Effect of camellia oil body-based oleogels on the film-forming properties of soy protein isolate.

Soybean protein isolate (SPI) was frequently used to make edible films due to its highly degradability and excellent film forming ability. However, the limited barrier properties and low tensile strength of SPI films prevent their application in food packaging. In this study, the SPI film was modified by blending camellia oil body-based oleogel (COBO). COBO improved the mechanical properties of SPI film and increased its light-blocking, water insolubility and barrier properties. Micrograph, particle size distribution, protein conformation and crystalline structure analysis illustrated that camellia saponin in COBO formed hydrogen bonds with SPI, significantly reduced the particle size of the film-forming emulsion, and enhanced the order and uniformity of composite films structure, thus improved the overall performance of the SPI films. The SPI-COBO film packing delayed the weight loss, total soluble solids content increase, and the decrease in hardness of stored strawberries. This study puts forwards a new approach for SPI film modification by blending natural emulsified lipids, contributing to the development of sustainable packaging alternatives.

Structural changes and degradation mechanism of type 3 resistant starch during in vitro fecal fermentation.

The colonic fermentation metabolites of resistant starch (RS) are recognized to have various health benefits. However, the relationship between the structural variation of RS and the colonic fermentation properties, remains inadequately studied, especially for type 3 resistant starch. The in vitro fecal fermentation properties with multi-structure evolution of A- and B-type polymorphic resistant starch spherulites (RSS) were investigated. Both polymorphic types of RSS showed similar fermentation rate and total short-chain fatty acid profiles, while the butyrate concentration of the A-type RSS subjected to 24 h of fermentation was significantly higher compared to B-type RSS. In the case of recrystallized starch spherulites, irrespective of the polymorphic type, gut bacteria preferentially degraded the intermediate chains and crystalline regions, as the local molecule-ordered area potentially serves as suitable attachment sites or surfaces for microbial enzymes.

Oil structuring from porous starch to powdered oil: Role of multi-scale structure in the oil adsorption and distribution.

Oil structuring from porous starch is a potential alternative for the industrial production of powdered oil, but their relationship between starch multi-scale structure and oil adsorption characteristics was not clear. This study compared the role of multi-scale structure of porous starch (PS) prepared by normal and waxy maize starch in the oil adsorption. Waxy maize porous starch exhibited higher oil adsorption capacity (32.43 %-98.71 %) and more oil distributed on the surface of granules than normal maize porous starch, resulting from the more pores, larger specific surface area (1.01-1.53 m2/g), and pore size (8.45-9.32 nm). The enzymolysis time of native starch dominated oil distribution, leading to different granule adhesion and aggregation state. Pearson correlation analysis further showed oil adsorption capacity was negatively correlated with particle size, but positively correlated with enzymolysis rate and specific surface area of PS. The formation of powdered oil was mainly through the physical adsorption, including surface adsorption and pore adsorption. These findings could provide a promising route for the preparation of powdered oil with controlled multi-scale structure of PS.

Amylose content and pre-freezing regulate the structure and oil absorption of polyelectrolytes-based starch cryogel.

Starch cryogel is a potential material for oil absorption. This study provided a facile and convenient polyelectrolyte-based preparation strategy of starch cryogel, in which the structural properties of the cryogel were regulated by amylose content and pre-freezing without long-time retrogradation. Sodium laurate was used as a guest model to form starch-fatty acid salt complex (polyelectrolyte). The amount of amylose content and sodium laurate added led more polyelectrolytes, significantly increased V-type crystallinity from 3.72 % to 22.40 % and complexing index from 4.32 % to 28.48 %. As the uniform pore structure improved the oil absorption ability of starch cryogel, the starch cryogel prepared by waxy maize starch followed by quick pre-freezing showed the highest specific surface area (9.87 m2/g) and oil absorption capacity (32.94 g/g). Our findings suggest that polyelectrolyte properties have great potential in the preparation of starch-based cryogels, which could be applied in the design of novel starch-based porous materials.

Effect of V-type crystallinity and starch particle structure on the oil loading capacity and anti-oxidation.

