RÉSUMÉ
PURPOSE OF REVIEW: In this review, we discuss the status of novel radiation shielding and other methods to reduce radiation exposure and its associated health risks within the CCL. RECENT FINDINGS: There are many devices on the market each with its unique advantages and inherent flaws. Several are available for widespread use with promising data, while others still in development. The field of percutaneous transcatheter interventions includes complex procedures often involving significant radiation exposure. Increased radiation exposes the proceduralist and CCL staff to potential harm from both direct effects of radiation but also from the ergonomic consequences of daily use of heavy personal protective equipment. Here we discuss several innovative efforts to reduce both radiation exposure and orthopedic injury within the CCL that are available, leading to a safer daily routine in a "lead [apron]-free" environment.
Sujet(s)
Cardiologie , Humains , Coronarographie , Maladie des artères coronaires/physiopathologie , Maladie des artères coronaires/diagnostic , Maladie des artères coronaires/chirurgie , Maladie des artères coronaires/thérapie , Fraction du flux de réserve coronaire/physiologie , Circulation coronarienne/physiologieSujet(s)
Microcirculation , Valeur prédictive des tests , Infarctus du myocarde avec sus-décalage du segment ST , Humains , Infarctus du myocarde avec sus-décalage du segment ST/thérapie , Infarctus du myocarde avec sus-décalage du segment ST/physiopathologie , Résistance vasculaire , Intervention coronarienne percutanée/instrumentation , Vaisseaux coronaires/physiopathologie , Vaisseaux coronaires/imagerie diagnostique , Fraction du flux de réserve coronaire , Résultat thérapeutiqueSujet(s)
Maladie des artères coronaires , Fraction du flux de réserve coronaire , Intervention coronarienne percutanée , Humains , Sténose pathologique , Tomographie par cohérence optique , Intervention coronarienne percutanée/effets indésirables , Études prospectives , Résultat thérapeutique , Maladie des artères coronaires/imagerie diagnostique , Maladie des artères coronaires/thérapie , Maladie des artères coronaires/physiopathologie , CoronarographieRÉSUMÉ
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.
Sujet(s)
Circulation coronarienne , Ischémie myocardique , Humains , Circulation coronarienne/physiologie , Résistance vasculaire/physiologie , Thermodilution/méthodes , Hémodynamique , Microcirculation/physiologie , Vaisseaux coronairesSujet(s)
Tumeurs du coeur , Léiomyomatose , Embolie pulmonaire , Tumeurs de l'utérus , Humains , Femelle , Léiomyomatose/imagerie diagnostique , Valeur prédictive des tests , Coeur , Embolie pulmonaire/imagerie diagnostique , Tumeurs du coeur/imagerie diagnostique , Tumeurs de l'utérus/imagerie diagnostique , Veine cave inférieure , Atrium du coeur/imagerie diagnostiqueRÉSUMÉ
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.