Kosei Terada

Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

BACKGROUND A novel index of the functional severity of coronary stenosis, quantitative flow ratio (QFR), may not consider the amount of viable myocardium in prior myocardial infarction (MI) because QFR is calculated from 3D quantitative coronary angiography.Methods and Results:We analyzed QFR (fixed-flow QFR [fQFR] and contrast-flow QFR [cQFR]) and fractional flow reserve (FFR) in prior-MI-related coronary arteries (n=75) and non-prior-MI-related coronary arteries (n=75). Both fQFR and cQFR directly correlated with FFR in the prior-MI-related coronary arteries (fQFR: r=0.84, P<0.001; and cQFR: r=0.88, P<0.001) and the non-prior-MI-related coronary arteries (fQFR: r=0.91, P<0.001; and cQFR: r=0.94, P<0.001). fQFR was significantly smaller than FFR in the prior-MI-related coronary arteries (0.73±0.14 vs. 0.79±0.11, P=0.002), but there was no significant difference between fQFR and FFR in the non-prior-MI-related coronary arteries. The value of cQFR minus FFR was significantly lower in the prior-MI-related coronary arteries compared with the non-prior-MI-related coronary arteries (-0.02±0.06 vs. 0.00±0.04, P=0.010). The diagnostic accuracy of fQFR ≤0.8 and cQFR ≤0.8 for predicting FFR ≤0.80 was numerically lower in the prior-MI-related coronary arteries compared with the non-prior-MI-related coronary arteries (fQFR: 77% vs. 87%; and cQFR: 87% vs. 92%). CONCLUSIONS When FFR is used as the gold standard, the accuracy of QFR for assessing the functional severity of coronary stenosis might be reduced in the prior-MI-related coronary arteries compared with non-prior-MI-related coronary arteries.

Three-vessel fractional flow reserve measurement for predicting clinical prognosis in patients with coronary artery disease

Coronary artery disease is a common form of heart disease affecting large numbers of people across the world. Coronary artery disease is caused by atherosclerosis that narrow the coronary artery lumen and limit myocardial blood supply.

Usefulness of rescue ultrasound guidance for transradial cardiac catheterization

INTRODUCTION AND OBJECTIVES Transradial cardiac catheterization reduces access site complications and is more comfortable for patients than the transfemoral approach. However, failure of the transradial approach is more common than the transfemoral approach. This study aimed to investigate whether ultrasound-guided rescue could facilitate transradial cardiac catheterization. METHODS We retrospectively analyzed 592 consecutive patients who underwent coronary angiography and/or percutaneous coronary intervention. Patients were divided into 2 groups: the palpation technique (PT) (n = 280) and the ultrasound guidance (UG) available group (n = 312). The application and the timing of introduction of ultrasound guidance in the UG group were at the discretion of the individual operators. RESULTS Real-time ultrasound guidance was used in 98 patients (31.4%) in the UG group. No statistically significant intergroup differences were observed in the incidence of hematoma (6.8% vs. 5.8%, p = 0.62). Although the procedural time in the UG group was longer than that in the PT group (303 s vs. 357 s, p < 0.01), the success rate of sheath insertion was significantly higher in the UG group (97% vs. 92%, p < 0.01). Multivariate analysis revealed that the availability of UG was the only independent predictor of success of sheath insertion (odds ratio 2.79, 95% confidence interval 1.24-6.31, p = 0.01). CONCLUSIONS Although UG maneuvers require additional procedural time for setting up systems, UG rescue was effective for successful transradial cardiac catheterization.