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Current Atherosclerosis Reports
Erschienen in: Current Atherosclerosis Reports 10/2016

01.10.2016 | Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)

Coronary Physiology Assessment for the Diagnosis and Treatment of Stable Ischemic Heart Disease

verfasst von: Ali E. Denktas, David Paniagua, Hani Jneid

Erschienen in: Current Atherosclerosis Reports | Ausgabe 10/2016

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Abstract

Coronary artery disease is the most prevalent cardiovascular disease in the USA. In the majority of settings, percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) reduces angina and improves quality of life; however, it does not improve survival and is associated with infrequent but serious complications. Selection of appropriate patients and coronary lesions for revascularization with PCI is crucial to maximize the benefit-to-risk ratio. The assessment of the hemodynamic significance of intermediate coronary lesions has been shown to improve outcomes and reduce healthcare costs. The current review summarizes the existing evidence regarding the physiological assessment of coronary lesions, with emphasis on fractional flow reserve, the most common invasive hemodynamic assessment modality.
Literatur
1.
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133:e38–360.CrossRefPubMed
2.
Nallamothu BK, Bates ER. Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? Am J Cardiol. 2003;92:824–6.CrossRefPubMed
3.
Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet. 1996;348:771–5.CrossRefPubMed
4.
Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.CrossRefPubMed
5.
Chung SC, Hlatky MA, Faxon D, Ramanathan K, Adler D, Mooradian A, et al. The effect of age on clinical outcomes and health status BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes). J Am Coll Cardiol. 2011;58:810–9.CrossRefPubMedPubMedCentral
6.
Group BDS, Frye RL, August P, Brooks MM, Hardison RM, Kelsey SF, et al. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–15.CrossRef
7.
Henderson RA, Pocock SJ, Clayton TC, Knight R, Fox KA, Julian DG, et al. Seven-year outcome in the RITA-2 trial: coronary angioplasty versus medical therapy. J Am Coll Cardiol. 2003;42:1161–70.CrossRefPubMed
8.
Poole-Wilson PA, Lubsen J, Kirwan BA, van Dalen FJ, Wagener G, Danchin N, et al. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial. Lancet. 2004;364:849–57.CrossRefPubMed
9.
Steg PG, Greenlaw N, Tardif JC, Tendera M, Ford I, Kaab S, et al. Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry. Eur Heart J. 2012;33:2831–40.CrossRefPubMedPubMedCentral
10.
Shaw LJ, Heller GV, Casperson P, Miranda-Peats R, Slomka P, Friedman J, et al. Gated myocardial perfusion single photon emission computed tomography in the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial, Veterans Administration Cooperative study no. 424. J Nucl Cardiol. 2006;13:685–98.CrossRefPubMed
11.•
Tonino PA, De Bruyne B, Pijls NH, Siebert U, Ikeno F, van’ t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24. First randomized trial of its kind comparing angiography versus FFR-driven revascularization.CrossRefPubMed
12.
Fearon WF, Bornschein B, Tonino PA, Gothe RM, Bruyne BD, Pijls NH, et al. Economic evaluation of fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. Circulation. 2010;122:2545–50.CrossRefPubMed
13.
Toth G, Hamilos M, Pyxaras S, Mangiacapra F, Nelis O, De Vroey F, et al. Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses. Eur Heart J. 2014;35:2831–8.CrossRefPubMed
14.
Yaeger IA. A multi-artery Fractional Flow Reserve (FFR) approach for handling coronary stenosis-stenosis interaction in the multi-vessel disease (MVD) arena. Int J Cardiol. 2016;203:807–15.CrossRefPubMed
