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Peter De Jaegere - One of the best experts on this subject based on the ideXlab platform.
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comprehensive assessment of coronary artery stenoses computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:OBJECTIVES: We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography coronary angiography [CTCA]) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary Stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard. BACKGROUND: It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying coronary stenoses, but may lack accurate delineation of the hemodynamic significance. METHODS: We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete coronary stenoses. CTCA and conventional coronary angiography (CCA), and QCT and quantitative coronary angiography (QCA), were performed to determine the severity of a Stenosis that was compared with FFR measurements. A significant anatomical or functional Stenosis was defined as >/=50% diameter Stenosis or an FFR <0.75. Stented segments and bypass grafts were not included in the analysis. RESULTS: A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR <0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of -0.32 and -0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R = 0.53; p < 0.0001). CONCLUSIONS: The anatomical assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate Stenosis remains relevant before referral for revascularization treatment.
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comprehensive assessment of coronary artery stenoses computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography coronary angiography [CTCA]) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary Stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete coronary stenoses. CTCA and conventional coronary angiography (CCA), and QCT and quantitative coronary angiography (QCA), were performed to determine the severity of a Stenosis that was compared with FFR measurements. A significant anatomical or functional Stenosis was defined as 50% diameter Stenosis or an FFR 0.75. Stented segments and bypass grafts were not included in the analysis. Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR 0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of 0.32 and 0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R 0.53; p 0.0001). Conclusions The anatomical assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate Stenosis remains relevant before referral for revascularization treatment. (J Am Coll Cardiol 2008;52:636‐43) © 2008 by the American College of Cardiology Foundation
Javier Escaned - One of the best experts on this subject based on the ideXlab platform.
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head to head comparison of basal Stenosis resistance index instantaneous wave free ratio and fractional flow reserve diagnostic accuracy for Stenosis specific myocardial ischaemia
Eurointervention, 2015Co-Authors: Van De Hoef Tp, Van Lavieren, S S Nijjer, Mauro Echavarriapinto, Martijn Meuwissen, Javier Escaned, Steven A. J. Chamuleau, Ricardo Petraco, Froukje Nolte, Michiel VoskuilAbstract:Abstract We sought to compare the diagnostic accuracy of basal Stenosis resistance index (BSR), instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) for Stenosis-specific myocardial ischaemia identified by means of a combined reference standard of myocardial perfusion scintigraphy and the hyperaemic Stenosis resistance index. BSR and FFR were determined for 299 coronary stenoses, iFR was determined for 85 coronary stenoses (iFR cohort). The discriminative value for Stenosis-specific myocardial ischaemia was compared by means of the area under the receiver operating characteristic (ROC) curves (AUC). Classification agreement with the reference standard was determined according to ROC curve-derived ischaemic cut-off values, as well as according to clinical cut-off values, equivalent to the 0.80 FFR cut-off. Across all stenoses, the discriminative value of BSR and FFR was equivalent (AUC: 0.90 and 0.91, respectively, p=0.46). In the iFR cohort, the discriminative value was equivalent for BSR, iFR, and FFR (AUC: 0.88, 0.84, and 0.88, respectively; p≥0.20 for all). At both ischaemic as well as clinical cut-off values, classification agreement with the reference standard was equivalent for BSR and FFR across all stenoses, as well as for BSR, iFR, and FFR in the iFR cohort. BSR, iFR, and FFR have equivalent diagnostic accuracy for the detection of ischaemia-generating coronary stenoses.
