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fractional flow reserve measured via left internal mammary artery after coronary artery bypass grafting:Two case reports

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World Journal of Clinical Cases 2023年第13期11卷 3045-3051页

作者： Li-Ying Zhang Yi-Rong Gan Yan-Zhen Wang Ding-Xiong Xie Zong-Ke Kou Xiao-Qing Kou Yun-Long Zhang Bing Li Rui Mao Tian-Xiang Liang Jing Xie Jian-Jian Jin Jin-Mei Yang Gansu Institute of Cardiovascular Diseases Lanzhou 730050Gansu ProvinceChina Provincial Level Key Laboratory for Molecular Medicine of Major Diseases and Prevention and Treatment with Traditional Chinese Medicine Research in Gansu Colleges and Universities Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina Department of Functional Lanzhou First People’s HospitalLanzhou 730050Gansu ProvinceChina Department of Cardiology The First Hospital of Lanzhou UniversityLanzhou 730000Gansu ProvinceChina

BACKGROUND The fractional flow reserve(FFR)has made the treatment of coronary heart disease more ***,there are few reports on the measurement of FFR via the left internal mammary artery(LIMA).Herein,we described the determination of further treatments by measuring FFR via the LIMA in 2 cases after coronary artery bypass grafting(CABG).CASE SUMMARY Case 1 was a 66-year-old male who was admitted due to“chest tightness after CABG.”The patient underwent CABG 7 years prior due to coronary heart *** artery angiography showed complete occlusion of the left anterior descending artery(LAD),and subtotal occlusion of the third segment of the right coronary *** arterial angiography,there was 85%stenosis at the distal end of the anastomosis of the LIMA-LAD *** via LIMA was determined at ***,balloon dilation was performed in Case *** after balloon dilation was *** 2 was a 60-year-old male who was admitted due to“chest tightness after CABG.”The patient underwent CABG 6 years prior due to coronary heart *** was 60%segmental stenosis in the middle segment of LAD and 75%anastomotic *** measured via LIMA was 0.83(negative);thus the intervention was not *** 2 was given drug *** the 3-mo follow-up,there was no recurrence of chest tightness or shortness of breath in both *** are currently under continual *** We provided evidence that FFR measurement via grafted blood vessels,especially LIMA,after CABG is a good method to determine the intervention course.

关键词： Left internal mammary artery fractional flow reserve Coronary artery bypass Intervention Case report

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Clinical applications of fractional flow reserve in bifurcation lesions

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Journal of Geriatric Cardiology 2012年第3期9卷 278-284页

作者： Sang Hyun Park Bon-Kwon Koo Seoul National University College of Medicine I O1 Daehang-ro Chongno-gu Seoul 110-744 South Korea

Pereutaneous coronary intervention （PCI） for coronary bifurcation lesions has been associated with lower procedural success rates and worse clinical outcomes compared with PCI for simple coronary lesions. Angiographic evaluation alone is sometimes inaccurate and does not reflect the fimctional significance of bifurcation lesions. The fractional flow reserve （FFR） is an easily obtainable, reliable, and reproducible physiologic parameter. This parameter is epicardial lesion specific and reflects both degree of stenosis and the myocardial territory supplied by the specific artery. Recent studies have shown that FFR-guided provisional side branch intervention strategy for bifurcation lesions is feasible and effective and can reduce unnecessary complex interventions and related complications. However, an adequate understanding of coronary physiology and the pitfalls of FFR is essential to properly use FFR for PCI of complex bifurcation lesions.

关键词： Coronary stenosis Bifurcation lesion Physiology fractional flow reserve

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fractional flow reserve： From Homeland to Colony

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Chinese Medical Journal 2016年第1期129卷 101-104页

作者： Guo-Xin Fan Jia-Chen Luo Zhi Zhou Yue-Ye Wang Ji-Kun Wang Department of Orthopedics Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai 200072 China Department of Cardiology Shanghai Tenth People's Hospital Tongji University School of Medicine Shanghai 200072 China Department of Applied Psychology Key Laboratory of Brain Functional Genomics Ministry of Education Shanghai Key Laboratory of Brain Functional Genomics School of Psychology and Cognitive Science East China Normal University Shanghai 200062 China

In current catheter research, there are 3 main directions with respect to fractional flow reserve （FFR）, including instantaneous wave-tree ratio, noninvasive measurement of FFR, and FFR transferred from coronary circulation to other ischemia-inducing circulation. Recently, an interesting study was published, in which FFR was performed to diagnose and guide stenting in chronic mesenteric ischemia （CMI）. We herein highlighted, the implications and limitations of FFR from coronary artery to renal artery and mesenteric artery for future investigations, respectively.