15.•
Pijls NH, van Son JA, Kirkeeide RL, De Bruyne B, Gould KL. Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation. 1993;87:1354–67. First report establishing the basis of FFR.CrossRefPubMed
16.
Gould KL, Lipscomb K. Effects of coronary stenoses on coronary flow reserve and resistance. Am J Cardiol. 1974;34:48–55.CrossRefPubMed
17.••
Gould KL, Johnson NP, Kaul S, Kirkeeide RL, Mintz GS, Rentrop KP, et al. Patient selection for elective revascularization to reduce myocardial infarction and mortality: new lessons from randomized trials, coronary physiology, and statistics. Circ Cardiovasc Imaging. 2015;8. Excellent review of the concepts discussed in the current paper.
18.•
Bech GJ, De Bruyne B, Pijls NH, de Muinck ED, Hoorntje JC, Escaned J, et al. Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis: a randomized trial. Circulation. 2001;103:2928–34. One of the landmark trials on the subject.CrossRefPubMed
19.•
De Bruyne B, Fearon WF, Pijls NH, Barbato E, Tonino P, Piroth Z, et al. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med. 2014;371:1208–17. The more recent landmark randomized trial.CrossRefPubMed
20.
Berry C, van’t Veer M, Witt N, Kala P, Bocek O, Pyxaras SA, et al. VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice): a multicenter study in consecutive patients. J Am Coll Cardiol. 2013;61:1421–7.CrossRefPubMed
21.
Matsumoto H, Nakatsuma K, Shimada T, Ushimaru S, Mikuri M, Yamazaki T, et al. Effect of caffeine on intravenous adenosine-induced hyperemia in fractional flow reserve measurement. J Invasive Cardiol. 2014;26:580–5.PubMed
22.
Lim WH, Koo BK, Nam CW, Doh JH, Park JJ, Yang HM, et al. Variability of fractional flow reserve according to the methods of hyperemia induction. Catheter Cardiovasc Interv. 2015;85:970–6.CrossRefPubMed
23.
De Bruyne B, Pijls NH, Barbato E, Bartunek J, Bech JW, Wijns W, et al. Intracoronary and intravenous adenosine 5′-triphosphate, adenosine, papaverine, and contrast medium to assess fractional flow reserve in humans. Circulation. 2003;107:1877–83.CrossRefPubMed
24.
Prasad A, Zareh M, Doherty R, Gopal A, Vora H, Somma K, et al. Use of regadenoson for measurement of fractional flow reserve. Catheter Cardiovasc Interv. 2014;83:369–74.CrossRefPubMed
25.
Stolker JM, Lim MJ, Shavelle DM, Morris DL, Angiolillo DJ, Guzman LA, et al. Pooled comparison of regadenoson versus adenosine for measuring fractional flow reserve and coronary flow in the catheterization laboratory. Cardiovasc Revasc Med. 2015;16:266–71.CrossRefPubMed
26.
van Nunen LX, Lenders GD, Schampaert S, van’t Veer M, Wijnbergen I, Brueren GR, et al. Single bolus intravenous regadenoson injection versus central venous infusion of adenosine for maximum coronary hyperaemia in fractional flow reserve measurement. EuroIntervention. 2014.
27.
Pijls NH, van Nunen LX. Fractional flow reserve, maximum hyperemia, adenosine, and regadenoson. Cardiovasc Revasc Med. 2015;16:263–5.CrossRefPubMed
28.
Pijls NH. Fractional flow reserve to guide coronary revascularization. Circ J. 2013;77:561–9.CrossRefPubMed
29.
Nishi T, Kitahara H, Iwata Y, Fujimoto Y, Nakayama T, Takahara M, et al. Efficacy of combined administration of intracoronary papaverine plus intravenous adenosine 5′-triphosphate in assessment of fractional flow reserve. J Cardiol. 2016.
30.
Jeremias A, Whitbourn RJ, Filardo SD, Fitzgerald PJ, Cohen DJ, Tuzcu EM, et al. Adequacy of intracoronary versus intravenous adenosine-induced maximal coronary hyperemia for fractional flow reserve measurements. Am Heart J. 2000;140:651–7.CrossRefPubMed
31.
Adjedj J, Toth GG, Johnson NP, Pellicano M, Ferrara A, Flore V, et al. Intracoronary adenosine: dose-response relationship with hyperemia. JACC Cardiovasc Interv. 2015;8:1422–30.CrossRefPubMed
