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Flow Reserve (flow + reserve)

Distribution by Scientific Domains

Medical Sciences	100%

Kinds of Flow Reserve

coronary flow reserve

fractional flow reserve

Selected Abstracts

Relationship between Strain Rate Imaging and Coronary Flow Reserve in Assessing Myocardial Viability after Acute Myocardial Infarction

ECHOCARDIOGRAPHY, Issue 8 2010
Ph.D., Seong-Mi Park M.D.
Objectives: To evaluate the relationship between strain rate (SR) imaging and coronary flow reserve (CFR) in assessing viability of akinetic myocardium after acute myocardial infarction (MI). Methods: Forty patients with acute first ST-elevation MI were analyzed. SR imaging and CFR by intracoronary flow measurement were obtained on the same day, 3,5 days after primary percutaneous coronary intervention. Viability of the akinetic myocardium was determined on 6-week echocardiography. Results: Systolic SR (SRs, ,0.42 ± 0.10 vs. ,0.35 ± 0.11 per second, P = 0.03), early diastolic SR (SRe, 0.68 ± 0.31 vs. 0.41 ± 0.22 per second, P = 0.003), and systolic strain (Ss, ,5.9 ± 3.4 vs. ,2.5 ± 4.0%, P = 0.04) were greater in akinetic, but viable myocardium of 21 patients than in akinetic and nonviable myocardium of 19 patients. CFR was also higher in patients with akinetic, but viable myocardium (2.0 ± 0.5 vs. 1.5 ± 0.5, P < 0.001). SRs, SRe, and Ss were significantly related to CFR (r =,0.50, r = 0.58, r =,0.56, respectively, all P , 0.001) and SRe was most related to CFR (P < 0.001). The sensitivity and specificity to predict myocardial viability were 85.7% and 68.4% for CFR (cutoff = 1.75), and 90.5% and 57.9% for SRe (cutoff = 0.37 per second), respectively. Conclusions: The degree of myocardial deformation determined by SR imaging was related to the degree of microvascular integrity determined by CFR, and can be used as a noninvasive method to predict myocardial viability after acute MI. (Echocardiography 2010;27:977-984) [source]

Noninvasive Assessment of Coronary Flow Reserve in the Left Anterior Descending Artery by Transthoracic Echocardiography before and after Stenting

ECHOCARDIOGRAPHY, Issue 8 2007
Elie Chammas M.D., F.E.S.C.
Background: Noninvasive assessment of coronary flow reserve in the left anterior descending artery (LAD) by transthoracic Doppler echocardiography (TTDE) has been already validated as a new method for determining the degree of stenosis over the proximal flow. Objectives: The aim of the study is to determine, by TTDE, the feasibility and the value of the coronary flow reserve (CFR) (defined as the maximal increase in coronary blood flow above its basal pressure for a given perfusion pressure when coronary circulation is maximally dilated) in the mid-to-distal LAD before and after percutaneous angioplasty and to demonstrate the early recovery of microvascular tone immediately after stenting. Methods: The study population consisted of 36 patients with significant isolated LAD stenosis (70,90%) identified by coronary angiography. CFR was recorded in the mid-to-distal LAD at rest and during hyperemia obtained after adenosine intravenous infusion before and after stenting. Results: Adequate visualization of the LAD was obtained in 25 out of 36 patients (70%). At rest the mean CFR was 1.5132 ± 0.33 (1.1,2.58). However, after stenting the mean CFR was significantly higher: 2.18 ± 0.55 (1.3,3.8), with P <0.01. Conclusions: CFR can be easily determined by TTE in approximately 70% of patients. Noninvasive Doppler echocardiography shows impaired CFR in patients with LAD disease. After stenting CFR is restored, demonstrating early recovery of microvascular tone. These results are comparable to those published in the same conditions. Larger series with a long-term follow-up may allow identifying patients at high risk for restenosis after stenting. [source]

Left Internal Mammary Artery (LIMA) Flow Reserve in Ischemic Hypertrophied Hearts

JOURNAL OF CARDIAC SURGERY, Issue 1 2009
Tomas A. Salerno M.D.
We, herein, present clinical evidence suggesting that in ischemic hypertrophied hearts, single arterial inflow from the LIMA to multiple grafts based on the LIMA may not be sufficient and may not meet myocardial demands, at least during the early perioperative period. This observation was made in two patients in whom a vein graft, previously based on the LIMA, was also connected to the aorta. By providing additional inflow from the aorta, flows to the LAD significantly increased. [source]