关键词： Chronic Mesenteric Ischemia Coronary Artery Disease fractional flow reserve Renal Artery Stenosis

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fractional flow reserve Guided Percutaneous Coronary ntervention Improves Clinical Outcome with Reduced Cost in Contemporary Clinical Practice

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Chinese Medical Journal 2015年第15期128卷 2000-2005页

作者： Po Hu Meng-Yao Tang Wen-Chao Song Jun Jiang Yong Sun Xian-Bao Liu Chang-Ling Li Xin-Yang Hu Jian-An Wang Department of Cardiology Second Affiliated Hospital College of Medicine Zhejiang University Hangzhou Zhejiang 310009 China Key Laboratory for Diagnosis and Treatment of Cardiovascular Disease of Zhejiang Province Second Affiliated Hospital School of Medicine Zhejiang University Hangzhou Zhejiang 310009 China

Background：fractional flow reserve （FFR） is currently considered as the gold standard for evaluating the functional significance of coronary ***,its potential benefits in real-world practice remain unknown in *** study aimed to test the hypothesis that the use of FFR is associated with improved outcome and reduced cost in Chinese real-world clinical ***：A retrospective cohort study was carried out using the database of Second Affiliated Hospital of Zhejiang University,a tertiary and high-volume center in *** events were compared using the Cox proportional hazards model during a median follow-up of 13 ***：The study cohort consisted of 366 consecutive patients referred for coronary revascularization with adjunct FFR and 366 matched controls,from 2010 to *** adverse cardiac events （MACEs）（death,myocardial infarction,repeated revascularization,or hospitalization for angina） at 4 years were found in 12.0% ofangiography-guided patients and 4.9% in the FFR-guided group （P 〈 0.001）.The mean number of implanted stents was significantly lower in FFR treated subjects （0.52 ± 0.82 stents） compared with the angiography-guided group （0.93 ± 0.96 stents）（P 〈 0.001）.No difference in overall costs at initial hospitalization was observed between angiography-guided percutaneous coronary intervention （PCI） compared with FFR-guided PCI （RMB 33,000 Yuan,range：RMB 7393-44,700 Yuan） versus RMB 21,200 Yuan （RMB 19,100-47,100 Yuan）（P =0.54）.However,costs for MACEs during follow-up were significantly reduced in the FFR-guided arm （P 〈 0.001）.Conclusions：In the contemporary clinical practice,FFR-guided PCI is associated with decreased use of stents,improved clinical outcome,and reduced costs,compared with angiography-guided PCI.

关键词： Costs and Cost Analysis fractional flow reserve Myocardial Percutaneous Coronary Intervention Prognosis

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Non-invasive Angiographic-based fractional flow reserve:Technical Development,Clinical Implications,and Future Perspectives

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Current Medical Science 2023年第3期43卷 423-433页

作者： Joyce Peper Michiel L.Bots Tim Leiner Martin J.Swaans Department of Cardiology St.Antonius HospitalNieuwegein 3435 CMThe Netherlands Department of Radiology University Medical Center UtrechtUtrecht 3508 GAThe Netherlands Julius Center for Health Sciences and Primary Care University Medical Center UtrechtUtrecht 3584 CGThe Netherlands

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 *** FFR-techniques can obviate the need for the additional flow or pressure wires as used for FFR *** 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.

关键词： coronary artery disease quantitative flow ratio fractional flow reserve diagnostic accuracy physiology guided percutaneous coronary intervention

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Role of fractional flow reserve in guiding intervention for borderline coronary lesions

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Family Medicine and Community Health 2014年第3期2卷 18-25页

作者： Xuekun Shi Lu Cheng Affiliated Hospital of Traditional Chinese Medicine XinJiang Medical UniversityXinJiang 830000China

