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Bernard De Bruyne - One of the best experts on this subject based on the ideXlab platform.
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Fractional Flow Reserve to Assess Intermediate Stenosis
Coronary Pressure, 2020Co-Authors: Nico H. J. Pijls, Bernard De BruyneAbstract:As outlined in the previous chapters, myocardial Fractional Flow Reserve (FFR myo ) is a lesion-specific index of the functional severity of a coronary stenosis, calculated from pressure measurements during coronary arteriography1–8. It has been shown in chapter 11 that a value of 0.75 distinguishes lesions, associated with reversible ischemia or not, with minimal overlap. In this chapter the usefulness of Fractional Flow Reserve is investigated for clinical decision-making in patients with intermediate coronary stenosis, and compared to an ischemic standard composed by all presently used non-invasive tests: exercise testing, thallium scintigraphy, and dobutamine stress-echocardiography.
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validation study of image based Fractional Flow Reserve during coronary angiography
Circulation-cardiovascular Interventions, 2017Co-Authors: Mariano Pellicano, Bernard De Bruyne, Abid Assali, Ifat Lavi, Orna Valtzer, Yonit Lotringer, Hana Vakninassa, Giora Weisz, Yaron Almagor, Panagiotis XaplanterisAbstract:Background—Fractional Flow Reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from invasive measurements and requires a pressure-monitoring guidewire and hyperemic...
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Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve
Circulation-cardiovascular Imaging, 2017Co-Authors: Julien Adjedj, Emanuele Barbato, Angela Ferrara, Mariano Pellicano, Panagiotis Xaplanteris, Gabor G Toth, Giovanni Ciccarelli, Vincent Floré, Bernard De BruyneAbstract:Background—The correlation between angiographic assessment of coronary stenoses and Fractional Flow Reserve (FFR) is weak. Whether and how risk factors impact the diagnostic accuracy of angiography...
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Real-Life Fractional Flow Reserve.
Circulation, 2017Co-Authors: Bernard De Bruyne, Stephane Fournier, Emanuele BarbatoAbstract:Article, see p 2241 Rare are the approaches that have changed our understanding of coronary artery disease as has Fractional Flow Reserve (FFR). After extensive animal and human validation work and hypothesis-generating observational studies,1 larger randomized trials with a superiority design have reshaped our therapeutic strategies in stable coronary artery disease and, albeit to a lesser extent, of acute coronary syndromes. In a nutshell: (1) stenoses with an FFR >0.80 do not benefit from revascularization, not even the nonculprit vessels in patients with acute coronary syndromes2,3; (2) patients with ≤1 stenosis with an FFR ≤0.80 are better off with contemporary percutaneous coronary intervention than with medical therapy4; (3) the angiographic 50% diameter stenosis is a battered standard to define coronary artery disease, risk stratify patients, or guide therapy5,6; (4) performing FFR during diagnostic angiography modifies about half of the revascularization decisions7; and (5) there is a risk continuum for FFR over the entire range of stenosis severity.8,9 Therefore, one might wonder what an observational database could add to this knowledge. The results of the IRIS-FFR registry (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve) published in this issue of Circulation 10 …
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Fractional Flow Reserve Derived From Routine Coronary Angiograms.
Journal of the American College of Cardiology, 2016Co-Authors: Ran Kornowski, Abid Assali, Ifat Lavi, Mariano Pellicano, Panagiotis Xaplanteris, Hana Vaknin-assa, Orna Valtzer, Yonit Lotringer, Bernard De BruyneAbstract:Pressure wire-based Fractional Flow Reserve (FFR) has become the standard of reference for decision making regarding coronary revascularization. Deriving FFR from routine angiograms could facilitate the uptake of FFR-based clinical decisions. Several angiography-derived FFR methods have recently
Nico H. J. Pijls - One of the best experts on this subject based on the ideXlab platform.
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Fractional Flow Reserve to Assess Intermediate Stenosis
Coronary Pressure, 2020Co-Authors: Nico H. J. Pijls, Bernard De BruyneAbstract:As outlined in the previous chapters, myocardial Fractional Flow Reserve (FFR myo ) is a lesion-specific index of the functional severity of a coronary stenosis, calculated from pressure measurements during coronary arteriography1–8. It has been shown in chapter 11 that a value of 0.75 distinguishes lesions, associated with reversible ischemia or not, with minimal overlap. In this chapter the usefulness of Fractional Flow Reserve is investigated for clinical decision-making in patients with intermediate coronary stenosis, and compared to an ischemic standard composed by all presently used non-invasive tests: exercise testing, thallium scintigraphy, and dobutamine stress-echocardiography.