The Prognostic Value of Combined Fractional Flow Reserve and TIMI Frame Count Measurements in Patients with Stable Angina Pectoris and Acute Coronary Syndrome

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2010
ALI M. ESEN M.D.
Background:,The aim of this study was to evaluate the prognostic value of different fractional flow reserve (FFR) cutoff values and corrected thrombolysis in myocardial infarction frame (TIMI) count (CTFC) measurements in a series of consecutive patients with moderate coronary lesions, including patients with unstable angina, myocardial infarction, and/or positive noninvasive functional test findings. Methods:,We included 162 consecutive coronary patients in whom revascularization of a moderate coronary lesion was deferred based on a FFR value ,0.75. Patients were divided according to the results of the intracoronary pressure and flow measurements into four groups: group A: 0.75 , FFR , 0.85 and CTFC > 28 (n=22), group B: 0.75 , FFR , 0.85 and CTFC , 28 (n = 55), group C: 0.85 < FFR and CTFC > 28 (n = 19), and group D: 0.85 < FFR and CTFC , 28 (n = 66). Adverse cardiac events and the presence of angina were evaluated at follow-up. Results:,At a mean follow-up of 18 ± 10 months, cardiac event rate in patients with 0.75 , FFR , 0.85 and FFR > 0.85 were 22% and 9%, respectively (P = 0.026) and also, a trend was observed toward a higher cardiac event rate in case of an abnormal CTFC (CTFC > 28) compared to a normal CTFC (24% vs 12%, P = 0.066). Furthermore, a significantly higher cardiac event rate was observed when group A was compared to group D (31.8% vs 7.6%, respectively, P = 0.004). Conclusion:,Patients with potential microvascular dysfunction and borderline FFR values should be interpreted with caution, and management strategies should be guided not only by pressure measurement, but also by possibly supplementary clinical risk stratification and noninvasive tests. (J Interven Cardiol 2010;23:421,428) [source]

Physiologic Evaluation of Bifurcation Lesions Using Fractional Flow Reserve

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2009
BON-KWON KOO M.D., Ph.D.
Functional evaluation of bifurcation lesions is more difficult than usual lesions due to their complex anatomy. Angiographic and intravascular ultrasound criteria for main branch intervention cannot be directly applied to side branch lesions due to the difference in underlying lesion characteristics, geometric changes during intervention, and the size of myocardial territory. Fractional flow reserve is a physiologic parameter which reflects both the degree of stenosis and the area of perfusion supplied by a specific coronary artery. The present review will focus on using fractional flow reserve in bifurcation lesions. [source]

Measurement of Fractional Flow Reserve to Assess Moderately Severe Coronary Lesions: Correlation with Dobutamine Stress Echocardiography

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2001
MANUEL JIMÉNEZ-NAVARRO PH.D.
Background: New techniques to evaluate coronary artery disease, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to determine the correlation between FFR and dobutamine stress echocardiography in patients with moderately severe coronary stenosis in order to judge the usefulness of FFR for commonly encountered clinical problems. Methods and Results: We studied 21 patients with 23 moderately severe coronary artery stenoses on angiography. The FFR was calculated and dobutamine stress echocardiography was performed to detect ischemia. Of the 16 stenoses with a negative FFR (, 0.75), dobutamine echocardiography also was negative. In the seven stenoses with a positive FFR (< 0.75), dobutamine echocardiography was positive in three. The efficacy of FFR in detecting ischemia that was confirmed with stress echocardiography was sensitivity 100%, specificity 80%, positive and negative predictive value 42.8%, and 100%. respectively, with a global predictive value 82.6%. A moderate degree of correlation was found between the two diagnostic tests (kappa [k] = 0.51). Conclusions: FFR correlates moderately well with dobutamine stress echocardiography in the assessment of moderately severe lesions in patients for whom coronary arteriography is usually indicated. However, its high negative predictive value makes FFR a useful aid in reaching clinical decisions promptly in the hemodynamics laboratory. [source]

Coronary Flow Reserve by Transthoracic Echocardiography Predicts Epicardial Intimal Thickening in Cardiac Allograft Vasculopathy

