Severely calcified coronary stenoses: a war or a battle?

2021 ◽  
Vol 17 (6) ◽  
pp. 445-446
Author(s):  
Emanuele Barbato ◽  
Konstantinos Bermpeis
Keyword(s):  
Coronary Stenoses

ROC Analysis of Three Perfusion Display Options for ECG-gated Perfusion SPECT in Severe CAD

1999 ◽  
Vol 38 (06) ◽  
pp. 172-177
Author(s):  
H. Bailer ◽  
Marianne Gwechenberger ◽  
Martha Pruckmayer ◽  
A. Staudenherz ◽  
G. Kronik ◽  
...  
Keyword(s):  
Roc Analysis ◽  
Lateral Wall ◽  
Visual Assessment ◽  
3D Mapping ◽  
Operating Characteristics ◽  
Gated Perfusion Spect ◽  
Perfusion Spect ◽  
Coronary Stenoses ◽  
Definition Of ◽  
Valve Plane

Summary Aim: The simultaneous computation and display of wall motion and perfusion patterns in a single 3D ventricular model would considerably ease the assessment of ECG-gated Tc-99m-sestamibi SPECT, yet the effect on the accuracy of allocating regional perfusion has so far not been validated. Methods: 3D perfusion mapping (3D Perfusion/Motion Map Software) was compared to the visual assessment of ungated tomographic slices and polar perfusion mapping (Cedars-Sinai PTQ) by correlation analysis and receiver operating characteristics (ROC) analysis at different cut-off levels for coronary stenoses in 50 patients (11 single-, 22 two-, 16 three-vessel disease). Ungated SPECT data were obtained by adding the intervals prior to reconstruction and displaying conventional tomographic slices. All display options were visually assessed in 8 ventricular segments according to a 4-point scoring system and compared to the graded results of coronary angiography. Results: All three display options showed a comparable diagnostic performance for the detection of severe stenoses. The diagnostic gain for the detection of stenoses above 59% was highest for ungated tomographic slices, followed by ungated polar mapping and 3D mapping. Regional assessment revealed a limited performance of 3D mapping in the proximal anterior and distal lateral wall. Polar mapping showed a balanced regional performance. Conclusion: 3D Perfusion mapping provides comparable information to conventional display options with the highest diagnostic strength in severe stenoses. Further improvement of the algorithm is needed in the definition of the valve plane.

Preprocedural β-Blockers in the Functional Assessment of Intermediate Coronary Lesions by Instantaneous Wave-Free Ratio

Angiology ◽  
2021 ◽  
pp. 000331972199617
Author(s):  
Monica Verdoia ◽  
Rocco Gioscia ◽  
Matteo Nardin ◽  
Orazio Viola ◽  
Marta Francesca Brancati ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Lesion Length ◽  
Functional Evaluation ◽  
Luminal Diameter ◽  
Coronary Syndrome ◽  
Coronary Stenoses ◽  
Minimal Luminal Diameter ◽  
Coronary Lesions ◽  
Β Blockers ◽  
The Impact

Aim: Instantaneous wave-free ratio (iFR) has emerged as the strategy of choice for the assessment of intermediate coronary lesions. The impact of preprocedural β-blockers therapy on the iFR was the aim of this study. Methods: We included patients undergoing functional assessment of intermediate (40%-70%) coronary lesions in 2 centers. The iFR measurement was performed by pressure-recording guidewire and calculated at the core laboratory using the manufacturers’ dedicated software. Minimal luminal diameter, reference diameter, percent diameter stenosis, and length of the lesion were measured. Positive iFR was considered for values <0.90. Results: We included 197 patients undergoing functional evaluation of 223 coronary lesions. Patients on β-blockers (69%) had more frequently hypertension ( P = .05); previous myocardial infarction ( P = .01); therapy with clopidogrel ( P = .02), statins, and aspirin; and acute coronary syndrome at presentation ( P < .001, respectively). Mean iFR values were slightly higher in patients on β-blockers (0.94 ± 0.06 vs 0.92 ± 0.06, P = .11). The rate of positive iFR was significantly lower with β-blockers (14.9% vs 27.5%, P = .04). On multivariate analysis, β-blockers use was a predictor of the significance of coronary stenoses (odds ratio [OR] = 0.48; 95% CI = 0.23-0.98; P = .05) together with lesion length (OR = 1.04; 95% CI = 1.01-1.07; P = .007). Conclusion: Among patients undergoing iFR, preprocedural β-blockers are associated with higher absolute values and a lower rate of positive iFR.