Starch-based carriers have a great potential in functional oil encapsulation because of their mild preparation conditions, but the oil loading capacity and underlying anti-oxidation mechanism remain unclear. Here V-type starches were applied to fabricate flaxseed oil powder. Particle size analysis and scanning electron microscopy showed a loose aggregation microstructure of normal maize starch (NMS) prepared using the anti-solvent (AS) precipitation method, with an average size of 24.9 µm. Differential scanning calorimetry displayed a good thermo-oxidation resistance of NMS-derived V-type starch prepared via AS precipitation. Principal component analysis revealed that the oil loading capacity, related closely to V-type crystallinity and D50, has a significant positive correlation with the onset oxidation temperature and a negative correlation with the peroxide, thiobarbituric acid, and ρ-anisidine values. Our original study reveals the effects of V-type crystallinity and aggregation microstructure on the oil loading capacity and anti-oxidation, providing theoretical guidance for developing novel, starch-based carriers.

Multi-Scale Structures and Functional Properties of Quinoa Starch Extracted by Alkali, Wet-Milling, and Enzymatic Methods.

The purpose of this study is to investigate the effects of starch extraction methods (alkali, wet-milling, and enzymatic) on the multi-scale structures and functional properties of quinoa starch. When the enzymatic method was compared with alkali and wet-milling, it showed higher protein content (2.4%), larger mean size of aggregated granules (44.1 µm), higher relative crystallinity (29.0%), scattering intensity (17.8 α.u.), absorbance ratio of 1047/1022 (0.9), single and double helical content (8.2% and 23.1%), FWHM ratio (1.5), and average molecular weight and radius of gyration (1.58 × 107 g/mol and 106.8 nm), respectively. Similarly, quinoa starch by enzymatic extraction had a higher onset (82.1 °C), peak (83.8 °C), and conclusion (86.3 °C) temperatures, as well as an enthalpy change (6.8 J/g). It further showed maximum hardness (238.8 N), gumminess (105.6 N), chewiness (80.2 N), SDS content (7.5% of raw and 4.8% of cooked), and RS content (15.4% of raw and 13.9% of cooked), whereas it contained minimum RDS content (77.1% of raw and 81.9% of cooked). The results suggest that extraction of starch by the enzymatic method could be a viable approach to retain the native structure of starch and may eventually improve the glycemic response.

Multi-scale structures and physicochemical properties of waxy starches from different botanical origins.

The multi-scale structures and physicochemical relationships of three different types of waxy starches (maize, tapioca, and potato) were investigated. The maize and tapioca starches exhibited A-type crystalline polymorph compared to potato starch (B-type). The WMS showed higher amorphous content (5.56 %) than other waxy starches. The WTS exhibited a low tendency of retrogradation with its high fa (DP 6-12) and low fb3 (DP ≥ 37) proportion of chains. Double helix content of WPS was observed highest with a high pasting viscosity (952.3 BU). Low fa (DP 6-12) and high fb3 (DP ≥ 37) chain proportions of the WPS retrograded easily. The compactness of the semi-crystalline aggregation structure influenced the retrogradation properties of waxy starches with a positive correlation. Furthermore, the peak viscosity of pastes was correlated with the proportion of fb3 (DP ≥ 37) chains, mass fractal dimension, and double helix content. The results provide guidance to design the application of waxy starches in the production of clean-labels.

Effect of potassium salts on the structure of γ-cyclodextrin MOF and the encapsulation properties with thymol.

BACKGROUND: Thymol is a natural essential oil with strong volatility, low solubility, poor dispersion, strong irritation, and an unpleasant smell, which often requires appropriate porous materials to encapsulate thymol during the application process. However, the encapsulation efficiency of thymol in inclusion complexes is low, and new methods of encapsulation need to be developed. In the present study, the encapsulation capacity, storage stability, and antibacterial activity of thymol were investigated using γ-cyclodextrin (γ-CD) metal-organic frameworks (MOFs) by cocrystallization and high-temperature adsorption methods. The effect of different potassium salts (i.e. KOH, KCl, and KAc) on the structure and complexation of γ-CD-MOFs was also analyzed. RESULTS: Compared with γ-CD, the thymol encapsulation capacity of γ-CD-MOFs was increased by two- to three-fold, with the encapsulation content following the order: KAc-γ-CD-MOF (293.8 mg g-1 ) > KOH-γ-CD-MOF (287.7 mg g-1 ) > KCl-γ-CD-MOF (249.3 mg g-1 ). The anions in the solution participate in the coordination and influence the symmetry relationship between atoms and ions. This explains the differences in both the three-dimensional γ-CD-MOF structure and the thymol encapsulation amount, as well as the high storage stability of thymol. CONCLUSION: The in vitro release kinetics and antibacterial experiments showed that the inclusion complexes prepared by γ-CD-MOFs had higher stability, sustainability, and antibacterial activity, which suggests that it is an excellent complex material for industrial and agricultural applications. © 2022 Society of Chemical Industry.

