Measurement of fractional flow reserve to assess moderately severe coronary lesions: correlation with dobutamine stress echocardiography.

BACKGROUND: New techniques to evaluate coronary artery disease, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to determine the correlation between FFR and dobutamine stress echocardiography in patients with moderately severe coronary stenosis in order to judge the usefulness of FFR for commonly encountered clinical problems. METHODS AND RESULTS: We studied 21 patients with 23 moderately severe coronary artery stenoses on angiography. The FFR was calculated and dobutamine stress echocardiography was performed to detect ischemia. Of the 16 stenoses with a negative FFR (> or = 0.75), dobutamine echocardiography also was negative. In the seven stenoses with a positive FFR (< 0.75), dobutamine echocardiography was positive in three. The efficacy of FFR in detecting ischemia that was confirmed with stress echocardiography was sensitivity 100%, specificity 80%, positive and negative predictive value 42.8%, and 100%, respectively, with a global predictive value 82.6%. A moderate degree of correlation was found between the two diagnostic tests (kappa [kappa] = 0.51). CONCLUSIONS: FFR correlates moderately well with dobutamine stress echocardiography in the assessment of moderately severe lesions in patients for whom coronary arteriography is usually indicated. However, its high negative predictive value makes FFR a useful aid in reaching clinical decisions promptly in the hemodynamics laboratory.

Clinical management of patients with coronary syndromes and negative fractional flow reserve findings.

AIMS: New interventional techniques to diagnose coronary artery stenosis, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to investigate the occurrence of cardiac events in patients with coronary syndromes and negative FFR findings in moderately severe coronary stenosis in order to determine the usefulness of this technique in predicting coronary events during follow-up for problems commonly encountered in clinical practice. A further objective was to evaluate the safety of deferring angioplasty in patients with a negative FFR result. METHODS: We studied 43 patients with 44 moderately severe coronary artery stenoses on angiography and FFR > or = 0.75. Mean age of the patients was 58 +/- 11.4 years. The indications for coronary angiography included recent unstable angina in 24 (55.8%) patients, recent acute myocardial infarction in 10 (23.2%) patients, 5 (11.6%) patients with a coronary stent who had symptoms of uncertain cause, and stable angina in 4 (9.3%) patients. RESULTS: During a mean follow-up period of 10.7 +/- 5.9 months, clinical events (unstable angina) occurred in five patients. In three patients, the initially investigated artery was involved, and in the two patients who required coronary revascularization, unstable angina was related with an artery different from the one studied initially. CONCLUSIONS: Patients with recent coronary syndromes and negative FFR findings in moderately severe coronary stenosis were unlikely to have cardiac events during a 10-month follow-up period. Our findings suggest that FFR is a potentially useful indicator of the likelihood of cardiac events and thus represents a useful aid in clinical decision-making in the hemodynamics laboratory. This diagnostic technique also is potentially useful in identifying patients for whom angioplasty can be safely deferred.

[Tympanosclerosis. Review of 138 cases]. / Timpanoesclerosis. Revisión de 138 casos.

Tympanosclerosis is a pathological finding that is accompanied by two surgical drawbacks: first, poor functional results, and second, increased risk of surgical procedures. We reviewed 138 cases operated in our Service in order to describe the audiological outcome and discuss surgical options for tympanosclerosis.

[Reconstructive and functional surgery of the middle ear (review of 276 cases)]. / Cirurgía reconstructivo-funcional del oído medio (revisión de 276 casos).

The present work presents the review of 276 cases that underwent the following surgeries: 62 myringoplasties, 176 tympano-ossicular reconstructions, 9 functional second look surgery and 29 tympanoplasties with ossiculoplasties. Regarding two different parameters, results were as follows: 1) New eardrum after one-year evolution: 94% were complete, 3.8% were perforated and 2.3% had cholesteatoma pearls. 2) Hearing level after one-year evolution: 33% was the same, 29% gained less than 15 dB, 26.8% gained between 15 and 30 dB, and 11.2% gained over 30 dB.