Combined Assessment of Fractional Flow Reserve and Coronary Flow Velocity Reserve after Drug-Eluting Stent Implantation.

BACKGROUND: Coronary flow velocity reserve (CFVR) can be measured noninvasively using stress transthoracic Doppler echocardiography (S-TDE). The prognostic significance of S-TDE-derived CFVR after percutaneous coronary intervention (PCI) remains unknown. The aim of this study was to investigate the prognostic value of post-PCI CFVR and its additional efficacy to fractional flow reserve (FFR) in patients undergoing elective PCI. METHODS: A retrospective study was conducted involving 187 consecutive patients with chronic coronary syndrome who underwent elective PCI guided by FFR for the left anterior descending coronary artery. Pre- and post-PCI wire-based FFR and CFVR assessments of the left anterior descending coronary artery using S-TDE were performed in all patients. The association between post-PCI clinical and physiologic parameters and major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, heart failure, and unplanned remote target vessel revascularization, was evaluated. RESULTS: Three-quarters of patients exhibited CFVR increase after PCI, while all patients showed FFR improvement. During a median follow-up period of 1.5 years, MACE occurred in 21 patients (11.2%). Among clinical demographics, patients with MACE had higher levels of N-terminal pro-brain natriuretic peptide compared with those without MACE (median, 615 pg/mL [interquartile range, 245-1,500 pg/mL] vs 180 pg/mL [interquartile range, 70-559 pg/mL]; P = .010). Post-PCI S-TDE-derived CFVR was lower in patients with MACE, while post-PCI FFR showed a nonsignificant tendency to be lower in patients with MACE. In a multivariable analysis, higher NT-proBNP (adjusted hazard ratio, 1.33; 95% CI, 1.02-1.74; P = .038), post-PCI CFVR ≤ 2.0 (adjusted hazard ratio, 2.93; 95% CI, 1.16-7.40; P = .023), and post-PCI FFR ≤ 0.82 (adjusted hazard ratio, 3.93; 95% CI, 1.52-10.18; P = .005) were independently associated with MACE. CONCLUSIONS: In patients with chronic coronary syndrome who underwent successful elective PCI for left anterior descending coronary artery, the combined assessment of S-TDE-derived post-PCI CFVR and post-PCI FFR provided a significant association with the occurrence of MACE.

Medium-range correlation of Ag ions in superionic melts of Ag2Se and AgI by reverse Monte Carlo structural modelling-connectivity and void distribution.

High-energy x-ray diffraction measurements on molten Ag(2)Se were performed. Partial structure factors and radial distribution functions were deduced by reverse Monte Carlo (RMC) structural modelling on the basis of our new x-ray and earlier published neutron diffraction data. These partial functions were compared with those of molten AgI. Both AgI and Ag(2)Se have a superionic solid phase prior to melting. New RMC structural modelling for molten AgI was performed to revise our previous model with a bond-angle restriction to reduce the number of unphysical Ag triangles. The refined model of molten AgI revealed that isolated unbranched chains formed by Ag ions are the cause of the medium-range order of Ag. In contrast with molten AgI, molten Ag(2)Se has 'cage-like' structures with approximately seven Ag ions surrounding a Se ion. Connectivity analysis revealed that most of the Ag ions in molten Ag(2)Se are located within 2.9 Å of each other and only small voids are found, which is in contrast to the wide distribution of Ag-void radii in molten AgI. It is conjectured that the collective motion of Ag ions through small voids is required to realize the well-known fast diffusion of Ag ions in molten Ag(2)Se, which is comparable to that in molten AgI.