enddate>201902</enddate><creator>Modi, Bhavik N</creator><creator>Sankaran, Sethuraman</creator><creator>Kim, Hyun Jin</creator><creator>Ellis, Howard</creator><creator>Rogers, Campbell</creator><creator>Taylor, Charles A</creator><creator>Rajani, Ronak</creator><creator>Perera, Divaka</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201902</creationdate><title>Predicting the Physiological Effect of Revascularization in Serially Diseased Coronary Arteries</title><author>Modi, Bhavik N ; Sankaran, Sethuraman ; Kim, Hyun Jin ; Ellis, Howard ; Rogers, Campbell ; Taylor, Charles A ; Rajani, Ronak ; Perera, Divaka</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2357-5151d62ca87ce02997f71fae43aba03c1f0682ba0a1cf121617b920557b27fec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Cardiac Catheterization</topic><topic>Computed Tomography Angiography</topic><topic>Coronary Angiography - methods</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary Stenosis - diagnostic imaging</topic><topic>Coronary Stenosis - physiopathology</topic><topic>Coronary Stenosis - therapy</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Female</topic><topic>Fractional Flow Reserve, Myocardial</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Cardiovascular</topic><topic>Patient-Specific Modeling</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Modi, Bhavik N</creatorcontrib><creatorcontrib>Sankaran, Sethuraman</creatorcontrib><creatorcontrib>Kim, Hyun Jin</creatorcontrib><creatorcontrib>Ellis, Howard</creatorcontrib><creatorcontrib>Rogers, Campbell</creatorcontrib><creatorcontrib>Taylor, Charles A</creatorcontrib><creatorcontrib>Rajani, Ronak</creatorcontrib><creatorcontrib>Perera, Divaka</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Modi, Bhavik N</au><au>Sankaran, Sethuraman</au><au>Kim, Hyun Jin</au><au>Ellis, Howard</au><au>Rogers, Campbell</au><au>Taylor, Charles A</au><au>Rajani, Ronak</au><au>Perera, Divaka</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicting the Physiological Effect of Revascularization in Serially Diseased Coronary Arteries</atitle><jtitle>Circulation. Cardiovascular interventions</jtitle><addtitle>Circ Cardiovasc Interv</addtitle><date>2019-02</date><risdate>2019</risdate><volume>12</volume><issue>2</issue><spage>e007577</spage><epage>e007577</epage><pages>e007577-e007577</pages><eissn>1941-7632</eissn><abstract>Fractional flow reserve (FFR) is commonly used to assess the functional significance of coronary artery disease but is theoretically limited in evaluating individual stenoses in serially diseased vessels. We sought to characterize the accuracy of assessing individual stenoses in serial disease using invasive FFR pullback and the noninvasive equivalent, fractional flow reserve by computed tomography (FFR
). We subsequently describe and test the accuracy of a novel noninvasive FFR
-derived percutaneous coronary intervention (PCI) planning tool (FFR
) in predicting the true significance of individual stenoses.
Patients with angiographic serial coronary artery disease scheduled for PCI were enrolled and underwent prospective coronary CT angiography with conventional FFR
-derived post hoc for each vessel and stenosis (FFR
). Before PCI, the invasive hyperemic pressure-wire pullback was performed to derive the apparent FFR contribution of each stenosis (FFR
). The true FFR attributable to individual lesions (FFR
) was then measured following PCI of one of the lesions. The predictive accuracy of FFR
, FFR
, and the novel technique (FFR
) was then assessed against FFR
. From the 24 patients undergoing the protocol, 19 vessels had post hoc FFR
and FFR
calculation. When assessing the distal effect of all lesions, FFR
correlated moderately well with invasive FFR ( R=0.71; P<0.001). For lesion-specific assessment, there was significant underestimation of FFR
using FFR
(mean discrepancy, 0.06±0.05; P<0.001, representing a 42% error) and conventional trans-lesional FFR
(0.05±0.06; P<0.001, 37% error). Using FFR
, stenosis underestimation was significantly reduced to a 7% error (0.01±0.05; P<0.001).
FFR pullback and conventional FFR
significantly underestimate true stenosis contribution in serial coronary artery disease. A novel noninvasive FFR
-based PCI planner tool more accurately predicts the true FFR contribution of each stenosis in serial coronary artery disease.</abstract><cop>United States</cop><pmid>30722688</pmid><doi>10.1161/CIRCINTERVENTIONS.118.007577</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation. Cardiovascular interventions, 2019-02, Vol.12 (2), p.e007577-e007577 |
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| language | eng |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Cardiac Catheterization Computed Tomography Angiography Coronary Angiography - methods Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - physiopathology Coronary Artery Disease - therapy Coronary Stenosis - diagnostic imaging Coronary Stenosis - physiopathology Coronary Stenosis - therapy Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Female Fractional Flow Reserve, Myocardial Humans Male Middle Aged Models, Cardiovascular Patient-Specific Modeling Percutaneous Coronary Intervention - adverse effects Predictive Value of Tests Prospective Studies Reproducibility of Results Treatment Outcome |
| title | Predicting the Physiological Effect of Revascularization in Serially Diseased Coronary Arteries |
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