32.
Waksman R, Legutko J, Singh J, Orlando Q, Marso S, Schloss T, et al. FIRST: fractional flow reserve and intravascular ultrasound relationship study. J Am Coll Cardiol. 2013;61:917–23.CrossRefPubMed
33.
Kang SJ, Lee JY, Ahn JM, Mintz GS, Kim WJ, Park DW, et al. Validation of intravascular ultrasound-derived parameters with fractional flow reserve for assessment of coronary stenosis severity. Circ Cardiovasc Interv. 2011;4:65–71.CrossRefPubMed
34.
Lim HS, Tonino PA, De Bruyne B, Yong AS, Lee BK, Pijls NH, et al. The impact of age on fractional flow reserve-guided percutaneous coronary intervention: a FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) trial substudy. Int J Cardiol. 2014;177:66–70.CrossRefPubMed
35.
Kang SJ, Ahn JM, Han S, Lee JY, Kim WJ, Park DW, et al. Sex differences in the visual-functional mismatch between coronary angiography or intravascular ultrasound versus fractional flow reserve. JACC Cardiovasc Interv. 2013;6:562–8.CrossRefPubMed
36.
Li J, Rihal CS, Matsuo Y, Elrashidi MY, Flammer AJ, Lee MS, et al. Sex-related differences in fractional flow reserve-guided treatment. Circ Cardiovasc Interv. 2013;6:662–70.CrossRefPubMedPubMedCentral
37.
Leone AM, Scalone G, De Maria GL, Tagliaferro F, Gardi A, Clemente F, et al. Efficacy of contrast medium induced Pd/Pa ratio in predicting functional significance of intermediate coronary artery stenosis assessed by fractional flow reserve: insights from the RINASCI study. EuroIntervention. 2014.
38.
Johnson NP, Kirkeeide RL, Gould KL. Is discordance of coronary flow reserve and fractional flow reserve due to methodology or clinically relevant coronary pathophysiology? JACC Cardiovasc Imaging. 2012;5:193–202.CrossRefPubMed
39.
Nijjer SS, Sen S, Petraco R, Davies JE. Advances in coronary physiology. Circ J. 2015;79:1172–84.CrossRefPubMed
40.
Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA. 2012;308:1237–45.CrossRefPubMedPubMedCentral
41.
Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol. 2011;58:1989–97.CrossRefPubMed
42.
Norgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63:1145–55.CrossRefPubMed
43.
Douglas PS, Pontone G, Hlatky MA, Patel MR, Norgaard BL, Byrne RA, et al. Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFRct: outcome and resource impacts study. Eur Heart J. 2015.
44.
Desai RR, Jha S. Diagnostic performance of cardiac stress perfusion MRI in the detection of coronary artery disease using fractional flow reserve as the reference standard: a meta-analysis. AJR Am J Roentgenol. 2013;201:W245–52.CrossRefPubMed
45.
Gould KL. Coronary flow reserve and pharmacologic stress perfusion imaging: beginnings and evolution. JACC Cardiovasc Imaging. 2009;2:664–9.CrossRefPubMed
46.••
Gould KL, Johnson NP, Bateman TM, Beanlands RS, Bengel FM, Bober R, et al. Anatomic versus physiologic assessment of coronary artery disease. Role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making. J Am Coll Cardiol. 2013;62:1639–53. The explanation of the concepts described in the current review are described here.CrossRefPubMed
47.
Johnson NP, Toth GG, Lai D, Zhu H, Acar G, Agostoni P, et al. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes. J Am Coll Cardiol. 2014;64:1641–54.CrossRefPubMed
48.
Curzen N, Rana O, Nicholas Z, Golledge P, Zaman A, Oldroyd K, et al. Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?: the RIPCORD study. Circ Cardiovasc Interv. 2014;7:248–55.CrossRefPubMed
49.
Van Belle E, Rioufol G, Pouillot C, Cuisset T, Bougrini K, Teiger E, et al. Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography: insights from a large French multicenter fractional flow reserve registry. Circulation. 2014;129:173–85.CrossRefPubMed
