Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (...Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009,we identified 167 patients in whom FFR was measured in at least one 70%–89% stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80),and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively,an additional 1176 patients undergoing PCI in at least one lesion with 70%–89% stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16% in the FFR-defer group and 33% in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82,95% CI: 0.37–1.82,P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8,P < 0.001). Conclusions Functional revascularization for lesions with visually severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable.展开更多
Coronary blood flow reserve (CFR) was assessed by transesophageal Doppler echocardiography in normal subjects (group A. n=20),hypertensive non-left ventricular hypertrophy (non-LVH)Patients (group B,n=22). hypertensiv...Coronary blood flow reserve (CFR) was assessed by transesophageal Doppler echocardiography in normal subjects (group A. n=20),hypertensive non-left ventricular hypertrophy (non-LVH)Patients (group B,n=22). hypertensive patients with LVH(group C.n=32)and coronary heart disease patients (group D. n=33) with the volume sample placed at the bifurcation of the left main and left main and left descending coronary artery. Coronary blood flow velocity (CBFV)was evaluated at rest.2 minutes after dipyridamole (0. 56mg/kg. i. v.) . and 2 minutes after aminophylline i.v. The ratio of dipyridamole to rest maximal diastolic velocity (D/R PDV) was considered the index of coronary blood flow reserve.It was found that D/R PDV was significantly less in groups C and D compared with that in groups A and B (D PDC,1.84±0. 57. 1. 57±0. 41 versus 2.59±0.70 and 2.22+0.58,respectively),with no difference in D/R PDV between groups C and D.Twenty-four out of 32 patients in group C with D/R PDV were less than 2.0 compared to 29 out of 33 patients in group D (P>0.05).Significant negative correlation was found between D/R PDV. D/R PSV and interseptal thickness. left ventricular mass index in hypertensive patients.These data show that impaired CFR in hypertensive patients with LVH is comparable to that in patients with coronary heart disease.展开更多
The left anterior descending （LAD） coronary artery is the main vessel of human coronary circulation, and life-threa- tening consequences are seen when flow in this area is im- paired, Noninvasive measurement of coro...The left anterior descending （LAD） coronary artery is the main vessel of human coronary circulation, and life-threa- tening consequences are seen when flow in this area is im- paired, Noninvasive measurement of coronary flow re- serve （CFR）, defined as the ratio of maximal to baseline coronary blood flow, has been repeatedly shown to be a feasible technique by ultrasound transthoracic Doppler （TTD） both in the LAD and, with some limitations, in the posterior descending （PD） coronary artery.展开更多
Pereutaneous coronary intervention （PCI） for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiograph...Pereutaneous coronary intervention （PCI） for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the fimctional significance of bifurcation lesions. The fractional flow reserve （FFR） is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.展开更多
Background The computational fluid dynamics(CFD)approach has been frequently applied to compute the fractional flow reserve(FFR)using computed tomography angiography(CTA).This technique is efficient.We developed the D...Background The computational fluid dynamics(CFD)approach has been frequently applied to compute the fractional flow reserve(FFR)using computed tomography angiography(CTA).This technique is efficient.We developed the DEEPVESSEL-FFR platform using the emerging deep learning technique to calculate the FFR value out of CTA images in five minutes.This study is to evaluate the DEEPVESSEL-FFR platform using the emerging deep learning technique to calculate the FFR value from CTA images as an efficient method.Methods A single-center,prospective study was conducted and 63 patients were enrolled for the evaluation of the diagnostic performance of DEEPVESSEL-FFR.Automatic quantification method for the three-dimensional coronary arterial geometry and the deep learning based prediction of FFR were developed to assess the ischemic