Physiology and Intravascular Imaging Coregistration —Best of all Worlds?
Percutaneous coronary intervention is increasingly guided by coronary physiology and optimized using intravascular imaging. Pressure-based measurements determine the significance of a stenosis using hyperemic or nonhyperemic pressure ratios (eg, the instantaneous wave-free ratio). Intravascular ultrasound and optical coherence tomography provide cross-sectional and longitudinal detail regarding plaque composition and vessel characteristics. These facilitate lesion preparation and optimization of stent sizing and positioning. This review explores the evidence-base and practical aspects of coregistering pressure gradient ass...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Tobin Joseph, Michael Foley, Rasha Al-Lamee Source Type: research
Physiologic Assessment After Percutaneous Coronary Interventions and Functionally Optimized Revascularization
Coronary physiologic assessment has become a standard of care for patients with coronary atherosclerotic disease. While most attention has focused on pre-interventional physiologic assessment to aid in revascularization decision-making, post-interventional physiologic assessment has not been as widely used, despite evidence supporting its role in assessment and optimization of the revascularization procedure. A thorough understanding of such evidence and ongoing studies would be crucial to incorporate post-interventional physiologic assessment into daily practice. Thus, this review provides a comprehensive overview of curr...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Doosup Shin, Seung Hun Lee, David Hong, Ki Hong Choi, Joo Myung Lee Source Type: research
Using Physiology Pullback for Percutaneous Coronary Intervention Guidance
This article describes the use and techniques needed to understand coronary physiology pullback data and how use it to make revascularization decisions. The article describes instantaneous wave-free ratio, fractional flow reserve, and the data that support their use and how they differ when used in tandem disease. Common practical mistakes and errors are discussed together with a brief review of the limited published research data. (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Sukhjinder Singh Nijjer Source Type: research
What About All the Recent “Negative” FFR Trials?
During the past 30 years, fractional flow reserve (FFR) has moved from animal models to class IA recommendations in guidelines. However, the FLOWER-MI, RIPCORD-2, FUTURE, and FAME 3 trials in 2021 were “negative”—has FFR exceeded its expiration date? We critically examine these randomized trials in order to dr aw insights not just about FFR but also about study design and interpretation. Are all randomized trials created equal? No, rather we must focus on discordant decisions between angiography and FFR and highlight clinical endpoints that can be improved by percutaneous coronary intervention instead of medical th...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Nils P. Johnson Source Type: research
Is Coronary Physiology Assessment Valid in Special Circumstances?
Fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs) provide an important clinical tool to evaluate the hemodynamic significance of coronary lesions. However, these indices have major limitations. As these indices are meant to be surrogates of coronary flow, clinical scenarios such as aortic stenosis (with increased end-systolic and end-diastolic pressures) or atrial fibrillation (with significant beat-to-beat cardiac output variability) can have significant effect on the accuracy and reliability of these hemodynamic indices. Here, we provide a comprehensive evaluation of the pitfalls, limitations, and st...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: David M. Tehrani, Arnold H. Seto Source Type: research
Nonhyperemic Pressure Ratios —All the Same or Nuanced Differences?
Fractional flow reserve (FFR) has become the gold standard for invasively assessing the functional significance of coronary artery disease (CAD) to guide revascularization. The amount of evidence supporting the role of FFR in the cardiac catheterization laboratory is large and still growing. However, FFR uptake in the daily practice is limited by a variety of factors such as invasive instrumentation of the coronary artery that requires extra time and need for vasodilator medications for hyperemia. In this review, we describe the details of wire-based alternatives to FFR, providing insights as to their development, clinical...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Samineh Sehatbakhsh, Weijia Li, Tatsunori Takahashi, Kayo Takahashi, Manish A. Parikh, Yuhei Kobayashi Source Type: research
Understanding the Basis for Hyperemic and Nonhyperemic Coronary Pressure Assessment
Despite the now routine integration of invasive physiologic systems into coronary catheter laboratories worldwide, it remains critical that all operators maintain a sound understanding of the fundamental physiologic basis for coronary pressure assessment. More specifically, performing operators should be well informed regarding the basis for hyperemic (ie, fractional flow reserve) and nonhyperemic (ie, instantaneous wave-free ratio and other nonhyperemic pressure ratio) coronary pressure assessment. In this article, we provide readers a comprehensive history charting the inception, development, and validation of hyperemic ...
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Samer Fawaz, Christopher M. Cook Source Type: research
Coronary Physiology In Contemporary Clinical Practice
CARDIOLOGY CLINICS (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Authors: Allen Jeremias Source Type: research
Copyright
ELSEVIER (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Source Type: research
Contributors
JAMIL A. ABOULHOSN, MD, FACC, FSCAI (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Source Type: research
Contents
Allen Jeremias (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Source Type: research
Forthcoming Issues
Cardiac Emergencies (Source: Cardiology Clinics)
Source: Cardiology Clinics - November 9, 2023 Category: Cardiology Source Type: research
Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter?
The conventional sequence of guideline-directed medical therapy (GDMT) initiation in heart failure with reduced ejection fraction (HFrEF) assumes that the effectiveness and tolerability of GDMT agents mirror their order of discovery, which is not true. In this review, the authors discuss flexible GDMT sequencing that should be permitted in special populations, such as patients with bradycardia, chronic kidney disease, or atrial fibrillation. Moreover, the initiation of certain GDMT medications may enable tolerance of other GDMT medications. Most importantly, the achievement of partial doses of all four pillars of GDMT is b...
Source: Cardiology Clinics - September 23, 2023 Category: Cardiology Authors: Jiun-Ruey Hu, Alexandra N. Schwann, Jia Wei Tan, Abdulelah Nuqali, Ralph J. Riello, Michael H. Beasley Source Type: research
Turning Heart Failure into Heart Success
Cardiovascular disease has remained a leading cause of demise for both sexes. Clinicians have been able to delay the onset of disease and help people live longer. However, longevity has come with an increasing population of heart failure (HF) patients. Luckily, an expanding set of tools has allowed us to manage these patients through different stages of HF. But our challenges extend beyond methods of treatment, and a humanistic approach is required to address the whole problem, not just the pathophysiology of the disease. (Source: Cardiology Clinics)
Source: Cardiology Clinics - September 23, 2023 Category: Cardiology Authors: Asad Ghafoor Tags: Preface Source Type: research
Heart Failure with Reduced Ejection Fraction
CARDIOLOGY CLINICS (Source: Cardiology Clinics)
Source: Cardiology Clinics - September 23, 2023 Category: Cardiology Authors: Asad Ghafoor Source Type: research
