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Noguchi M, Dohi T. Recent advances and clinical implications of intravascular imaging. J Cardiol 2025:S0914-5087(25)00069-3. [PMID: 40058524 DOI: 10.1016/j.jjcc.2025.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Revised: 02/27/2025] [Accepted: 03/03/2025] [Indexed: 03/20/2025]
Abstract
Coronary artery disease (CAD) remains a major contributor to the global mortality rate. Accurate and detailed evaluation of atherosclerotic plaque characteristics is essential for effective risk assessment and treatment planning. Although conventional coronary angiography excels at quantifying luminal stenosis, information on plaque composition and structure remains limited. Recent advances in intravascular imaging (IVI) have bridged this gap by enabling high-resolution visualization of the vessel wall and plaque morphology, thereby enhancing treatment strategies and facilitating comprehensive risk stratification. Among the principal IVI modalities, intravascular ultrasound (IVUS), optical coherence tomography (OCT), and near-infrared spectroscopy (NIRS) provide distinct benefits. IVUS accurately measures vessel diameter and plaque burden, offering critical guidance for managing complex lesions and left main artery disease. The extremely high spatial resolution of OCT allows precise identification of high-risk plaque features, such as thin fibrous caps. NIRS complements these techniques by quantitatively assessing lipid components within plaques, making it particularly useful in predicting future cardiovascular events. In this review, we summarize the latest evidence on applying IVI modalities to the evaluation and treatment of CAD. We focus on the assessment of plaque morphology, identification of high-risk lesions, and the role of IVI-guided percutaneous coronary intervention (PCI). The continued development of hybrid imaging systems and artificial intelligence-based image analysis may produce more precise and safer PCI approaches. Consequently, IVI is poised to become indispensable in managing CAD, paving the way for more personalized treatment strategies tailored to the specific lesion characteristics of each patient.
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Affiliation(s)
- Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
| | - Tomotaka Dohi
- Department of Prevention of Cardiovascular Diseases, Yumino Medical, Tokyo, Japan; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Sugane H, Asaumi Y, Ogata S, Kimura M, Kanaya T, Hoshi T, Sato A, Miura H, Tomishima Y, Morita Y, Nakao K, Otsuka F, Kataoka Y, Kawasaki T, Nishimura K, Narula J, Yasuda S, Noguchi T. Evaluation of fractional flow reserve and atherosclerotic plaque characteristics on coronary non-contrast T1-weighted magnetic resonance imaging. Atherosclerosis 2024; 392:117530. [PMID: 38583287 DOI: 10.1016/j.atherosclerosis.2024.117530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/05/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS The relationship between high-risk coronary plaque characteristics regardless of the severity of lesion stenosis and myocardial ischemia remains unsettled. High-intensity plaques (HIPs) on non-contrast T1-weighted magnetic resonance imaging (T1WI) have been characterized as high-risk coronary plaques. We sought to elucidate whether the presence of coronary HIPs on T1WI influences fractional flow reserve (FFR) in the distal segment of the vessel. METHODS We retrospectively analyzed 281 vessels in 231 patients with chronic coronary syndrome who underwent invasive FFR measurement and coronary T1WI using a multicenter registry. The plaque-to-myocardial signal intensity ratio (PMR) of the most stenotic lesion was evaluated; a coronary plaque with PMR ≥1.4 was defined as a HIP. RESULTS The median PMR of coronary plaques on T1WI in vessels with FFR ≤0.80 was significantly higher than that of plaques with FFR >0.80 (1.17 [interquartile range (IQR): 0.99-1.44] vs. 0.97 [IQR: 0.85-1.09]; p < 0.001). Multivariable analysis showed that an increase in PMR of the most stenotic segment was associated with lower FFR (beta-coefficient, -0.050; p < 0.001). The presence of coronary HIPs was an independent predictor of FFR ≤0.80 (odds ratio (OR), 6.18; 95% confidence interval (CI), 1.93-19.77; p = 0.002). Even after adjusting for plaque composition characteristics based on computed tomography angiography, the presence of coronary HIPs was an independent predictor of FFR ≤0.80 (OR, 4.48; 95% CI, 1.19-16.80; p = 0.026). CONCLUSIONS Coronary plaques with high PMR are associated with low FFR in the corresponding vessel, indicating that plaque morphology might influence myocardial ischemia severity.
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Affiliation(s)
- Hiroki Sugane
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiology, Chikamori Hospital, Kochi-city, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michito Kimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoaki Kanaya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Dokkyo Medical Univeristy, Mibu, Japan
| | - Tomoya Hoshi
- Department of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Sato
- Second Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiyuki Tomishima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Fumiyuku Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Torres-Ruiz G, Mallofré-Vila N, Rojas-Flores P, Carrión-Montaner P, Bosch-Peligero E, Valcárcel-Paz D, Cardiel-Perez A, Guindo-Soldevila J, Martínez-Rubio A. Evidence-based Management of Left Main Coronary Artery Disease. Eur Cardiol 2023; 18:e63. [PMID: 38213664 PMCID: PMC10782428 DOI: 10.15420/ecr.2023.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/16/2023] [Indexed: 01/13/2024] Open
Abstract
Left main coronary artery disease (LMCAD) is associated with high morbidity and mortality due to the large myocardial mass at risk. Although medical treatment may be an option in selected low-risk patients, revascularisation is recommended to improve survival in the majority of patients presenting with a significant left main stenosis. In the past decade, multiple randomised clinical trials and meta-analyses have compared coronary artery bypass grafting surgery (CABG) versus percutaneous coronary intervention (PCI), finding controversial results. The strategy for LMCAD revascularisation is still challenging. Coronary anatomy complexity, clinical features and patient preferences are key elements to be considered by the heart team. The current guidelines define CABG as standard therapy, but the continuous improvements in PCI techniques, the use of intracoronary imaging and functional assessment make PCI a feasible alternative in selected patients, particularly in those with comorbidities and contraindications to CABG. This review analyses the most important studies comparing CABG versus PCI in patients with LMCAD.
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Affiliation(s)
- Gabriel Torres-Ruiz
- Department of Cardiology, Parc Taulí Hospital UniversitariSabadell, Spain
- Department of Medicine, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Nuria Mallofré-Vila
- Department of Cardiology, Parc Taulí Hospital UniversitariSabadell, Spain
- Department of Medicine, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Paola Rojas-Flores
- Department of Cardiology, Parc Taulí Hospital UniversitariSabadell, Spain
- Department of Medicine, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Pablo Carrión-Montaner
- Department of Cardiology, Parc Taulí Hospital UniversitariSabadell, Spain
- Department of Medicine, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Eduard Bosch-Peligero
- Department of Cardiology, Parc Taulí Hospital UniversitariSabadell, Spain
- Department of Medicine, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Daniel Valcárcel-Paz
- Department of Cardiology, Parc Taulí Hospital UniversitariSabadell, Spain
- Department of Medicine, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Ada Cardiel-Perez
- Department of Gynaecology and Obstetrics, Hospital Clínic i ProvincialBarcelona, Spain
| | - Josep Guindo-Soldevila
- Department of Cardiology, Parc Taulí Hospital UniversitariSabadell, Spain
- Department of Medicine, Universitat Autònoma de BarcelonaBarcelona, Spain
| | - Antoni Martínez-Rubio
- Department of Cardiology, Parc Taulí Hospital UniversitariSabadell, Spain
- Department of Medicine, Universitat Autònoma de BarcelonaBarcelona, Spain
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Nafee T, Shah A, Forsberg M, Zheng J, Ou J. State-of-art review: intravascular imaging in percutaneous coronary interventions. CARDIOLOGY PLUS 2023; 8:227-246. [PMID: 38304487 PMCID: PMC10829907 DOI: 10.1097/cp9.0000000000000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Abstract
The history of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) reflects the relentless pursuit of innovation in interventional cardiology. These intravascular imaging technologies have played a pivotal role in our understanding of coronary atherosclerosis, vascular pathology, and the interaction of coronary stents with the vessel wall. Two decades of clinical investigations demonstrating the clinical efficacy and safety of intravascular imaging modalities have established these technologies as staples in the contemporary cardiac catheterization lab's toolbox and earning their place in revascularization clinical practice guidelines. In this comprehensive review, we will delve into the historical evolution, mechanisms, and technical aspects of IVUS and OCT. We will discuss the expanding evidence supporting their use in complex percutaneous coronary interventions, emphasizing their crucial roles in optimizing patient outcomes and ensuring procedural success. Furthermore, we will explore the substantial advances that have propelled these imaging modalities to the forefront of contemporary interventional cardiology. Finally, we will survey the latest developments in the field and explore the promising future directions that have the potential to further revolutionize coronary interventions.
