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1.
Arq. bras. cardiol ; 116(6): 1091-1098, Jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1278330

ABSTRACT

Resumo Fundamento A quantificação não invasiva da reserva fracionada de fluxo miocárdico (FFR TC ) através de software baseado em inteligência artificial em versão mais atualizada e tomógrafo de última geração (384 cortes) apresenta elevada performance na detecção de isquemia coronariana. Objetivos Avaliar o desempenho diagnóstico da FFR TC na detecção de doença arterial coronariana (DAC) significativa em relação ao FFRi, em tomógrafos de gerações anteriores (128 e 256 cortes). Métodos Estudo retrospectivo com pacientes encaminhados à angiotomografia de artérias coronárias (TCC) e cateterismo (FFRi). Foram utilizados os tomógrafos Siemens Somatom Definition Flash (256 cortes) e AS+ (128 cortes). A FFR TC e a área luminal mínima (ALM) foram avaliadas em software (cFFR versão 3.0.0, Siemens Healthineers, Forchheim, Alemanha). DAC obstrutiva foi definida como TCC com redução luminal ≥50% e DAC funcionalmente obstrutiva como FFRi ≤0,8. Todos os valores de p reportados são bicaudais; e quando <0,05, foram considerados estatisticamente significativos. Resultados Noventa e três pacientes consecutivos (152 vasos) foram incluídos. Houve boa concordância entre FFR TC e FFRi, com mínima superestimação da FFR TC (viés: -0,02; limites de concordância: 0,14 a 0,09). Diferentes tomógrafos não modificaram a relação entre FFR TC e FFRi (p para interação = 0,73). A FFR TC demonstrou performance significativamente superior à classificação visual de estenose coronariana (AUC 0,93 vs. 0,61, p <0,001) e à ALM (AUC 0,93 vs. 0,75, p <0,001) reduzindo o número de casos falso-positivos. O melhor ponto de corte para a FFR TC utilizando um índice de Youden foi de 0,85 (sensiblidade, 87%; especificidade, 86%; VPP, 73%; NPV, 94%), com redução de falso-positivos. Conclusão FFR TC baseada em inteligência artificial, em tomógrafos de gerações anteriores (128 e 256 cortes), apresenta boa performance diagnóstica na detecção de DAC, podendo ser utilizada para reduzir procedimentos invasivos.


Abstract Background The non-invasive quantification of the fractional flow reserve (FFRCT) using a more recent version of an artificial intelligence-based software and latest generation CT scanner (384 slices) may show high performance to detect coronary ischemia. Objectives To evaluate the diagnostic performance of FFRCT for the detection of significant coronary artery disease (CAD) in contrast to invasive FFR (iFFR) using previous generation CT scanners (128 and 256- detector rows). Methods Retrospective study with patients referred to coronary artery CT angiography (CTA) and catheterization (iFFR) procedures. Siemens Somatom Definition Flash (256-detector rows) and AS+ (128-detector rows) CT scanners were used to acquire the images. The FFRCT and the minimal lumen area (MLA) were evaluated using a dedicated software (cFFR version 3.0.0, Siemens Healthineers, Forchheim, Germany). Obstructive CAD was defined as CTA lumen reduction ≥ 50%, and flow-limiting stenosis as iFFR ≤0.8. All reported P values are two-tailed, and when <0.05, they were considered statistically significant. Results Ninety-three consecutive patients (152 vessels) were included. There was good agreement between FFRCT and iFFR, with minimal FFRCT overestimation (bias: -0.02; limits of agreement:0.14-0.09). Different CT scanners did not modify the association between FFRCT and FFRi (p for interaction=0.73). The performance of FFRCT was significantly superior compared to the visual classification of coronary stenosis (AUC 0.93vs.0.61, p<0.001) and to MLA (AUC 0.93vs.0.75, p<0.001), reducing the number of false-positive cases. The optimal cut-off point for FFRCT using a Youden index was 0.85 (87% Sensitivity, 86% Specificity, 73% PPV, 94% NPV), with a reduction of false-positives. Conclusion Machine learning-based FFRCT using previous generation CT scanners (128 and 256-detector rows) shows good diagnostic performance for the detection of CAD, and can be used to reduce the number of invasive procedures.


Subject(s)
Humans , Coronary Artery Disease , Coronary Stenosis , Fractional Flow Reserve, Myocardial , Severity of Illness Index , Artificial Intelligence , Tomography, X-Ray Computed , Predictive Value of Tests , Retrospective Studies , Coronary Angiography , Constriction, Pathologic , Coronary Vessels , Machine Learning , Computed Tomography Angiography
2.
Article in Portuguese | LILACS | ID: biblio-1253834