risk of the stenotic coronary arteries.Diagnostic performance of the DEEPVESSEL-FFR was assessed by using wire-based FFR as reference standard.The primary evaluation factor was defined by using the area under receiver-operation characteristics curve(AUC)analysis.Results For per-patient level,taking the cut-off value<0.8 referring to the FFR measurement,DEEPVESSEL-FFR presented higher diagnostic performance in determining ischemia-related lesions with area under the curve of 0.928 compare to CTA stenotic severity 0.664.DEEPVESSEL-FFR correlated with FFR(R=0.686,P<0.001),with a mean di&ference of-0.006士0.0091(P=0.619).The secondary evaluation factors,indicating per vessel accuracy,sensitivity,specificity,positive predictive value,and negative predictive value were 87.3%,97.14%,75%,82.93%,and 95.45%,respectively.Conclusion DEEPVESSEL-FFR is a novel method that allows efficient assessment of the functional significance of coronary stenosis.展开更多
Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usua...Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.展开更多
Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve （FFR） in interme- diate coronary artery stenosis. Methods The study enrolled 143 patients with 203 in...Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve （FFR） in interme- diate coronary artery stenosis. Methods The study enrolled 143 patients with 203 intermediate coronary lesions. Pressure-derived FFR of these lesions was gained at maximal hyperemia induced by intravenous adenosine infusion. An FFR 〈 0.80 was considered as abnormal functional significance. Anatomic parameters at the lesion sites were obtained by off-line quantitative coronary angiography analysis （QCA）. The predictive value of the demographic characteristics and anatomic parameters for FFR in these intermediate lesions was assessed using multiple linear and binary logistic regression analysis. Results Overall, FFR 〈 0.8 was found in 70 （34%） of the total 203 intermediate coronary lesions. FFR values were positively correlated with QCA-measured minimum lumen diameters （MLD, r = 0.372, P = 0.000） and the reference vessel diameters （RVD, r = 0.217, P〈 0.002） were negatively correlated with percent area stenosis （AS, r = -0.251, P = 0.000） and percent diameter stenosis （DS, r = -0.210, P = 0.000）. Age, MLD and the lesion location in different coronary arteries were the inde- pendent determinants of FFR 〈 0.8. Conclusions MLD can predict the functional significance of intermediate coronary stenosis, while age and the lesion location in different coronary arteries should be taken into account as important influencing factors of FFR values.展开更多
目的探讨基于冠状动脉CT血管成像(CCTA)的人工智能(AI)诊断系统及CT无创血流储备分数(CT-FFR)在评估高海拔地区冠状动脉临界病变结构及功能学中的应用价值。方法前瞻性收集2022年1月~2023年10月青海大学附属医院冠心病临界病变患者164例...目的探讨基于冠状动脉CT血管成像(CCTA)的人工智能(AI)诊断系统及CT无创血流储备分数(CT-FFR)在评估高海拔地区冠状动脉临界病变结构及功能学中的应用价值。方法前瞻性收集2022年1月~2023年10月青海大学附属医院冠心病临界病变患者164例,按居住地海拔进行分组,其中2000~3000m为A组(n=83),3000m以上为B组(n=81),再将两组患者按冠脉狭窄程度细分为50%~60%亚组(n=84)和61%~70%亚组(n=80)。将患者冠状动脉CT血管成像数据导入AI辅助诊断及CT-FFR测量系统,以冠脉造影及冠脉传统血流储备分数(FFR)为金标准,分别评价AI及CT-FFR在高海拔地区冠脉临界病变诊断中的应用。结果以FFR为金标准,CT-FFR与FFR的一致性为83.75%。B组钙化斑块、易损斑块高于A组(P=0.037、0.020);B组冠状动脉多支病变、61%~70%狭窄程度发生率均高于A组(P<0.05);A组、B组在61%~70%亚组钙化斑块、易损斑块发生率均高于50%~60%亚组(P<0.05)。B组CT-FFR值低于A组(0.76±0.04 vs 0.88±0.05,P<0.01);A、B两组在61%~70%亚组CT-FFR值≤0.80、<0.70的发生率高于50%~60%亚组(P<0.05)。结论AI诊断系统及CT-FFR对评估高海拔地区冠状动脉临界病变的结构特征及血流动力学改变的结果与冠脉造影、FFR一致性高,具有较高的诊断敏感度和特异度。展开更多
基金supported by the National Institute of Health (NIH Grant HL-92954 and AG-31750 to A.L)supported by an unrestricted grant from St Jude Medical+1 种基金supported by the National Natural Science Foundation of China (No.81470491)the Beijing Municipal Natural Science Foundation (No. 7192078)
文摘Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009,we identified 167 patients in whom FFR was measured in at least one 70%–89% stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80),and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively,an additional 1176 patients undergoing PCI in at least one lesion with 70%–89% stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16% in the FFR-defer group and 33% in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82,95% CI: 0.37–1.82,P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8,P < 0.001). Conclusions Functional revascularization for lesions with visually severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable.