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Affiliation(s)
- Tarek Nafee
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
| | - Areeb Shah
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | - Michael Forsberg
- Cardiovascular Division, Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
| | - Jingsheng Zheng
- Department of Cardiology, AtlantiCare Regional Medical Center, Pomona, NJ 08240, USA
| | - Jiafu Ou
- The Division of Cardiology, Department of Medicine, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63106, USA
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
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Almoghairi A, Al-Asiri N, Aljohani K, AlSaleh A, Alqahtani NG, Alasmary M, Alali R, Tamam K, Alasnag M. Left Main Percutaneous Coronary Revascularization. US CARDIOLOGY REVIEW 2023; 17:e09. [PMID: 39493943 PMCID: PMC11526480 DOI: 10.15420/usc.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/21/2023] [Indexed: 11/05/2024] Open
Abstract
Left main (LM) coronary artery disease accounts for approximately 4-6% of all percutaneous coronary interventions (PCIs). There has been mounting evidence indicating the non-inferiority of LM PCI as a revascularization option, particularly for those with a low SYNTAX score. The EXCEL and NOBEL trials have shaped current guidelines. The European Society of Cardiology assigned a class 2a (level of evidence B) for isolated LM disease involving the shaft and ostium and a class IIb (level of evidence B) for isolated LM disease involving the bifurcation or additional two- or three-vessel disease and a SYNTAX score <32. However, data on the use of a single stent or an upfront two-stent strategy for distal LM disease are conflicting, wherein the EBC Main trial reported similar outcomes with a stepwise provisional approach and the DKCRUSH-V trial reported better outcomes with an upfront two-stent strategy using the 'double-kissing' crush technique. Although several studies have noted better immediate results with image-guided PCI, there are few data on outcomes in LM disease specifically. In fact, the uptake of imaging in the aforementioned landmark trials was only 40%. More importantly, the role of mechanical circulatory support (MCS) has been less well studied in LM PCI. Indiscriminate use of MCS for LM PCI has been noted in clinical practice. Trials evaluating the benefit of MCS in high-risk PCI demonstrated no benefit. This review highlights contemporary trials as they apply to current practice in LM PCI.
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Affiliation(s)
| | - Nayef Al-Asiri
- Cardiac Center, Mouwasat HospitalJubail Industrial City, Saudi Arabia
| | - Khalid Aljohani
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine King Saudi UniversityRiyadh, Saudi Arabia
| | - Ayman AlSaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine King Saudi UniversityRiyadh, Saudi Arabia
| | - Nasser G Alqahtani
- Department of Internal Medicine, Cardiology Section, College of Medicine, King Khalid UniversityAbha, Saudi Arabia
| | | | - Rudaynah Alali
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal UniversityDammam, Saudi Arabia
| | - Khaled Tamam
- International Medical CenterJeddah, Saudi Arabia
| | - Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces HospitalJeddah, Saudi Arabia
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Dörr O. Hauptstammintervention – Ist ein Stent doch besser als zwei? Herz 2022; 47:495-502. [DOI: 10.1007/s00059-022-05143-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 12/05/2022]
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Popa-Fotea NM, Scafa-Udriste A, Dorobantu M. The Continuum of Invasive Techniques for the Assessment of Intermediate Coronary Lesions. Diagnostics (Basel) 2022; 12:diagnostics12061492. [PMID: 35741302 PMCID: PMC9221746 DOI: 10.3390/diagnostics12061492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
Ischemic heart disease is one of the most important causes of mortality and morbidity worldwide. Revascularization of coronary stenosis inducing ischemia, either by percutaneous or surgical intervention, significantly reduces major adverse cardiovascular events and improves quality of life. However, in cases of intermediate lesions, classified by a diameter stenosis between 50 and 90% by European guidelines and 40–70% in American counterparts with no clear evidence of ischemia, the indication of revascularization and impact is determined using various methods that altogether comprehensively evaluate the lesions. This review will discuss the various techniques to assess intermediate stenoses, highlighting indications and advantages, but also drawbacks. Fractional flow rate (FFR) and instantaneous wave-free ratio (iFR) are the gold standard for the functional evaluation of intermediate lesions, but there are clinical circumstances in which these pressure-wire-derived indices are not accurate. Complementary invasive investigations, mainly intravascular ultrasound and/or optical coherence tomography, offer parameters that can be correlated with FFR/iFR and additional insights into the morphology of the plaque guiding the eventual percutaneous intervention in terms of length and size of stents, thus improving the outcomes of the procedure. The development of artificial intelligence and machine learning with advanced algorithms of prediction will offer multiple scenarios for treatment, allowing real-time selection of the best strategy for revascularization.
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Affiliation(s)
- Nicoleta-Monica Popa-Fotea
- Cardiothoracic Department, University of Medicine and Pharmacy “Carol Davila”, 8, Bulevardul Eroii Sanitari, 050474 Bucharest, Romania; (A.S.-U.); (M.D.)
- Emergency Clinical Hospital, 10, Calea Floreasca, 014461 Bucharest, Romania
- Correspondence: ; Tel.: +40-724381385
| | - Alexandru Scafa-Udriste
- Cardiothoracic Department, University of Medicine and Pharmacy “Carol Davila”, 8, Bulevardul Eroii Sanitari, 050474 Bucharest, Romania; (A.S.-U.); (M.D.)
- Emergency Clinical Hospital, 10, Calea Floreasca, 014461 Bucharest, Romania
| | - Maria Dorobantu
- Cardiothoracic Department, University of Medicine and Pharmacy “Carol Davila”, 8, Bulevardul Eroii Sanitari, 050474 Bucharest, Romania; (A.S.-U.); (M.D.)
- Romanian Academy, 010071 Bucharest, Romania
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De Maria GL, Testa L, de la Torre Hernandez JM, Terentes-Printzios D, Emfietzoglou M, Scarsini R, Bedogni F, Spitzer E, Banning A. A multi-center, international, randomized, 2-year, parallel-group study to assess the superiority of IVUS-guided PCI versus qualitative angio-guided PCI in unprotected left main coronary artery (ULMCA) disease: Study protocol for OPTIMAL trial. PLoS One 2022; 17:e0260770. [PMID: 34995276 PMCID: PMC8740965 DOI: 10.1371/journal.pone.0260770] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/02/2021] [Indexed: 12/28/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is used increasingly for revascularization of unprotected left main coronary artery (LMCA) disease. Observational studies and subgroup analyses from clinical trials, have suggested a possible benefit from the use of intravascular ultrasound (IVUS) guidance when performing unprotected LMCA PCI. However, the value of imaging with IVUS has never been proven in an appropriately powered randomized clinical trial. The OPtimizaTIon of Left MAin PCI With IntravascuLar Ultrasound (OPTIMAL) trial has been designed to establish whether IVUS-guided PCI optimization on LMCA is associated with superior clinical outcomes when compared with standard qualitative angiography-guided PCI. Methods The OPTIMAL trial is a randomized, multicenter, international study designed to enroll a total of 800 patients undergoing PCI for unprotected LMCA disease. Patients will be randomized in a 1:1 fashion to IVUS-guided PCI versus angiogram-guided PCI. In patients allocated to the angiogram-guided arm, use of IVUS is discouraged, unless there are safety concerns. In patients allocated to the IVUS guidance arm, pre-procedural IVUS assessment is highly recommended, whilst post-procedural IVUS assessment is mandatory to confirm appropriate stenting result and/or to guide stent result optimization, according to predefined criteria. Patients will be followed up to 2 years after the index procedure. The primary outcome measure is the Academic Research Consortium (ARC) patient-oriented composite endpoint (PoCE) which includes all-cause death, any stroke, any myocardial infarction and any repeat revascularization at 2 years follow-up. Discussion The OPTIMAL trial aims to provide definitive evidence about the clinical impact of IVUS-guidance during PCI to an unprotected LMCA. It is anticipated by the investigators, that an IVUS-guided strategy will be associated with less clinical events compared to a strategy guided by angiogram alone. Trial registration ClinicalTrials.gov: NCT04111770. Registered on October 1, 2019.
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Affiliation(s)
- Giovanni Luigi De Maria
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Luca Testa
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy
| | | | - Dimitrios Terentes-Printzios
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Maria Emfietzoglou
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Roberto Scarsini
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Francesco Bedogni
- Coronary Revascularisation Unit, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy
| | - Ernest Spitzer
- European Cardiovascular Research Institute, Rotterdam, The Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Adrian Banning
- Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
- * E-mail:
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Sui Y, Yang M, Xu Y, Wu N, Qian J. Diagnostic performance of intravascular ultrasound-based fractional flow reserve versus angiography-based quantitative flow ratio measurements for evaluating left main coronary artery stenosis. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1403-1409. [PMID: 35129284 DOI: 10.1002/ccd.30078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We compared the diagnostic performance of the ultrasonic flow ratio (UFR) and quantitative flow ratio (QFR) for left main coronary artery (LMCA) stenosis. BACKGROUND Evaluation of LMCA stenosis remains challenging because of its complex pathogenesis and severity. Computing QFR allows rapid determination of fractional flow reserve (FFR) from coronary angiograms. A novel intravascular ultrasound (IVUS)-based FFR (UFR) allows rapid FFR computation from IVUS images. Neither of the computational approaches required a pressure wire or hyperemia induction. Previous studies have validated the good diagnostic accuracy of QFR and UFR in identifying hemodynamically significant coronary stenosis using FFR as the reference standard. METHODS This retrospective observational study enrolled consecutive patients with intermediate-grade LMCA stenosis who underwent IVUS evaluation. UFR and QFR of all LMCA stenosis patients were assessed, their correlation and agreement were analyzed, and diagnostic performance of UFR in LMCA stenosis was evaluated. RESULTS Eighty-three paired comparisons between UFR and QFR were obtained. UFR excellently correlated with QFR (r = 0.74, p < 0.01). The Bland-Altman plot showed good agreement between UFR and QFR (mean differences: 0.01 ± 0.05, p = 0.34). The area under the curve of UFR for identifying physiological LMCA stenosis was 0.97 (95% confidence interval [CI]: 0.93-1.00, p < 0.01). The overall UFR diagnostic accuracy was 0.95 (95% CI: 0.88-0.99). CONCLUSIONS UFR showed excellent correlation and good agreement with QFR in LMCA stenosis assessment, indicating that it is highly feasible to use UFR for functional evaluation of LMCA stenosis.