Starch retrogradation in potato cells: Structure and in vitro digestion paradigm.

The consumption of foods with intact cellular structure is recognized to lower the glycemic index. Studies have focused on the gelatinization and digestibility of starch in intact cells. However, the effects of intact cells on starch retrogradation and digestibility are still unclear. Mild acid and alkali soaking were used to isolate intact potato cells and hydrothermal treatment (73 °C for 30 min) followed by retrogradation (4 °C for 0-15 days). The retrogradation period of 0-15 days increased the crystallinity and enthalpy change, while decreased the digestion rate and extent in potato cell and starch ghost samples. Furthermore, the existence of cell wall (potato cell) lowered the starch digestion rate and extent than potato starch ghost. It was concluded that the ghost structure is the main factor that controls the starch retrogradation, whereas the intact cell wall structure provides the barrier for starch digestion and protects the ghost structure.

Triiodothyronine (T3), inflammation and mortality risk in patients with acute myocardial infarction.

Objectives: To study the relationship between serum-free T3 (FT3), C-reactive protein (CRP) and all-cause mortality in patients with acute myocardial infarction (AMI). Design: Prospective multicentre longitudinal cohort study. Methods: Between December 2014 and December 2016, thyroid function and CRP were analysed in AMI (both ST-elevation (STEMI) and non-ST-elevation) patients from the Thyroxine in Acute Myocardial Infarction study. The relationship of FT3 and CRP at baseline with all-cause mortality up to June 2020 was assessed. Mediation analysis was performed to evaluate if CRP mediated the relationship between FT3 and mortality. Results: In 1919 AMI patients (29.2% women, mean (s.d.) age: 64.2 (12.1) years and 48.7% STEMI) followed over a median (interquartile range) period of 51 (46-58) months, there were 277 (14.4%) deaths. Overall, lower serum FT3 and higher CRP levels were associated with higher risk of mortality. When divided the patients into tertiles based on the levels of FT3 and CRP; the group with the lowest FT3 and highest CRP levels had a 2.5-fold increase in mortality risk (adjusted hazard ratio (95% CI) of 2.48 (1.82-3.16)) compared to the group with the highest FT3 and lowest CRP values. CRP mediated 9.8% (95% CI: 6.1-15.0%) of the relationship between FT3 and mortality. Conclusions: In AMI patients, lower serum FT3 levels on admission are associated with a higher mortality risk, which is partly mediated by inflammation. Adequately designed trials to explore the potential benefits of T3 in AMI patients are required.

Characteristics and ethylene encapsulation properties of V-type linear dextrin with different degrees of polymerisation.

The objective of this research was to investigate the effects of preparation method on the characteristics and ethylene loading capacity of V-type linear dextrin (LD). LD with different degrees of polymerisation were obtained from debranched starch by gradient ethanol precipitation. X-ray diffraction (XRD) patterns of samples obtained by precipitation and anti-solvent precipitation presented A + V-type crystalline structure. However, the percentage of V-type structure of samples obtained by anti-solvent precipitation was significantly higher than for samples prepared by precipitation, which was further confirmed by nuclear magnetic resonance spectroscopy (NMR), and molecular dynamics simulation supported the XRD and NMR results. The ethylene encapsulation capabilities of samples fabricated by different methods were in range of 1.15-4.68 cm3/g. Ethylene release from V-type LD was a physical process at different storage temperatures, and the higher percentage of V-type structure, the slower release rate. Thus, a higher V-type structure content was beneficial for encapsulation of gaseous molecules.

Starch structure and nutritional functionality - Past revelations and future prospects.

Starch exists naturally as insoluble semi-crystalline granules assembled by amylose and amylopectin. Acknowledging the pioneers, we have reviewed the major accomplishments in the area of starch structure from the early 18th century and further established the relation of starch structure to nutritional functionality. Although a huge array of work is reported in the area, the review identified that some features of starch are still not fully understood and needs further elucidation. With the rise of diet-related diseases, it has never been more important to understand starch structure and use that knowledge to improve the nutritional value of the world's principal energy source.