ABSTRACT

Fundamento: O fluxo coronariano com predomínio diastólico aumenta duas a cinco vezes na hiperemia, mediada por vasodilatação (reserva de fluxo coronariano), podendo, na hipertrofia, ocorrer isquemia relativa. Na hipertrofia secundária, o fluxo em repouso torna-se isquêmico pelo aumento da demanda. Na cardiomiopatia hipertrófica com fibrose perivascular, há funcionalização de vasos colaterais, para aumentar a irrigação dos segmentos hipertrofiados. Objetivo: Determinar o padrão do fluxo coronariano em pacientes com hipertrofia secundária e cardiomiopatia hipertrófica, avaliando a reserva de fluxo coronariano. Métodos: Avaliamos o fluxo coronariano em 34 pacientes com hipertrofia secundária, em 24 com cardiomiopatia hipertrófica e em 16 controles. A artéria descendente anterior foi detectada com Doppler transtorácico com calibração adequada do equipamento. Nos grupos controle e com hipertrofia secundária, foi calculada a reserva de fluxo coronariano com dipiridamol (0,84 mg/kg) endovenoso. O mesmo procedimento foi realizado em seis pacientes do grupo com cardiomiopatia hipertrófica, nos quais também foi avaliado o fluxo das colaterais da região hipertrófica. Os dados foram comparados por variância com significância de 5%. Resultados: Na hipertrofia secundária, houve aumento do índice de massa e, na cardiomiopatia hipertrófica, predominou o aumento da espessura relativa. A fração de ejeção e a disfunção diastólica foram maiores no grupo com cardiomiopatia hipertrófica. A reserva de fluxo coronariano foi menor no grupo com cardiomiopatia hipertrófica, sendo detectado, também, fluxo de colaterais com redução da reserva de fluxo coronariano. Conclusão: A análise da circulação coronariana com Doppler transtorácico é possível em indivíduos normais e hipertróficos. Pacientes com hipertrofia secundária e cardiomiopatia hipertrófica apresentam diminuição da reserva de fluxo coronariano, e aqueles com cardiomiopatia hipertrófica mostram fluxo de vasos colaterais dilatados observados na região hipertrófica, com diminuição da reserva de fluxo coronariano.(AU)


Background: Coronary flow with a diastolic predominance increases two to five times in hyperemia, mediated by vasodilation (coronary flow reserve, CFR) and, in hypertrophy, relative ischemia may occur. In secondary hypertrophy (LVH), the flow, normal at rest, becomes ischemic due to increased demand. In hypertrophic cardiomyopathy (HCM) with perivascular fibrosis, collateral vessels appear to increase the irrigation of hypertrophied segments. Objective: To determine the coronary flow pattern in patients with secondary hypertrophy and hypertrophic cardiomyopathy, evaluating the coronary flow reserve. Methods: Coronary flow was evaluated in 34 patients with secondary hypertrophy, 24 with hypertrophic cardiomyopathy and in 16 controls. The anterior descending artery was detected with transthoracic Doppler with adequate equipment calibration. In the hypertrophic cardiomyopathy group, the flow of collaterals from the hypertrophic region was evaluated. In the control and secondary hypertrophy groups and in six patients in the hypertrophic cardiomyopathy group, the intravenous dipyridamole (0.84 mg) coronary flow reserve was calculated. The data were compared by variance with a significance of 5%Results: In secondary hypertrophy there was an increase in mass index and blood pressure, and in hypertrophic cardiomyopathy an increase in relative thickness predominated. Ejection fraction and diastolic dysfunction were higher in the hypertrophic cardiomyopathy group. The coronary flow reserve was lower in the hypertrophic cardiomyopathy group, and flow of collaterals was also detected, with a reduction in the coronary flow reserve. Conclusion: the analysis of coronary circulation with transthoracic Doppler is possible in normal and hypertrophic individuals. Patients with secondary hypertrophy and hypertrophic cardiomyopathy have a decrease in the coronary flow reserve, and patients with hypertrophic cardiomyopathy show a hyper flow of dilated collateral vessels observed in the hypertrophic region, with a decrease in the coronary flow reserve.(AU)


Subject(s)
Humans , Male , Child , Adolescent , Middle Aged , Cardiomyopathy, Hypertrophic/diagnostic imaging , Hypertrophy, Left Ventricular/complications , Hypertrophy, Left Ventricular/diagnostic imaging , Coronary Angiography/methods , Echocardiography, Doppler, Color/methods , Dipyridamole/administration & dosage , Fractional Flow Reserve, Myocardial , Aminophylline/administration & dosage
3.
Article in English | WPRIM | ID: wpr-922114

ABSTRACT

OBJECTIVE@#To evaluate the effect of Danhong Injection (, DH) on the index of microcirculatory resistance (IMR) and myocardial injury in patients with unstable angina undergoing elective percutaneous coronary intervention (PCI).@*METHODS@#Seventy-eight patients with unstable angina were randomly divided into DH group (39 cases) and the control group (39 cases) during elective PCI. Randomization was performed using a random-number table. The DH group received DH at a dosage of 40 mL (mixed with 250 mL saline, covered by a light-proof bag, intravenous drip) during PCI and daily for 7 consecutive days, while the control group only received the same dosage of saline. Both groups received standardized treatment. The IMR and fractional flow reserve (FFR) were measured at maximal hyperemia before and after PCI. Myocardial markers, including myoglobin, creatine kinase (CK), creatine kinase MB (CK-MB), and coronary troponin T (cTnT) values were measured at baseline and 24 h after PCI.@*RESULTS@#Among the 78 patients enrolled, the baseline and procedural characteristics were similar between the two groups. There was no significant difference in pre-PCI myocardial markers and coronary physiological indexes between the two groups. However, post-PCI CK and CK-MB levels in the DH group were significantly lower than those in the control group (111.97 ± 80.97 vs. 165.47 ± 102.99, P=0.013; 13.08 ± 6.90 vs. 19.75 ± 15.49, P=0.016). Post-PCI myoglobin and cTNT-positive tend to be lower in the DH group than in the control group but did not reach statistical significance (88.07 ± 52.36 vs. 108.13 ± 90.94, P=0.52; 2.56% vs.7.69%, P=0.065). Compared with the control group, the post-IMR levels of the DH group tended to decrease, but there was no statistical difference (20.73 ± 13.15 vs. 26.37 ± 12.31, P=0.05). There were no statistical differences in post-FFR in both groups. The peri-procedural myocardial injury of the DH group was significantly lower than that of the control group (2.56% vs. 15.38%, P=0.025). During the 30-d follow-up period, no major adverse cardiovascular events occurred in either group.@*CONCLUSION@#This study demonstrated benefit of DH in reducing myocardial injury and potential preserving microvascular function in patients with unstable angina undergoing elective PCI.