文摘Coronary blood flow reserve (CFR) was assessed by transesophageal Doppler echocardiography in normal subjects (group A. n=20),hypertensive non-left ventricular hypertrophy (non-LVH)Patients (group B,n=22). hypertensive patients with LVH(group C.n=32)and coronary heart disease patients (group D. n=33) with the volume sample placed at the bifurcation of the left main and left main and left descending coronary artery. Coronary blood flow velocity (CBFV)was evaluated at rest.2 minutes after dipyridamole (0. 56mg/kg. i. v.) . and 2 minutes after aminophylline i.v. The ratio of dipyridamole to rest maximal diastolic velocity (D/R PDV) was considered the index of coronary blood flow reserve.It was found that D/R PDV was significantly less in groups C and D compared with that in groups A and B (D PDC,1.84±0. 57. 1. 57±0. 41 versus 2.59±0.70 and 2.22+0.58,respectively),with no difference in D/R PDV between groups C and D.Twenty-four out of 32 patients in group C with D/R PDV were less than 2.0 compared to 29 out of 33 patients in group D (P>0.05).Significant negative correlation was found between D/R PDV. D/R PSV and interseptal thickness. left ventricular mass index in hypertensive patients.These data show that impaired CFR in hypertensive patients with LVH is comparable to that in patients with coronary heart disease.
文摘The left anterior descending （LAD） coronary artery is the main vessel of human coronary circulation, and life-threa- tening consequences are seen when flow in this area is im- paired, Noninvasive measurement of coronary flow re- serve （CFR）, defined as the ratio of maximal to baseline coronary blood flow, has been repeatedly shown to be a feasible technique by ultrasound transthoracic Doppler （TTD） both in the LAD and, with some limitations, in the posterior descending （PD） coronary artery.
文摘Pereutaneous coronary intervention （PCI） for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the fimctional significance of bifurcation lesions. The fractional flow reserve （FFR） is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.
文摘Background The computational fluid dynamics(CFD)approach has been frequently applied to compute the fractional flow reserve(FFR)using computed tomography angiography(CTA).This technique is efficient.We developed the DEEPVESSEL-FFR platform using the emerging deep learning technique to calculate the FFR value out of CTA images in five minutes.This study is to evaluate the DEEPVESSEL-FFR platform using the emerging deep learning technique to calculate the FFR value from CTA images as an efficient method.Methods A single-center,prospective study was conducted and 63 patients were enrolled for the evaluation of the diagnostic performance of DEEPVESSEL-FFR.Automatic quantification method for the three-dimensional coronary arterial geometry and the deep learning based prediction of FFR were developed to assess the ischemic risk of the stenotic coronary arteries.Diagnostic performance of the DEEPVESSEL-FFR was assessed by using wire-based FFR as reference standard.The primary evaluation factor was defined by using the area under receiver-operation characteristics curve(AUC)analysis.Results For per-patient level,taking the cut-off value<0.8 referring to the FFR measurement,DEEPVESSEL-FFR presented higher diagnostic performance in determining ischemia-related lesions with area under the curve of 0.928 compare to CTA stenotic severity 0.664.DEEPVESSEL-FFR correlated with FFR(R=0.686,P<0.001),with a mean di&ference of-0.006士0.0091(P=0.619).The secondary evaluation factors,indicating per vessel accuracy,sensitivity,specificity,positive predictive value,and negative predictive value were 87.3%,97.14%,75%,82.93%,and 95.45%,respectively.Conclusion DEEPVESSEL-FFR is a novel method that allows efficient assessment of the functional significance of coronary stenosis.
