ABSTRACT
Nowadays an invasive evaluation of fractional flow reserve (FFR) is one of the main methods used for detecting lesions that cause ischemia. Invasively obtained FFR <0.75 has the specificity of 100 %, and FFR >0.80 has the sensitivity >90 %. Recent achievements in computational fluid dynamics and computer simulations allow noninvasive assessment of FFR using data obtained by CT angiography performed according to standard protocol at rest without additional radiation, modification of image acquisition protocols, or added medications for vasodilatation. The present review covers the results of the DISCOVER, the NXT, the DEFACTO and the PLATFORM randomized multicenter studies as well as the prospects of using a noninvasive method for measuring FFR developed by specialists of the Institute of Numerical Mathematics in collaboration with specialists of the I. M. Sechenov First Moscow State Medical University.
Subject(s)
Coronary Stenosis , Fractional Flow Reserve, Myocardial , Coronary Angiography , Hemodynamics , Humans , Moscow , Predictive Value of TestsABSTRACT
Acute cerebrovascular accident (ACVA) and transient ischemic attack are among the leading causes of morbidity, disability, and mortality in the Russian Federation and the world. Ischemic strokes account for 70-80% of all ACVAs, with 20-30% of them being associated with stenotic atherosclerosis of the brachiocephalic arteries (BCA). The paper describes modern views on the problem of asymptomatic BCA atherosclerosis and considers the possibilities of identifying risk groups among the patients with asymptomatic atherosclerosis of the BCA.
Subject(s)
Atherosclerosis , Brachiocephalic Trunk , Ischemic Attack, Transient , Atherosclerosis/diagnosis , Atherosclerosis/therapy , Brachiocephalic Trunk/pathology , Humans , Ischemic Attack, Transient/etiology , Russia , Stroke/etiologyABSTRACT
We use a mathematical model of one-dimensional blood flow in a network of blood vessels for in silico evaluation of hemodynamic significance of stenoses in multivessel coronary disease. Two cases were addressed: two stenosed vessels with different diameters and with the same degree of occlusion and two consecutive stenoses in the same vessel. We show that two criteria for the evaluation of hemodynamic significance based on the degree of stenosis and based on fractional flow reserve can give contradictory indications for surgical intervention. We also show that fractional flow reserve computation originally proposed for a single stenosis should be modified in the case of multivessel stenotic disease.
Subject(s)
Coronary Artery Disease/physiopathology , Coronary Stenosis/physiopathology , Coronary Vessels/physiopathology , Models, Statistical , Coronary Artery Disease/diagnosis , Coronary Artery Disease/pathology , Coronary Stenosis/diagnosis , Coronary Stenosis/pathology , Coronary Vessels/pathology , Fractional Flow Reserve, Myocardial , Hemodynamics , Humans , Mathematical ComputingABSTRACT
The paper considers coronary flow in health and coronary flow autoregulation in health and disease. It gives basic methods used to estimate coronary flow reserve in patients with coronary atherosclerosis. The physiological bases for determining fractional flow reserve are presented. Clinical trials investigating the use of fractional flow reserve in patients with coronary heart disease are analyzed.
