The ability of contemporary cardiologists to judge the ischemic impact of a coronary lesion visually
Foley, Michael, Rajkumar, Christopher A., Ahmed-Jushuf, Fiyyaz, Nour, Daniel, Fung, Chi Ho, Seligman, Henry, Pathimagaraj, Rachel H., Petraco, Ricardo, Sen, Sayan, Nijjer, Sukhjinder, Howard, James P., Ahmad, Yousif, Allahwala, Usaid, Bhindi, Ravinay, Chamie, Daniel, Doi, Shunich, Kuwata, Shingo, Kaihara, Toshiki, Koga, Masashi, Ishibashi, Yuki, Higuma, Takumi, Tanabe, Yasuhiro, Nakayama, Masafumi, Kawase, Yoshiaki, Watanabe, Akifumi, Funayama, Naohiro, Horinaka, Ryo, Hijikata, Nobuhiro, Takahashi, Takamichi, Matsuo, Hitoshi, Hansen, Peter S., Manica, Andre, Weaver, James, Alzuhairi, Karam, Yong, Thon-Hon, Warisawa, Takayuki, Francis, Darrel P., Shun-Shin, Matthew J., and Al-Lamee, Rasha K. (2024) The ability of contemporary cardiologists to judge the ischemic impact of a coronary lesion visually. Cardiovascular Revascularization Medicine, 59. pp. 60-66.
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Abstract
Background: Landmark trials showed that invasive pressure measurement (Fractional Flow Reserve, FFR) was a better guide to coronary stenting than visual assessment. However, present-day interventionists have benefited from extensive research and personal experience of mapping anatomy to hemodynamics. Aims: To determine if visual assessment of the angiogram performs as well as invasive measurement of coronary physiology.
Methods: 25 interventional cardiologists independently visually assessed the single vessel coronary disease of 200 randomized participants in The Objective Randomized Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina trial (ORBITA). They gave a visual prediction of the FFR and Instantaneous Wave-free Ratio (iFR), denoted vFFR and viFR respectively. Each judged each lesion on 2 occasions, so that every lesion had 50 vFFR, and 50 viFR assessments. The group consensus visual estimates (vFFR-group and viFR-group) and individual cardiologists' visual estimates (vFFR-individual and viFR-individual) were tested alongside invasively measured FFR and iFR for their ability to predict the placebo-controlled reduction in stress echo ischemia with stenting.
Results: Placebo-controlled ischemia improvement with stenting was predicted by vFFR-group (p < 0.0001) and viFR-group (p < 0.0001), vFFR-individual (p < 0.0001) and viFR-individual (p < 0.0001). There were no significant differences between the predictive performance of the group visual estimates and their invasive counterparts: p = 0.53 for vFFR vs FFR and p = 0.56 for viFR vs iFR.
Conclusion: Visual assessment of the angiogram by contemporary experts, provides significant additional information on the amount of ischaemia which can be relieved by placebo-controlled stenting in single vessel coronary artery disease.
Item ID: | 80366 |
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Item Type: | Article (Research - C1) |
ISSN: | 1878-0938 |
Keywords: | Coronary artery disease, Fractional flow reserve, Instantaneous wave free ratio, Ischemia, ORBITA, Visual angiography |
Copyright Information: | © 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
Date Deposited: | 06 Feb 2024 23:23 |
FoR Codes: | 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100% |
SEO Codes: | 20 HEALTH > 2001 Clinical health > 200101 Diagnosis of human diseases and conditions @ 100% |
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