Diagnostic performance of intracoronary optical coherence tomography-based versus angiography-based fractional flow reserve for the evaluation of coronary lesions.
- 作者列表："Huang J","Emori H","Ding D","Kubo T","Yu W","Huang P","Zhang S","Gutiérrez-Chico JL","Akasaka T","Wijns W","Tu S
AIMS:The aim of this study was to evaluate the diagnostic performance of OCT-based optical flow ratio (OFR) in unselected patients and compare it with angiography-based quantitative flow ratio (QFR), using wire-based FFR as reference standard. METHODS AND RESULTS:All patients with OCT and FFR assessment prior to revascularisation were analysed. OFR and QFR were computed in a blinded fashion and compared with FFR, applying the same cut-off value of ≤0.80 to all to define ischaemia. Paired comparison between OFR and QFR was performed in 212 vessels from 181 patients. Average FFR was 0.82±0.10 and 40.1% of vessels had an FFR ≤0.80. OFR showed a significantly better correlation and agreement with FFR than QFR (r=0.87 versus 0.77, p<0.001; SD of the difference=0.05 versus 0.07, p<0.001). The AUC was 0.97 for OFR, higher than for QFR (difference=0.05, p=0.017), and much higher than the minimal lumen area (difference=0.15, p<0.001) and diameter stenosis (difference=0.17, p<0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for OFR to identify FFR ≤0.80 were 92%, 86%, 95%, 92%, 91%, 18.2 and 0.2, respectively. The diagnostic accuracy of OFR was not significantly different in MI-related vessels (95% versus 90%, p=0.456), or in vessels with and without previously implanted stents (90% versus 93%, p=0.669). CONCLUSIONS:OFR had an excellent agreement with FFR in consecutive patients with coronary artery disease. OFR was superior to QFR, and much better than conventional morphological parameters in determining physiological significance of coronary stenosis. The diagnostic performance of OFR was not influenced by the presence of prior myocardial infarction or implanted stents.
目的: 本研究的目的是评估基于OCT的光流比 (OFR) 在未经选择的患者中的诊断性能，并将其与基于血管造影的定量流量比 (QFR) 进行比较，使用基于导线的FFR作为参考标准。 方法和结果: 分析所有在血运重建前进行OCT和FFR评估的患者。以盲法计算OFR和QFR，并与FFR进行比较，对all应用 ≤ 0.80的相同截止值来定义缺血.在来自212名患者的181个血管中进行OFR和QFR之间的配对比较。平均FFR为0.82 ± 0.10，40.1% 的血管FFR ≤ 0.80。与QFR相比，OFR显示出显著更好的相关性和与FFR的一致性 (r = 0.87对0.77，p<0.001; 差异的SD = 0.05对0.07，p<0.001)。OFR的AUC为0.97，高于QFR (差异 = 0.05，p = 0.017)，远高于最小管腔面积 (差异 = 0.15，p<0.001) 和直径狭窄 (差异 = 0.17，p<0.001)。OFR鉴别FFR ≤ 0.80的诊断准确率、灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比分别为92% 、86% 、95% 、92% 、91% 、18.2和0.2。OFR的诊断准确性在MI相关血管 (95% 对90%，p = 0.456) 或有或没有先前植入支架的血管 (90% 对93%，p = 0.669) 中没有显著差异。 结论: 在连续的冠心病患者中，OFR与FFR具有极好的一致性。OFR优于QFR，在确定冠状动脉狭窄的生理意义方面明显优于常规形态学参数。OFR的诊断性能不受既往心肌梗死或植入支架的影响。
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.