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010
F. Tona
Cardiac allograft vasculopathy (CAV) is the leading cause of morbidity and mortality in heart transplantation (HT). We sought to investigate the role of coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in CAV diagnosis. CAV was defined as maximal intimal thickness (MIT) assessed by intravascular ultrasound (IVUS) ,0.5 mm. CFR was assessed in the left anterior descending coronary artery in 22 HT recipients at 6 ± 4 years post-HT. CAV was diagnosed in 10 patients (group A), 12 had normal coronaries (group B). The mean MIT was 0.7 ± 0.1 mm (range 0.03,1.8). MIT was higher in group A (1.16 ± 0.3 mm vs. 0.34 ± 0.07 mm, p < 0.0001). CFR was 3.1 ± 0.8 in all patients and lower in group A (2.5 ± 0.6 vs. 3.7 ± 0.3, p < 0.0001). CFR was inversely related with MIT (r =,0.774, p < 0.0001). A cut point of ,2.9, identified as optimal by receiver operating characteristics analysis was 100% specific and 80% sensitive (PPV = 100%, NPV = 89%, Accuracy = 91%). CFR assessment by CE-TTE is a novel noninvasive diagnostic tool in the detection of CAV defined as MIT ,0.5 mm. CFR by CE-TTE may reduce the need for routine IVUS in HT. [source]

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5p1 2006
F. Tona
Noninvasive tests have proven unsatisfactory in cardiac allograft vasculopathy (CAV) diagnosis. We assessed coronary flow reserve (CFR) by contrast-enhanced transthoracic echocardiography (CE-TTE) in heart transplantation (HT). CFR was assessed in the left anterior descending coronary artery in 73 HT recipients (59 male, aged 50 ± 12 years at HT), at 8 ± 4.5 years post-HT. CFR measurements were taken blindly from coronary angiographies. CFR cut points were the standard value of ,2 and those defined by receiver operating characteristics (ROC) curve analysis. CFR was lower in patients with CAV (2.3 ± 0.7 vs. 3.2 ± 0.5, p < 0.0001). The ,2 cut point was 100% specific and 38% sensitive. The ,2.7 cut point, optimal by ROC analysis, was 87% specific and 82% sensitive. Accuracy rose from 71% with the standard ,2 cut point to 85% with the optimal cut point of ,2.7. CFR by CE-TTE may offer promise as a novel, easily repeatable and accurate noninvasive tool in CAV detection. However, further longitudinal studies in larger patient cohorts are warranted before widespread adoption can be advocated. [source]

Coronary pressure never lies

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2008
Jacques J. Koolen MD
Abstract Fractional Flow Reserve (FFR), calculated by coronary pressure measurement, is the invasive gold standard to assess the hemodynamic significance of a coronary stenosis. FFR reliably indicates whether a stenosis is responsible for inducible ischemia and if percutaneous coronary intervention is appropriate. False positive or negative FFR is rare. Occasionally, however, a clinical or angiographic condition is encountered in which in first instance the FFR measurement contradicts the intuitive feeling of the interventionalist. Further examination in such cases, however, often reveals a clear physiologic explanation and in this manner FFR "lifts the veil". Two such patients are presented in this case report and the reasons for apparent or actual false positive or negative FFR are discussed. © 2008 Wiley-Liss, Inc. [source]

Effect of Chronic Sustained-Release Dipyridamole on Myocardial Blood Flow and Left Ventricular Function in Patients With Ischemic Cardiomyopathy

CONGESTIVE HEART FAILURE, Issue 3 2007
Mateen Akhtar MD
Dipyridamole increases adenosine levels and augments coronary collateralization in patients with coronary ischemia. This pilot study tested whether a 6-month course of sustained-release dipyridamole/aspirin improves coronary flow reserve and left ventricular systolic function in patients with ischemic cardiomyopathy. Six outpatients with coronary artery disease and left ventricular ejection fraction (LVEF) <40% were treated with sustained-release dipyridamole 200 mg/aspirin 25 mg twice daily for 6 months. Myocardial function and perfusion, including coronary sinus flow at rest and during intravenous dipyridamole-induced hyperemia, were measured using velocity-encoded cine magnetic resonance stress perfusion studies at baseline, 3 months, and 6 months. There was no change in heart failure or angina class at 6 months. LVEF increased by 39%±64% (31.0%±13.3% at baseline vs 38.3%±10.7% at 6 months; P=.01), hyperemic coronary sinus flow increased more than 2-fold (219.6±121.3 mL/min vs 509.4±349.3 mL/min; P=.01), and stress-induced relative myocardial perfusion increased by 35%±13% (9.4%±3.4% vs 13.9%±8.5%; P=.004). Sustained-release dipyridamole improved hyperemic myocardial blood flow and left ventricular systolic function in patients with ischemic cardiomyopathy. [source]