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Affiliation(s)
- Yonggang Sui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanlu Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Naqiong Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Qian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 785] [Impact Index Per Article: 261.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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11
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 276] [Impact Index Per Article: 92.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abdul-Kafi O, Toole M, Montes-Rivera M, Shroff A, Ardati A. Measure Twice, Cut Once: Adjunctive Physiology and Imaging in Left Main PCI. CURRENT CARDIOVASCULAR IMAGING REPORTS 2021. [DOI: 10.1007/s12410-021-09562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Milasinovic D, Stankovic G. Towards a common pathway for the treatment of left main disease: contemporary evidence and future directions: Left main disease treatment. ASIAINTERVENTION 2021; 7:85-95. [PMID: 34913011 PMCID: PMC8670569 DOI: 10.4244/aij-d-21-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
There is increasing evidence to support percutaneous treatment of left main (LM) disease. Due to its major clinical impact, any procedure in the left main should be meticulously planned and performed. In this review, we aim to integrate the available evidence into a common treatment pathway, starting with understanding the distinct anatomical features of the left main. A three-level decision-making process is presented. First, in instances of angiographic ambiguity, intravascular ultrasound and fractional flow reserve can be used to decide if revascularisation could be deferred. Second, if revascularisation is indicated, the risks and benefits of percutaneous versus surgical procedures should be evaluated. Third, if percutaneous coronary intervention (PCI) is chosen, the operator should decide between the provisional single-stent versus upfront two-stent strategies. Regardless of the PCI technique selected, it should be performed according to the recommendations of a stepwise procedure utilising proximal optimisation (POT) after each instance of crossover stenting and kissing balloon inflation (KBI) where necessary. In addition to the recognised quality markers such as POT and KBI, we discuss the clinical relevance of the operator's LM PCI experience and the intracoronary imaging guidance when treating patients with left main disease.
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Affiliation(s)
- Dejan Milasinovic
- University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Stankovic
- University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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14
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Bouki KP, Vlad DI, Goulas N, Lambadiari VA, Dimitriadis GD, Kotsakis AA, Barοutsi K, Toutouzas KP. Diagnostic Performance of Frequency-Domain Optical Coherence Tomography to Predict Functionally Significant Left Main Coronary Artery Stenosis. J Interv Cardiol 2021; 2021:7108284. [PMID: 34867107 PMCID: PMC8608539 DOI: 10.1155/2021/7108284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/09/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
AIMS The aim of this study was to assess the safety and diagnostic efficacy of frequency-domain optical coherence tomography (FD-OCT) in identifying functional severity of the left main coronary artery (LM) stenosis determined by fractional flow reserve (FFR). METHODS AND RESULTS 101 patients with LM lesion (20-70% diameter stenosis angiographically) underwent FFR measurement and FD-OCT imaging of the LM. The following parameters were measured by FD-OCT in the LM: reference lumen area (RLA), reference lumen diameter (RLD), minimum lumen area (MLA), minimum lumen diameter (MLD), % lumen area stenosis, and % diameter stenosis. The LM lesions were analyzable by FD-OCT in 88/101 (87.1%) patients. FFR at maximum hyperemia was ≤0.80 in 39/88 (44.3%) patients. FFR values were correlated significantly with FD-OCT-derived LM lumen parameters. An MLA cutoff value of 5.38 mm2 had the highest sensitivity and specificity of 82% and 81%, respectively, followed by an MLD of 2.43 mm (sensitivity 77%, specificity 72%) and AS of 60% (sensitivity 72%, specificity 72%) for predicting FFR <0.80. CONCLUSIONS FD-OCT is a safe and feasible imaging technique for the assessment of LM stenosis. An FD-OCT-derived MLA of ≤5.38 mm2 strongly predicts the functional severity of an LM lesion.
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Affiliation(s)
| | - Delia I. Vlad
- 2 Department of Cardiology, General Hospital of Nikea-Piraeus, Nikaia, Greece
| | - Nikolaos Goulas
- 2 Department of Cardiology, General Hospital of Nikea-Piraeus, Nikaia, Greece
| | - Vaia A. Lambadiari
- 2 Department of Internal Medicine, University of Athens, Attikon Hospital, Athens, Greece
| | - George D. Dimitriadis
- 2 Department of Internal Medicine, University of Athens, Attikon Hospital, Athens, Greece
| | | | - Kyriaki Barοutsi
- Department of Medical Imaging, General Hospital of Nikea-Piraeus, Nikaia, Greece
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15
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Coronary physiologic assessment based on angiography and intracoronary imaging. J Cardiol 2021; 79:71-78. [PMID: 34384666 DOI: 10.1016/j.jjcc.2021.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 01/20/2023]
Abstract
Despite the current evidence supporting clinical benefits of fractional flow reserve (FFR), its uptake in the cardiac catheterization laboratory has been slow due to procedural cost and increased time with the need for maximum hyperemia. Recently, novel physiological indices derived from coronary angiography and intracoronary imaging have emerged to overcome issues with a wire-based FFR. Angiography-based FFR can be measured without vessel instrumentation and has shown excellent diagnostic performance using wire-based FFR as the reference standard. Thus, angiography-based FFR may facilitate coronary functional assessment before and after percutaneous coronary intervention (PCI). Angiography-based index of microcirculatory resistance (IMR) is another new computational index for assessing the coronary microcirculation. Although angiography-derived IMR remains in an early phase of development and requires further validation, its less-invasive nature may help broaden the adoption of microvascular functional assessment in various conditions such as myocardial infarction and cardiac allograft vasculopathy. Lastly, computational FFR based on intravascular ultrasound and optical coherence tomography allows detailed lesion assessment from both morphological and functional standpoints. Given a growing interest in physiology-guided PCI optimization strategies, intravascular imaging-based FFR may become the main assessment tool to confirm successful PCI.
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16
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El Hajj SC, Toya T, Warisawa T, Nan J, Lewis BR, Cook CM, Rajkumar C, Howard JP, Seligman H, Ahmad Y, Doi S, Nakajima A, Nakayama M, Goto S, Vera-Urquiza R, Sato T, Kikuta Y, Kawase Y, Nishina H, Nakamura S, Matsuo H, Escaned J, Akashi YJ, Davies JE, Lerman A. Correlation of Intravascular Ultrasound and Instantaneous Wave-Free Ratio in Patients With Intermediate Left Main Coronary Artery Disease. Circ Cardiovasc Interv 2021; 14:e009830. [PMID: 34092096 DOI: 10.1161/circinterventions.120.009830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Stephanie C El Hajj
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.C.H., T.T., J.N., A.L.)
| | - Takumi Toya
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.C.H., T.T., J.N., A.L.).,Division of Cardiology, National Defense Medical College, Tokorozawa, Japan (T.T.)
| | - Takayuki Warisawa
- National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.).,Department of Cardiovascular Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Japan (T.W.)
| | - John Nan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.C.H., T.T., J.N., A.L.)
| | - Bradley R Lewis
- Department of Biomedical Statistics and Informatics, Mao Clinic, Rochester, MN (B.R.L.)
| | - Christopher M Cook
- National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.)
| | - Christopher Rajkumar
- National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.)
| | - James P Howard
- National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.)
| | - Henry Seligman
- National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.)
| | - Yousif Ahmad
- National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.)
| | - Shunichi Doi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan (S.D.)
| | - Akihiro Nakajima
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (A.N., S.N.)
| | - Masafumi Nakayama
- Cardiovascular Centre, Toda Central General Hospital, Japan (M.N.).,Tokyo Women's Medical University - Waseda University Joint Institution for Advanced Biomedical Sciences, Japan (M.N.)
| | - Sonoka Goto
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Spain (S.G., R.V.-U., J.E.).,Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan (S.G., T.S., Y. Kawase)
| | - Rafael Vera-Urquiza
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Spain (S.G., R.V.-U., J.E.)
| | - Takao Sato
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan (S.G., T.S., Y. Kawase)
| | - Yuetsu Kikuta
- National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.).,Division of Cardiology, Fukuyama Cardiovascular Hospital, Japan (Y. Kikuta)
| | - Yoshiaki Kawase
- Department of Cardiology, Tachikawa General Hospital, Nagaoka, Japan (S.G., T.S., Y. Kawase)
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Japan (H.N.)
| | - Sunao Nakamura
- Department of Cardiovascular Medicine, New Tokyo Hospital, Matsudo, Japan (A.N., S.N.)
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (H.M.)
| | - Javier Escaned
- Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Spain (S.G., R.V.-U., J.E.)
| | | | - Justin E Davies
- National Heart and Lung Institute, Imperial College London (T.W., C.M.C., C.R., J.P.H., H.S., Y.A., Y. Kikuta, J.E.D.)
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (S.C.H., T.T., J.N., A.L.)
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17
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Primary Percoutaneous Coronary Intervention on Unprotected Left Main Coronary Artery with Staged Complex Bifurcational Treatment: A Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2018-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
We present the case of patient with ST elevation myocardial infarction in cardiogenic shock with primary percutaneous coronary intervention of Left anterior descending coronary artery and Left main coronary artery with staged complex procedure on Left anterior descending/Diagonal branch bifurcation in Culotte manner. This case shows that “the simpler, the better” approach of only infarct related artery revascularization may be applied in acute patients with cardiogenic shock and optimal clinical and hemodynamic response on revascularization and intra-aortic balloon pump. But, complete revascularization should be done in staged procedure and later, a control coronary angiography with intravascular ultrasound assistance is mandatory.
