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coronary physiology assessment in the catheterization laboratory

World Journal of Cardiology 2015年第9期7卷 525-538页

作者： Felipe Díez-delhoyo Enrique Gutiérrez-Ibanes Gerard Loughlin Ricardo Sanz-Ruiz María Eugenia Vázquez-álvarez Fernando Sarnago-Cebada Rocío Angulo-Llanos Ana Casado-Plasencia Jaime Elízaga Francisco Fernández Avilés Diáz Instituto de Investigación Sanitaria Gregorio Maranón Servicio de CardiologíaDepartamento de MedicinaUniversidad Complutense de Madrid

Physicians cannot rely solely on the angiographic appearance of epicardial coronary artery stenosis when evaluating patients with myocardial ischemia. Instead, sound knowledge of coronary vascular physiology and of the methods currently available for its characterization can improve the diagnostic and prognostic accuracy of invasive assessment of the coronary circulation, and help improve clinical decision-making. In this article we summarize the current methods available for a thorough assessment of coronary physiology.

关键词： coronary heart disease coronary physiology Endothelial dysfunction Microvascular dysfunction Fractional flow reserve coronary flow reserve Index of microcirculatory resistance

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coronary physiology in the Management of CAD Patients: Position Paper Regarding the Current Scenario in India

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World Journal of Cardiovascular Diseases 2023年第11期13卷 795-810页

作者： Sridhar Kasturi Ramneek Kaur Manish Narang Surinder Kher Department of Cardiology Sunshine Heart Institute Secunderabad Hyderabad India Department of Medical Affairs Abbott Vascular Abbott Healthcare Pvt Ltd. Delhi India Asia Pacific & Japan Department of Medical Affairs Abbott Vascular Abbott Healthcare Pvt Ltd. Delhi India Independent Clinical Research Professional Bangalore India

Fractional flow reserve (FFR), a physiology-based diagnostic method, has emerged as an important decision-making tool in determining the borderline or intermediate coronary lesions requiring revascularization. As per the guidelines recommended by European and American cardiology associations, functional assessment of indeterminate lesions is to be considered strongly prior to PCI. However, in India, FFR continues to be a much-underutilized tool due to limited facilities, and many times, physicians are reluctant to advise FFR because of its time-consuming nature with additional cost implications of simple diagnostic tests. Notably, for stenoses ranging between 50% - 70% where the choice between revascularization and medication becomes ambiguous, FFR provides invaluable insight. Without such guidance, there is a risk of improper decisions and strategies while planning revascularization procedures, which might adversely influence clinical outcomes, escalation of the cost due to unnecessary procedures, and prolonged hospitalization as a result of simple vs complex procedures. Landmark studies have validated the efficacy of FFR in enhancing outcomes in coronary artery disease (CAD) patients, especially when paired with a coronary angiogram. This combination provides robust evidence of the functional significance of stenosis in stable CAD. Additionally, non-hyperemic pressure ratio indices correlate well with conventional FFR. Hence, adopting FFR-guided management can have transformative effects on the clinical and economic facets of treating severe CAD with intermediary lesions in Indian settings.

关键词： coronary physiology Fractional Flow Reserve Percutaneous coronary Intervention Revascularization

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Usefulness of Fractional Flow Reserve during Routine Clinical Procedures in All-Comer coronary Artery Disease Patients

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World Journal of Cardiovascular Diseases 2021年第11期11卷 509-522页

作者： Sridhar Kasturi Shailender Singh Vijay Kumar Reddy Shanivaram Manikandhar Pendyala Chandrashekar Challa Department of Cardiology Sunshine Heart Institute Secunderabad Hyderabad Telangana

Background: Fractional flow reserve (FFR)-guided interventions, though proved to be safe, continue to be a much-underutilized modality in determining treatment strategy, and data is lacking in Indian population. Objective: We aimed to determine the use of FFR-guided PCI and assess the overall impact on treatment decisions and clinical outcomes in patients with acute coronary syndrome (ACS) or chronic coronary syndromes (CCS). Methods: In this single-center retrospective and prospective observational study, FFR had been performed for the evaluation of treatment reclassification and clinical outcomes, as per physician’s clinical practice. Results: Data was obtained for 250 subjects (mean age 60.45 ± 9.6 years) with 324 lesions. The treatment plan based on angiography alone changed in 28% of lesions post-hyperemic FFR. The initial treatment plan based on angiography vs. the final treatment plan post-FFR (>0.80) was medical management 56.5% vs. 66.0%;CABG 11.1% vs. 7.7%;and PCI 32.4% vs. 26.2%. In subjects initially assigned to medical management, 14% had changed to PCI, and for subjects initially assigned to PCI, 44% had changed to medical therapy. Receiver operating characteristics (ROC) curve analysis revealed a good correlation between a resting FFR value of <0.87 and hyperemic FFR value of <0.80. T

关键词： Angiogram Fractional Flow Reserve Percutaneous coronary Intervention coronary physiology

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