Subject(s)
Angina, Unstable/drug therapy , Drugs, Chinese Herbal , Fractional Flow Reserve, Myocardial , Humans , Microcirculation , Percutaneous Coronary Intervention , Pilot Projects , Treatment Outcome
4.
Chinese Medical Journal ; (24): 1450-1456, 2021.
Article in English | WPRIM | ID: wpr-878191

ABSTRACT

BACKGROUND@#Drug-coated balloons (DCBs) have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions. Quantitative flow ratio (QFR) is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography (CAG), obviating the need for an invasive fractional flow reserve procedural. This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR, which predict vessel restenosis (diameter stenosis [DS] ≥50%) at mid-term follow-up.@*METHODS@#The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis. From their QFR performances, which were analyzed by CAG images at follow-up, we divided them into two groups: group A, showing target vessel DS ≥50%, and group B, showing target vessel DS <50%. The median follow-up time was 287 days in group A and 227 days in group B. We compared the clinical characteristics, parameters during DCB therapy, and QFR performances, which were analyzed by CAG images between the two groups, in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis. Student's t test was used for the comparison of normally distributed continuous data, Mann-Whitney U test for the comparison of non-normally distributed continuous data, and receiver operating characteristic (ROC) curves for the evaluation of QFR performance which can predict vessel restenosis (DS ≥50%) at mid-term follow-up using the area under the curve (AUC).@*RESULTS@#A total of 112 patients with 112 target vessels were enrolled in this study. Group A had 41 patients, while group B had 71. Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy, and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS ≥50% post-DCB therapy were 0.905 (AUC, 0.741 [95% confidence interval, CI: 0.645, 0.837]; sensitivity, 0.817; specificity, 0.561; P < 0.001) and 0.890 (AUC, 0.796 [95% CI: 0.709, 0.882]; sensitivity, 0.746; specificity, 0.780; P < 0.001).@*CONCLUSIONS@#The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy. When lesion/vessel QFR values are <0.905/0.890 post-DCB therapy, a higher risk of vessel restenosis is potentially predicted at follow-up.


Subject(s)
Constriction, Pathologic , Coronary Angiography , Coronary Artery Disease/therapy , Coronary Restenosis , Follow-Up Studies , Fractional Flow Reserve, Myocardial , Humans , Pharmaceutical Preparations , Predictive Value of Tests , Retrospective Studies , Treatment Outcome
8.
Arch. cardiol. Méx ; 89(4): 308-314, Oct.-Dec. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149088

ABSTRACT

Resumen Antecedentes: La reserva de flujo fraccional (FFR) es una herramienta con evidencia demostrada para guiar las angioplastias coronarias. El reembolso por los sistemas de cobertura de salud es parcial o nulo a pesar de frecuentemente diferir la angioplastia. Nuestro objetivo fue determinar el beneficio económico de la utilización del FFR en la evaluación de lesiones intermedias, y evaluar asimismo puntos finales clínicos en el seguimiento a un año. Métodos: Estudio observacional prospectivo que incluyó una cohorte de pacientes consecutivos con lesiones coronarias intermedias, evaluadas con FFR, entre abril de 2013 y marzo de 2016. Para el análisis económico se evaluaron los recursos específicos utilizados para la realización del procedimiento. Se analizaron puntos finales clínicos (muerte cardiovascular, revascularización de la arteria objetivo e infarto agudo de miocardio) durante la internación y en el seguimiento a un año Resultados: Se incluyeron 222 lesiones en 151 pacientes consecutivos. Se registró FFR positivo en el 26.1% de las lesiones evaluadas. Se estimó que sin la utilización de FFR, 126 pacientes hubieran sido tratados con angioplastia transluminal coronaria y 25 con cirugía de revascularización miocárdica. El costo estimado con la utilización de FFR fue US$ 891,290.08, mientras que sin el mismo hubiera sido de US$ 1,557,352. Esto implicó un ahorro del 43% de los gastos. Se observaron una muerte de origen cardiovascular y dos reinternaciones en el grupo FFR positivo en el seguimiento a un año. Conclusiones: La revascularización de lesiones intermedias guiada por FFR resultó en un beneficio económico al reducir los costos generales sin resultar clínicamente perjudicial.