Relationship between Strain Rate Imaging and Coronary Flow Reserve in Assessing Myocardial Viability after Acute Myocardial Infarction

Transthoracic Doppler Echocardiographic Coronary Flow Imaging in Identification of Left Anterior Descending Coronary Artery Stenosis in Patients with Left Bundle Branch Block

ECHOCARDIOGRAPHY, Issue 10 2008
Ozer Soylu M.D.
Background: Conventional noninvasive methods have well-known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Methods: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two-step (0.56,0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. Results: The hyperemic diastolic peak velocity (44 ± 9 cm/sec vs 62 ± 2 cm/sec; P=0.01) and diastolic CFR (1.38 ± 0.17 vs 1.93 ± 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of <1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. Conclusions: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB. [source]

Noninvasive Assessment of Coronary Flow Reserve in the Left Anterior Descending Artery by Transthoracic Echocardiography before and after Stenting

Functional significance of hepatic arterial flow reserve in patients with cirrhosis

HEPATOLOGY, Issue 2 2003
Alexander Zipprich
In cirrhosis, hepatic arterial vasodilatation occurs in response to reduced portal venous blood flow. However, although the hepatic arterial flow reserve is high in patients with cirrhosis, its impact on hepatic function is unknown. This study investigated the effect of adenosine-induced hepatic arterial vasodilatation on different markers of liver function. In 20 patients with cirrhosis (Child-Pugh class A/B/C: n = 2/7/11) adenosine (2-30 ,g · min,1 · kg body wt,1) was infused into the hepatic artery and hepatic arterial average peak flow velocities (APV), pulsatility indices (PI), and blood flow volumes (HABF) were measured using digital angiography and intravascular Doppler sonography. Indocyanine green (ICG), lidocaine, and galactose were administered intravenously in doses of 0.5, 1.0, and 500 mg/kg body weight in the presence of adenosine-induced hepatic arterial vasodilatation and, on a separate study day, without adenosine. ICG disappearance, galactose elimination capacity (GEC), and formation of the lidocaine metabolite monoethylglycinxylidide (MEGX) were assessed. Adenosine markedly increased APV and HABF and markedly decreased PI. Serum MEGX concentrations were 63.7 ± 18.2 (median, 62; range, 36-107) and 99.0 ± 46.3 (82.5; 49-198) ng/mL in the absence and presence of adenosine infusion, respectively (P = .001). Adenosine-induced changes in MEGX concentrations were correlated inversely to changes in APV (r = ,0.5, P = .02) and PI (r = ,0.55, P = .01) and were more marked in Child-Pugh class C compared with Child-Pugh class A patients (57.4 ± 49.9 [44; ,14 to 140] vs. 8.4 ± 16.5 [13; ,11 to 35] ng/mL, P < .01). In conclusion, hepatic arterial vasodilatation provides substantial functional benefit in patients with cirrhosis. The effect does not depend directly on hepatic arterial macroperfusion and is observed preferentially in patients with decompensated disease. [source]

The Prognostic Value of Combined Fractional Flow Reserve and TIMI Frame Count Measurements in Patients with Stable Angina Pectoris and Acute Coronary Syndrome