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18
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Tomaniak M, Masdjedi K, van Zandvoort LJ, Neleman T, Tovar Forero MN, Vermaire A, Kochman J, Kardys I, den Dekker W, Wilschut J, Diletti R, de Jaegere P, Van Mieghem NM, Zijlstra F, Daemen J. Correlation between 3D-QCA based FFR and quantitative lumen assessment by IVUS for left main coronary artery stenoses. Catheter Cardiovasc Interv 2021; 97:E495-E501. [PMID: 32725862 PMCID: PMC7984347 DOI: 10.1002/ccd.29151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/27/2020] [Accepted: 07/03/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We aimed to evaluate the feasibility of using three dimensional-quantitative coronary angiography (3D-QCA) based fractional flow reserve (FFR) (vessel fractional flow reserve [vFFR], CAAS8.1, Pie Medical Imaging) and to correlate vFFR values with intravascular ultrasound (IVUS) for the evaluation of intermediate left main coronary artery (LMCA) stenosis. BACKGROUND 3D-QCA derived FFR indices have been recently developed for less invasive functional lesion assessment. However, LMCA lesions were vastly under-represented in first validation studies. METHODS This observational single-center cohort study enrolled consecutive patients with stable angina, unstable angina, or non-ST-segment elevation myocardial infarction and nonostial, intermediate grade LMCA stenoses who underwent IVUS evaluation. vFFR was computed based on two angiograms with optimal LMCA stenosis projection and correlated with IVUS-derived minimal lumen area (MLA). RESULTS A total of 256 patients with intermediate grade LMCA stenosis evaluated with IVUS were screened for eligibility; 147 patients met the clinical inclusion criteria and had a complete IVUS LMCA footage available, of them, 63 patients (63 lesions) underwent 3D-QCA and vFFR analyses. The main reason for screening failure was insufficient quality of the angiogram (51 patients,60.7%). Mean age was 65 ± 11 years, 75% were male. Overall, mean MLA within LMCA was 8.77 ± 3.17 mm2 , while mean vFFR was 0.87 ± 0.09. A correlation was observed between vFFR and LMCA MLA (r = .792, p = .001). The diagnostic accuracy of vFFR ≤0.8 in identifying lesions with MLA < 6.0 mm2 (sensitivity 98%, specificity 71.4%, area under the curve (AUC) 0.95, 95% confidence interval (CI) 0.89-1.00, p = .001) was good. CONCLUSIONS In patients with good quality angiographic visualization of LMCA and available complete LMCA IVUS footage, 3D-QCA based vFFR assessment of LMCA disease correlates well to LMCA MLA as assessed by IVUS.
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Affiliation(s)
- Mariusz Tomaniak
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
- First Department of CardiologyMedical University of WarsawPoland
| | - Kaneshka Masdjedi
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Laurens J van Zandvoort
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Tara Neleman
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Maria N Tovar Forero
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Alise Vermaire
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Janusz Kochman
- First Department of CardiologyMedical University of WarsawPoland
| | - Isabella Kardys
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Wijnand den Dekker
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Jeroen Wilschut
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Roberto Diletti
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Peter de Jaegere
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Nicolas M Van Mieghem
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Felix Zijlstra
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
| | - Joost Daemen
- Department of CardiologyErasmus Medical Center, University Medical Center Rotterdam, Thorax CentreRotterdamThe Netherlands
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19
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Case BC, Yerasi C, Forrestal BJ, Shlofmitz E, Garcia-Garcia HM, Mintz GS, Waksman R. Intravascular ultrasound guidance in the evaluation and treatment of left main coronary artery disease. Int J Cardiol 2020; 325:168-175. [PMID: 33039578 DOI: 10.1016/j.ijcard.2020.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 01/17/2023]
Abstract
Percutaneous coronary intervention (PCI) of left main coronary artery (LMCA) disease has become an acceptable revascularization strategy. Evaluating the extent and characteristics of obstructive disease of the LMCA by angiography is challenging and limited in its accuracy. In contrast, intravascular ultrasound (IVUS) provides accurate imaging of the coronary lumen as well as quantitative measurements and quantitative assessment of the vessel wall components. IVUS for LMCA PCI should be performed before, during, and after intervention; IVUS enhances every step in the procedure and is associated with a mortality advantage in comparison with angiographic guidance alone. In this review, we provide an update on LMCA PCI and the role of IVUS for lesion assessment and stent optimization. In addition, the latest clinical evidence of the benefits of IVUS-guided LMCA PCI as compared to angiography is reviewed.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Hector M Garcia-Garcia
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Gary S Mintz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC, United States of America.
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20
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Nogic J, Prosser H, O’Brien J, Thakur U, Soon K, Proimos G, Brown AJ. The assessment of intermediate coronary lesions using intracoronary imaging. Cardiovasc Diagn Ther 2020; 10:1445-1460. [PMID: 33224767 PMCID: PMC7666953 DOI: 10.21037/cdt-20-226] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023]
Abstract
Intermediate coronary artery stenosis, defined as visual angiographic stenosis severity of between 30-70%, is present in up to one quarter of patients undergoing coronary angiography. Patients with this particular lesion subset represent a distinct clinical challenge, with operators often uncertain on the need for revascularization. Although international guidelines appropriately recommend physiological pressure-based assessment of these lesions utilizing either fractional flow reserve (FFR) or quantitative flow ratio (QFR), there are specific clinical scenarios and lesion subsets where the use of such indices may not be reliable. Intravascular imaging, mainly utilizing intravascular ultrasound (IVUS) and optical coherence tomography (OCT) represents an alternate and at times complementary diagnostic modality for the evaluation of intermediate coronary stenoses. Studies have attempted to validate these specific imaging measures with physiological markers of lesion-specific ischaemia with varied results. Intravascular imaging however also provides additional benefits that include portrayal of plaque morphology, guidance on stent implantation and sizing and may portend improved clinical outcomes. Looking forward, research in computational fluid dynamics now seeks to integrate both lesion-based physiology and anatomical assessment using intravascular imaging. This review will discuss the rationale and indications for the use of intravascular imaging assessment of intermediate lesions, while highlighting the current limitations and benefits to this approach.
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Affiliation(s)
- Jason Nogic
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Hamish Prosser
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Joseph O’Brien
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Udit Thakur
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
| | - Kean Soon
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - George Proimos
- Department of Cardiology, Eastern Health, Melbourne, Victoria, Australia
| | - Adam J. Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Victoria, Australia
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21
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Sezer M, Aslanger E, Cakir O, Atici A, Sezer I, Ozcan A, Umman B, Bugra Z, Umman S. The Interplay between Features of Plaque Vulnerability and Hemodynamic Relevance of Coronary Artery Stenoses. Cardiology 2020; 146:1-10. [PMID: 32846410 DOI: 10.1159/000508885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/23/2020] [Indexed: 11/19/2022]
Abstract
Fractional flow reserve (FFR) may not be immune from hemodynamic perturbations caused by both vessel and lesion related factors. The aim of this study was to investigate the impact of plaque- and vessel wall-related features of vulnerability on the hemodynamic effect of intermediate coronary stenoses. Methods and Results: In this cross-sectional study, patients referred to catheterization laboratory for clinically indicated coronary angiography were prospectively screened for angiographically intermediate stenosis (50-80%). Seventy lesions from 60 patients were evaluated. Mean angiographic stenosis was 62.1 ± 16.3%. After having performed FFR assessment, intravascular ultrasound (IVUS) was performed over the FFR wire. Virtual histology IVUS was used to identify the plaque components and thin cap fibroatheroma (TCFA). TCFA was significantly more frequent (65 vs. 38%, p = 0.026), and necrotic core volume (26.15 ± 14.22 vs. 16.21 ± 8.93 mm3, p = 0.04) was significantly larger in the positively remodeled than non-remodeled vessels. Remodeling index correlated with necrotic core volume (r = 0.396, p = 0.001) and with FFR (r = -0. 419, p = 0.001). With respect to plaque components, only necrotic core area (r = -0.262, p = 0.038) and necrotic core volume (r = -0.272, p = 0.024) were independently associated with FFR. In the multivariable model, presence of TCFA was independently associated with significantly lower mean FFR value as compared to absence of TCFA (adjusted, 0.71 vs. 0.78, p = 0.034). Conclusion: The current study demonstrated that for a given stenosis geometry, features of plaque vulnerability such as necrotic core volume, TCFA, and positive remodeling may influence the hemodynamic relevance of intermediate coronary stenoses.