Abstract Background: Fractional flow reserve (FFR) is a proven technology for guiding percutaneous coronary intervention, but it is not reimbursed despite the fact that it frequently allows to defer revascularization. Our goal was to determine the economic benefit of FFR on intermediate lesions, as well as the clinical endpoints at 1 year follow up. Methods: Observational prospective study that included consecutive patients with intermediate lesions evaluated with FFR between April 2013 and March 2016. For the economic analysis we evaluated the specific resources used during the procedure. Clinical endpoints including cardiovascular death, target lesion revascularization and acute myocardial infarction, were followed up over a one-year period. Results: FFR was performed on 222 lesions in 151 consecutive patients. FFR was positive in 26.1% of the assessed lesions. The estimated total cost using FFR was US$ 891,290.08 while cost estimate without FFR was US$ 1,557,352, meaning 43% in cost savings. There was one cardiovascular death and two readmissions during follow up in the positive FFR group. Conclusions: FFR guided revascularization on intermediate coronary lesions resulted in an economic benefit by reducing overall costs without harming clinical outcomes.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Coronary Disease/therapy , Fractional Flow Reserve, Myocardial , Percutaneous Coronary Intervention/methods , Prospective Studies , Follow-Up Studies , Treatment Outcome , Cost-Benefit Analysis , Percutaneous Coronary Intervention/economics
9.
Int. j. cardiovasc. sci. (Impr.) ; 32(4): 326-330, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1012346

ABSTRACT

Despite the health benefits of routine exercise, coronary artery disease (CAD) is common among older competitive athletes and is an important cause of sudden cardiac death. Athletes with suspected or confirmed CAD routinely undergo conventional coronary angiography involving the performance of invasive coronary physiological assessment using the fractional flow reserve (FFR) or the instantaneous-wave free ratio (iFR). Data defining the role of invasive coronary physiological assessment, while robust in general clinical populations, are untested among older competitive athletes with CAD. The paper discusses the challenges and uncertainties surrounding the use of the FFR and iFR in this unique population with an emphasis on the need for future work to better define this approach


Subject(s)
Humans , Male , Middle Aged , Coronary Artery Disease , Athletes , Middle Aged/physiology , Physical Fitness , Death, Sudden, Cardiac , Coronary Angiography/methods , Fractional Flow Reserve, Myocardial
10.
Rev. bras. cir. cardiovasc ; 34(2): 165-172, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990563

ABSTRACT

Abstract Introduction: Quantitative flow ratio (QFR) is a novel method enabling efficient computation of FFR from three-dimensional quantitative coronary angiography (3D QCA) and thrombolysis in myocardial infarction (TIMI) frame counting. We decided to perform a systematic review and quantitative meta-analysis of the literature to determine the correlation between the diagnosis of functionally significant stenosis obtained by QFR versus FFR and to determine the diagnostic accuracy of QFR for intermediate coronary artery stenosis. Methods: We searched PubMed, Embase, and Web of Science for studies concerning the diagnostic performance of QFR. Our meta-analysis was performed using the DerSimonian and Laird random effects model to determine sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). The sROC was used to determine diagnostic test accuracy. Results: Nine studies consisting of 1175 vessels in 1047 patients were included in our study. The pooled sensitivity, specificity, LR+, LR-, and DOR for QFR were 0.89 (95% CI: 0.86-0.92), 0.88 (95% CI: 0.86-0.91), 6.86 (95% CI,: 5.22-9.02), 0.14 (95% CI: 0.10-0.21), and 53.05 (95% CI: 29.75-94.58), respectively. The area under the summary receiver operating characteristic (sROC) curve for QFR was 0.94. Conclusion: QFR is a simple, useful, and noninvasive modality for diagnosis of functional significance of intermediate coronary artery stenosis.


Subject(s)
Humans , Coronary Angiography/methods , Coronary Stenosis/physiopathology , Coronary Stenosis/diagnostic imaging , Fractional Flow Reserve, Myocardial/physiology , Regression Analysis , Reproducibility of Results , Sensitivity and Specificity , Imaging, Three-Dimensional/methods
11.
Arq. bras. cardiol ; 112(1): 40-47, Jan. 2019. tab, graf
Article in English | LILACS | ID: biblio-973839

ABSTRACT

Abstract Background: In multivessel disease patients with moderate stenosis, fractional flow reserve (FFR) allows the analysis of the lesions and guides treatment, and could contribute to the cost-effectiveness (CE) of non-pharmacological stents (NPS). Objectives: To evaluate CE and clinical impact of FFR-guided versus angiography-guided angioplasty (ANGIO) in multivessel patients using NPS. Methods: Multivessel disease patients were prospectively randomized to FFR or ANGIO groups during a 5 year-period and followed for < 12 months. Outcomes measures were major adverse cardiac events (MACE), restenosis and CE. Results: We studied 69 patients, 47 (68.1%) men, aged 62.0 ± 9.0 years, 34 (49.2%) in FFR group and 53 (50.7%) in ANGIO group, with stable angina or acute coronary syndrome. In FFR, there were 26 patients with biarterial disease (76.5%) and 8 (23.5%) with triarterial disease, and in ANGIO, 24 (68.6%) with biarterial and 11 (31.4%) with triarterial disease. Twelve MACEs were observed - 3 deaths: 2 (5.8%) in FFR and 1 (2.8%) in ANGIO, 9 (13.0%) angina: 4(11.7%) in FFR and 5(14.2%) in ANGIO, 6 restenosis: 2(5.8%) in FFR and 4 (11.4%) in ANGIO. Angiography detected 87(53.0%) lesions in FFR, 39(23.7%) with PCI and 48(29.3%) with medical treatment; and 77 (47.0%) lesions in ANGIO, all treated with angioplasty. Thirty-nine (33.3%) stents were registered in FFR (0.45 ± 0.50 stents/lesion) and 78 (1.05 ± 0.22 stents/lesion) in ANGIO (p = 0.0001), 51.4% greater in ANGIO than FFR. CE analysis revealed a cost of BRL 5,045.97 BRL 5,430.60 in ANGIO and FFR, respectively. The difference of effectiveness was of 1.82%. Conclusion: FFR reduced the number of lesions treated and stents, and the need for target-lesion revascularization, with a CE comparable with that of angiography.