Editorial: At the Bifurcation of the Last Frontiers

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2010
THACH NGUYEN M.D.
The concept of coronary angioplasty percutaneous coronary intervention (PCI) was pioneered by Andreas Gruntzig. Since then, several modifications, innovative devices, techniques, and advances have revolutionized the practice of interventional cardiology. Coronary bifurcation and chronic total occlusion are the last two frontiers that continue to challenge the skills of the interventional cardiologists. Proceedings of the second Bifurcation Summit held from November 26 to 28, 2009 in Nanjing, China are published in this symposium. In a general review, the state of the art in management of bifurcation lesion is summarized in the statement of the "Bifurcation Club in KOKURA." A new-presented concept was the "extension distance" between the main vessel and the sidebranch ostia and its association with restenosis. The results of two studies on shear stress (SS) after PCI showed that contradictory lower SS after stenting was associated with lower in-stent restenosis. There was better fractional flow reserve after double kissing crush technique than provisional one-stent technique. There was also lower rate of stent thrombosis after bifurcation stenting with excellent final angiographic results. In a negative note, the SYNTAX score had no predictive values on trifurcated left main stenting. In summary, different aspects of percutaneous management for bifurcated lesion are described seen from different perspectives and evidenced by novel techniques and strategies. (J Interven Cardiol 2010;23:293,294) [source]

Physiologic Evaluation of Bifurcation Lesions Using Fractional Flow Reserve

Measurement of Fractional Flow Reserve to Assess Moderately Severe Coronary Lesions: Correlation with Dobutamine Stress Echocardiography

Impairment of Coronary Microvascular Function in Patients with Neurally Mediated Syncope

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2p1 2003
JAW-WEN CHEN
CHEN, J.-W., et al.: Impairment of Coronary Microvascular Function in Patients with Neurally Mediated Syncope.Recent evidence suggests that myocardial ischemia may occur in patients with neurally mediated syncope and normal coronary angiograms. This study was conducted to evaluate if coronary microvascular function is impaired in such patients. Coronary hemodynamic studies and head-up tilt table tests (HUTs) were performed on 30 consecutive patients with normal coronary angiograms and recurrent syncope. Another ten subjects with atypical chest pain and no evidence of myocardial ischemia or syncope served as a control. Great cardiac vein flow (GCVF) and coronary sinus flow (CSF) were measured by the thermodilution method at baseline and after dipyridamole infusion (0.56 mg/kg IV for 4 minutes). Coronary flow reserve (CFR), derived from CSF and GCVF, was significantly lower in the 15 patients with positive HUT than in the other 15 patients with negative HUT (1.75 ± 0.48vs2.64 ± 0.8, P < 0.01and2.29 ± 0.45vs3.07 ± 0.63, P < 0.01, respectively). Ischemic-like ECG was noted during treadmill exercise test in 40% of the former and in 7% of the latter group(P = 0.01). There was no significant difference in CFR between patients with negative HUT and control subjects. Coronary microvascular function was impaired in syncopal patients with positive HUT and relatively preserved in those with negative HUT, suggesting the possible linkage between coronary microvascular dysfunction and the development of neurally mediated syncope. (PACE 2003; 26[Pt. I]:605,612) [source]

Coronary Flow Reserve by Transthoracic Echocardiography Predicts Epicardial Intimal Thickening in Cardiac Allograft Vasculopathy

Coronary Flow Reserve by Contrast-Enhanced Echocardiography: A New Noninvasive Diagnostic Tool for Cardiac Allograft Vasculopathy

Altered coronary vasomotor function in young patients with systemic lupus erythematosus

ARTHRITIS & RHEUMATISM, Issue 6 2007
Kumiko Hirata
Objective Accelerated atherosclerosis is an important cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Altered coronary microvascular function may act as a marker of changes that predispose to the development of significant coronary vascular disease. The purpose of this study was to compare coronary flow reserve (CFR) in a group of premenopausal women with SLE and a group of age-, sex-, and race-matched healthy control subjects. Methods Coronary flow velocity in 18 premenopausal women with SLE (mean ± SD age 29.4 ± 5.9 years) and 19 matched healthy controls (mean ± SD age 28.2 ± 4.3 years) was assessed by transthoracic Doppler echocardiography after an overnight fast. The CFR was calculated as the ratio of hyperemic to baseline coronary blood flow velocity in the left anterior descending coronary artery. Hyperemia was induced by intravenous administration of adenosine triphosphate. Results The mean ± SD duration of SLE was 8.2 ± 7.2 years (range 0.25,25 years), and the mean ± SD score on the Systemic Lupus Erythematosus Disease Activity Index was 11.0 ± 5.3 (range 4.0,21.0). Adequate recordings of flow velocity in the left anterior descending artery under both conditions were obtained using an ultrasound procedure in all study subjects. CFR was significantly lower in SLE patients as compared with control subjects (mean ± SD 3.4 ± 0.8 versus 4.5 ± 0.5; P < 0.0001). Conclusion These findings provide evidence that coronary vasomotor function is impaired in patients with SLE and support the notion that many of these young patients have subclinical coronary artery disease. [source]