50.
Pijls NH, Fearon WF, Tonino PA, Siebert U, Ikeno F, Bornschein B, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol. 2010;56:177–84.CrossRefPubMed
51.
van Nunen LX, Zimmermann FM, Tonino PA, Barbato E, Baumbach A, Engstrom T, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet. 2015.
52.
Shiono Y, Kubo T, Tanaka A, Ino Y, Yamaguchi T, Tanimoto T, et al. Long-term outcome after deferral of revascularization in patients with intermediate coronary stenosis and gray-zone fractional flow reserve. Circ J. 2015;79:91–5.CrossRefPubMed
53.
Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van’t Veer M, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49:2105–11.CrossRefPubMed
54.
Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/scai Guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:e44–122.CrossRefPubMed
55.
Dattilo PB, Prasad A, Honeycutt E, Wang TY, Messenger JC. Contemporary patterns of fractional flow reserve and intravascular ultrasound use among patients undergoing percutaneous coronary intervention in the United States: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2012;60:2337–9.CrossRefPubMed
56.
Sen S, Escaned J, Malik IS, Mikhail GW, Foale RA, Mila R, et al. Development and validation of a new adenosine-independent index of stenosis severity from coronary wave-intensity analysis: results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) study. J Am Coll Cardiol. 2012;59:1392–402.CrossRefPubMed
57.
Johnson NP, Kirkeeide RL, Asrress KN, Fearon WF, Lockie T, Marques KM, et al. Does the instantaneous wave-free ratio approximate the fractional flow reserve? J Am Coll Cardiol. 2013;61:1428–35.CrossRefPubMed
58.
Tarkin JM, Nijjer S, Sen S, Petraco R, Echavarria-Pinto M, Asress KN, et al. Hemodynamic response to intravenous adenosine and its effect on fractional flow reserve assessment: results of the Adenosine for the Functional Evaluation of Coronary Stenosis Severity (AFFECTS) study. Circ Cardiovasc Interv. 2013;6:654–61.CrossRefPubMed
59.
Sen S, Asrress KN, Nijjer S, Petraco R, Malik IS, Foale RA, et al. Diagnostic classification of the instantaneous wave-free ratio is equivalent to fractional flow reserve and is not improved with adenosine administration. Results of CLARIFY (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study). J Am Coll Cardiol. 2013;61:1409–20.CrossRefPubMed
60.
DeWaard G, Danad I, da Cunha RP, Teunissen P, van de Hoef T, Raijmakers PG, et al. Hyperemic FFR and baseline iFR have an equivalent diagnostic accuracy when compared to myocardial blood flow quantified by H215O PET perfusion imaging. J Am Coll Cardiol. 2014;63:A1692.CrossRef
61.
Jeremias A, Maehara A, Genereux P, Asrress KN, Berry C, De Bruyne B, et al. Multicenter core laboratory comparison of the instantaneous wave-free ratio and resting Pd/Pa with fractional flow reserve: the RESOLVE study. J Am Coll Cardiol. 2014;63:1253–61.CrossRefPubMed
62.
Escaned J, Echavarria-Pinto M, Garcia-Garcia HM, van de Hoef TP, de Vries T, Kaul P, et al. Prospective assessment of the diagnostic accuracy of instantaneous wave-free ratio to assess coronary stenosis relevance: results of ADVISE II International, Multicenter Study (ADenosine Vasodilator Independent Stenosis Evaluation II). JACC Cardiovasc Interv. 2015;8:824–33.CrossRefPubMed
Metadaten
Titel
Coronary Physiology Assessment for the Diagnosis and Treatment of Stable Ischemic Heart Disease
verfasst von
Ali E. Denktas
David Paniagua
Hani Jneid
Publikationsdatum
01.10.2016
Verlag
Springer US
Erschienen in
Current Atherosclerosis Reports / Ausgabe 10/2016
Print ISSN: 1523-3804
Elektronische ISSN: 1534-6242
DOI
https://doi.org/10.1007/s11883-016-0613-2

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