Objective The study sought to investigate the clinical predictive value of quantitative flow ratio(QFR)for the long-term target vessel failure(TVF)outcome in patients with in-stent restenosis(ISR)by using drug-coated ...Objective The study sought to investigate the clinical predictive value of quantitative flow ratio(QFR)for the long-term target vessel failure(TVF)outcome in patients with in-stent restenosis(ISR)by using drug-coated balloon(DCB)treatment after a long-term follow-up.Methods This was a retrospective study.A total of 186 patients who underwent DCB angioplasty for ISR in two hospitals from March 2014 to September 2019 were enrolled.The QFR of the entire target vessel was measured offline.The primary endpoint was TVF,including target vessel-cardiac death(TV-CD),target vessel-myocardial infarction(TV-MI),and clinically driven-target vessel revascularization(CD-TVR).Results The follow-up time was 3.09±1.53 years,and 50 patients had TVF.The QFR immediately after percutaneous coronary intervention(PCI)was significantly lower in the TVF group than in the no-TVF group.Multivariable Cox regression analysis indicated that the QFR immediately after PCI was an excellent predictor for TVF after the long-term follow-up[hazard ratio(HR):5.15×10−5(6.13×10−8−0.043);P<0.01].Receiver-operating characteristic(ROC)curve analysis demonstrated that the optimal cut-off value of the QFR immediately after PCI for predicting the long-term TVF was 0.925(area under the curve:0.886,95%confidence interval:0.834–0.938;sensitivity:83.40%,specificity:88.00;P<0.01).In addition,QFR≤0.925 post-PCI was strongly correlated with the TVF,including TV-MI and CD-TVR(P<0.01).Conclusion The QFR immediately after PCI showed a high predictive value of TVF after a long-term follow-up in ISR patients who underwent DCB angioplasty.A lower QFR immediately after PCI was associated with a worse TVF outcome.展开更多
Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent...Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.展开更多
New non-and less-invasive techniques have been developed to overcome the procedural and operator related burden of the fractional flow reserve(FFR)for the assessment of potentially significant stenosis in the coronary...New non-and less-invasive techniques have been developed to overcome the procedural and operator related burden of the fractional flow reserve(FFR)for the assessment of potentially significant stenosis in the coronary arteries.Virtual FFR-techniques can obviate the need for the additional flow or pressure wires as used for FFR measurements.This review provides an overview of the developments and validation of the virtual FFR-algorithms,states the challenges,discusses the upcoming clinical trials,and postulates the future role of virtual FFR in the clinical practice.展开更多
Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiolo...Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis.FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy,deferring unnecessary procedures for lesions with a FFR>0.8,improving patients'management and clinical outcome.Post intervention,an optimal FFR>0.9 post stenting should be reached and>0.8 post drug eluting balloons.Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89.They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated.FFR remains the gold standard reference for invasive assessment of ischemia.We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio.We conclude introducing a hybrid approach to intermediate lesions(DFR 0.85-0.95)potentially maximizing clinical decision from all measurements.展开更多
基金supported by the Nanjing Municipal Science and Technology Bureau(No.201803008)the Cardiocare Sponsored Optimized Antithrombotic Research Fund(No.BJUHFCSOARF201801-13).
文摘Objective The study sought to investigate the clinical predictive value of quantitative flow ratio(QFR)for the long-term target vessel failure(TVF)outcome in patients with in-stent restenosis(ISR)by using drug-coated balloon(DCB)treatment after a long-term follow-up.Methods This was a retrospective study.A total of 186 patients who underwent DCB angioplasty for ISR in two hospitals from March 2014 to September 2019 were enrolled.The QFR of the entire target vessel was measured offline.The primary endpoint was TVF,including target vessel-cardiac death(TV-CD),target vessel-myocardial infarction(TV-MI),and clinically driven-target vessel revascularization(CD-TVR).Results The follow-up time was 3.09±1.53 years,and 50 patients had TVF.The QFR immediately after percutaneous coronary intervention(PCI)was significantly lower in the TVF group than in the no-TVF group.Multivariable Cox regression analysis indicated that the QFR immediately after PCI was an excellent predictor for TVF after the long-term follow-up[hazard ratio(HR):5.15×10−5(6.13×10−8−0.043);P<0.01].Receiver-operating characteristic(ROC)curve analysis demonstrated that the optimal cut-off value of the QFR immediately after PCI for predicting the long-term TVF was 0.925(area under the curve:0.886,95%confidence interval:0.834–0.938;sensitivity:83.40%,specificity:88.00;P<0.01).In addition,QFR≤0.925 post-PCI was strongly correlated with the TVF,including TV-MI and CD-TVR(P<0.01).Conclusion The QFR immediately after PCI showed a high predictive value of TVF after a long-term follow-up in ISR patients who underwent DCB angioplasty.A lower QFR immediately after PCI was associated with a worse TVF outcome.
基金supported by grants from National Key R&D Program of China (2016YFC1300304)
文摘Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.
文摘New non-and less-invasive techniques have been developed to overcome the procedural and operator related burden of the fractional flow reserve(FFR)for the assessment of potentially significant stenosis in the coronary arteries.Virtual FFR-techniques can obviate the need for the additional flow or pressure wires as used for FFR measurements.This review provides an overview of the developments and validation of the virtual FFR-algorithms,states the challenges,discusses the upcoming clinical trials,and postulates the future role of virtual FFR in the clinical practice.
文摘Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact.Fractional flow reserve(FFR)received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis.FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy,deferring unnecessary procedures for lesions with a FFR>0.8,improving patients'management and clinical outcome.Post intervention,an optimal FFR>0.9 post stenting should be reached and>0.8 post drug eluting balloons.Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89.They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated.FFR remains the gold standard reference for invasive assessment of ischemia.We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio.We conclude introducing a hybrid approach to intermediate lesions(DFR 0.85-0.95)potentially maximizing clinical decision from all measurements.