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prospective assessment of the diagnostic accuracy of instantaneous wave free ratio to assess coronary Stenosis relevance results of advise ii international multicenter study adenosine vasodilator independent Stenosis evaluation ii
Jacc-cardiovascular Interventions, 2015Co-Authors: Javier Escaned, Mauro Echavarriapinto, Hector M Garciagarcia, Tim Van Der Hoef, Ton De Vries, Prashant Kaul, Ganesh Raveendran, John D Altman, Howard I KurzAbstract:Objectives The purpose of this study was to assess the diagnostic accuracy of the instantaneous wave-free ratio (iFR) to characterize, outside of a pre-specified range of values, Stenosis severity, as defined by fractional flow reserve (FFR) ≤0.80, in a prospective, independent, controlled, core laboratory–based environment. Background Studies with methodological heterogeneity have reported some discrepancies in the classification agreement between iFR and FFR. The ADVISE II (ADenosine Vasodilator Independent Stenosis Evaluation II) study was designed to overcome limitations of previous iFR versus FFR comparisons. Methods A total of 919 intermediate coronary stenoses were investigated during baseline and hyperemia. From these, 690 pressure recordings (n = 598 patients) met core laboratory physiology criteria and are included in this report. Results The pre-specified iFR cut-off of 0.89 was optimal for the study and correctly classified 82.5% of the stenoses, with a sensitivity of 73.0% and specificity of 87.8% (C statistic: 0.90 [95% confidence interval (CI): 0.88 to 0.92, p < 0.001]). The proportion of stenoses properly classified by iFR outside of the pre-specified treatment (≤0.85) and deferral (≥0.94) values was 91.6% (95% CI: 88.8% to 93.9%). When combined with FFR use within these cut-offs, the percent of stenoses properly classified by such a pre-specified hybrid iFR-FFR approach was 94.2% (95% CI: 92.2% to 95.8%). The hybrid iFR-FFR approach obviated vasodilators from 65.1% (95% CI: 61.1% to 68.9%) of patients and 69.1% (95% CI: 65.5% to 72.6%) of stenoses. Conclusions The ADVISE II study supports, on the basis rigorous methodology, the diagnostic value of iFR in establishing the functional significance of coronary stenoses, and highlights its complementariness with FFR when used in a hybrid iFR-FFR approach. (ADenosine Vasodilator Independent Stenosis Evaluation II–ADVISE II; NCT01740895)
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development and validation of a new adenosine independent index of Stenosis severity from coronary wave intensity analysis results of the advise adenosine vasodilator independent Stenosis evaluation study
Journal of the American College of Cardiology, 2012Co-Authors: Javier Escaned, Ricardo Petraco, Iqbal S Malik, Ghada W Mikhail, Rodney A Foale, Rafael Mila, Jason M Tarkin, Christopher Broyd, Richard J Jabbour, Amarjit SethiAbstract:Objectives The purpose of this study was to develop an adenosine-independent, pressure-derived index of coronary Stenosis severity. Background Assessment of Stenosis severity with fractional flow reserve (FFR) requires that coronary resistance is stable and minimized. This is usually achieved by administration of pharmacological agents such as adenosine. In this 2-part study, we determine whether there is a time when resistance is naturally minimized at rest and assess the diagnostic efficiency, compared with FFR, of a new pressure-derived adenosine-free index of Stenosis severity over that time. Methods A total of 157 stenoses were assessed. In part 1 (39 stenoses), intracoronary pressure and flow velocity were measured distal to the Stenosis; in part 2 (118 stenoses), intracoronary pressure alone was measured. Measurements were made at baseline and under pharmacologic vasodilation with adenosine. Results Wave-intensity analysis identified a wave-free period in which intracoronary resistance at rest is similar in variability and magnitude (coefficient of variation: 0.08 ± 0.06 and 284 ± 147 mm Hg s/m) to those during FFR (coefficient of variation: 0.08 ± 0.06 and 302 ± 315 mm Hg s/m; p = NS for both). The resting distal-to-proximal pressure ratio during this period, the instantaneous wave-free ratio (iFR), correlated closely with FFR (r = 0.9, p Conclusions Intracoronary resistance is naturally constant and minimized during the wave-free period. The instantaneous wave-free ratio calculated over this period produces a drug-free index of Stenosis severity comparable to FFR. (Vasodilator Free Measure of Fractional Flow Reserve [ADVISE]; NCT01118481 )