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Affiliation(s)
- Murat Sezer
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Emre Aslanger
- Department of Cardiology, Yeditepe University, Istanbul, Turkey
| | - Ozan Cakir
- Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Adem Atici
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Irem Sezer
- Department of Cardiology, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Alp Ozcan
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Berrin Umman
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zehra Bugra
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sabahattin Umman
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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22
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Skowronski J, Cho I, Mintz GS, Wolny R, Opolski MP, Cha MJ, Lee WS, Michalowska I, Kepka C, Kruk M, Tyczynski P, Kalinczuk L, Kukula K, Ciszewski M, Banasiak A, Chmielak Z, Witkowski A, Kim SW, Pregowski J. Inter-ethnic differences in normal coronary anatomy between Caucasian (Polish) and Asian (Korean) populations. Eur J Radiol 2020; 130:109185. [PMID: 32771813 DOI: 10.1016/j.ejrad.2020.109185] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/14/2020] [Accepted: 07/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Little is known about ethnic differences in the size of coronary arteries in disease-free individuals. Our aim was to compare coronary artery dimensions between Asian and Caucasian population without atherosclerosis. METHODS One hundred and twelve Caucasian patients without any discernible atherosclerosis detected on coronary computed tomography angiography were matched with 112 Asian patients using sex, age, coronary dominance pattern and body surface area (BSA). Maximal and minimal lumen areas (LA) and diameters (LD) of proximal and middle coronary segments were measured, and the mean values were used for analyses. RESULTS Caucasians had larger LA and LD than Asian patients in all proximal coronary segments. Overall, the mean difference in LA and LD was 11.4 % and 5.2 %, respectively. Significant differences were observed for all proximal segments (left anterior descending: 13 % and 6%, left circumflex 14 % and 8% and right coronary artery 8% and 4% for LA and LD), but not for mid segments. The greatest difference between Caucasians and Asians was found in left main coronary artery (LMCA) LA (21.2 ± 6.5 vs.16.8 ± 5.4 mm2, p < 0.01 respectively). The independent predictors of larger LA and LD of LMCA and proximal coronary segments were male sex (p < 0.05), Caucasian ethnicity (p < 0.05), and left dominance pattern (p < 0.05). CONCLUSION In subjects without atherosclerosis, Asians have smaller dimensions of all proximal coronary arteries, most prominently displayed in LMCA, than the Caucasians regardless of age, sex, or body size.
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Affiliation(s)
- Jaroslaw Skowronski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Iksung Cho
- Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Gary S Mintz
- Cardiovascular Research Foundation, Broadway 1700, 10019, New York, NY, United States.
| | - Rafal Wolny
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Maksymilian P Opolski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Min Jae Cha
- Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Wang Soo Lee
- Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Ilona Michalowska
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Cezary Kepka
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Mariusz Kruk
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Pawel Tyczynski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Lukasz Kalinczuk
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Krzysztof Kukula
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Michal Ciszewski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Adam Banasiak
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Zbigniew Chmielak
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Adam Witkowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
| | - Sang-Wook Kim
- Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 06973 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Jerzy Pregowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
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23
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Ono M, Kawashima H, Hara H, Gao C, Wang R, Kogame N, Takahashi K, Chichareon P, Modolo R, Tomaniak M, Wykrzykowska JJ, Piek JJ, Mori I, Courtney BK, Wijns W, Sharif F, Bourantas C, Onuma Y, Serruys PW. Advances in IVUS/OCT and Future Clinical Perspective of Novel Hybrid Catheter System in Coronary Imaging. Front Cardiovasc Med 2020; 7:119. [PMID: 32850981 PMCID: PMC7411139 DOI: 10.3389/fcvm.2020.00119] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been developed and improved as both diagnostic and guidance tools for interventional procedures over the past three decades. IVUS has a resolution of 100 μm with a high tissue penetration and capability of assessing the entire structure of a coronary artery including the external elastic membrane, whereas OCT has a higher resolution of 10–20 μm to assess endoluminal structures with a limited tissue penetration compared to IVUS. Recently, two companies, CONAVI and TERUMO, integrated IVUS and OCT into a single catheter system. With their inherent strength and limitations, the combined IVUS and OCT probes are complementary and work synergistically to enable a comprehensive depiction of coronary artery. In this review, we summarize the performance of the two intracoronary imaging modalities—IVUS and OCT—and discuss the expected potential of the novel hybrid IVUS–OCT catheter system in the clinical field.
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Affiliation(s)
- Masafumi Ono
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hironori Hara
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland.,Department of Cardiology, Radboud University, Nijmegen, Netherlands.,Depatrment of Cardiology, Xijing hospital, Xi'an, China
| | - Norihiro Kogame
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Kuniaki Takahashi
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ply Chichareon
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rodrigo Modolo
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,Cardiology Division, Department of Internal Medicine, University of Campinas (UNICAMP), Campinas, Brazil
| | - Mariusz Tomaniak
- Thoraxcentre, Erasmus Medical Centre, Rotterdam, Netherlands.,First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Joanna J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Jan J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Brian K Courtney
- Schulich Heart Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada.,Conavi Medical, North York, ON, Canada
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | | | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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24
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Nguyen P, Seto A. Contemporary practices using intravascular imaging guidance with IVUS or OCT to optimize percutaneous coronary intervention. Expert Rev Cardiovasc Ther 2020; 18:103-115. [PMID: 32077345 DOI: 10.1080/14779072.2020.1732207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Angiography is routinely used to perform percutaneous coronary intervention (PCI). However, angiography has many limitations that prevent accurate assessment of coronary lesions. The development and evolution of intravascular imaging have offset the limitations of angiography. Overwhelming evidence supports intravascular imaging guidance to optimize PCI results and studies have shown that it is associated with better outcomes. Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) are the most commonly used modalities and both have far greater spatial resolution compared with angiography. There are advantages and disadvantages to both IVUS and OCT, and the optimal modality will depend on patient factors and indications.Areas covered: This review will summarize clinical evidence and current practices in the use of intravascular imaging in PCI. Literature review from year 2000-2019 was completed via PubMed search using keywords.Expert commentary: Intravascular imaging is an essential tool in PCI that has outcome implications, but it is still underutilized. Proper image acquisition, accurate interpretation, and correct decision-making are needed for patients to benefit from imaging-guided PCI. Training and education are essential in successful utilization of imaging technology. High-definition IVUS is likely to gain favor as there is improved image resolution without the use of contrast.
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Affiliation(s)
- Peter Nguyen
- Cardiology, University of California, Irvine, CA, USA.,Cardiology, VA Long Beach Health Care System, Long Beach, CA, USA
| | - Arnold Seto
- Cardiology, University of California, Irvine, CA, USA.,Cardiology, VA Long Beach Health Care System, Long Beach, CA, USA
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25
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Alasnag M, Yaqoub L, Saati A, Al-Shaibi K. Left Main Coronary Artery Interventions. Interv Cardiol 2019; 14:124-130. [PMID: 31871488 PMCID: PMC6926361 DOI: 10.15420/icr.2019.10.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/03/2019] [Indexed: 11/08/2022] Open
Abstract
The management of left main coronary artery (LMCA) disease has evolved over the past two decades. Historically, coronary artery bypass grafting (CABG) surgery has been the gold standard for the treatment of LMCA disease. However, with the advancements in percutaneous coronary interventions (PCIs) and stent technology, PCI in select patients has achieved comparable outcomes to CABG. As such, this has led to changes in the American College of Cardiology and European Society of Cardiology guidelines, which recommend that PCI might be an alternative to CABG in select patients. In this review article, we describe the historical perspective and early experience with coronary interventions of LMCA disease, landmark clinical trials and their effect on guidelines, and the role of intravascular imaging in the management of LMCA lesions.
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26
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Kang DY, Ahn JM, Kim YW, Moon JY, Lee JS, Koo BK, Lee PH, Park DW, Kang SJ, Lee SW, Kim YH, Park SW, Park SJ. Impact of Coronary Lesion Geometry on Fractional Flow Reserve: Data From Interventional Cardiology Research In-Cooperation Society-Fractional Flow Reserve and Intravascular Ultrasound Registry. Circ Cardiovasc Imaging 2019; 11:e007087. [PMID: 29895713 DOI: 10.1161/circimaging.117.007087] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 04/25/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of various coronary lesion geometries on fractional flow reserve (FFR) is poorly understood. METHODS AND RESULTS A total of 1552 coronary lesions in 1236 patients from a prospective Interventional Cardiology Research In-cooperation Society Fractional Flow Reserve and Intravascular Ultrasound registry were assessed using quantitative coronary angiography, intravascular ultrasound, and FFR. Computational fluid dynamics simulation was performed for theoretical validation. Patients with complex geometries, such as longitudinal eccentricity, cross-sectional eccentricity, and surface roughness, showed significantly lower FFR values. In multivariable analysis, distal longitudinal eccentricity (adjusted odds ratio, 1.55; 95% confidence interval, 1.04-2.87; P=0.031), cross-sectional eccentricity (adjusted odds ratio, 1.65; 95% confidence interval, 1.27-2.14; P<0.001), and surface roughness (adjusted odds ratio, 1.55; 95% confidence interval, 1.04-2.32; P=0.033), as well as male sex, left anterior descending artery territory, proximal location, high degree of diameter stenosis, long lesion, and high plaque burden, were identified as independent predictors for significantly low FFR values (≤0.80). Computational simulation supported the impact of lesion geometry on FFR. CONCLUSIONS The complex coronary lesion geometries were independently associated with reduced FFR values. The visual-functional mismatch between coronary angiography and FFR could be partly attributable to local geometric factors. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01366404.