Pea cell wall integrity controls the starch and protein digestion properties in the INFOGEST in vitro simulation.

The cell wall microstructure has been recognized to modulate the digestibility and bioaccessibility of nutrients in whole pulse foods, while the role of cell wall integrity is unclarified in the hydrolysis of intracellular nutrients during human gastrointestinal transit. Intact pea cells were isolated to prepare a series of cell wall integrity subjected to cooking and followed by the in vitro hydrolysis of starch and protein properties using the INFOGEST 2.0 in vitro simulation. Thermal properties showed that cell samples either in raw or cooked form with different wall integrity exhibited similar and higher starch gelatinization temperatures compared to the isolated starch counterpart. It was found that intact pea cells showed the limited hydrolysis extent of the maltose (16.2%) and NH2 (6.7%) compared to the damaged cells. In addition, intact cells also withheld the cell wall integrity throughout gastrointestinal digestion with minor rupture, and presented the higher protein molecular weight (70 kDa) in the SDS-PAGE profiles. Results suggested that the in vitro starch and protein digestion properties are modulated by the cell wall integrity, which may lead to lower glycemic response and open up the possibilities of designing health food products.

Effect of Levothyroxine on Left Ventricular Ejection Fraction in Patients With Subclinical Hypothyroidism and Acute Myocardial Infarction: A Randomized Clinical Trial.

Importance: Thyroid hormones play a key role in modulating myocardial contractility. Subclinical hypothyroidism in patients with acute myocardial infarction is associated with poor prognosis. Objective: To evaluate the effect of levothyroxine treatment on left ventricular function in patients with acute myocardial infarction and subclinical hypothyroidism. Design, Setting, and Participants: A double-blind, randomized clinical trial conducted in 6 hospitals in the United Kingdom. Patients with acute myocardial infarction including ST-segment elevation and non-ST-segment elevation were recruited between February 2015 and December 2016, with the last participant being followed up in December 2017. Interventions: Levothyroxine treatment (n = 46) commencing at 25 µg titrated to aim for serum thyrotropin levels between 0.4 and 2.5 mU/L or identical placebo (n = 49), both provided in capsule form, once daily for 52 weeks. Main Outcomes and Measures: The primary outcome measure was left ventricular ejection fraction at 52 weeks, assessed by magnetic resonance imaging, adjusted for age, sex, type of acute myocardial infarction, affected coronary artery territory, and baseline left ventricular ejection fraction. Secondary measures were left ventricular volumes, infarct size (assessed in a subgroup [n = 60]), adverse events, and patient-reported outcome measures of health status, health-related quality of life, and depression. Results: Among the 95 participants randomized, the mean (SD) age was 63.5 (9.5) years, 72 (76.6%) were men, and 65 (69.1%) had ST-segment elevation myocardial infarction. The median serum thyrotropin level was 5.7 mU/L (interquartile range, 4.8-7.3 mU/L) and the mean (SD) free thyroxine level was 1.14 (0.16) ng/dL. The primary outcome measurements at 52 weeks were available in 85 patients (89.5%). The mean left ventricular ejection fraction at baseline and at 52 weeks was 51.3% and 53.8%, respectively, in the levothyroxine group compared with 54.0% and 56.1%, respectively, in the placebo group (adjusted difference in groups, 0.76% [95% CI, -0.93% to 2.46%]; P = .37). None of the 6 secondary outcomes showed a significant difference between the levothyroxine and placebo treatment groups. There were 15 (33.3%) and 18 (36.7%) cardiovascular adverse events in the levothyroxine and placebo groups, respectively. Conclusions and Relevance: In this preliminary study involving patients with subclinical hypothyroidism and acute myocardial infarction, treatment with levothyroxine, compared with placebo, did not significantly improve left ventricular ejection fraction after 52 weeks. These findings do not support treatment of subclinical hypothyroidism in patients with acute myocardial infarction. Trial Registration: isrctn.org Identifier: http://www.isrctn.com/ISRCTN52505169.

Tea polyphenols attenuate liver inflammation by modulating obesity-related genes and down-regulating COX-2 and iNOS expression in high fat-fed dogs.