Diagnostic accuracy of Instantaneous Wave-Free Ratio (iFR) for the assessment of myocardial ischaemia: a comparison with non-invasive stress imaging

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Stazzoni ◽  
L Tessandori ◽  
P Spontoni ◽  
M Angelillis ◽  
C Giannini ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Myocardial Ischaemia ◽  
Gold Standard ◽  
Coronary Revascularization ◽  
Stress Test ◽  
Invasive Coronary Angiography ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Coronary Stenoses ◽  
Epicardial Stenosis

Abstract Background Instantaneous Wave-Free Ratio (iFR) allows for the assessment of the haemodynamic effects of epicardial coronary stenoses without the need for hyperaemia; iFR is currently recommended as a means to evaluate myocardial ischaemia. Purpose To assess the diagnostic accuracy of iFR with respect to the identification of coronary epicardial stenoses causing ischemia. Therefore, we combined anatomical (% stenosis at invasive coronary angiography, ICA) and functional (non-invasive imaging stress test, NIST) information to obtain a “gold standard” for the identification of stenoses causing ischaemia. Methods We enrolled 71 patients (52 male, 19 female; age mean 68.4±8.1 years) with chronic coronary syndrome or low-risk acute coronary syndrome without ST segment elevation who had at least a NIST and who had at least one vessel with a 50%-85% stenosis at ICA. iFR was measured in all coronary arteries with stenosis &gt;50% and categorised according to the 0.89 threshold for ischaemia. Results iFR was assessed in 122 vessels. In a per-vessel analysis, in 56.7% ischaemia was present both at iFR and NIST, in 21.3% ischaemia was absent in both, while in 23.0% ischaemia was found at NIST but not confirmed by iFR. The overall accuracy of iFR with respect to NIST was 90.1%. However, when considering as the “gold standard” for coronary disease causing ischaemia the contemporary presence of an epicardial stenosis &gt;70% at ICA and a positive NIST, the diagnostic accuracy of iFR greatly improved. The sensibility, specificity, PPV, NPV and accuracy were 96.5%, 75.0%, 73.3%, 96.7% and 84.4%, respectively. In case of discordance between NIST and iFR, revascularization was based on iFR. At a mean follow-up of 23±18 months, the composite endpoint of MACE (major adverse cardiac events, defined as the composite of all-cause death, nonfatal MI and unplanned coronary revascularization) occurred in 16.4%, while death/MI occurred in 11.9%. Stratification according to the per-patient concordance between iFR and NIST showed no significant differences in rates of MACE (p=0.50) and death/MI (p=0.20). Stratification based on iFR showed a higher death/MI rate in iFR-positive patients (11.9% vs. 0%, p=0.047) and a trend to higher MACE rate (11.9% vs. 4.47% p=0.14), Conclusions The diagnostic accuracy of iFR is low when compared with NIST as the reference for myocardial ischaemia, but it is very high when compared with the combined presence of epicardial stenosis and positive NIST. Therefore, iFR can accurately guide the decision to treat or defer revascularization of intermediate coronary stenoses, being most useful in patients with multivessel CAD and when non-invasive functional data are lacking or discordant with anatomy. Funding Acknowledgement Type of funding source: None

Role of Cardiac Sympathetic Nerves in the Genesis of Myocardial Ischemia Distal to Coronary Stenoses

1985 ◽  
Vol 7 ◽  
pp. S13-S18 ◽  
Author(s):  
Gerd Heusch ◽  
Andreas Deussen ◽  
Jochen Schipke ◽  
Holger Vogelsang ◽  
Vera Hoffmann ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Sympathetic Nerves ◽  
Coronary Stenoses

scholarly journals 978-118 Exercise Capacity and Coronary Flow Reserve in Patients with Intermediate Coronary Stenoses

1995 ◽  
Vol 25 (2) ◽  
pp. 259A ◽  
Author(s):  
James D. Joye ◽  
Angel R. Flores ◽  
Judith E. Orie ◽  
Nathaniel Reichek ◽  
Douglas S. Schulman
Keyword(s):  
Exercise Capacity ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Flow Reserve ◽  
Coronary Stenoses

scholarly journals Alpha-adrenergic receptor blockade and hyperaemic response in patients with intermediate coronary stenoses

2004 ◽  
Vol 25 (22) ◽  
pp. 2034-2039 ◽  
Author(s):  
E BARBATO ◽  
J BARTUNEK ◽  
W AARNOUDSE ◽  
M VANDERHEYDEN ◽  
F STAELENS ◽  
...  
Keyword(s):  
Adrenergic Receptor ◽  
Receptor Blockade ◽  
Alpha Adrenergic Receptor ◽  
Hyperaemic Response ◽  
Coronary Stenoses ◽  
Adrenergic Receptor Blockade
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