基金supported by grants from National Key R&D Program of China (2016YFC1300304)
文摘Woven coronary artery (WCA) is a rare and underdiagnosed anomaly characterized by epicardial coronary artery dividing into multiple twisted single channels then anastomosing at distal segment. The malformation is usually believed as a benign condition without traces of thrombosis or dissection flaps, and merely diagnosed incidentally. However, coincidence of WCA with atherosclerosis or tachycardia may incur myocardium ischemia,[1] and even caused acute coronary syndrome (ACS) or sudden cardiac death (SCD) in reported cases.[2–4] Since the absence of evidence, the guideline for management of the coronary malformation is still lacking. Notably, as an intravascular image modality with high resolution,[5] optical coherence tomography (OCT) may shed lights on diagnosis and management of WCA.[2] Herein, we reported three cases of optimizing WCA management through performing OCT.
文摘Objective To analyze the influencing factors of the functional significance determined by fractional flow reserve （FFR） in interme- diate coronary artery stenosis. Methods The study enrolled 143 patients with 203 intermediate coronary lesions. Pressure-derived FFR of these lesions was gained at maximal hyperemia induced by intravenous adenosine infusion. An FFR 〈 0.80 was considered as abnormal functional significance. Anatomic parameters at the lesion sites were obtained by off-line quantitative coronary angiography analysis （QCA）. The predictive value of the demographic characteristics and anatomic parameters for FFR in these intermediate lesions was assessed using multiple linear and binary logistic regression analysis. Results Overall, FFR 〈 0.8 was found in 70 （34%） of the total 203 intermediate coronary lesions. FFR values were positively correlated with QCA-measured minimum lumen diameters （MLD, r = 0.372, P = 0.000） and the reference vessel diameters （RVD, r = 0.217, P〈 0.002） were negatively correlated with percent area stenosis （AS, r = -0.251, P = 0.000） and percent diameter stenosis （DS, r = -0.210, P = 0.000）. Age, MLD and the lesion location in different coronary arteries were the inde- pendent determinants of FFR 〈 0.8. Conclusions MLD can predict the functional significance of intermediate coronary stenosis, while age and the lesion location in different coronary arteries should be taken into account as important influencing factors of FFR values.
文摘目的探讨基于冠状动脉CT血管成像(CCTA)的人工智能(AI)诊断系统及CT无创血流储备分数(CT-FFR)在评估高海拔地区冠状动脉临界病变结构及功能学中的应用价值。方法前瞻性收集2022年1月~2023年10月青海大学附属医院冠心病临界病变患者164例,按居住地海拔进行分组,其中2000~3000m为A组(n=83),3000m以上为B组(n=81),再将两组患者按冠脉狭窄程度细分为50%~60%亚组(n=84)和61%~70%亚组(n=80)。将患者冠状动脉CT血管成像数据导入AI辅助诊断及CT-FFR测量系统,以冠脉造影及冠脉传统血流储备分数(FFR)为金标准,分别评价AI及CT-FFR在高海拔地区冠脉临界病变诊断中的应用。结果以FFR为金标准,CT-FFR与FFR的一致性为83.75%。B组钙化斑块、易损斑块高于A组(P=0.037、0.020);B组冠状动脉多支病变、61%~70%狭窄程度发生率均高于A组(P<0.05);A组、B组在61%~70%亚组钙化斑块、易损斑块发生率均高于50%~60%亚组(P<0.05)。B组CT-FFR值低于A组(0.76±0.04 vs 0.88±0.05,P<0.01);A、B两组在61%~70%亚组CT-FFR值≤0.80、<0.70的发生率高于50%~60%亚组(P<0.05)。结论AI诊断系统及CT-FFR对评估高海拔地区冠状动脉临界病变的结构特征及血流动力学改变的结果与冠脉造影、FFR一致性高,具有较高的诊断敏感度和特异度。