Resumo Fundamentos: Em pacientes multiarteriais e lesões moderadas, a reserva de fluxo fracionada (FFR) avalia cada lesão e direciona o tratamento, podendo ser útil no custo-efetividade (CE) de implante de stents não farmacológicos (SNF). Objetivos: Avaliar CE e impacto clínico da angioplastia + FFR versus angioplastia + angiografia (ANGIO), em multiarteriais, utilizando SNF. Métodos: pacientes com doença multiarteriais foram randomizados prospectivamente durante ±5 anos para FFR ou ANGIO, e acompanhados por até 12 meses. Foram avaliados eventos cardíacos maiores (ECAM), reestenose e CE. Resultados: foram incluídos 69 pacientes, 47(68,1%) homens, 34(49,2%) no FFR e 35(50,7%) no ANGIO, idade 62,0 ± 9,0 anos, com angina estável e Síndrome Coronariana Aguda estabilizada. No FFR, havia 26 com doença (76,5%) biarterial e 8 (23,5%) triarterial, e no grupo ANGIO, 24(68,6%) biarteriais e 11(31,4%) triarteriais. Ocorreram 12(17,3%) ECAM - 3(4,3%) óbitos: 2(5,8%) no FFR e 1(2,8%) no ANGIO, 9(13,0%) anginas, 4(11,7%) no FFR e 5(14,2%) no ANGIO, 6 reestenoses: 2(5,8%) no FFR e 4 (11,4%) no ANGIO. Angiografia detectou 87(53,0%) lesões no FFR, 39(23,7%) com ICP e 48(29,3%) com tratamento clínico; e 77(47,0%) lesões no ANGIO, todas submetidas à angioplastia. Quanto aos stents, registrou-se 39(33,3%) (0,45 ± 0,50 stents/lesão) no FFR e 78(66,6%) (1,05 ± 0,22 stents/lesão) no ANGIO (p = 0,0001); ANGIO utilizou 51,4% a mais que o FFR. Análise de CE revelou um custo de R$5045,97 e R$5.430,60 nos grupos ANGIO e FFR, respectivamente. A diferença de efetividade foi 1,82%. Conclusões: FFR diminuiu o número de lesões tratadas e de stents e necessidade de revascularização do vaso-alvo, com CE comparável ao da angiografia.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Angioplasty, Balloon, Coronary/methods , Coronary Angiography/methods , Fractional Flow Reserve, Myocardial/physiology , Acute Coronary Syndrome/therapy , Angina, Stable/therapy , Time Factors , Angioplasty, Balloon, Coronary/economics , Stents , Prospective Studies , Treatment Outcome , Coronary Angiography/economics , Cost-Benefit Analysis , Statistics, Nonparametric , Coronary Restenosis/mortality , Coronary Restenosis/therapy , Kaplan-Meier Estimate , Acute Coronary Syndrome/economics , Acute Coronary Syndrome/pathology , Angina, Stable/economics , Angina, Stable/mortality
13.
In. Consolim-Colombo, Fernanda M; Saraiva, José Francisco Kerr; Izar, Maria Cristina de Oliveira. Tratado de Cardiologia: SOCESP / Cardiology Treaty: SOCESP. São Paulo, Manole, 4ª; 2019. p.156-164.
Monography in Portuguese | LILACS | ID: biblio-1009286
14.
Korean Circulation Journal ; : 1022-1032, 2019.
Article in English | WPRIM | ID: wpr-759411

ABSTRACT

BACKGROUND AND OBJECTIVES: Intermediate coronary lesion that can be under- or over-estimated by visual estimation frequently results in stenting of functionally nonsignificant lesions or deferral of percutaneous coronary intervention (PCI) of significant lesions inappropriately. We evaluated current status of PCI for intermediate lesions from a standardized database in Korea. METHODS: We analyzed the Korean percutaneous coronary intervention (K-PCI) registry data which collected a standardized PCI database of the participating hospitals throughout the country from January 1, 2014, through December 31, 2014. Intermediate lesion was defined as a luminal narrowing between 50% and 70% by visual estimation and then compared whether the invasive physiologic or imaging study was performed or not. RESULTS: Physiology-guided PCI for intermediate lesions was performed in 16.8% for left anterior descending artery (LAD), 9.8% for left circumflex artery (LCX), 13.2% for right coronary artery (RCA). PCI was more frequently performed using intravascular ultrasound (IVUS) than using fractional flow reserve (FFR) for coronary artery segments (27.7% vs. 13.9% for LAD, 32.9% vs. 8.1% for LCX, and 33.8% vs. 10.8% for RCA). In accordance with or without FFR, PCI for intermediate lesions was more frequently performed in the hospitals with available FFR device than without FFR, especially in left main artery (LM), proximal LAD lesion (40.9% vs. 5.9% for LM, 24.6% vs 7.6% for proximal LAD). CONCLUSIONS: These data provide the current PCI practice pattern with the use of FFR and IVUS in intermediate lesion. More common use of FFR for intermediate lesion should be encouraged.