Fractional flow reserve: FFR B4 U stent,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2008
FSCAI, Massoud A. Leesar MD
No abstract is available for this article. [source]

The effect of drug eluting stents on cardiovascular events in patients with intermediate lesions and borderline fractional flow reserve,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2007
Shahar Lavi MD
Abstract Objective: To assess the role of fractional flow reserve (FFR) in guiding therapy in the drug eluting stent (DES) era. Background: FFR is a useful index for evaluation of the physiological significance of angiographically indeterminate coronary artery lesions. However, its role in the DES era is unknown. Methods: Long term outcome of 281 patients with angiographically indeterminate coronary lesions and borderline FFR (0.75 , FFR < 0.9) was obtained. The outcome of patients who had a DES placed (n = 58), was compared with that of consecutive patients with borderline FFR that were treated by PCI with bare metal stents (BMS, n = 58), or were deferred from revascularization (n = 165). Results: FFR was significantly higher in the deferred group (median and IQR); 0.85 (0.82 to 0.88) compared with the BMS (0.78; 0.76 to 0.82) and the DES (0.79; 0.77 to 0.82), P < 0.001. Pretreatment FFR was a significant determinant of long term event rates in the deferred patients (P = 0.002) but had no effect in patients treated by PCI. In the deferred group, there were fewer events (death, myocardial infarction, target vessel revascularization) compared with the BMS group; but no significant difference was observed between the DES and the deferred groups. Conclusions: In borderline FFR, long term outcome after PCI with BMS is inferior to conservative therapy or PCI with DES. While conservative management is preferable in these patients, PCI with DES may be considered in specific circumstances. © 2007 Wiley-Liss, Inc. [source]

Effects of left ventricular unloading by Impella recover LP2.5 on coronary hemodynamics

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2007
Maurice Remmelink MD
Abstract Objectives: We studied the effects of LV unloading by the Impella on coronary hemodynamics by simultaneously measuring intracoronary pressure and flow and the derived parameters fractional flow reserve (FFR), coronary flow velocity reserve (CFVR), and coronary microvascular resistance (MR). Background: Patients with compromised left ventricular (LV) function undergoing high-risk percutaneous coronary intervention (PCI) may benefit from LV unloading. Limited information is available on the effects of LV unloading on coronary hemodynamics. Methods: Eleven patients (mean LV ejection fraction of 35 ± 11%) underwent PCI during LV support by the LV unloading device (Impella Recover® LP2.5). Intracoronary measurements were performed in a nonstenotic coronary artery after the PCI, before and after adenosine-induced hyperemia at four different support levels (0,2.5 L/min). Results: Aortic and coronary pressure increased with increasing support levels, whereas FFR remained unchanged. Baseline flow velocity remained unchanged, while hyperemic flow velocity and CFVR increased significantly with increasing support levels (61 ± 24 to 72 ± 27 cm/sec, P = 0.001 and 1.88 ± 0.52 to 2.34 ± 0.63, P < 0.001 respectively). The difference between baseline MR and hyperemic MR significantly increased with increasing support levels (1.28 ± 1.32 to 1.89 ± 1.43 mm Hg cm,1 sec, P = 0.005). Conclusions: Unloading of the LV by the Impella increased aortic and intracoronary pressure, hyperemic flow velocity and CFVR, and decreased MR. The Impella-induced increase in coronary flow, probably results from both an increased perfusion pressure and a decreased LV volume-related intramyocardial resistance. © 2007 Wiley-Liss, Inc. [source]

Outcome of patients with acute coronary syndromes and moderate coronary lesions undergoing deferral of revascularization based on fractional flow reserve assessment