BACKGROUND: Tea polyphenols (TPs) attenuate obesity related liver inflammation; however, the anti-obesity effects and anti-inflammatory mechanisms are not clearly understood. This study aimed to determine whether the anti-obesity and anti-inflammatory TPs mechanisms associated with cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS) expression levels, and obesity-related gene response in dogs. RESULTS: Dogs fed TPs displayed significantly decreased (p < 0.01) mRNA expression of tumor necrosis factor-α (TNF-α), interleukin-1 beta (IL-1ß), and interleukin-6 (IL-6) compared to dogs that consumed high-fat diet (HFD) alone. TPs significantly (p < 0.01) inhibited COX-2 and iNOS expression level, and decreased liver fat content and degeneration. CONCLUSION: These results suggested that TPs act as a therapeutic agent for obesity, liver inflammation, and fat degeneration via COX-2 and iNOS inhibition, with TNF-α, IL-1ß, and IL-6 involvement.

Superfine wheat bran improves the hyperglycemic and hyperlipidemic properties in a high-fat rat model.

Wheat bran (WB) is an abundant source of fiber, promoting the health for constipation, irritable bowel syndrome, and gastrointestinal disorders. However, the role of superfine-WB in improving the obesity, hyperglycemia, and hyperlipidemia needs to be revealed. The superfine-WB (low and high treatments) was studied on body-weight, blood sugar, serum, and liver lipids in a high-fat rat model for 5-weeks. The high-fat diet substantially increased body-weight, sugar levels, lipids, and malondialdehyde in serum and liver. In contrast, the superfine-WB treatments reduced food and energy intake, postprandial glucose, body-weight, blood and liver cholesterol, triglycerides, malondialdehyde, low-density lipoprotein, and increased the level of high-density lipoprotein. Additionally, when the two different concentrations were compared, the maximum impact was exhibited by the superfine-WB containing high concentration. These results suggest that the superfine-WB significantly improves the hyperglycemia, hyperlipidemia, and possibly also protecting against other acute, recurrent, or chronic diseases.

Sample Timing, Diagnosis of Subclinical Thyroid Dysfunction and Mortality in Acute Myocardial Infarction: ThyrAMI1 Study.

OBJECTIVE: The objective of this study was to determine the impact of blood sample timing on the diagnosis of subclinical thyroid dysfunction (SCTD) and mortality in patients with acute myocardial infarction (AMI). PATIENTS, DESIGN, AND MAIN OUTCOME MEASURES: Patients with AMI had thyroid function evaluated on admission between December 2014 and December 2016 and those with abnormal serum thyrotropin (TSH) had repeat thyroid function assessed at least a week later. The association between sample timing and SCTD was evaluated by logistic regression analysis. Secondary outcomes were confirmation of SCTD on repeat testing and all-cause mortality up to June 2018. RESULTS: Of the 1806 patients [29.2% women, mean (± standard deviation) age of 64.2 (±12.1) years] analyzed, the prevalence of subclinical hypothyroidism (SCH) was 17.2% (n = 311) and subclinical hyperthyroidism (SHyper) was 1.2% (n = 22) using a uniform TSH reference interval. The risk of being diagnosed with SCTD varied by sample timing in fully-adjusted models. The risk of SCH was highest between 00.01 and 06.00 hours and lowest between 12.01 and 18.00 hours, P for trend <.001, and risk of SHyper was highest between 12.01 hours and 18.00 hours and lowest between 00.01 hours and 06.00 hours. Furthermore, time of the initial sample was associated with the risk of remaining in a SCH state subsequently. Mortality in SCH patients was not elevated when a uniform TSH reference interval was utilized. However, when time period-specific TSH reference ranges were utilized, the mortality risk was significantly higher in SCH patients with HR (95% CI) of 2.26 (1.01-5.19), P = .04. CONCLUSIONS: Sample timing impacts on the diagnosis and prognosis of SCH in AMI patients. If sample timing is not accounted for, SCH is systemically misclassified, and its measurable influence on mortality is lost.

Depression and congestive heart failure: A large prospective cohort study from Pakistan.