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Fractional Flow Reserve
2020Co-Authors: Jan-willem E. M. Sels, W.a.l. Tonino, Nico H. J. PijlsAbstract:Fractional Flow Reserve has become an essential tool in the modern catheterization laboratories. FFR has shown to be more accurate for the detection of ischemia than available non-invasive methods. Unlike these modalities, FFR is able to pinpoint the lesions causing ischemia, thereby achieving unequaled spatial resolution. Its use has been validated in numerous studies and different populations. It is easy to use, gives virtually dichotomous information, and is readily available worldwide. In this chapter, the principle concepts of FFR measurements to assess the hemodynamic severity of coronary artery lesions are reviewed.
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Fractional Flow Reserve in Acute Coronary Syndromes.
Journal of the American College of Cardiology, 2016Co-Authors: William F. Fearon, Bernard De Bruyne, Nico H. J. PijlsAbstract:The clinical utility of measuring Fractional Flow Reserve (FFR) in the cardiac catheterization laboratory to guide the decision regarding coronary revascularization is now well established. In particular, multiple studies have demonstrated the safety of deferring revascularization of coronary
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standardization of Fractional Flow Reserve measurements
Journal of the American College of Cardiology, 2016Co-Authors: Gabor G Toth, William F. Fearon, Nico H. J. Pijls, Emanuele Barbato, Allen Jeremias, Mariano Pellicano, Nils P Johnson, Pascal Vranckx, Morton J Kern, Bernard De BruyneAbstract:Pressure wire–based Fractional Flow Reserve is considered the standard of reference for evaluation of the ischemic potential of coronary stenoses and the expected benefit from revascularization. Accordingly, its application in daily practice or for research purposes has to be as standardized as possible to avoid technical or operator-related artifacts in pressure recordings. This document proposes a standardized way of acquiring, recording, interpreting, and archiving the pressure tracings for daily practice and for the purpose of clinical research involving a core laboratory. Proposed standardized steps enhance the uniformity of clinical practices and data interpretation.
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impact of right atrial pressure on Fractional Flow Reserve measurements comparison of Fractional Flow Reserve and myocardial Fractional Flow Reserve in 1 600 coronary stenoses
Jacc-cardiovascular Interventions, 2016Co-Authors: Gabor G Toth, Bernard De Bruyne, Jozef Bartunek, Mariano Pellicano, William Wijns, Dan Rusinaru, Giuseppe Di Gioia, Marc Vanderheyden, Julien Adjedj, Nico H. J. PijlsAbstract:Abstract Objectives This study sought to assess the impact of a wide range of mean right atrial pressure (P ra ) on Fractional Flow Reserve (FFR) measurements. Background FFR invasively assesses the ischemic potential of coronary stenoses. FFR is calculated as the ratio of mean distal coronary pressure (P d ) to mean aortic pressure (P a ) during maximal hyperemia. The P ra is considered to have little impact if it is within normal range, so it is neglected in the formula. Methods In 1,676 stenoses of 1,235 patients undergoing left-right heart catheterization for ischemic (642 [52%]) or valvular heart disease (593 [48%]), the authors compared the FFR values calculated without accounting for P ra (FFR= P d /P a ) to the corresponding myocardial Fractional Flow Reserve (FFR myo ) values accounting for P ra (FFR myo = P d − P ra /P a − P ra ). Results The median P ra was 7 (interquartile range [IQR]: 5 to 10) mm Hg with a maximum of 27 mm Hg. The correlation and agreement between FFR and FFR myo was excellent (R 2 = 0.987; slope 1.096 ± 0.003). The median FFR (0.85; IQR: 0.78 to 0.91) was slightly but statistically significantly higher than the median FFR myo (0.83; IQR: 0.76 to 0.90; p myo ≤0.80 in 110 (9%) stenoses. No FFR value above 0.80 provided an FFR myo ≤0.75. Conclusions The difference between FFR and FFR myo was minimal even in patients with markedly increased P ra . FFR values above the gray zone (i.e., >0.80) did not yield values below the gray zone (i.e., ≤0.75) in any case, which suggests that the impact of right atrial pressure on FFR measurement is indeed negligible.
Charles A Taylor - One of the best experts on this subject based on the ideXlab platform.
