bluuebunny/crossref_metadata_2025_split huggingface dataset:
FFRCT and recurrent symptoms in patients with stable chest pain
Authors: Madsen K T , Noergaard B L , Oevrehus K A , Parner E , Jensen J M , Grove E L , Fairbairn T A , Nieman K , Patel M , Rogers C , Mickley H , Thomsen K K , Boetker H E , Leipsic J , Sand N P R 
Published: October 2022

Abstract

Introduction
The major benefit of coronary revascularization when compared with optimal medical treatment (OMT) in patients with stable chest pain (CP) relates to improvement of symptoms and reduction of reinterventions. Non-invasive methods are warranted to discriminate between patients at low and high risk of recurrent CP for subsequent guidance of antianginal treatment (invasive or OMT).

Purpose
To evaluate the association between coronary CT angiography (CTA) derived fractional flow reserve (FFRCT), recurrent CP and quality of life (QOL) in patients with new onset stable CP and stenosis by CTA.

Methods
Multicenter cohort 3-year follow-up sub-study of 769 patients from the Assessing Diagnostic Value of Non-invasive FFRCT in Coronary Care (ADVANCE) registry at three Danish sites, the “ADVANCE-DK Registry”. All patients had at least one ≥30% coronary stenosis by CTA and underwent subsequent core laboratory FFRCT analysis by HeartFlow. An abnormal FFRCT was defined as the lowest in vessel FFRCT value ≤0.80. Patients were classified according to completeness of revascularization by FFRCT: 1) completely revascularized (CR-FFRCT), all coronary arteries with an abnormal FFRCT test result revascularized; 2) incompletely revascularized (IR-FFRCT), ≥1 coronary artery with an abnormal FFRCT test result not revascularized. All patients completed the Seattle Angina Questionnaire (SAQ-7), the EuroQol questionnaire (EQ-5D-5L) and graded (0–100) overall health using the EQ VAS scale at 3-year follow-up. Recurrent CP was defined as CP within the last 4 weeks prior to this follow-up.

Results
Patient characteristics are given in Table 1. At follow-up 23% patients reported recurrent CP. An abnormal vs a normal FFRCT increased the risk of recurrent CP, 27% vs 15%, RR: 1.82; 95% CI: 1.31–2.52, p&lt;0.001. Amongst patients with abnormal FFRCT, revascularization (+/−) was associated to a numerical, but not statistical significantly, reduced risk of recurrent CP, 23% vs 30%, RR: 0.76; 95% CI: 0.56–1.03, p=0.07. IR-FFRCT vs CR-FFRCT had a higher risk for recurrent CP, 31% vs 13%, RR: 2.34; 95% CI: 1.48–3.68, p&lt;0.001, whilst no difference was observed for CR-FFRCT vs normal FFRCT, 13% vs 15%, RR: 0.92; 95% CI: 0.54–1.54, p=0.74. IR-FFRCT vs CR-FFRCT or normal FFRCT, had lower SAQ-7, EQ-5D-5L and EQ-VAS scores, Table 1, all p&lt;0.005. Scores for three selected SAQ-7 domains are shown in Figure 1. Use of antianginal medicine was higher in IR-FFRCT compared to CR-FFRCT and normal FFRCT, mean ± SD: 1.2±0.05 vs 1.0±0.04, p=0.02.

Conclusion
An abnormal FFRCT identifies patients with an increased risk of recurrent CP up to 3 years after index testing. Completeness of revascularization by FFRCT reclassifies patients with abnormal FFRCT into groups with low and high risk for recurrent CP and impaired QOL.

Funding Acknowledgement
Type of funding sources: None.
Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is associated with cardiac injury and stroke severity in patients after acute ischemic stroke
Authors: Mihalovic M , Mikulenka P , Linkova H , Stetkarova I , Peisker T , Lauer D , Tousek P 
Published: October 2022

Abstract

Background
Patients after acute stroke frequently show signs of myocardial injury. The pathophysiology and impact on patient's outcome are not fully understood. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is cytokine known to be associated with cardiovascular events.

Purpose
We aimed to assess TRAIL level dynamic changes in patients after acute ischemic stroke and its relations to cardiac injury, stroke severity and impact on short-term outcome.