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Affiliation(s)
- Do-Yoon Kang
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
| | - Jung-Min Ahn
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
| | - Young Woo Kim
- School of Mechanical Engineering, Yonsei University, Seoul, South Korea (Y.W.K., J.S.L.)
| | - Ji Young Moon
- School of Aerospace, Mechanical, and Mechatronic Engineering, The University of Sydney, Australia (J.Y.M.)
| | - Joon Sang Lee
- School of Mechanical Engineering, Yonsei University, Seoul, South Korea (Y.W.K., J.S.L.)
| | - Bon-Kwon Koo
- Department of Internal Medicine and the Cardiovascular Center, Seoul National University Hospital, South Korea (B.-K.K.)
| | - Pil Hyung Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
| | - Duk-Woo Park
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
| | - Soo-Jin Kang
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
| | - Seung-Whan Lee
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
| | - Young-Hak Kim
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
| | - Seong-Wook Park
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
| | - Seung-Jung Park
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.)
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27
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Pradhan A, Saran M, Vishwakarma P, Sethi R. Optical Coherence Tomography in In-Stent Restenosis: A Challenge Made Easier. Heart Views 2019; 20:28-31. [PMID: 31143385 PMCID: PMC6524424 DOI: 10.4103/heartviews.heartviews_6_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In-stent restenosis (ISR) has been an area of concern for the interventional cardiologists since the era of bare-metal stents (BMS). Although the incidence of ISR is more with BMS as compared to drug-eluting stents, due to the underlying pathophysiological differences, between the two; the latter has a more accelerated course and is difficult to treat. In this case report, we try to address this issue of difficult treatment of ISR and the benefit of using optical coherence tomography in these situations.
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Affiliation(s)
- Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Mahim Saran
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh, India
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28
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Cerrato E, Echavarria-Pinto M, D'Ascenzo F, Gonzalo N, Quadri G, Quirós A, de la Torre Hernández JM, Tomassini F, Barbero U, Nombela-Franco L, Nuñez-Gil I, Biondi-Zoccai G, Macaya C, Varbella F, Escaned J. Safety of intermediate left main stenosis revascularization deferral based on fractional flow reserve and intravascular ultrasound: A systematic review and meta-regression including 908 deferred left main stenosis from 12 studies. Int J Cardiol 2018; 271:42-48. [PMID: 30223378 DOI: 10.1016/j.ijcard.2018.04.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/18/2018] [Accepted: 04/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Current guidelines recommend intravascular ultrasound (IVUS) or fractional flow reserve (FFR) to decide upon ambiguous left main (LM) disease. However, no study has compared the safety of LM revascularization deferral based on FFR or IVUS. METHODS MEDLINE/PubMed was systematically screened for studies reporting on deferred treatment of angiographically ambiguous LM based upon FFR or IVUS evaluation. Baseline, angiographic and outcome data were appraised and pooled separately for each strategy according to random-effect models with inverse-variance weighting. RESULTS A total of 908 LM stenoses from 7 FFR and 5 IVUS studies were included with median follow-up of 29.0 and 31.5 months respectively. Per year of follow-up occurrence of overall MACE were 5.1% in FFR group and 6.4% in IVUS group while death, myocardial infarction, LM revascularization were respectively 2.6%, 1.5% and 1.8% vs. 3.0%, 0.5% and 2.2%. Meta-regression analysis suggested the influence of a distal LM stenosis on MACE in FFR group (β = 0.06, p = 0.01) and age in IVUS group (β = 0.4, p = 0.001). In individual studies several independent predictors of MACE were identified including use of lower doses of intracoronary adenosine (OR 1.39, p = 0.04) in FFR group and plaque burden (OR 1.34, p = 0.025), number of other diseased vessels (OR 1.39, p = 0.04) and any untreated stenosis (OR 3.80; p = 0.037) in IVUS- studies. CONCLUSIONS Deferring LM intermediate stenosis on the basis of FFR or IVUS showed an acceptable and similar risk of events in a mid-term follow-up. Conversely, several different variables related to each technique showed an interaction on outcome.
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy. http://www.cardiogroup.org
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Nieves Gonzalo
- Interventional Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Giorgio Quadri
- Interventional Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Alicia Quirós
- Statistical Department, Univeristy of Leon, Leon, Spain
| | | | - Francesco Tomassini
- Interventional Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Umberto Barbero
- Division of Cardiology, Santissima Annunziata Hospital, Savigliano, Italy; Cardiovascular Research Unit, Royal Brompton Hospital, London, UK
| | | | - Ivan Nuñez-Gil
- Interventional Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
| | - Carlos Macaya
- Interventional Cardiology, Hospital Clinico San Carlos, Madrid, Spain
| | - Ferdinando Varbella
- Interventional Cardiology, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Javier Escaned
- Interventional Cardiology, Hospital Clinico San Carlos, Madrid, Spain
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29
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Testa L, Latib A, Bollati M, Bedogni F. Patient selection and percutaneous technique of unprotected left main revascularization. Catheter Cardiovasc Interv 2018. [PMID: 29521440 DOI: 10.1002/ccd.27528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Increasing evidence suggests that percutaneous coronary intervention with newer generation drug-eluting stents may be an acceptable alternative, or even preferred in selected cases to the surgical approach, in patients with left main disease. This review will discuss the anatomic factors, the clinical variables, and the procedural strategies to consider, including physiology assessment and imaging guidance, in order to optimize outcomes.
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Affiliation(s)
- L Testa
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - A Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, EMO GVM Centro Cuore Columbus, Milan, Italy
| | - M Bollati
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - F Bedogni
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
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30
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Zandvoort LJC, Tovar Forero MN, Masdjedi K, Lemmert ME, Diletti R, Wilschut J, Jaegere P, Zijlstra F, Van Mieghem NM, Daemen J. References for left main stem dimensions: A cross sectional intravascular ultrasound analysis. Catheter Cardiovasc Interv 2018; 93:233-238. [DOI: 10.1002/ccd.27826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 06/22/2018] [Accepted: 07/15/2018] [Indexed: 11/09/2022]
Affiliation(s)
| | - Maria N. Tovar Forero
- Department of cardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Kaneshka Masdjedi
- Department of cardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Miguel E. Lemmert
- Department of cardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Roberto Diletti
- Department of cardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Jeroen Wilschut
- Department of cardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Peter Jaegere
- Department of cardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | - Felix Zijlstra
- Department of cardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
| | | | - Joost Daemen
- Department of cardiologyThoraxcenter, Erasmus Medical Center Rotterdam The Netherlands
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31
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Comparison of coronary angiography and intracoronary imaging with fractional flow reserve for coronary artery disease evaluation: An anatomical-functional mismatch. Anatol J Cardiol 2018; 20:182-189. [PMID: 30152800 PMCID: PMC6237939 DOI: 10.14744/anatoljcardiol.2018.42949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Myocardial ischemia is a leading cause of death worldwide, and it corresponds to the imbalance between blood supply and myocardial demand. Epicardial coronary artery disease (CAD) is detected on the basis of coronary angiogram, whereas invasive detection of myocardial ischemia induced by coronary stenosis is commonly based on fractional flow reserve (FFR). The use of FFR for revascularization decision-making demonstrated clinical benefit and cost-effectiveness compared with that of angiographic indices. Discrepancies between anatomical metrics and physiological assessment of CAD are frequent, which lead to change in revascularization decision from angiography compared to functional evaluation of CAD. Despite several clinical studies and guidelines recommending with high level of evidence demonstrating that FFR should be adopted in stable CAD, revascularization decision-making is still based on coronary angiogram in current practice. Because of the unique coronary anatomy, coronary stenosis characteristics, risk factors profile, and microcirculation quality, the unique evaluation based on epicardial coronary stenosis threshold failed to be a landmark of ischemia compared with FFR. Furthermore, coronary angiogram can detect only epicardial vessels, which represent only 10% of the entire coronary vasculature; therefore, microcirculation is not seen and is poorly assessed in clinical practice. Thus, the role of microcirculation is of importance in myocardial ischemia and might impact these discrepancies between angiography and FFR evaluation of CAD. In this review, we aimed to describe the poor correlation between anatomical evaluation compared with physiological evaluation to detect myocardial ischemia induced by coronary stenosis as well as the clinical implications of this visual-functional mismatch.
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32
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Hachinohe D, Mitomo S, Candilio L, Latib A. A Practical Approach to Assessing Stent Results with IVUS or OCT. Methodist Debakey Cardiovasc J 2018; 14:32-41. [PMID: 29623170 DOI: 10.14797/mdcj-14-1-32] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Coronary angiography is routinely used to assess the extent and severity of coronary artery disease and for decision-making during percutaneous coronary interventions (PCI). However, it is sometimes inadequate for deciding a strategy and defining optimal stenting outcomes. In this review, we present a comprehensive and practical approach to PCI using intravascular ultrasound or optical coherence tomography to optimize stent deployment and assess procedural complications after stent implantation.