OBJECTIVES: Evidence demonstrates the detrimental impact of depression in patients with congestive heart failure (CHF), however, large-scale prospective data from Low and Middle Income Countries (LMICs) is limited. We assessed the prevalence of depression in a large sample with CHF from Karachi, Pakistan, and the impact of depression on all-cause mortality, disability and health-related quality of life (QoL). METHODS: 1009 patients diagnosed with CHF were recruited from public hospitals in Karachi, Pakistan. Patients were screened for depression at baseline using the Beck Depression Inventory (BDI) and the diagnosis was confirmed using the Clinical Interview Schedule-Revised (CIS-R). Health-related QoL and disability were measured using the EuroQol (EQ-5D) and Brief Disability Questionnaire respectively at baseline and after a 6-month follow-up. RESULTS: A total of 670 (66%) patients were depressed at baseline and 821 participants completed 6-month follow up assessments (retention rate: 81%). At baseline, lower income (p < 0.001) and lower education level (p = 0.03) were associated with higher BDI scores. Higher BDI scores were associated with a history of depression (p < 0.001), higher NYHA class (p < 0.001), diabetes (p < 0.001), COPD (p = 0.007), renal disease (p < 0.001) and stroke (p = 0.02). 145 participants were deceased at 6-months. Regression analysis showed that at follow up, higher BDI scores in depressed participants were associated with higher all-cause mortality (OR 1.23 (95% CI: 1.11-1.36); p < 0.001). CONCLUSION: The rate of depression was high among Pakistani patients with CHF. Severity of depression correlated with increased mortality. Further research on controlled intervention trials in this population is warranted.

Anti-hyperlipidemic and hepatoprotective properties of wheat bran with different particle sizes.

BACKGROUND: Wheat bran has been shown to have health-promoting benefits in relation to diabetes, colorectal cancer, cardiovascular disease, constipation, irritable bowel syndrome, diverticulitis, and gastrointestinal disease. However, its effects on obesity, hyperglycemia, hepatotoxicity, and hyperlipidemia are not yet clear. The effects of the consumption of wheat bran of different particle sizes (coarse, 427.55 µm versus ultra-fine, 11.63 µm) on body weight, serum glucose, liver, and blood lipid metabolism levels in high-fat-diet induced rats fed for 5 weeks were investigated. RESULTS: The high-fat diet significantly increased body weight, serum glucose, serum and liver lipids, and malondialdehyde levels. However, addition of coarse and ultra-fine wheat bran to a high-fat diet decreased weight gain, reduced the levels of serum and liver total cholesterol, triglycerides, malondialdehyde, serum low-density lipoprotein, and serum glucose, and improved serum high-density lipoprotein. Moreover, when two particle sizes were compared, the highest impact was exhibited by the wheat bran containing the larger particle size. CONCLUSIONS: The results suggest that micronized wheat bran significantly improves anti-hyperlipidemic and hepatoprotective properties that might provide a safeguard to protect humans against metabolic syndrome abnormalities and other acute, recurrent, or chronic diseases. © 2018 Society of Chemical Industry.

Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods.

BACKGROUND: In the Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST elevation myocardial infarction (FAMOUS) clinical trial, FFR was shown to significantly reduce coronary revascularisation, compared to visual interpretation of standard coronary angiography without FFR. We estimated the cost-effectiveness from a UK National Health Service perspective, based on the results of FAMOUS. METHODS: A mixed trial- and model-based approach using decision and statistical modelling was used. Within-trial (1-year) costs and QALYs were assembled at the individual level and then modelled on subsequent management strategy [coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or medical therapy (MT)] and major adverse coronary events (death, MI, stroke and revascularisation). One-year resource uses included: material, hospitalisation, medical, health professional service use and events. Utilities were derived from individual EQ5D responses. Unit costs were derived from the literature. Outcomes were extended to a lifetime on the basis of MACE during the 1st year. Costs and QALYs were modelled using generalized linear models whilst MACE was modelled using logistic regression. The analysis adopted a payer perspective. Costs and outcomes were discounted at 3.5 %. RESULTS: Costs were related to the subsequent management strategy and MACE whilst QALYs were not. FFR led to a modest cost increase, albeit an imprecise increase, over both the trial [£112 (-£129 to £357)] and lifetime horizons [£133 (-£199 to £499)]. FFR led to a small, albeit imprecise, increase in QALYs over both the trial [0.02 (-0.03 to 0.06)] and lifetime horizons [0.03 (-0.21 to 0.28)]. The mean ICER was £7516/QALY and £4290/QALY over the trial and lifetime horizons, respectively. Decision remained high; FFR had 64 and 59 % probability of cost-effectiveness over trial and lifetime horizons, respectively. CONCLUSIONS: FFR was cost-effective at the mean, albeit with considerable decision uncertainty. Uncertainty can be reduced with more information on long-term health events.