Microcirculation , Predictive Value of Tests , ST Elevation Myocardial Infarction , Humans , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/physiopathology , Vascular Resistance , Percutaneous Coronary Intervention/instrumentation , Coronary Vessels/physiopathology , Coronary Vessels/diagnostic imaging , Fractional Flow Reserve, Myocardial , Treatment Outcome
Coronary Artery Disease , Fractional Flow Reserve, Myocardial , Percutaneous Coronary Intervention , Humans , Constriction, Pathologic , Tomography, Optical Coherence , Percutaneous Coronary Intervention/adverse effects , Prospective Studies , Treatment Outcome , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Coronary Artery Disease/physiopathology , Coronary Angiography
Diagnosing coronary microvascular dysfunction remains challenging, primarily due to the lack of direct measurements of absolute coronary blood flow (Q) and microvascular resistance (Rµ). However, there has been recent progress with the development and validation of continuous intracoronary thermodilution, which offers a simplified and validated approach for clinical use. This technique enables direct quantification of Q and Rµ, leading to precise and accurate evaluation of the coronary microcirculation. To ensure consistent and reliable results, it is crucial to follow a standardized protocol when performing continuous intracoronary thermodilution measurements. This document aims to summarize the principles of thermodilution-derived absolute coronary flow measurements and propose a standardized method for conducting these assessments. The proposed standardization serves as a guide to ensure the best practice of the method, enhancing the clinical assessment of the coronary microcirculation.
Coronary Circulation , Myocardial Ischemia , Humans , Coronary Circulation/physiology , Vascular Resistance/physiology , Thermodilution/methods , Hemodynamics , Microcirculation/physiology , Coronary Vessels
Heart Neoplasms , Leiomyomatosis , Pulmonary Embolism , Uterine Neoplasms , Humans , Female , Leiomyomatosis/diagnostic imaging , Predictive Value of Tests , Heart , Pulmonary Embolism/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Uterine Neoplasms/diagnostic imaging , Vena Cava, Inferior , Heart Atria/diagnostic imaging
BACKGROUND: Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated. OBJECTIVES: This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery. METHODS: We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization. RESULTS: Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005). CONCLUSIONS: The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.
Coronary Artery Disease , Fractional Flow Reserve, Myocardial , Percutaneous Coronary Intervention , Humans , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Percutaneous Coronary Intervention/adverse effects , Coronary Angiography , Treatment Outcome , Predictive Value of Tests
Cardiovascular Diseases , Coronary Artery Disease , Coronary Stenosis , Fractional Flow Reserve, Myocardial , Humans , Cardiovascular Diseases/diagnosis , Risk Factors , Coronary Angiography , Ischemia , Heart Disease Risk Factors , Predictive Value of Tests , Coronary Vessels , Severity of Illness Index
Coronary Stenosis , Fractional Flow Reserve, Myocardial , Humans , Treatment Outcome , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/therapy , Coronary Angiography , Predictive Value of Tests , Coronary Vessels/diagnostic imaging , Severity of Illness Index , Cardiac Catheterization , Blood Flow Velocity
Coronary Artery Disease , Coronary Stenosis , Fractional Flow Reserve, Myocardial , Humans , Treatment Outcome , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/therapy , Predictive Value of Tests
Coronary Artery Disease , Coronary Stenosis , Fractional Flow Reserve, Myocardial , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/therapy , Humans , Predictive Value of Tests , Severity of Illness Index , Treatment Outcome