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Assessment of lesion-specific ischemia using fractional flow reserve (FFR) profiles derived from coronary computed tomography angiography (FFRCT) and invasive pressure measurements (FFRINV): Importance of the site of measurement and implications for patient referral for invasive coronary angiography and percutaneous coronary intervention

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العنوان: Assessment of lesion-specific ischemia using fractional flow reserve (FFR) profiles derived from coronary computed tomography angiography (FFRCT) and invasive pressure measurements (FFRINV): Importance of the site of measurement and implications for patient referral for invasive coronary angiography and percutaneous coronary intervention
المؤلفون: Robert D. Safian, Travis Tagami, Kavitha M. Chinnaiyan, Abhay N. Bilolikar, Michael Gallagher, Adam Hafeez, Brian M. Renard, Gilbert Raff, Elvis Cami, Timothy A. Fonte, Austin Fan
المصدر: Journal of cardiovascular computed tomography. 12(6)
سنة النشر: 2018
مصطلحات موضوعية: Male, medicine.medical_specialty, Cardiac Catheterization, Computed Tomography Angiography, medicine.medical_treatment, Clinical Decision-Making, Fractional flow reserve, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Severity of Illness Index, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Percutaneous Coronary Intervention, Predictive Value of Tests, medicine.artery, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, cardiovascular diseases, Referral and Consultation, Computed tomography angiography, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Coronary Stenosis, Percutaneous coronary intervention, Reproducibility of Results, Middle Aged, medicine.disease, Prognosis, Coronary Vessels, Coronary arteries, Fractional Flow Reserve, Myocardial, Stenosis, Ostium, medicine.anatomical_structure, Right coronary artery, Conventional PCI, cardiovascular system, Cardiology, Female, Cardiology and Cardiovascular Medicine, business
الوصف: Fractional flow reserve (FFR)-derived from computed tomography angiography (CTA; FFRCT) and invasive FFR (FFRINV) are used to assess the need for invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI). The optimal location for measuring FFR and the impact of measurement location have not been well defined.930 patients (age 60.7 + 10 years, 59% male) were included in this study. Normal and diseased coronary arteries were classified into stenosis grades 0-4 in the left anterior descending artery (LAD, n = 518), left circumflex (LCX, n = 112) and right coronary artery (RCA, n = 585). FFRCT (n = 1215 arteries) and FFRINV (n = 26 LAD) profiles were developed by plotting FFR values (y-axis) versus site of measurement (x-axis: ostium, proximal, mid, distal segments). The best location to measure FFR was defined relative to the distal end of the stenosis. FFR ≤0.8 was considered positive for ischemia.In normal and stenotic coronary arteries there are significant declines in FFRCT and FFRINV from the ostium to the distal vessel (p 0.001), due to lesion-specific ischemia and to effects unrelated to the lesion. A reliable location (distal to the stenosis) is 10.5 mm [IQR 7.3-14.8 mm] for FFRCT and within 20-30 mm for FFRINV. Rates of positive FFR (from the distal vessel) reclassified to negative FFR (distal to the stenosis) are 61% (FFRCT) and 33% (FFRINV).FFRCT and FFRINV values are influenced by stenosis severity and the site of measurement. FFR measurements from the distal vessel may over-estimate lesion-specific ischemia and result in unnecessary referrals for ICA and PCI.
تدمد: 1876-861X
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::afa265e4f0ae7dfcc718397efab2e097
https://pubmed.ncbi.nlm.nih.gov/30274795
حقوق: CLOSED
رقم الأكسشن: edsair.doi.dedup.....afa265e4f0ae7dfcc718397efab2e097
قاعدة البيانات: OpenAIRE
الوصف
تدمد:1876861X