Objective:This study investigated the clinical efficacy and value of fractional flow reserve(FFR)in guiding the treatment of borderline coronary ***:Forty-three patients with borderline coronary lesions,as demonstrated by coronary angiography,and who had FFR measurements were *** patients were grouped accord-ing to FFR *** patients were evaluated 6 months after surgery to record major adverse cardiac events(MACE[sudden cardiac death,non-fatal myocardial infarction,or revasculariza-tion])and recurrence of angina ***:After the 6-month follow-up,no sudden cardiac deaths or myocardial infarctions occurred in either group,and there were no statistically significant differences(P>0.05).Inter-group comparisons showed that in the groups with a FFR0.05).The recurrence rate of angina pectoris in the simple drug therapy group among the groups with a FFR<0.75 was higher than the same groups with a FFR≥0.75(0.27%vs.0.05%,P<0.05).Conclusion:When coronary intervention is used to treat borderline lesions,guiding inter-ventional therapy with measurement of FFR does not increase the incidence of adverse cardiovas-cular events in the short term and can better guide PCI therapy.

关键词： Coronary intervention Borderline lesion fractional flow reserve

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Modes of failure with fractional flow reserve guidewires:Insights from the manufacturer and user facility device experience database

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World Journal of Cardiology 2021年第7期13卷 223-229页

作者： Nauman Khalid Yagya Pandey Umair Khalid Hassan Kamran Jason P Wermers Lovely Chhabra Mahboob Alam Hani Jneid Waleed Tallat Kayani Department of Interventional Cardiology St.Francis Medical CenterMonroeLA 71201United States Department of Internal Medicine Baylor College of MedicineHoustonTX 77030United States Department of Interventional Cardiology Michael E.DeBakey VA Medical CenterHoustonTX 77030United States Department of Interventional Cardiology Baylor College of MedicineHoustonTX 77030United States Health Sciences University of Maryland Graduate SchoolBaltimoreMD 21201United States

BACKGROUND fractional flow reserve(FFR)measurement is commonly used in the cardiac catheterization laboratory to assess the functional significance of coronary arterial *** real-world data on complications and modes of failure of FFR guidewires are *** To characterize these outcomes by analyzing the post-marketing surveillance data from the United States Food and Drug Administration Manufacturer and User Facility Device Experience(MAUDE)database for commonly used FFR *** The MAUDE database was queried from January 2010 through April 2020 for 3 FFR guidewires[PressureWireTM X(Abbott),CometTM(Boston Scientific),and VerrataTM(Philips)]by searching for the following events:“Injury”,“malfunction”,“death”,and“other”.This yielded 544 *** excluding incomplete reports,486 reports were *** Guidewire tip fracture was the most commonly reported mode of failure,in 174(35.8%)cases followed by guidewire kinking(n=152,31.3%),communication failure(n=141,29.0%),and shaft fracture(n=67,13.8%).In total,133(27.4%)device failures resulted in patient adverse *** most common adverse event was retained guidewire tip,in 71(53.4%)cases,followed by freshly deployed stent dislodgment(n=26,19.6%)and coronary artery dissection(n=23,17.3%).Seven deaths were *** FFR guidewire failures can occur because of various mechanisms and cause patient adverse *** MAUDE database serves as an important platform for improved collaboration among clinicians,device manufacturers,and regulators to improve device performance and optimize patient *** analysis provides mechanistic insights of FFR guidewire failure and associated adverse events but cannot verify causality or provide a comparison among different guidewires.

关键词： fractional flow reserve Coronary guidewire Adverse events Modes of failure Food and Drug Administration Manufacturer and user facility device experience

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Comparative efficacy and safety of adenosine and regadenoson for assessment of fractional flow reserve:A systematic review and meta-analysis

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World Journal of Cardiology 2022年第5期14卷 319-328页

作者： Gauravpal Singh Gill Akshaya Gadre Arun Kanmanthareddy Cardiovascular Medicine Creighton University School of MedicineOmahaNE 68124United States Internal Medicine Western Michigan University Homer Stryker MD School of MedicineKalamazooMI 49007United States

