scholarly journals The Impact of Virtual Fractional Flow Reserve and Virtual Coronary Intervention Upon Treatment Decisions in the Cardiac Catheter Laboratory

2021 ◽  
Author(s):  
Dr Rebecca C Gosling ◽  
Zulfiquar Adam ◽  
David S Barmby ◽  
Javaid Iqbal ◽  
Kenneth P Morgan ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Treatment Decisions ◽  
Fractional Flow ◽  
Cardiac Catheter ◽  
Flow Reserve ◽  
Catheter Laboratory ◽  
The Impact

scholarly journals Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment

2021 ◽  
Author(s):  
Katherine Lal ◽  
Rebecca Gosling ◽  
Mina Ghobrial ◽  
Gareth J Williams ◽  
Vignesh Rammohan ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Intraclass Correlation ◽  
Computational Modelling ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Operator Experience ◽  
Flow Reserve ◽  
Modelling Techniques ◽  
Artery Disease ◽  
The Impact

Abstract Aims To extend the benefits of physiologically guided percutaneous coronary intervention to many more patients, angiography-derived, or ‘virtual’ fractional flow reserve (vFFR) has been developed, in which FFR is computed, based upon the images, instead of being measured invasively. The effect of operator experience with these methods upon vFFR accuracy remains unknown. We investigated variability in vFFR results based upon operator experience with image-based computational modelling techniques. Methods and results Virtual fractional flow reserve was computed using a proprietary method (VIRTUheart) from the invasive angiograms of patients with coronary artery disease. Each case was processed by an expert (>100 vFFR cases) and a non-expert (<20 vFFR cases) operator and results were compared. The primary outcome was the variability in vFFR between experts and non-experts and the impact this had upon treatment strategy (PCI vs. conservative management). Two hundred and thirty-one vessels (199 patients) were processed. Mean non-expert and expert vFFRs were similar overall [0.76 (0.13) and 0.77 (0.16)] but there was significant variability between individual results (variability coefficient 12%, intraclass correlation coefficient 0.58), with only moderate agreement (κ = 0.46), and this led to a statistically significant change in management strategy in 27% of cases. Variability was significantly lower, and agreement higher, for expert operators; a change in their recommended management occurred in 10% of repeated expert measurements and 14% of inter-expert measurements. Conclusion Virtual fractional flow reserve results are influenced by operator experience of vFFR processing. This had implications for treatment allocation. These results highlight the importance of training and quality assurance to ensure reliable, repeatable vFFR results.

scholarly journals The Impact of Sex Differences on Fractional Flow Reserve–Guided Percutaneous Coronary Intervention

2012 ◽  
Vol 5 (10) ◽  
pp. 1037-1042 ◽  
Author(s):  
Hyun-Sook Kim ◽  
Pim A.L. Tonino ◽  
Bernard De Bruyne ◽  
Andy S.C. Yong ◽  
Jennifer A. Tremmel ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Sex Differences ◽  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
The Impact

Fractional Flow Reserve: Does a Cut-off Value add Value?

2016 ◽  
Vol 11 (1) ◽  
pp. 17
Author(s):  
Shah R Mohdnazri ◽  
◽  
◽  
◽  
Thomas R Keeble ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Grey Zone ◽  
Fractional Flow ◽  
Non Invasive ◽  
Invasive Test ◽  
Flow Reserve ◽  
A Value ◽  
Percutaneous Coronary ◽  
Value Add

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a ‘grey zone’ for FFR values of between 0.76 and 0.80 was demonstrated, where a positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI.

scholarly journals Fractional Flow Reserve After Functionally Optimized Coronary Intervention Predicts Very Long-Term Outcomes

2021 ◽  
Vol 14 (3) ◽  
pp. 355-356
Author(s):  
Shiv Kumar Agarwal ◽  
Abdul Hakeem ◽  
Rimsha Hasan ◽  
Mohamed Ayan ◽  
Aisha Siraj ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Long Term Outcomes ◽  
Flow Reserve
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