Subject(s)
Arteries , Coronary Artery Disease , Coronary Stenosis , Coronary Vessels , Fractional Flow Reserve, Myocardial , Korea , Percutaneous Coronary Intervention , Phenobarbital , Stents , Ultrasonography
15.
Article in Chinese | WPRIM | ID: wpr-813047

ABSTRACT

The evaluation of coronary artery ischemia is of great significance in the diagnosis and treatment of coronary heart disease. In recent years, fractional flow reserve derived from computed tomographic angiography (FFRct) has been used to evaluate the diagnosis of coronary artery specific ischemia, which enriches the clinical management of patients with coronary artery disease. A number of studies have confirmed that FFRct has reliable diagnostic performance compared with invasive fraction flow reserve (FFR). Because of its non-invasive, repeatable measurement and other advantages, the application universality of FFRct is significantly higher than that of invasive examination. At the same time, the application scope of FFRct is also continuously expanding, and it is not limited to its position as a "gatekeeper" for invasive coronary angiography. It has good accuracy in the diagnosis of complex coronary artery disease, and can also be used to guide the choice of surgical strategies such as coronary artery bypass grafting and stent implantation.


Subject(s)
Computed Tomography Angiography , Coronary Angiography , Coronary Artery Disease , Fractional Flow Reserve, Myocardial , Humans , Prospective Studies
16.
ABC., imagem cardiovasc ; 31(4)Out.- Dez. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-964027

ABSTRACT

Fundamento: Ocorre modificação no fluxo da artéria torácica interna, após sua anastomose na artéria coronária descendente anterior. Objetivo: Avaliar o efeito da ligadura dos ramos proximais da artéria torácica interna anastomosada na artéria coronária descendente anterior, quanto às velocidades e à reserva de velocidade de fluxo coronariano, em pacientes com fração de ejeção do ventrículo esquerdo preservada (> 50%). Métodos: Estudo prospectivo de pacientes com fração de ejeção do ventrículo esquerdo > 50% revascularizados. O Grupo I foi formado por 25 pacientes com ligadura dos grandes ramos da artéria torácica interna antes de sua anastomose na artéria coronária descendente anterior, e o Grupo II por 28 pacientes sem ligadura. Registrou-se o Doppler em nível proximal da artéria torácica interna no pré-operatório, pós-operatório precoce e no pós-operatório tardio de 6 meses. Foram mensurados os picos de velocidade sistólica e diastólica, e as velocidades médias sistólica e diastólica. A reserva de velocidade de fluxo coronariano foi obtida durante o ecocardiograma sob estresse com dobutamina no pós-operatório tardio de 6 meses. Resultados: No pós-operatório precoce, o pico de velocidade sistólica e a velocidade média sistólica diminuíram, enquanto aumentaram o pico de velocidade diastólica e a velocidade média diastólica nos dois grupos (p < 0,05). Do pós-operatório precoce para o tardio em 6 meses, apenas o pico de velocidade diastólica se modificou, diminuindo nos dois grupos (p < 0,05). Durante o ecocardiograma sob estresse com dobutamina, o pico de velocidade diastólica e a velocidade média diastólica aumentaram (p < 0,05), e os grupos não diferiram, mas o pico de velocidade sistólica e a velocidade média sistólica aumentaram apenas no Grupo II (p < 0,05). A reserva de velocidade de fluxo coronariano dos grupos calculada pelo pico de velocidade diastólica (Grupo I = 2,17 ± 0,64 e Grupo II = 2,28 ± 0,63) e pela velocidade média diastólica (Grupo I = 2,27 ± 0,54 e Grupo II = 2,5 ± 0,79) não diferiu. Conclusão: Em pacientes com fração de ejeção do ventrículo esquerdo preservada, a ligadura dos grandes ramos da artéria torácica interna anastomosada na artéria coronária descendente anterior não compromete a reserva de velocidade de fluxo coronariano, mas determina limitação no aumento das velocidades sistólicas


Introduction: Modification of internal thoracic artery flow occurs after its anastomosis in the left anterior descending coronary artery. Objective: To evaluate the effect of ligation of the proximal branches of anastomosed internal thoracic artery flow on the left anterior descending in relation to velocities and coronary flow velocity reserve in patients with left ventricular ejection fraction preserved (> 50%). Methods: Prospective study of patients with left ventricular ejection fraction > 50% and revascularized. Group I was composed of 25 patients with ligation of the major branches of the internal thoracic artery flow before its anastomosis in the left anterior descending coronary artery, and Group II was composed of 28 patients without ligation. Doppler was recorded at the proximal level of internal thoracic artery flow in the preoperative, early postoperative and 6 months later. The systolic peak velocity and diastolic, and systolic mean velocity and diastolic were measured. Coronary flow velocity reserve was obtained during dobutamine stress echocardiography in postoperative period 6 months later. Results: In the postoperative, the systolic peak velocity and the systolic mean velocity decreased while increasing the diastolic peak velocity and the diastolic mean velocity in the groups (p < 0.05). From the postoperative to the postoperative period 6 months later, only the diastolic peak velocity modified, occurring its decrease in the groups (p < 0.05). During the dobutamine stress echocardiography, diastolic peak velocity and the diastolic mean velocity increased (p < 0.05) and groups did not differ, however, the systolic peak velocity and the systolic mean velocity increased only in Group II (p < 0.05). The coronary flow velocity reserve of the groups calculated by diastolic peak velocity (Group I = 2.17 ± 0.64 and Group II =2.28 ± 0.63) and diastolic mean velocity (Group I = 2.27 ± 0.54 and Group II = 2.5 ± 0.79) did not differ. Conclusion: In patients with preserved left ventricular ejection fraction, the ligation of the large branches of the anastomosed internal thoracic artery flow into the left anterior descending coronary artery does not compromise the coronary flow velocity reserve, but determines limitation in the increase of the systolic velocities