Methods
Between August 2020 and August 2021, 104 consecutive patients after acute ischemic stroke (AIS) were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24- and 48-hours later to determine levels of Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and high-sensitive Troponin I (hs-cTnI). Twelve lead ECG at admission, 24-, 48-hours later and at the release of the patients were obtained. Patients underwent echocardiographic examination within first 5 days of hospitalization, if eligible. National Institutes of Health Stroke Scale (NIHSS) at admission and modified Rankin Scale (mRS) at 90 days following the patient's discharge from the hospital were performed. Chi-square, Fishers exact test and regression analysis were performed to detect differences between variables using SPSS statistics. Results were considered statistically significant at a significance level of p&lt;0.05.

Results
We found significant negative association between TRAIL and NT-proBNP at admission (p=0.039), after 24 (p=0.043) and 48 hours (p=0.023) of hospitalization. There was significant negative association between TRAIL and hs-cTnI at admission (p=0.04). Moreover, we found significant negative association between TRAIL and stroke severity evaluated by NIHSS at admission (p=0.044) and negative association with severe disability or death evaluated by mRS at 90 days both after 24 (p=0.0022) and 48 hours (p=0.044) of hospitalization. In ECG analysis, lower TRAIL levels were associated with the occurrence of premature ventricular extrasystoles (p=0.043), and there was a near statistically significant association with prolonged QTc interval (p=0.07). Two patients presented with new left ventricular regional wall motion abnormality.

Conclusions
Lower TRAIL levels are associated with laboratory markers of cardiac injury, stroke severity and unfavorable functional outcome in patients after acute ischemic stroke.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Charles University Research Program Cooperatio – Cardiovascular sciences
Diagnostic performance of angiography-derived index of microvascular resistance: a systematic review and pooled meta-analysis
Authors: Zhou J , Onuma Y , Kotoku N , Kageyama S , Ninomiya K , Masuda S , Yan H , Serruys P 
Published: October 2022

Abstract

Background
The index of microvascular resistance (IMR) is an established measurement of coronary microcirculation status. However, it has not been widely incorporated into routine practice due to need for intracoronary instrumentation (pressure wire) and hyperaemic agents. Several angiography-derived quantitative flow ratio-based indexes of microvascular resistance (angio-IMR) have been proposed rekindling the interest for the assessment and management of microvascular disease.

Purpose
To review the overall diagnostic accuracy of angio-IMR against wire based IMR.

Methods
A systematic review of the literature was performed and studies comparing angio-IMR with wire based IMR were included. Individual data was extracted using semi-automatic digitalization. Correlation of angio-IMR with IMR and its diagnostic performance against IMR were analysed.

Results
Six studies directly comparing angio-IMR with IMR were included. Data extraction rate was 85.1% (582/684 vessels). There was a linear correlation between angio-IMR and IMR (β=0.483, R square=0.298) (Figure 1A). Pooled sensitivity was 77%, specificity was 66%, positive predictive value was 65%, negative predictive value was 78%, and accuracy was 71.0%. Pooled area under receiver operator curve of angio-IMR for predicting IMR diagnosed coronary microvascular disease was 0.754 (95% confidential interval 0.715 to 0.793) (Figure 1B). Similar diagnostic performance was observed in subgroups of patients with or without ST-segment elevation myocardial infarction.

Conclusions
Currently available angio-IMR showed a clearly useful discrimination and diagnostic performance against the standard of wire based IMR.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): China Scholarship Council
The isovolumetric contraction as marker of ventricular performance in patients with afterload mismatch
Authors: Sinanis T , Markidis E , Mavroudeas S , Sideras E , Vittorakis E 
Published: October 2022

Abstract

Introduction
The gold standard for the evaluation of ventricular function is currently the echocardiographic measured ejection fraction (EF). However, the use of this parameter has limitations, which are more important in populations with afterload mismatch and especially when this mismatch is severe. On the other hand, the assessment of a pump function in fluid dynamics is done using the head pressure, which is product of pressure when the flow is zero. During the cardiac cycle, this situation occurs during the isovolumetric contraction.

Purpose
The aim of this study is to assess the clinical and pathophysiological importance of the isovolumentric contraction in the evaluation of the ventricular performance.

Method
110 patients with severe aortic stenosis and pulmonary arterial hypertension were investigated. The area under the curve (AUC) of the isovolumetric contraction was measured using the pressure curves of the right ventricle-pulmonary artery and left ventricle-aorta ascendens. This AUC was then correlated with the echocardiographic measured ejection fraction (EF), the stroke volume (SV) and the total ventricular work, defined as the product of pressure and flow.