BACKGROUND Adenosine is a coronary hyperemic agent used to measure invasive fractional flow reserve(FFR)of intermediate severity coronary *** To compare FFR assessment using adenosine with an alternate hyperemic agent,*** PubMed,Google Scholar,CINAHL and Cochrane databases were queried for studies comparing adenosine and regadenoson for assessment of *** on FFR,correlation coefficient and adverse events from the selected studies were extracted and analyzed by means of random effects *** tailed P-value less than 0.05 was considered *** was assessed using I2 *** Five studies with 248 patients were included in the final *** included patients and coronary lesions underwent FFR assessment using both adenosine and *** was no significant mean difference between FFR measurement by the two agents[odds ratio(OR)=-0.00;95%confidence interval(CI):(-0.02)-0.01,P=0.88].The cumulative correlation coefficient was 0.98(0.96-0.99,P<0.01).Three of five studies reported time to FFR with cumulative results favoring regadenoson(mean difference 34.31 s;25.14-43.48 s,P<0.01).Risk of adverse events was higher with adenosine compared to regadenoson(OR=2.39;95%CI:1.22-4.67,P=0.01),which most commonly included bradycardia and *** majority of the adverse events associated with both agents were *** The performance of regadenoson in inducing maximal hyperemia was comparable to that of *** was excellent correlation between the FFR measurements by both the *** use of adenosine,was however associated with higher risk of adverse events and longer time to FFR compared to regadenoson.

关键词： Adenosine Regadenoson fractional flow reserve Meta-analysis

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Current status of assessment of fractional flow reserve

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Chinese Medical Journal 2009年第6期122卷 725-731页

作者： FANG Yi-min Grisana Grootenhuijs-Triyasut Pieter A. Doevendans Yolande Appelman Department of Cardiology Affiliated Yantai Yuhuangding Hospital of Medical College Qingdao University Yantai Shandong 264000 China Radi Medical Systems BV Eindhoven The Netherlands epartmentof Cardiology Utrecht University Hospital Utrecht The Netherlands Department of Cardiology VU University Medical Center Amsterdam The Netherlands

Coronary angiography presently remains the main method tor the diagnosis and instruction of epicardial coronary disease. However, precise characterization of the significance for any given stenosis is limited by the inability to identify intermediate coronary lesions responsible for ischemia. In clinical practice, in addition to the assessment of the anatomical details of vessel narrowing, a more impediment to coronary precise assessment of the blood flow has become extremely important. At present, several physiological parameters have been introduced to improve discrimination in functional coronary lesion severity during cardiac catheterization. Of these parameters, myocardial fractional flow reserve （FFR） has been the most frequently used and is being increasingly applied to assess the functional significance of intermediate lesions. FFR can provide important information, both for decision making in diagnostic angiography and for monitoring and evaluating coronary interventions.

关键词： coronary angiography fractional flow reserve stent adenosine

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Hemodynamic changes of fractional flow reserve after double kissing crush and provisional stenting technique for true bifurcation lesions

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Chinese Medical Journal 2012年第15期125卷 2658-2662页

作者： YE Fei CHEN Shao-liang ZHANG Jun-jie ZHU Zhong-sheng KAN Jing TIAN Nai-liang LIN Song LIU Zhi-zhong YOU Wei XU Hai-mei XU Jing Department of Cardiology Nanjing First Hospital of NanjingMedical University Nanjing Jiangsu 210006 China

Background fractional flow reserve （FFR）-guided percutaneous coronary intervention （PCI） is associated with fewer unfavorable events. However, the hemodynamic change in FFR after different stenting approaches for bifurcation lesions is still not fully studied. The aim of this study was to analyze the hemodynamic changes in FFR after double kissing （DK） crush and provisional side branch （SB） stenting （PS） for true coronary bifurcation lesions. Methods Seventy-five patients with true bifurcated lesions were randomly divided into DK （n=38） and PS （n=37） groups. Additional SB stenting in the PS group was required if there was any pinched SB ostium 〉70% stenosis, or ≥ type B dissection, or TIMI flow 〈grade 3. FFR at hyperemia in the main vessel （MV） and SB was measured prior- and post-stenting, and at 8 months follow-up. Results Baseline clinical, angiographic and lesion characteristics were matched well between the two groups, with the exception of the final kissing balloon inflation （FKBI, 100.0% in the DK vs. 83.8% in the PS group, P 〈0.001）. Baseline FFR was comparable between the DK and the PS groups, however, the acute gain and late loss of SB FFR at 8-month follow-up in the DK group were 0.18±0.15 and -0.06±0.11, compared to 0.12±0.18 （P=0.044） and -0.002±0.07 （P=-0.037） in the PS group, respectively. MV FFR post-stenting 〉0.94 was seen in about 40% of patients. There was no significant difference in the clinical events at 1-year follow-up between the two groups. Conclusions DK crush was associated with improved acute gain and late loss of SB FFR. The lower rate of FFR 〉0.94 after stenting underscored the further improvement of stentinq quality.

关键词： double kissing crush bifurcation, provisional fractional flow reserve

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