In part I, multimodality imaging was used for coronary plaque characterization and computational haemodynamic simulation. Quantitative flow ratio (QFR) is a novel technique to calculate invasive... Show moreIn part I, multimodality imaging was used for coronary plaque characterization and computational haemodynamic simulation. Quantitative flow ratio (QFR) is a novel technique to calculate invasive fractional flow reserve (FFR), without the need for a pressure wire or hyperaemia induction. We confirmed the potential of QFR to accurately detect myocardial ischaemia on single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). Despite the increased risk of coronary microvascular dysfunction, QFR was highly accurate in a diabetic patient population compared with invasive FFR. Moreover, QFR is feasible to use for the selection of patients for invasive FFR referral. Coronary computed tomography angiography is able to non-invasively assess the progression of coronary artery disease. We showed an increased progression of calcified coronary plaque and reduced progression of non-calcified coronary plaque in statin-taking patients. Moreover, our results show the ability of specific lipid species to predict non-calcified coronary plaque changes. In part II, non-invasive imaging modalities were used for risk stratification. Our results confirmed the long-term prognostic value of SPECT MPI to predict cardiac death or reinfarction. Also, we showed that left atrial appendage morphology could be assessed for risk stratification in patients with and without atrial fibrillation. Show less
Background: The ADVANCE registry is a large prospective study of outcomes and resource utilization in patients undergoing coronary computed tomography angiography (CCTA) and CT-based fractional... Show moreBackground: The ADVANCE registry is a large prospective study of outcomes and resource utilization in patients undergoing coronary computed tomography angiography (CCTA) and CT-based fractional flow reserve (FFRCT). As experience with new technologies and practices develops over time, we investigated temporal changes in the use of FERCT within the ADVANCE registry.Methods: 5083 patients with coronary artery disease (CAD) on CCTA were prospectively enrolled in the ADVANCE registry and were divided into 3 equally sized cohorts based on the temporal order of enrollment per site. Demographics, CCTA and FERCT findings, and clinical outcomes through 1-year follow-up, were recorded and compared between tertiles.Results: The number of patients with a >= 70% stenosis on CCTA was similar over time (33.6%, 30.9%, and 33.8% for cohort 1-3). The rate of positive FFRCT <= 0.80 was higher for cohorts 2 (67.3%) and 3 (74.6%) than for cohort 1 (57.1%, p < 0.001). Invasive FFR rates decreased from 25.8% to 22.4% between cohort 1 and 3 (p = 0.023). Moreover, patients with a FFRCT <= 0.80 were less frequently referred for invasive coronary angiography (ICA) (from 62.9% to 52.9%, p < 0.001), and underwent fewer revascularizations between cohort 1 and 3 (from 41.9% to 32.0%, p < 0.001). The prevalence of major events was low (1.2%) and similar between cohorts.Conclusions: Growing experience with FFRCT improved the likelihood of identifying hemodynamically significant CAD and safely reduced the need for ICA and revascularization in patients with anatomically significant disease even in the instance of an abnormal FFRCT. Show less
Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance ofepicardial coronary stenosis.... Show moreFractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance ofepicardial coronary stenosis. Despite the overall trend towards more physiology-guided revasculari-zati-on, there remains a gap, between guideline recommendations and the clinical adoption of functional evaItAatiorl of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologi'es, we sought to highlight the pri'nci'ples, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization Laboratory. Computational FFR has the potential to ex Pand and facilitate the use of physiology for diagnosis, procedural guidance, and evaluation of therapies, with anticipated impact on resource utilization and patient outcomes. Show less
In conclusion, this thesis proposes a new approach for reconstruction of coronary artery and the implanted BRS by fusion of OCT and X-ray angiography to analyze intracoronary ESS in vivo. The... Show moreIn conclusion, this thesis proposes a new approach for reconstruction of coronary artery and the implanted BRS by fusion of OCT and X-ray angiography to analyze intracoronary ESS in vivo. The studies conducted in this thesis demonstrate the feasibility of the proposed approach to analyze the detailed local coronary hemodynamics in patients, including the SS patterns after BRS implantation in coronary bifurcations. We observed that in vivo assessment of ESS was closely related to: (1) reconstruction of the side branches; (2) reconstruction of the BRS; (3) patient-specific flow; (4) post-processing portion size in which ESS was calculated. Based on these findings, we propose the following standard analysis procedures for assessment of intracoronary ESS in vivo: (1) reconstruct both the main vessel and its side branches to create a more accurate geometric model. (2) reconstruct BRS in naturally-bent shape and include it in the CFD analysis for assessment of ESS after BRS implantation; (3) use patient-specific coronary flow in the CFD analysis to have more accurate boundary condition; (4) set the proportion size according to the interrogated region of interest for quantification of the ESS in portions. Show less
Chu, M.; Birgelen, C. von; Li, Y.G.; Westra, J.; Yang, J.Q.; Holm, N.R.; ... ; Tu, S.X. 2018
In contemporary clinical practice, multimodality invasive assessment of coronary lesions offers an invaluable insight on clinical decision-making and PCI-guidance. Intracoronary imaging and... Show moreIn contemporary clinical practice, multimodality invasive assessment of coronary lesions offers an invaluable insight on clinical decision-making and PCI-guidance. Intracoronary imaging and functional assessment are two different diagnostic entities that offer complementary, rather than competitive, information. The role of this integrative understanding during a heart catheterization procedure is of outmost importance to achieve optimal procedural results, particularly regarding complicated coronary anatomies. Furthermore, this holistic approach can potentially lead to outcome improvement in patients with CAD treated percutaneously. Show less
Pyxaras, S.A.; Adriaenssens, T.; Barbato, E.; Ughi, G.J.; Serafino, L. di; Vroey, F. de; ... ; Wijns, W. 2018