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morphometric assessment of coronary Stenosis relevance with optical coherence tomography a comparison with fractional flow reserve and intravascular ultrasound
Journal of the American College of Cardiology, 2012Co-Authors: Nieve Gonzalo, Javier Escaned, Fernando Alfonso, Christian Nolte, Vera Rodriguez, Pilar Jimenezquevedo, Camino Banuelos, Antonia Fernandezortiz, Eulogio Garcia, Rosana HernandezantolinAbstract:Objectives The study sought to assess the diagnostic efficiency of optical coherence tomography (OCT) in identifying hemodynamically severe coronary stenoses as determined by fractional flow reserve (FFR). Concomitant OCT and intravascular ultrasound (IVUS) area measurements were performed in a subgroup of patients to compare the diagnostic efficiency of both techniques. Background The value of OCT to determine Stenosis severity remains unsettled. Methods Sixty-one stenoses with intermediate angiographic severity were studied in 56 patients. Stenoses were labeled as severe if FFR ≤0.80. OCT interrogation was performed in all cases, with concomitant IVUS imaging in 47 cases. Results Angiographic Stenosis severity was 50.9 ± 8% diameter Stenosis with 1.28 ± 0.3 mm minimal lumen diameter. FFR was ≤0.80 in 28 (45.9%) stenoses. An overall moderate diagnostic efficiency of OCT was found (area under the curve [AUC]: 0.74; 95% confidence interval [CI]: 0.61 to 0.84), with sensitivity/specificity of 82%/63% associated with an optimal cutoff value of 1.95 mm2. Comparison of the results in patients with simultaneous IVUS and OCT imaging revealed no significant differences in the diagnostic efficiency of OCT (AUC: 0.70; 95% CI: 0.55 to 0.83) and IVUS (AUC. 0.63; 95% CI: 0.47 to 0.77; p = 0.19). Sensitivity/specificity for IVUS was 67%/65% for an optimal cutoff value of 2.36 mm2. In the subgroup of small vessels (reference diameter <3 mm) OCT showed a significantly better diagnostic efficiency (AUC: 0.77; 95% CI: 0.60 to 0.89) than IVUS (AUC: 0.63; 95% CI: 0.46 to 0.78) to identify functionally significant stenoses (p = 0.04). Conclusions OCT has a moderate diagnostic efficiency in identifying hemodynamically severe coronary stenoses. Although OCT seems slightly superior to IVUS for this purpose (particularly in vessels <3 mm), its low specificity precludes its use as a substitute of FFR for functional Stenosis assessment.
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morphometric assessment of coronary Stenosis relevance with optical coherence tomography a comparison with fractional flow reserve and intravascular ultrasound
Journal of the American College of Cardiology, 2012Co-Authors: Nieve Gonzalo, Javier Escaned, Fernando Alfonso, Christian Nolte, Vera Rodriguez, Pilar Jimenezquevedo, Camino Banuelos, Antonia Fernandezortiz, Eulogio Garcia, Rosana HernandezantolinAbstract:Objectives The study sought to assess the diagnostic efficiency of optical coherence tomography (OCT) in identifying hemodynamically severe coronary stenoses as determined by fractional flow reserve (FFR). Concomitant OCT and intravascular ultrasound (IVUS) area measurements were performed in a subgroup of patients to compare the diagnostic efficiency of both techniques. Background The value of OCT to determine Stenosis severity remains unsettled. Methods Sixty-one stenoses with intermediate angiographic severity were studied in 56 patients. Stenoses were labeled as severe if FFR ≤0.80. OCT interrogation was performed in all cases, with concomitant IVUS imaging in 47 cases. Results Angiographic Stenosis severity was 50.9 ± 8% diameter Stenosis with 1.28 ± 0.3 mm minimal lumen diameter. FFR was ≤0.80 in 28 (45.9%) stenoses. An overall moderate diagnostic efficiency of OCT was found (area under the curve [AUC]: 0.74; 95% confidence interval [CI]: 0.61 to 0.84), with sensitivity/specificity of 82%/63% associated with an optimal cutoff value of 1.95 mm2. Comparison of the results in patients with simultaneous IVUS and OCT imaging revealed no significant differences in the diagnostic efficiency of OCT (AUC: 0.70; 95% CI: 0.55 to 0.83) and IVUS (AUC. 0.63; 95% CI: 0.47 to 0.77; p = 0.19). Sensitivity/specificity for IVUS was 67%/65% for an optimal cutoff value of 2.36 mm2. In the subgroup of small vessels (reference diameter Conclusions OCT has a moderate diagnostic efficiency in identifying hemodynamically severe coronary stenoses. Although OCT seems slightly superior to IVUS for this purpose (particularly in vessels
Bob W Meijboom - One of the best experts on this subject based on the ideXlab platform.