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Affiliation(s)
- Daisuke Hachinohe
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
| | - Satoru Mitomo
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
| | - Luciano Candilio
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY.,cHAMMERSMITH HOSPITAL, IMPERIAL COLLEGE LONDON, UNITED KINGDOM
| | - Azeem Latib
- aSAN RAFFAELE SCIENTIFIC INSTITUTE, MILAN, ITALY.,bEMO-GVM CENTRO CUORE COLUMBUS, MILAN, ITALY
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33
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Comparison between minimum lumen cross-sectional area and intraluminal ultrasonic intensity analysis using integrated backscatter intravascular ultrasound for prediction of functionally significant coronary artery stenosis. Heart Vessels 2018; 34:208-217. [DOI: 10.1007/s00380-018-1233-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 07/27/2018] [Indexed: 01/10/2023]
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34
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Mintz GS, Lefèvre T, Lassen JF, Testa L, Pan M, Singh J, Stankovic G, Banning AP. Intravascular ultrasound in the evaluation and treatment of left main coronary artery disease: a consensus statement from the European Bifurcation Club. EUROINTERVENTION 2018; 14:e467-e474. [PMID: 29688182 DOI: 10.4244/eij-d-18-00194] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Interventional cardiology and coronary stent insertion have an increasing role in the optimal management of left main coronary artery (LMCA) stenosis. Assessing the extent of obstructive disease of the LMCA by angiography alone can be challenging. However, in contrast to the two-dimensional, shadow graphic nature of coronary angiography, intravascular ultrasound (IVUS) is an accurate tomographic technique for assessing both the coronary lumen and the vessel wall characteristics. Consequently, it is a particularly useful technique in imaging the LMCA before, during and after intervention. The European Bifurcation Club (EBC) recommends the use of IVUS during most LMCA interventions. The purpose of this consensus document is to review the available IVUS data on LMCA disease evaluation and treatment. It is a practical guide to show "how and when" to use the imaging modality. It is hoped that a standardisation of the practical approach to imaging may allow consolidation of learning and, ultimately, improve patient outcomes.
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Affiliation(s)
- Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
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Lotfi A, Davies JE, Fearon WF, Grines CL, Kern MJ, Klein LW. Focused update of expert consensus statement: Use of invasive assessments of coronary physiology and structure: A position statement of the society of cardiac angiography and interventions. Catheter Cardiovasc Interv 2018; 92:336-347. [DOI: 10.1002/ccd.27672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Amir Lotfi
- Baystate Medical Center; Tufts University School of Medicine; Springfield Massachusetts
| | | | | | - Cindy L. Grines
- Northwell Health, North Shore University Hospital; Manhasset New York
| | - Morton J. Kern
- Long Beach Veterans Administration Hospital; University of California, Irvine; Irvine California
| | - Lloyd W. Klein
- Advocate Illinois Masonic Medical Center, Rush Medical College; Chicago Illinois
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Relationship between left main coronary artery plaque burden and nonleft main coronary atherosclerosis: results from the PROSPECT study. Coron Artery Dis 2018; 29:397-402. [PMID: 29781836 DOI: 10.1097/mca.0000000000000640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Whether the severity of left main coronary artery (LMCA) disease reflects LMCA and overall coronary atherosclerotic burden is not known. We aimed to assess nonculprit LMCA disease characteristics and the relationship with atherosclerosis in the rest of the coronary arteries as well as patient outcomes. PATIENTS AND METHODS In the PROSPECT study, 697 patients with acute coronary syndromes underwent three-vessel gray-scale and radiofrequency intravascular ultrasound after percutaneous coronary intervention. RESULTS Overall, 552 patients with adequate LMCA imaging were compared according to LMCA plaque burden. The tertile with the highest plaque burden in the LMCA had the smallest LMCA minimum lumen area (17.4, 14.2, 10.5, lowest through highest tertiles, respectively, P<0.0001) and the greatest percent necrotic core volume (2.8, 5.6, 9.5%, lowest through highest tertiles, respectively, P<0.0001). Furthermore, the tertile with the highest plaque burden was also significantly associated with the highest overall non-LMCA percent atheroma volume within the major epicardial arteries (48.3, 49.2, 50.8%, lowest through highest tertiles, respectively, P<0.0001). After adjusting for patient background, the LMCA plaque burden was independently associated with non-LMCA percent atheroma volume (P=0.003). Of the three PROSPECT predictors of future nonculprit major adverse cardiac events (MACE) (minimum lumen area≤4 mm, plaque burden≥70%, and virtual histology thin-cap fibroatheroma), the tertile with the highest LMCA plaque burden had the highest number of patients with at least one of three PROSPECT predictors (P=0.03). In multivariable model, though total atheroma volume (per 1%) was an independent predictor of all MACE [hazard ratio (95% confidence interval)=1.06 (1.01-1.11), P=0.02] and strong trend for non-culprit-related MACE [hazard ratio (95% confidence interval)=1.06 (1.00-1.13), P=0.06], plaque burden at LMCA was not (all MACE, P=0.90, non-culprit-related MACE, P=0.85). CONCLUSION The severity of atherosclerosis in LMCA predicted the overall atherosclerotic plaque burden as well as the presence of high-risk plaques in the three major epicardial coronary arteries.
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Song HG, Kang SJ, Mintz GS. Value of intravascular ultrasound in guiding coronary interventions. Echocardiography 2018; 35:520-533. [DOI: 10.1111/echo.13837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Hae Geun Song
- Department of Cardiology; DeltaHealth Hospital; Shanghai China
| | - Soo-Jin Kang
- Department of Cardiology; Asan Medical Center; University of Ulsan College of Medicine; Seoul South Korea
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De Maria GL, Banning AP. Use of Intravascular Ultrasound Imaging in Percutaneous Coronary Intervention to Treat Left Main Coronary Artery Disease. Interv Cardiol 2018; 12:8-12. [PMID: 29588723 DOI: 10.15420/icr.2017:1:3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Due to its potential prognostic implications and technical complexity, revascularisation of left main coronary artery (LMCA) disease requires careful consideration. Since publication of the results of the SYNTAX study, and more recently the EXCEL and NOBLE trials, there has been particular interest in percutaneous revascularisation of the LMCA. It is becoming clear that percutaneous revascularisation of LMCA disease requires appropriate lesion preparation and carefully optimised stenting in order to offer patients a treatment option as effective as coronary artery bypass grafting. For this reason intravascular imaging, and especially intravascular ultrasound, is becoming a key procedural step in LMCA percutaneous coronary intervention. In the current review paper we analyse the role of intravascular imaging with intravascular ultrasound in LMCA percutaneous coronary intervention, focusing on the main applications in this context from lesion assessment to stent sizing and optimisation.
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Affiliation(s)
| | - Adrian P Banning
- Heart Centre, Oxford University Hospitals NHS Trust Foundation, Oxford, UK
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Parviz Y, Shlofmitz E, Fall KN, Konigstein M, Maehara A, Jeremias A, Shlofmitz RA, Mintz GS, Ali ZA. Utility of intracoronary imaging in the cardiac catheterization laboratory: comprehensive evaluation with intravascular ultrasound and optical coherence tomography. Br Med Bull 2018; 125:79-90. [PMID: 29360941 DOI: 10.1093/bmb/ldx049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/15/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND Intracoronary imaging is an important tool for guiding decision making in the cardiac catheterization laboratory. SOURCES OF DATA We have reviewed the latest available evidence in the field to highlight the various potential benefits of intravascular imaging. AREAS OF AGREEMENT Coronary angiography has been considered the gold standard test to appropriately diagnose and manage patients with coronary artery disease, but it has the inherent limitation of being a 2-dimensional x-ray lumenogram of a complex 3-dimensional vascular structure. AREAS OF CONTROVERSY There is well-established inter- and intra-observer variability in reporting coronary angiograms leading to potential variability in various management strategies. Intracoronary imaging improves the diagnostic accuracy while optimizing the results of an intervention. Utilization of intracoronary imaging modalities in routine practice however remains low worldwide. Increased costs, resources, time and expertise have been cited as explanations for low incorporation of these techniques. GROWING POINTS Intracoronary imaging supplements and enhances an operator's decision-making ability based on detailed and objective lesion assessment rather than a subjective visual estimation. The benefits of intravascular imaging are becoming more profound as the complexity of cases suitable for revascularization increases. AREAS TIMELY FOR DEVELOPING RESEARCH While the clinical benefits of intravascular ultrasound have been well validated, optical coherence tomography in comparison is a newer technology, with robust clinical trials assessing its clinical benefit are underway.
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Affiliation(s)
- Yasir Parviz
- Division of Cardiology, Columbia UniversityMedical Center, New York, NY, USA
| | - Evan Shlofmitz
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Khady N Fall
- Division of Cardiology, Columbia UniversityMedical Center, New York, NY, USA
| | | | - Akiko Maehara
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Allen Jeremias
- Cardiovascular Research Foundation, New York, NY, USA.,St. Francis Hospital, Roslyn, NY, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ziad A Ali
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA.,Cardiovascular Research Foundation, New York, NY, USA
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40
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Kodaira M, Tabei R, Kuno T, Numasawa Y. Catastrophic catheter-induced coronary artery vasospasm successfully rescued using intravascular ultrasound imaging guidance. BMJ Case Rep 2017; 2017:bcr-2017-222607. [PMID: 29222206 DOI: 10.1136/bcr-2017-222607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 46-year-old man underwent coronary angiography for stable angina. He developed inferior ST-segment myocardial infarction during the angiography. Intravascular ultrasound (IVUS) findings suggested coronary vasospasm. Intracoronary administration of isosorbide dinitrate restored the coronary flow. This case illustrates the essential role IVUS imaging played in establishing the diagnosis of catheter-induced coronary vasospasm.