Subject(s)
Humans , Male , Female , Middle Aged , Fractional Flow Reserve, Myocardial , Internal Mammary-Coronary Artery Anastomosis , Mammary Arteries/surgery , Myocardial Revascularization/methods , Atropine/administration & dosage , Stroke Volume , Transplantation , Echocardiography/methods , Echocardiography, Doppler/methods , Statistical Analysis , Prospective Studies , Analysis of Variance , Echocardiography, Stress/methods , Dobutamine/administration & dosage , Heart Ventricles
17.
Arq. bras. cardiol ; 111(4): 542-550, Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-973779

ABSTRACT

Abstract Background: There are limited data on the prognosis of deferral of lesion treatment in patients with acute coronary syndrome (ACS) based on fractional flow reserve (FFR). Objectives: To provide a systematic review of the current evidence on the prognosis of deferred lesions in ACS patients compared with deferred lesions in non-ACS patients, on the basis of FFR. Methods: We searched Medline, EMBASE, and the Cochrane Library for studies published between January 2000 and September 2017 that compared prognosis of deferred revascularization of lesions on the basis of FFR in ACS patients compared with non-ACS patients. We conducted a pooled relative risk meta-analysis of four primary outcomes: mortality, cardiovascular (CV) mortality, myocardial infarction (MI) and target-vessel revascularization (TVR). Results: We identified 7 studies that included a total of 5,107 patients. A pooled meta-analysis showed no significant difference in mortality (relative risk [RR] = 1.44; 95% CI, 0.9-2.4), CV mortality (RR = 1.29; 95% CI = 0.4-4.3) and TVR (RR = 1.46; 95% CI = 0.9-2.3) after deferral of revascularization based on FFR between ACS and non-ACS patients. Such deferral was associated with significant additional risk of MI (RR = 1.83; 95% CI = 1.4-2.4) in ACS patients. Conclusion: The prognostic value of FFR in ACS setting is not as good as in stable patients. The results demonstrate an increased risk of MI but not of mortality, CV mortality, and TVR in ACS patients.


Resumo Fundamento: Existem dados limitados sobre o prognóstico do adiamento do tratamento das lesões em pacientes com síndrome coronária com base na reserva de fluxo fracionada (FFR). Objetivos: Realizar uma revisão sistemática da evidência atual sobre o prognóstico do adiamento do tratamento de lesões em pacientes com SCA com base na FFR, comparando-o com o prognóstico em pacientes sem SCA. Métodos: Pesquisamos as bases de dados do Medline, EMBASE, e Cochrane Library por estudos publicados entre janeiro de 2000 e setembro de 2017 que compararam o prognóstico do adiamento da revascularização das lesões com base na FFR em pacientes com SCA em comparação a pacientes sem SCA. Conduzimos uma metanálise do risco relativo de quatro desfechos primários: mortalidade, mortalidade cardiovascular, infarto do miocárdio (IM) e revascularização do vaso-alvo (TVR). Resultados: Identificamos sete estudos que incluíram um total de 5107 pacientes. A metanálise mostrou que não houve diferença quanto à mortalidade [risco relativo (RR) = 1,44; IC95%, 0,9-2,4), mortalidade cardiovascular (RR = 1,29; IC95% = 0,4-4,3) e TVR (RR = 1,46; IC95% = 0,9-2,3) após adiamento da revascularização com base na FFR entre pacientes com SCA e pacientes sem SCA. Tal adiamento foi associado com risco adicional de IM (RR = 1,83; IC95% = 1,4-2,4) em pacientes com SCA. Conclusão: O valor prognóstico da FFR na SCA não é tão bom como em pacientes estáveis. Os resultados mostram um risco aumentado de IM, mas não de mortalidade, mortalidade cardiovascular, e TVR em pacientes com SCA.


Subject(s)
Humans , Fractional Flow Reserve, Myocardial/physiology , Acute Coronary Syndrome/surgery , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/mortality , Prognosis , Time Factors , Risk Assessment , Myocardial Revascularization/methods , Myocardial Revascularization/mortality
19.
Int. j. cardiovasc. sci. (Impr.) ; 31(4): 333-338, jul.-ago. 2018. ta, graf
Article in Portuguese | LILACS | ID: biblio-910215