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comprehensive assessment of coronary artery stenoses computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:OBJECTIVES: We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography coronary angiography [CTCA]) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary Stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard. BACKGROUND: It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying coronary stenoses, but may lack accurate delineation of the hemodynamic significance. METHODS: We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete coronary stenoses. CTCA and conventional coronary angiography (CCA), and QCT and quantitative coronary angiography (QCA), were performed to determine the severity of a Stenosis that was compared with FFR measurements. A significant anatomical or functional Stenosis was defined as >/=50% diameter Stenosis or an FFR <0.75. Stented segments and bypass grafts were not included in the analysis. RESULTS: A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR <0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of -0.32 and -0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R = 0.53; p < 0.0001). CONCLUSIONS: The anatomical assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate Stenosis remains relevant before referral for revascularization treatment.
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comprehensive assessment of coronary artery stenoses computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography coronary angiography [CTCA]) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary Stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete coronary stenoses. CTCA and conventional coronary angiography (CCA), and QCT and quantitative coronary angiography (QCA), were performed to determine the severity of a Stenosis that was compared with FFR measurements. A significant anatomical or functional Stenosis was defined as 50% diameter Stenosis or an FFR 0.75. Stented segments and bypass grafts were not included in the analysis. Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR 0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of 0.32 and 0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R 0.53; p 0.0001). Conclusions The anatomical assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate Stenosis remains relevant before referral for revascularization treatment. (J Am Coll Cardiol 2008;52:636‐43) © 2008 by the American College of Cardiology Foundation
Mauro Echavarriapinto - One of the best experts on this subject based on the ideXlab platform.
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coronary pressure and flow relationships in humans phasic analysis of normal and pathological vessels and the implications for Stenosis assessment a report from the iberian dutch english ideal collaborators
European Heart Journal, 2016Co-Authors: S S Nijjer, Mauro Echavarriapinto, Martijn Meuwissen, Ricardo Petraco, Guus A De Waard, Sayan Sen, Tim P Van De Hoef, Martijn A Van Lavieren, Ibrahim Danad, Paul KnaapenAbstract:Background Our understanding of human coronary physiological behaviour is derived from animal models. We sought to describe physiological behaviour across a large collection of invasive pressure and flow velocity measurements, to provide a better understanding of the relationships between these physiological parameters and to evaluate the rationale for resting Stenosis assessment. Methods and results Five hundred and sixty-seven simultaneous intracoronary pressure and flow velocity assessments from 301 patients were analysed for coronary flow velocity, trans-stenotic pressure gradient (TG), and microvascular resistance (MVR). Measurements were made during baseline and hyperaemic conditions. The whole cardiac cycle and the diastolic wave-free period were assessed. Stenoses were assessed according to fractional flow reserve (FFR) and quantitative coronary angiography DS%. With progressive worsening of stenoses, from unobstructed angiographic normal vessels to those with FFR ≤ 0.50, hyperaemic flow falls significantly from 45 to 19 cm/s, P trend 0.05 for all). Trans-stenotic pressure gradient rose with Stenosis severity for both rest and hyperaemic measures ( P trend < 0.001 for both). Microvascular resistance declines with Stenosis severity under resting conditions ( P trend < 0.001), but was unchanged at hyperaemia (2.3 ± 1.1 mmHg/cm/s; P trend = 0.19). Conclusions With progressive Stenosis severity, TG rises. However, while hyperaemic flow falls significantly, resting coronary flow is maintained by compensatory reduction of MVR, demonstrating coronary auto-regulation. These data support the translation of coronary physiological concepts derived from animals to patients with coronary artery disease and furthermore, suggest that resting pressure indices can be used to detect the haemodynamic significance of coronary artery stenoses.