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Coronary Computed Tomography Angiography Derived Fractional Flow Reserve and Plaque Stress
Current Cardiovascular Imaging Reports, 2016Co-Authors: Bjarne L Norgaard, Jonathon Leipsic, Christopher K. Zarins, Jesper Møller Jensen, Niels Peter Sand, Charles A TaylorAbstract:Fractional Flow Reserve (FFR) measured during invasive coronary angiography is an independent prognosticator in patients with coronary artery disease and the gold standard for decision making in coronary revascularization. The integration of computational fluid dynamics and quantitative anatomic and physiologic modeling now enables simulation of patient-specific hemodynamic parameters including blood velocity, pressure, pressure gradients, and FFR from standard acquired coronary computed tomography (CT) datasets. In this review article, we describe the potential impact on clinical practice and the science behind noninvasive coronary computed tomography (CT) angiography derived Fractional Flow Reserve (FFR_CT) as well as future applications of this technology in treatment planning and quantifying forces on atherosclerotic plaques.
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noninvasive Fractional Flow Reserve derived from coronary ct angiography clinical data and scientific principles
Jacc-cardiovascular Imaging, 2015Co-Authors: Charles A Taylor, Nico H. J. Pijls, Stephan Achenbach, Jonathon Leipsic, Bjarne L Norgaard, Bernard De BruyneAbstract:Fractional Flow Reserve derived from coronary computed tomography angiography enables noninvasive assessment of the hemodynamic significance of coronary artery lesions and coupling of the anatomic severity of a coronary stenosis with its physiological effects. Since its initial demonstration of feasibility of use in humans in 2011, a significant body of clinical evidence has developed to evaluate the diagnostic performance of coronary computed tomography angiography-derived Fractional Flow Reserve compared with an invasive Fractional Flow Reserve reference standard. The purpose of this paper was to describe the scientific principles and to review the clinical data of this technology recently approved by the U.S. Food and Drug Administration.
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Computed Fractional Flow Reserve (FFT_CT) Derived from Coronary CT Angiography
Journal of Cardiovascular Translational Research, 2013Co-Authors: Christopher K. Zarins, Charles A TaylorAbstract:Recent advances in image-based modeling and computational fluid dynamics permit the calculation of coronary artery pressure and Flow from typically acquired coronary computed tomography (CT) scans. Computed Fractional Flow Reserve is the ratio of mean coronary artery pressure divided by mean aortic pressure under conditions of simulated maximal coronary hyperemia, thus providing a noninvasive estimate of Fractional Flow Reserve (FFR_CT) at every point in the coronary tree. Prospective multicenter clinical trials have shown that computed FFR_CT improves diagnostic accuracy and discrimination compared to CT stenosis alone for the diagnosis of hemodynamically significant coronary artery disease (CAD), when compared to invasive FFR as the reference gold standard. This promising new technology provides a combined anatomic and physiologic assessment of CAD in a single noninvasive test that can help select patients for invasive angiography and revascularization or best medical therapy. Further evaluation of the clinical effectiveness and economic implications of noninvasive FFR_CT are now being explored.
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computed Fractional Flow Reserve fftct derived from coronary ct angiography
Journal of Cardiovascular Translational Research, 2013Co-Authors: Christopher K. Zarins, Charles A TaylorAbstract:Recent advances in image-based modeling and computational fluid dynamics permit the calculation of coronary artery pressure and Flow from typically acquired coronary computed tomography (CT) scans. Computed Fractional Flow Reserve is the ratio of mean coronary artery pressure divided by mean aortic pressure under conditions of simulated maximal coronary hyperemia, thus providing a noninvasive estimate of Fractional Flow Reserve (FFRCT) at every point in the coronary tree. Prospective multicenter clinical trials have shown that computed FFRCT improves diagnostic accuracy and discrimination compared to CT stenosis alone for the diagnosis of hemodynamically significant coronary artery disease (CAD), when compared to invasive FFR as the reference gold standard. This promising new technology provides a combined anatomic and physiologic assessment of CAD in a single noninvasive test that can help select patients for invasive angiography and revascularization or best medical therapy. Further evaluation of the clinical effectiveness and economic implications of noninvasive FFRCT are now being explored.
Julian Gunn - One of the best experts on this subject based on the ideXlab platform.