Results
The AUC of the isovolumetric contraction correlates statistically significant with the ejection fraction of the corresponding ventricle (p 0.0001). Both AUC of the isovolumetric contraction and the ejection fraction showed a statistic significance with the total work of the ventricle (AUC with R2 0.49, p 0.0001, EF R2 0.51, p 0.0001). Stroke volume was significant only in the correlation with the ejection fraction. A statistic significant one sample t test could be found for the EF (decreased, p 0.001) and for the AUC of the isovolumetric contraction (increased, p 0.001) but not for the total work of the ventricle.

Conclusion
The AUC of the isovolumetric contraction correlates statistically significant with the ejection fraction and the total ventricular work but not the stroke volume in patients with afterload mismatch. Especially in these populations it demonstrates a significant increase when compared with normal values.

Funding Acknowledgement
Type of funding sources: None.
Improvement in angina pectoris after percutaneous coronary interventions in focal and diffuse coronary artery disease
Authors: Munhoz D , Collet C , Collison D , Mizukami T , McCartney P , Sonck J , Ford T , Berry C , De Bruyne B , Oldroyd K 
Published: October 2022

Abstract

Objective
To investigate the effect of PCI on patient-reported outcomes in focal and diffuse coronary artery disease (CAD) as defined by the pullback pressure gradient (PPG).

Background
Improvements in fractional flow reserve (FFR) following PCI are associated with freedom from angina. CAD patterns influence the FFR change after stenting. Therefore, CAD patterns might be essential to assess the likelihood of PCI success in terms of angina relief.

Methods
This is a sub-analysis of the TARGET-FFR randomized clinical trial (NCT03259815). The 7-item Seattle Angina Questionnaire (SAQ-7) and EuroQol five-level EQ-5D questionnaire (EQ-5D-5L) were administered at baseline and three months after PCI. The PPG index was calculated from manual pre-PCI FFR pullbacks and the median PPG value was used to define focal and diffuse CAD.

Results
103 patients (51 with focal and 52 with diffuse disease) were analyzed. There were no differences in baseline characteristics between patients with focal and diffuse CAD. Patients with focal disease had larger increases in FFR with PCI than those with diffuse disease (0.30±0.14 units vs 0.19±0.12 units, p&lt;0.001). Patients who underwent PCI to focal CAD had significantly higher SAQ-7 summary scores at follow-up compared to those with diffuse CAD (87.1±20.3 vs. 75.6±24.4, mean difference 11.5 [95% CI 2.8 to 20.3], p=0.01). Following PCI, residual angina was present in 39.8% of all patients but was significantly lower among those with treated focal CAD (27.5% vs 51.9%, p-value=0.020).

Conclusion
Persistent angina after PCI was almost twice as common in patients with diffuse CAD as defined by the pre-PCI PPG. Patients with focal disease reported greater improvement in angina and quality of life with PCI. The likelihood of successful angina relief from PCI can be predicted by the baseline pattern of CAD.

Funding Acknowledgement
Type of funding sources: None.
Prognostic role of discordance between plain coronary angiography and quantitative flow ratio in revascularization guidance
Authors: Oikonomou D , Terentes-Printzios D , Gkini K P , Gardikioti V , Aznaouridis K , Dima I , Tsioufis K , Vlachopoulos C 
Published: October 2022

Abstract

Background/Introduction
Percutaneous coronary intervention (PCI) guided by functional coronary stenosis severity has been associated with less clinical adverse events compared with plain coronary angiography. Quantitative flow ratio (QFR) has proven to be a reliable tool for functional assessment of coronary lesions.

Purpose
To investigate the prognostic role and the extend of disagreement between plain coronary angiography and QFR in guiding the decision to treat a coronary lesion.

Methods
We retrospectively performed an offline QFR analysis in consecutive patients who underwent coronary angiography in a single center. Patients with referral for coronary artery bypass graft surgery after coronary angiography were excluded. We aimed to measure QFR in all vessels of each patient. Patients were divided in two groups according to the concordance or discordance of the two methods. Patients with at least one vessel with QFR value ≥0.80 treated with PCI and/or at least one vessel with QFR value &lt;0.80 not treated with PCI were included in the discordance group. The remaining patients formed the concordance group. Primary endpoint was the composite outcome of cardiovascular death, myocardial infraction and ischemia-driven revascularization.