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head to head comparison of basal Stenosis resistance index instantaneous wave free ratio and fractional flow reserve diagnostic accuracy for Stenosis specific myocardial ischaemia
Eurointervention, 2015Co-Authors: Van De Hoef Tp, Van Lavieren, S S Nijjer, Mauro Echavarriapinto, Martijn Meuwissen, Javier Escaned, Steven A. J. Chamuleau, Ricardo Petraco, Froukje Nolte, Michiel VoskuilAbstract:Abstract We sought to compare the diagnostic accuracy of basal Stenosis resistance index (BSR), instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) for Stenosis-specific myocardial ischaemia identified by means of a combined reference standard of myocardial perfusion scintigraphy and the hyperaemic Stenosis resistance index. BSR and FFR were determined for 299 coronary stenoses, iFR was determined for 85 coronary stenoses (iFR cohort). The discriminative value for Stenosis-specific myocardial ischaemia was compared by means of the area under the receiver operating characteristic (ROC) curves (AUC). Classification agreement with the reference standard was determined according to ROC curve-derived ischaemic cut-off values, as well as according to clinical cut-off values, equivalent to the 0.80 FFR cut-off. Across all stenoses, the discriminative value of BSR and FFR was equivalent (AUC: 0.90 and 0.91, respectively, p=0.46). In the iFR cohort, the discriminative value was equivalent for BSR, iFR, and FFR (AUC: 0.88, 0.84, and 0.88, respectively; p≥0.20 for all). At both ischaemic as well as clinical cut-off values, classification agreement with the reference standard was equivalent for BSR and FFR across all stenoses, as well as for BSR, iFR, and FFR in the iFR cohort. BSR, iFR, and FFR have equivalent diagnostic accuracy for the detection of ischaemia-generating coronary stenoses.
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prospective assessment of the diagnostic accuracy of instantaneous wave free ratio to assess coronary Stenosis relevance results of advise ii international multicenter study adenosine vasodilator independent Stenosis evaluation ii
Jacc-cardiovascular Interventions, 2015Co-Authors: Javier Escaned, Mauro Echavarriapinto, Hector M Garciagarcia, Tim Van Der Hoef, Ton De Vries, Prashant Kaul, Ganesh Raveendran, John D Altman, Howard I KurzAbstract:Objectives The purpose of this study was to assess the diagnostic accuracy of the instantaneous wave-free ratio (iFR) to characterize, outside of a pre-specified range of values, Stenosis severity, as defined by fractional flow reserve (FFR) ≤0.80, in a prospective, independent, controlled, core laboratory–based environment. Background Studies with methodological heterogeneity have reported some discrepancies in the classification agreement between iFR and FFR. The ADVISE II (ADenosine Vasodilator Independent Stenosis Evaluation II) study was designed to overcome limitations of previous iFR versus FFR comparisons. Methods A total of 919 intermediate coronary stenoses were investigated during baseline and hyperemia. From these, 690 pressure recordings (n = 598 patients) met core laboratory physiology criteria and are included in this report. Results The pre-specified iFR cut-off of 0.89 was optimal for the study and correctly classified 82.5% of the stenoses, with a sensitivity of 73.0% and specificity of 87.8% (C statistic: 0.90 [95% confidence interval (CI): 0.88 to 0.92, p < 0.001]). The proportion of stenoses properly classified by iFR outside of the pre-specified treatment (≤0.85) and deferral (≥0.94) values was 91.6% (95% CI: 88.8% to 93.9%). When combined with FFR use within these cut-offs, the percent of stenoses properly classified by such a pre-specified hybrid iFR-FFR approach was 94.2% (95% CI: 92.2% to 95.8%). The hybrid iFR-FFR approach obviated vasodilators from 65.1% (95% CI: 61.1% to 68.9%) of patients and 69.1% (95% CI: 65.5% to 72.6%) of stenoses. Conclusions The ADVISE II study supports, on the basis rigorous methodology, the diagnostic value of iFR in establishing the functional significance of coronary stenoses, and highlights its complementariness with FFR when used in a hybrid iFR-FFR approach. (ADenosine Vasodilator Independent Stenosis Evaluation II–ADVISE II; NCT01740895)
Carlos Van Mieghem - One of the best experts on this subject based on the ideXlab platform.