ABSTRACT

Lesões coronárias moderadas podem ser, ou não, responsáveis pela isquemia miocárdica. A análise funcional das lesões pode ser realizada por métodos invasivos e não invasivos. Comparar a análise funcional das lesões coronarianas moderadas pela reserva de fluxo fracionado e pela cintilografia de perfusão miocárdica. Foram estudados prospectivamente 47 pacientes com doença arterial coronária estável com pelo menos uma lesão coronariana moderada obstrutiva. Eles foram submetidos à reserva de fluxo fracionado e à cintilografia de perfusão miocárdica com intervalo médio de 24,5 dias, entre janeiro de 2013 e dezembro de 2015. Não houve alteração no estado clínico e nem no procedimento de revascularização entre exames. As variáveis populacionais foram descritas como mediana e interquartil. A reserva de fluxo fracionado foi realizada em um de tronco de coronária esquerda; 37 artérias coronárias descendentes; 12 artérias circunflexas e quatro artérias coronárias direitas. Reserva de fluxo fracionado < 0,8 foi considerada positiva. A análise comparativa entre os resultados dos testes foi feita pelo teste de Fisher bicaudal, sendo considerado significativo valor de p < 0,05. A reserva de fluxo fracionado < 0,8 foi encontrada no tronco de coronária esquerda (100%); 13 na artéria coronária descendente (35,14%); seis na artéria circunflexa (50%) e duas na artéria coronária direita (50%). Dentre os pacientes com reserva de fluxo fracionado positiva, 83% tinham isquemia miocárdica demonstrada na cintilografia de perfusão miocárdica (p = 0,058). Analisando especificamente o território da artéria coronária descendente, 83% dos pacientes com reserva de fluxo fracionado negativa não tinham isquemia na cintilografia de perfusão miocárdica, mas 69% dos pacientes com reserva de fluxo fracionado positiva não tinham isquemia na cintilografia de perfusão miocárdica (p = 0,413). Pode ocorrer discordância entre os resultados de análise funcional de lesões coronárias moderadas por testes invasivos e não invasivos


Moderate coronary artery lesions can be, or not, responsible for myocardial ischemia. The functional analysis of these lesions can be performed by invasive and noninvasive methods.To compare the functional analysis of moderate coronary lesions by fractional flow reserve and myocardial perfusion scintigraphy. 47 patients with stable coronary artery disease and at least one moderate coronary artery obstruction were prospectively studied. They were submitted to fractional flow reserve and myocardial perfusion scintigraphy with a median interval of 24.5 days between January 2013 and December 2015. There was no change in clinical status or revascularization procedure between the exams. The population variables were described as medians and interquartile range. Fractional flow reserve was performed in one left main coronary artery; 37 left descending coronary arteries; 12 circumflex arteries and 4 right coronary arteries. Fractional flow reserve < 0.8 was considered positive. The comparative analysis between the results of the tests was performed by two-tailed Fisher's test and a p-value 0.05 was considered significant.Fractional flow reserve < 0.8 was found in the left main coronary artery (100%); 13 in the left descending coronary artery (35.14%); 6 in circumflex artery (50%) and 2 in the right coronary artery (50%). Among the patients with positive fractional flow reserve, 83% had myocardial ischemia demonstrated by the myocardial perfusion scintigraphy (p = 0.058).When analyzing specifically the left descending coronary artery, 83% of the patients with negative fractional flow reserve showed no ischemia at the myocardial perfusion scintigraphy, but 69% of the patients with positive fractional flow reserve showed no ischemia at the myocardial perfusion scintigraphy (p = 0.413). Disagreements can occur between the results of the functional analysis of moderate coronary lesions by invasive and noninvasive tests


Subject(s)
Humans , Male , Female , Adult , Radionuclide Imaging/methods , Myocardial Ischemia/therapy , Fractional Flow Reserve, Myocardial , Prognosis , Coronary Artery Disease/physiopathology , Diagnostic Imaging/methods , Statistical Analysis , Prospective Studies , Microvascular Angina/diagnosis , Echocardiography, Stress/methods , Myocardial Perfusion Imaging/methods , Myocardium
20.
Yonsei Medical Journal ; : 252-257, 2018.
Article in English | WPRIM | ID: wpr-713096

ABSTRACT

PURPOSE: Coronary flow reserve (CFR) is recognized as an indicator of myocardial perfusion. The aim of this study was to assess the relationship between CFR in the non-infarcted myocardium and the incidence of major adverse cardiac events (MACEs). MATERIALS AND METHODS: 100 consecutive patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) were enrolled in the present study, and divided into MACE and non-MACE groups according to the incidence of 12-month MACEs. Left ventricular function and CFR were analyzed using two-dimensional echocardiography and myocardial contrast echocardiography at one week after PCI. Cardiac troponin I levels were assayed to estimate peak concentrations thereof. RESULTS: The MACE group was associated with lower CFR, compared to the non-MACE group (2.41 vs. 2.77, p < 0.001). In the multivariable model, CFR in the non-infarcted myocardium was an independent predictor of 12-month MACE (hazard ratio: 0.093, 95% confidence interval: 0.020–0.426, p=0.002) after adjustment for baseline demographic and clinical characteristics. CONCLUSION: CFR in the non-infarcted myocardium is a useful marker for predicting 12-month MACEs in patients with AMI undergoing primary PCI.


Subject(s)
Aged , Coronary Circulation/physiology , Echocardiography , Female , Fractional Flow Reserve, Myocardial , Humans , Male , Middle Aged , Myocardial Infarction/diagnostic imaging , Myocardial Perfusion Imaging , Myocardium/pathology , Percutaneous Coronary Intervention , Proportional Hazards Models , Treatment Outcome , Ventricular Function, Left/physiology
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