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fast virtual Fractional Flow Reserve based upon steady state computational fluid dynamics analysis results from the virtu fast study
JACC: Basic to Translational Science, 2017Co-Authors: Jeroen F.a. Feher, Dan Rafiroiu, Susheel Varma, Patricia V. Lawford, Adriana Lungu, Paul Morris, Rodney D Hose, Daniel Alejandro Silva Soto, Julian GunnAbstract:Summary Fractional Flow Reserve (FFR)-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel “pseudotransient” analysis protocol for computing virtual Fractional Flow Reserve (vFFR) based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis) using a desktop PC, with
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virtual Fractional Flow Reserve from coronary angiography modeling the significance of coronary lesions results from the virtu 1 virtual Fractional Flow Reserve from coronary angiography study
Jacc-cardiovascular Interventions, 2013Co-Authors: Paul Morris, Desmond Ryan, Richard Lycett, Patricia V. Lawford, Allison Morton, Rodney D Hose, Julian GunnAbstract:Objectives The aim of this study was to develop a computer model that accurately predicts myocardial Fractional Flow Reserve (FFR) from angiographic images alone, in patients with coronary artery disease. Background Percutaneous coronary intervention (PCI) guided by FFR is superior to standard assessment alone. FFR-guided PCI results in improved clinical outcomes, a reduction in the number of stents implanted, and reduced cost. Currently FFR is used in few patients. A less invasive FFR would be a valuable tool. Methods Nineteen patients with stable coronary artery disease awaiting elective PCI were studied. They underwent rotational coronary angiography. The FFR was measured, physiologically significant lesions were stented, and angiography and FFR were repeated. Three-dimensional arterial anatomy pre- and post-stenting was reconstructed offline. Generic boundary conditions for computational fluid dynamics analysis were applied. The virtual Fractional Flow Reserve (vFFR) and measured Fractional Flow Reserve (mFFR) values were compared. Results Thirty-five matched anatomical and physiological datasets were obtained: 10 right coronary arteries (RCA) (5 pre- and post-stenting), and 12 left coronary arteries (LCA) (8 pre- and post-stenting). The computational fluid dynamics model predicted which lesions were physiologically significant (FFR 0.80) with accuracy, sensitivity, specificity, positive and negative predictive values of 97%, 86%, 100%, 100%, and 97% respectively. On average, the vFFR values deviated from mFFR by ±0.06 (mean delta = 0.02, SD = 0.08). The vFFR and mFFR were closely correlated (r = 0.84). Conclusions We have developed a model of intracoronary physiology based upon a rotational coronary angiogram. Significant lesions were identified with 97% accuracy. The FFR was reliably predicted without the need for invasive measurements or inducing hyperemia.
Janelle Peralez Gunn - One of the best experts on this subject based on the ideXlab platform.
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Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis: Results From the VIRTU-Fast Study
JACC: Basic to Translational Science, 2017Co-Authors: Paul D. Morris, Daniel Alejandro Silva Soto, Jeroen F.a. Feher, Dan Rafiroiu, Susheel Varma, Patricia V. Lawford, D. Rodney Hose, Adriana Lungu, Janelle Peralez GunnAbstract:Fractional Flow Reserve (FFR)-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel “pseudotransient” analysis protocol for computing virtual Fractional Flow Reserve (vFFR) based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis) using a desktop PC, with
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Virtual Fractional Flow Reserve from coronary angiography: Modeling the significance of coronary lesions. Results from the VIRTU-1 (VIRTUal Fractional Flow Reserve from coronary angiography) study
JACC: Cardiovascular Interventions, 2013Co-Authors: Paul D. Morris, Desmond Ryan, Richard Lycett, Allison C Morton, Patricia V. Lawford, D. Rodney Hose, Janelle Peralez GunnAbstract:Objectives: The aim of this study was to develop a computer model that accurately predicts myocardial Fractional Flow Reserve (FFR) from angiographic images alone, in patients with coronary artery disease. Background: Percutaneous coronary intervention (PCI) guided by FFR is superior to standard assessment alone. FFR-guided PCI results in improved clinical outcomes, a reduction in the number of stents implanted, and reduced cost. Currently FFR is used in few patients. A less invasive FFR would be a valuable tool. Methods: Nineteen patients with stable coronary artery disease awaiting elective PCI were studied. They underwent rotational coronary angiography. The FFR was measured, physiologically significant lesions were stented, and angiography and FFR were repeated. Three-dimensional arterial anatomy pre- and post-stenting was reconstructed offline. Generic boundary conditions for computational fluid dynamics analysis were applied. The virtual Fractional Flow Reserve (vFFR) and measured Fractional Flow Reserve (mFFR) values were compared. Results: Thirty-five matched anatomical and physiological datasets were obtained: 10 right coronary arteries (RCA) (5 pre- and post-stenting), and 12 left coronary arteries (LCA) (8 pre- and post-stenting). The computational fluid dynamics model predicted which lesions were physiologically significant (FFR 0.80) with accuracy, sensitivity, specificity, positive and negative predictive values of 97%, 86%, 100%, 100%, and 97% respectively. On average, the vFFR values deviated from mFFR by ±0.06 (mean delta = 0.02, SD = 0.08). The vFFR and mFFR were closely correlated (r = 0.84). Conclusions: We have developed a model of intracoronary physiology based upon a rotational coronary angiogram. Significant lesions were identified with 97% accuracy. The FFR was reliably predicted without the need for invasive measurements or inducing hyperemia. © 2013 by the American College of Cardiology Foundation.
