Standardization of Fractional Flow Reserve Measurements Toth, Gabor G., MD; Johnson, Nils P., MD; Jeremias, Allen, MD, MSc ...
Journal of the American College of Cardiology,
08/2016, Letnik:
68, Številka:
7
Journal Article
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Abstract Pressure wire–based fractional flow reserve is considered the standard of reference for evaluation of the ischemic potential of coronary stenoses and the expected benefit from ...revascularization. Accordingly, its application in daily practice or for research purposes has to be as standardized as possible to avoid technical or operator-related artifacts in pressure recordings. This document proposes a standardized way of acquiring, recording, interpreting, and archiving the pressure tracings for daily practice and for the purpose of clinical research involving a core laboratory. Proposed standardized steps enhance the uniformity of clinical practices and data interpretation.
Over the last 15 years, the use of invasive coronary physiology in the catheterization laboratory has demonstrated favorable outcomes for decision making in patients with intermediate single-vessel ...stenoses, complex bifurcation and ostial branch stenoses, multivessel coronary artery disease, and left main stenoses. A recent large multicenter study (FAME FFR versus Angiography for Multivessel Evaluation) found that a physiologically-guided approach was superior to the standard angiographically-guided approach for percutaneous revascularization in patients with multivessel coronary artery disease. This review addresses selected pertinent concepts and studies supporting the integration of coronary physiology in the catheterization laboratory for optimal patient outcomes.
The decision to revascularize by either stenting or CABG is made based on the patient's clinical risk profile and personal preferences, as well as the operator's and surgeon's experiences and ...outcomes. Note: Because there are a number of different CSA left main thresholds for FFR (ranging from 4.8-7.0mm2, which likely represent different heart sizes in different patient populations), I prefer using FFR as the initial assessment tool then use IVUS for stent sizing and appreciating the degree of calcification.
Right ventricular (RV) failure is an increasingly common clinical problem that may require mechanical support. In contrast to severe left ventricular failure, RV failure is typically more reversible. ...Therefore, application of shorter-term percutaneous support devices is potentially attractive. Current innovations promise greater availability of such percutaneous RV support devices. This article considers the available mechanical approaches to provide hemodynamic support to treat profound RV failure in the common clinical scenarios in which percutaneous mechanical RV support may be most beneficial.
Acute Heart Failure Syndromes and Coronary Perfusion Beohar, Nirat, MD, FACC; Erdogan, Ata K., MD; Lee, Daniel C., MD ...
Journal of the American College of Cardiology,
07/2008, Letnik:
52, Številka:
1
Journal Article
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Acute Heart Failure Syndromes and Coronary Perfusion Nirat Beohar, Ata K. Erdogan, Daniel C. Lee, Hani N. Sabbah, Morton J. Kern, John Teerlink, Robert O. Bonow, Mihai Gheorghiade Acute heart failure ...syndromes (AHFS) represent a significant public health burden, with a high post-discharge mortality and rehospitalization rate. A significant number of patients with heart failure have underlying coronary artery disease and may be at greater risk from hemodynamic alterations that can diminish coronary perfusion. In AHFS, the relationship among vasoactive medications, coronary perfusion, and potential myocardial injury needs further investigation. Newer techniques now available to evaluate coronary perfusion should provide guidance for the evaluation of existing and future vasoactive therapies for AHFS.
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