Results
Overall, we included 549 patients in the study. Concordance between plain coronary angiography and QFR was present in 404 (73.6%) patients, while discordance between the two methods was found in 145 patients (26.4%). Baseline patient characteristics are displayed in Figure 1. Patients in the discordance group were older, with more extended coronary artery disease and higher SYNTAX score. After a median follow-up period of 30.5 (26.4–33.7) months, multivariate regression analysis showed significant higher rate of the composite outcome in the discordance group (OR: 2.975 95% CI 1.782–4.967, p&lt;0.001) (Figure 2).

Conclusion
In our study, discordance between plain coronary angiography and QFR in revascularization guidance was present in approximately one fourth of patients and was found to be a strong independent predictor of higher cardiovascular adverse events.

Funding Acknowledgement
Type of funding sources: None.
Diagnostic performance of angiography-derived FFR in patients presenting with NSTE-ACS
Authors: Skalidis I , Meier D , Muller O , Fournier S 
Published: October 2022

Abstract

Background
Precise non-invasive methods to measure fractional flow reserve (FFR) are actively being explored, aiming to avoid the use of invasive pressure wire and the administration of hyperaemic stimulus. Coronary angiography-derived FFR (FFRangio) has already proved its diagnostic performance in validation studies in the context of stable coronary artery disease. However, its applicability in the context of non-ST-segment elevation acute coronary syndromes (NSTE-ACS) has yet to be established.

Purpose
The study sought to determine the diagnostic performance of FFRangio in patients presenting with NSTE-ACS and evaluate if it could serve as a reliable alternative to invasive FFR.

Methods
This study is a prospective, single-center, single-arm, double-blinded clinical study comparing the FFR calculated by FFRangio to invasive FFR and it represents a sub-study of a protocol evaluating the diagnostic performance of FFR-CT in NSTE-ACS patients, whose design and rationale has been previously published. Invasive FFR was measured in all angiographically intermediate lesions (30%-70% stenoses) in NSTE-ACS patients and was then compared to FFRangio which was measured in the same position, by a blinded operator. The study primary endpoints were the per lesion diagnostic characteristics of FFRangio using invasive FFR as the standard of reference. A value of ≤0.80 was considered as the threshold for a positive result (i.e. functionally significant lesion) for both invasive and FFRangio.

Results
Among the 46 NSTE-ACS patients included in the study according to the inclusion/exclusion criteria, a total of 60 vessels underwent invasive FFR measurement. The mean value of invasive FFR was 0.83±0.3 with 36% being positive. The mean FFRangio was 0.82±0.1 with 36% being positive. FFRangio showed a sensitivity of 95.5%, a specificity of 97.4% and a diagnostic accuracy of 96.7% to detect the functional significance of an angiographically intermediate stenosis. Moreover, it showed similar diagnostic performance across all three coronary arteries. FFRangio values correlated well with invasive FFR measurements (r=0.83, P&lt;0.001) and the Bland–Altman 95% confidence limits were between −0.12 and 0.10.

Conclusions
This study adds to the limited knowledge on the validity of FFRangio in the context of acute coronary syndromes and demonstrates excellent diagnostic performance as well as strong correlation to the invasive FFR for in the setting of NSTE-ACS. It contributes to the growing body of evidence suggesting that FFRangio can precisely calculate FFR in a wide range of clinical situations thus diminishing the risks of an invasive procedure and the use of hyperaemic agent. Since it is non-invasive, simple and cost-effective, the use of FFRangio could be routinely considered to guide treatment decision in angiographically intermediate coronary lesions in the context of NSTE-ACS.

Funding Acknowledgement
Type of funding sources: None.
Side effects and major adverse cardiac events caused by fractional flow reserve measurement: a systematic review and meta-analysis of 12,215 patients
Authors: Altstidl J M , Gaede L , Troebs M , Marwan M , Achenbach S 
Published: October 2022

Abstract

Background
Current guidelines recommend revascularization based on fractional flow reserve (FFR) in angiographically intermediate coronary stenoses. Side effects of FFR caused by adenosine administration are usually transient with little relevance. However, major adverse cardiac events (MACE), such as coronary artery occlusion, may infrequently occur as a consequence of intracoronary wire manipulation and little is known about their incidence. This systematic review aims to analyze the rate of side effects including MACE caused by FFR measurement as reported in large multicenter studies.