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comprehensive assessment of coronary artery stenoses computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:OBJECTIVES: We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography coronary angiography [CTCA]) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary Stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard. BACKGROUND: It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying coronary stenoses, but may lack accurate delineation of the hemodynamic significance. METHODS: We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete coronary stenoses. CTCA and conventional coronary angiography (CCA), and QCT and quantitative coronary angiography (QCA), were performed to determine the severity of a Stenosis that was compared with FFR measurements. A significant anatomical or functional Stenosis was defined as >/=50% diameter Stenosis or an FFR <0.75. Stented segments and bypass grafts were not included in the analysis. RESULTS: A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR <0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of -0.32 and -0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R = 0.53; p < 0.0001). CONCLUSIONS: The anatomical assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate Stenosis remains relevant before referral for revascularization treatment.
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comprehensive assessment of coronary artery stenoses computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina
Journal of the American College of Cardiology, 2008Co-Authors: Bob W Meijboom, Carlos Van Mieghem, Niels Van Pelt, Annick C Weustink, Francesca Pugliese, Nico R Mollet, Eric Boersma, E Regar, Robert Jan Van Geuns, Peter De JaegereAbstract:Objectives We sought to determine the diagnostic accuracy of noninvasive visual (computed tomography coronary angiography [CTCA]) and quantitative computed tomography coronary angiography (QCT) to predict the hemodynamic significance of a coronary Stenosis, using intracoronary fractional flow reserve (FFR) as the reference standard. Background It has been demonstrated that CTCA provides excellent diagnostic sensitivity for identifying coronary stenoses, but may lack accurate delineation of the hemodynamic significance. Methods We investigated 79 patients with stable angina pectoris who underwent both 64-slice or dual-source CTCA and FFR measurement of discrete coronary stenoses. CTCA and conventional coronary angiography (CCA), and QCT and quantitative coronary angiography (QCA), were performed to determine the severity of a Stenosis that was compared with FFR measurements. A significant anatomical or functional Stenosis was defined as 50% diameter Stenosis or an FFR 0.75. Stented segments and bypass grafts were not included in the analysis. Results A total of 89 stenoses were evaluated of which 18% (16 of 89) had an FFR 0.75. The diagnostic accuracy of CTCA, QCT, CCA, and QCA to detect a hemodynamically significant coronary lesion was 49%, 71%, 61%, and 67%, respectively. Correlation between QCT and QCA with FFR measurement was weak (R values of 0.32 and 0.30, respectively). Correlation between QCT and QCA was significant, but only moderate (R 0.53; p 0.0001). Conclusions The anatomical assessment of the hemodynamic significance of coronary stenoses determined by visual CTCA, CCA, or QCT or QCA does not correlate well with the functional assessment of FFR. Determining the hemodynamic significance of an angiographically intermediate Stenosis remains relevant before referral for revascularization treatment. (J Am Coll Cardiol 2008;52:636‐43) © 2008 by the American College of Cardiology Foundation