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Affiliation(s)
- Masaki Kodaira
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Ryota Tabei
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Toshiki Kuno
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
| | - Yohei Numasawa
- Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan
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41
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Dato I, Burzotta F, Trani C, Romano A, Paraggio L, Aurigemma C, Porto I, Leone AM, Niccoli G, Crea F. Optical coherence tomography guidance for the management of angiographically intermediate left main bifurcation lesions: Early clinical experience. Int J Cardiol 2017; 248:108-113. [DOI: 10.1016/j.ijcard.2017.06.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/25/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
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Ihdayhid AR, Yong A, Harper R, Rankin J, Wong C, Brown AJ, Leung M, Ko B. A Practical Guide for Fractional Flow Reserve Guided Revascularisation. Heart Lung Circ 2017; 27:406-419. [PMID: 29191506 DOI: 10.1016/j.hlc.2017.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/04/2017] [Accepted: 09/13/2017] [Indexed: 11/15/2022]
Abstract
The presence and extent of myocardial ischaemia is a major determinant of prognosis and benefit from revascularisation in patients with stable coronary artery disease. Fractional Flow Reserve (FFR) is accepted as the reference standard for invasive assessment of ischaemia. Its ability to detect lesion specific ischaemia makes it a useful test in a wide range of patient and lesion subsets, with FFR guided intervention improving clinical outcomes and reducing health care costs compared to assessment with coronary angiography alone. This article will review the basic principles in FFR, practical tips in FFR guided revascularisation and the role of emerging non-hyperaemic indices of ischaemia.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Andy Yong
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia
| | - Richard Harper
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | | | - Christopher Wong
- Department of Cardiology, Concord Hospital, Sydney, NSW, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Michael Leung
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Melbourne, Vic, Australia.
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Picard F, Pighi M, Ly HQ. Fractional flow reserve and resting indices for coronary physiologic assessment: Practical guide, tips, and tricks. Catheter Cardiovasc Interv 2017; 90:598-611. [PMID: 28160376 DOI: 10.1002/ccd.26933] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 11/19/2016] [Accepted: 12/22/2016] [Indexed: 01/10/2023]
Abstract
Physiologic assessment using fractional flow reserve (FFR) to guide percutaneous coronary interventions (PCI) has been demonstrated to improve clinical outcomes, compared to angiography-guided PCI. Recently, resting indices such as resting Pd/Pa, "instantaneous wave-free ratio", and contrast medium induced FFR have been evaluated for the assessment of the functional consequences of coronary lesions. Herein, we review and discuss the use of FFR and other indices for the functional assessment of coronary lesions. This review will cover theoretical aspects, as well as practical points and common pitfalls related to coronary physiological assessment. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Fabien Picard
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
| | - Michele Pighi
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
| | - Hung Q Ly
- Interventional Cardiology Division, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Qubec, Canada
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Song HG, Kang SJ. Current Clinical Applications of Intravascular Ultrasound in Coronary Artery Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2017. [DOI: 10.1007/s12410-017-9424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Assessing the left main stem in the cardiac catheterization laboratory. What is "significant"? Function, imaging or both? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:51-56. [PMID: 28666791 DOI: 10.1016/j.carrev.2017.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 05/31/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
Revascularization of significant Left Main Stem (LMS) disease improves clinical outcomes. This can be achieved through either Coronary Artery Bypass Grafting or Percutaneous coronary intervention. Defining a significant stenosis of the LMS can be challenging and debatable, as most data have been derived using angiographic assessment alone, with a threshold of 50% luminal stenosis used as a marker of functional significance. The use of adjunctive technologies like Intravascular Ultrasound and Fractional Flow Reserve has improved our ability to accurately assess the anatomical severity and physiological significance of coronary artery stenoses, much more so, than can be achieved through conventional angiography alone. An improved assessment of LMS disease through these adjunctive techniques offers procedural and clinical benefits. Rather than focus on the preferred methods of revascularisation, this article aims to highlight the common pitfalls and misconceptions in the assessment of LMS stenoses. We also propose a simple algorithm for the assessment of LMS disease to help guide revascularisation decisions.
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Chu M, Dai N, Yang J, Westra J, Tu S. A systematic review of imaging anatomy in predicting functional significance of coronary stenoses determined by fractional flow reserve. Int J Cardiovasc Imaging 2017; 33:975-990. [PMID: 28265791 DOI: 10.1007/s10554-017-1085-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/28/2017] [Indexed: 01/06/2023]
Abstract
Fractional flow reserve (FFR) is the current gold standard to assess the physiological significance of coronary stenoses. With the development of coronary imaging techniques, several anatomic parameters have been investigated in vivo and their associations with FFR have been studied. The aim of this review is to summarize the accuracy of anatomic parameters derived by the present coronary imaging techniques including invasive coronary angiography, coronary computed tomography angiography, intravascular ultrasound and optical coherence tomography, in predicting a significant FFR. The impact of patient characteristics, lesion locations, variability of FFR and imaging resolution on the predictive ability are discussed.
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Affiliation(s)
- Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China
| | - Neng Dai
- Cardiovascular Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junqing Yang
- The 3rd Division of Cardiology, Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, No.106, 2nd Zhongshan Road, Yuexiu district, Guangzhou, Guangdong, 510080, China.
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China.
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Habibi SE, Shah R, Berzingi CO, Melchior R, Sumption KF, Jovin IS. Left main coronary artery stenosis: severity evaluation and implications for management. Expert Rev Cardiovasc Ther 2017; 15:157-163. [PMID: 28256180 DOI: 10.1080/14779072.2017.1294065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The significant stenosis of the left main coronary artery is associated with poor outcomes and is considered a strong indication for revascularization. However, deciding whether the stenosis is significant can sometimes be challenging, especially when the degree of stenosis is intermediate, and can necessitate additional tests and imaging modalities. Areas covered: We did a literature search using keywords like 'left main', 'imaging', 'intravascular ultrasound', 'fractional flow reserve', 'computed tomographic angiography' and 'magnetic resonance imaging'. The most commonly used methods for better characterizing intermediate left main coronary stenoses are intravascular ultrasound and fractional flow reserve, while optical coherence tomography is the newer technique that provides better images, but for which not as much data is available. The noninvasive techniques are coronary computed tomographic angiography and, to a lesser degree, coronary magnetic resonance imaging. Expert commentary: Accurately determining the severity of left main coronary stenosis can mean the difference between a major intervention and conservative therapy. The reviewed newer imaging modalities give us greater confidence that patients with left main stenosis are assigned to the right treatment modality.
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Affiliation(s)
- Susan E Habibi
- a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA
| | - Rahman Shah
- a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA
| | - Chalak O Berzingi
- a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA
| | - Ryan Melchior
- a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA
| | - Kevin F Sumption
- a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA
| | - Ion S Jovin
- a Virginia Commonwealth University/McGuire VAMC , Richmond , VA , USA
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Abudayyeh I, Tran BG, Tobis JM. Optimizing Coronary Angioplasty with FFR and Intravascular Imaging. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gnanadesigan M, Kameyama T, Karanasos A, van Ditzhuijzen N, van der Sijde J, van Geuns RJ, Ligthart J, Witberg K, Ughi G, van der Steen A, Regar E, van Soest G. Automated characterisation of lipid core plaques in vivo by quantitative optical coherence tomography tissue type imaging. EUROINTERVENTION 2016; 12:1490-1497. [DOI: 10.4244/eij-d-15-00320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Jang JS, Shin HC, Bae JS, Jin HY, Seo JS, Yang TH, Kim DK, Cho KI, Kim BH, Park YH, Je HG, Kim DS. Diagnostic Performance of Intravascular Ultrasound-Derived Minimal Lumen Area to Predict Functionally Significant Non-Left Main Coronary Artery Disease: a Meta-Analysis. Korean Circ J 2016; 46:622-631. [PMID: 27721852 PMCID: PMC5054173 DOI: 10.4070/kcj.2016.46.5.622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/04/2015] [Accepted: 12/08/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention frequently results in unnecessary stenting due to the low positive predictive value of IVUS-derived minimal lumen area (MLA) for identification of functionally significant coronary stenosis. We appraised the diagnostic accuracy of IVUS-derived MLA compared with the fractional flow reserve (FFR) to assess intermediate coronary stenosis. SUBJECTS AND METHODS We searched MEDLINE and Cochrane databases for studies using IVUS and FFR methods to establish the best MLA cut-off values to predict significant non-left main coronary artery stenosis. Summary estimates were obtained using a random-effects model. RESULTS The 17 studies used in our analysis enrolled 3920 patients with 4267 lesions. The weighted overall mean MLA cut-off value was 2.58 mm2. The pooled MLA sensitivity that predicted functionally significant coronary stenosis was 0.75 (confidence interval [CI]: 0.72 to 0.77) and the specificity was 0.66 (CI: 0.64 to 0.68). The positive likelihood ratio (LR) was 2.33 (CI: 2.06 to 2.63) and LR (-) was 0.33 (CI: 0.26 to 0.42). The pooled diagnostic odds ratio (DOR) was 7.53 (CI: 5.26 to 10.76) and the area under the summary receiver operating characteristic curve for all the trials was 0.782 with a Q point of 0.720. Meta-regression analysis demonstrated that an FFR cut-off point of 0.75 was associated with a four times higher diagnostic accuracy compared to that of 0.80 (relative DOR: 3.92; 95% CI: 1.25 to 12.34). CONCLUSION IVUS-derived MLA has limited diagnostic accuracy and needs careful interpretation to correlate with functionally significant non-left main coronary artery stenosis.
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Affiliation(s)
- Jae-Sik Jang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Ho-Cheol Shin
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Han-Young Jin
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Dae-Kyeong Kim
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
| | - Kyoung-Im Cho
- Division of Cardiology, Kosin University Medical Center, Busan, Korea
| | - Bo-Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Yong Hyun Park
- Division of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung-Gon Je
- Department of Cardiovascular Surgery, Busan National University Yangsan Hospital, Yangsan, Korea
| | - Dong-Soo Kim
- Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, Korea
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