Methods
A PubMed database query for “fractional flow reserve” of the type “multicenter study” identified 348 records. Subsequently, one retracted record was excluded, another record was excluded as it contained no digital object identifier, 52 records were excluded since access could not be obtained, and one was a duplicate. Of the 293 records screened, only 15 contained relevant information on adverse effects or events due to FFR measurement and had included at least 100 patients. To systematically report the frequency of adverse events, the micro average for each event type was calculated across all studies where it was described.

Results
This systematic review includes data from 15 studies with a total of 12,215 patients. Measurement of FFR was successful in 99.1% (5,163 of 5,210). Hyperemia for FFR measurement was usually induced by adenosine, in most cases administered intravenously. Adverse effects are summarized in Figure 1. With 34.5% (778 of 2,257) of patients reporting chest pain or discomfort, this was the most common side effect of adenosine administration. Dyspnea was noted by 20.0% (250 of 1,250) of patients. Heart-rhythm disturbances occurred in 3.3% (185 of 5,646) of patients. More specifically, a transient atrioventricular block was reported in 2.6% (115 of 4,396) of patients, whereas ventricular arrhythmia was considerably less frequent with 0.2% (11 of 5,864). Hypotension was described by 0.9% (14 of 1,574) of patients, vomiting or nausea by 0.9% (11 of 1,250), and bronchospasm by 0.2% (11 of 4,836). MACE were infrequent, but not negligible: the pressure wire used for FFR measurement was reported to cause coronary artery dissection in 0.2% (8 of 4,158) of patients, coronary artery occlusion in 0.2% (4 of 2,381) of patients, and coronary artery perforation in 0.1% (2 of 3,228) of patients.

Conclusions
Chest pain, dyspnea, and transient arrhythmias are commonly experienced by patients in the context of adenosine but bear limited clinical relevance. The analysis of a large patient cohort revealed that MACE caused by vessel injury, while infrequent, occur at a rate of approximately 0.5% and should hence be considered relevant.

Funding Acknowledgement
Type of funding sources: None.
Saline-induced coronary hyperemia with continuous intracoronary thermodilution is mediated by intravascular hemolysis
Authors: Bertolone D , Gallinoro E , Candreva A , Fernandez Peregrina E , Bailleul E , Meeus P , Sonck J , Bermpeis K , Esposito G , Paolisso P , Heggermont W , Adjedj J , Barbato E , Collet C , De Bruyne B 
Published: October 2022

Abstract

Objectives
To test whether local hemolysis is a potential mechanism of saline-induced coronary hyperemia.

Background
Absolute coronary flow can be measured by intracoronary continuous thermodilution of saline through the lateral side holes of a dedicated infusion cathete. A saline infusion rate at 15–20 mL/min induces an immediate, steady-state, maximal microvascular vasodilation. The mechanism of this hyperemic response remains unclear.

Methods
Twelve patients undergoing left and right catheterization were included. The left coronary artery and the coronary sinus were selectively cannulated. Absolute resting and hyperemic coronary flow were measured by continuous intracoronary thermodilution. Arterial and venous samples were collected from the coronary artery and the coronary sinus in five phases: baseline (BL); resting flow measurement (Rest, saline infusion at 10 mL/min); hyperemia (Hyperemia,saline infusion at 20 mL/min); post-hyperemia (Post-Hyperemia, two minutes after the cessation of saline infusion); and control phase (Control, during infusion of saline through the guide catheter at 30 mL/min).

Results
Hemolysis was visually detected only in the centrifugated venous blood samples collected during the Hyperemia phase. As compared to Rest, during Hyperemia both LDH (131.50±21.89 U/dL [Rest] and 258.33±57.40 U/dL [Hyperemia], p&lt;0.001) and plasma free hemoglobin (PFHb, 4.92±3.82 mg/dL [Rest] and 108.42±46.58 mg/dL [Hyperemia], p&lt;0.001) significantly increased in the coronary sinus. The percentage of hemolysis was significantly higher during the Hyperemia phase (0.04±0.02% [Rest] vs 0.89±0.34% [Hyperemia], p&lt;0.001).

Conclusions
Saline-induced hyperemia through a dedicated intracoronary infusion catheter is associated with hemolysis. Vasodilatory compounds released locally, like ATP, are likely ultimately responsible for localized microvascular vasodilation.

Funding Acknowledgement
Type of funding sources: None.