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2006
Joshua J. Fischer MD
Abstract Objectives: To determine the outcome of consecutive patients with and without acute coronary syndromes (ACS) in whom revascularization was deferred on the basis of fractional flow reserve (FFR). Background: FFR < 0.75 correlates with ischemia on noninvasive tests and deferral of treatment on the basis of FFR is associated with low event rates in selected populations. Whether these low event rates apply to patients undergoing assessment of moderate stenoses in association with an ACS is not known and is an important clinical question. Methods: Retrospective analysis and 12 month follow-up of consecutive, moderate (50,70%) de novo coronary lesions assessed with FFR. Results: Revascularization was deferred in 120 lesions (111 patients) with FFR , 0.75. ACS was present in 35 patients (40 lesions). The clinical, angiographic and coronary hemodynamic characteristics of patients with and without ACS were similar. Among the 35 patients with ACS, there were 3 deaths, 1 MI, and 6 target vessel revascularizations (TVRs) (15% of lesions). Among the 76 patients without ACS, there were 5 deaths, 1 MI, and 7 TVR's (9% of lesions). Conclusions: Deferral of revascularization based on FFR in patients with ACS and moderate coronary stenoses is associated with acceptable and low event rates at 1 year. © 2006 Wiley-Liss, Inc. [source]

Percutaneous coronary intervention or bypass surgery in multivessel disease?

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2004
A tailored approach based on coronary pressure measurement
Abstract The optimal revascularization strategy, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG), for patients with multivessel coronary artery disease (MVD) remains controversial. The aim of the present study was to compare the long-term outcomes after selective PCI of only hemodynamically significant lesions (fractional flow reserve, or FFR < 0.75) to CABG of all stenoses in patients with MVD. In 150 patients with MVD referred for CABG, FFR was determined in 381 coronary arteries considered for bypass grafting. If the FFR was less than 0.75 in three vessels or in two vessels including the proximal left anterior descending (LAD) artery, CABG was performed (CABG group). If only one or two vessels were physiologically significant (not including the proximal LAD), PCI of those lesions was performed (PCI group). Of the 150 patients, 87 fulfilled the criteria for CABG and 63 for PCI. There were no significant differences in the angiographic or other baseline characteristics between the two groups. At 2-year follow-up, no differences were seen in adverse events, including repeat revascularization (event-free survival 74% in the CABG group and 72% in the PCI group). A similar number of patients were free from angina (84% in the CABG group and 82% in the PCI group). Importantly, the results in both groups were as good as the surgical groups in previous studies comparing PCI and CABG in MVD. In patients with multivessel disease, PCI in those with one or two hemodynamically significant lesions as identified by an FFR < 0.75 yields a similar favorable outcome as CABG in those with three or more culprit lesions despite a similar angiographic extent of disease. Catheter Cardiovasc Interv 2004;63:184,191. © 2004 Wiley-Liss, Inc. [source]

Transient global left ventricular dysfunction in a localized myocardial infarction related to occlusion of the distal left anterior descending artery

CLINICAL CARDIOLOGY, Issue 9 2006
Seong Bo Yoon M.D.
Abstract In some patients with acute myocardial infarction (MI), wall motion in the noninfarcted area declines globally despite localized myocardial damage. In most, an infarct-related lesion is the proximal part of the left anterior descending artery (LAD). Previous studies have reported that hypo-kinesis of remote myocardium may be related to multivessel disease, impaired coronary flow, or coronary flow reserve in nonculprit arteries. This report describes the case of a 53-year-old man who presented with severe global left ventricular (LV) dysfunction after an acute MI associated with distal LAD occlusion. Follow-up echocardiographic examination revealed nearly normalized LV function 5 days after the episode. We discuss a plausible mechanism of dysfunction of noninfarcted myocardium. [source]

Assessment of coronary morphology and flow in a patient with guillain-barré syndrome and st-segment elevation

CLINICAL CARDIOLOGY, Issue 3 2001
Nikolaos Dagres M.D.
Abstract Patients with Guillain-Barré syndrome often have cardiac disturbances as a manifestation of autonomic dysfunction. Such abnormalities consist of arrhythmias and disturbances of heart rate and blood pressure. We report a case of a patient with Guillain-Barré syndrome who developed ST-segment elevation in the inferolateral leads, suggestive of an acute coronary syndrome. Cardiac catheterization revealed angiographically normal coronary arteries. Intracoronary ultrasound was also normal. Intracoronary Doppler flow measurements revealed an elevated baseline coronary flow velocity of up to 41 cm/s and decreased coronary flow reserve, particularly in the left circumflex artery. Myopericarditis as cause of the electrocardiographic changes could be ruled out by echocardiography and endomyocardial biopsy. We postulate that the intracoronary Doppler findings are caused by autonomic dysfunction with decrease of coronary resistance and redistribution of the transmural myocardial blood flow. [source]