Validation of a three-dimensional quantitative coronary angiography-based software to calculate fractional flow reserve: the FAST study.
- 作者列表："Masdjedi K","van Zandvoort LJC","Balbi MM","Gijsen FJH","Ligthart JMR","Rutten MCM","Lemmert ME","Wilschut JM","Diletti R","de Jaegere P","Zijlstra F","Van Mieghem NM","Daemen J
AIMS:The aim of this study was to validate novel software to calculate vessel fractional flow reserve (vFFR) based on 3D-QCA and to assess inter-observer variability in patients who underwent routine preprocedural FFR assessment for intermediate coronary artery stenosis. METHODS AND RESULTS:In vitro validation was performed in an experimental model. Clinical validation was performed in an observational, retrospective, single-centre cohort study. A total of 100 patients presenting with stable angina or non-ST-segment elevation myocardial infarction and an indication to perform FFR between January 2016 and October 2016 were included. vFFR was calculated based on the aortic root pressure along with two angiographic projections and validated against pressure wire-derived FFR. Mean FFR and vFFR were 0.82±0.08 and 0.84±0.07, respectively. A good linear correlation was found between FFR and vFFR (r=0.89; p<0.001). Assessment of vFFR had a low inter-observer variability (r=0.95; p<0.001). The diagnostic accuracy of vFFR in identifying lesions with an FFR ≤0.80 was higher as compared with 3D-QCA: AUC 0.93 (95% CI: 0.88-0.97) vs 0.66 (95% CI: 0.55-0.77), respectively. CONCLUSIONS:The 3D-QCA-derived vFFR has a high linear correlation to invasively measured FFR, a high diagnostic accuracy to detect FFR ≤0.80 and a low inter-observer variability.
目的: 本研究的目的是验证基于3D-QCA计算血管血流储备分数 (vFFR) 的新型软件，并评估接受中间冠状动脉狭窄常规术前FFR评估的患者的观察者间变异性。 方法和结果: 在实验模型中进行体外验证。在观察性、回顾性、单中心队列研究中进行临床验证。纳入2016年1月至2016年10月期间出现稳定型心绞痛或非ST段抬高型心肌梗死且有行FFR指征的患者共100例。基于主动脉根部压力以及两个血管造影投影计算vFFR，并针对压力线衍生的FFR进行验证。平均FFR和vFFR分别为0.82 ± 0.08和0.84 ± 0.07。发现FFR和vFFR之间具有良好的线性相关性 (r = 0.89; p<0.001)。vFFR的评估具有较低的观察者间变异性 (r = 0.95; p<0.001)。与3D-QCA相比，vFFR在识别FFR ≤ 0.80的病变方面的诊断准确性更高: AUC分别为0.93 (95% CI: 0.88-0.97) 和0.66 (95% CI: 0.55-0.77)。 结论: 3d-qca衍生的vFFR与侵入性测量的FFR具有高线性相关性，检测FFR ≤ 0.80的诊断准确性高，观察者间变异性低。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.