At a Glance
448 Pages
Revised
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Preface | p. vii |
List of Abbreviations | p. xix |
Introduction | p. 1 |
Historical overview | p. 1 |
How to use this book | p. 2 |
Acknowledgements | p. 3 |
The coronary circulation | p. 5 |
The coronary tree | p. 5 |
The arterial system | p. 5 |
Capillaries | p. 5 |
Collaterals | p. 8 |
Coronary flow mechanics | p. 10 |
Regulation of myocardial blood flow | p. 11 |
Autoregulation | p. 12 |
Extravascular coronary compression | p. 13 |
Neural regulation | p. 14 |
Coronary endothelium | p. 14 |
The concept of flow reserve | p. 16 |
Reactive hyperemia | p. 16 |
Minimal coronary resistance | p. 16 |
Coronary flow reserve | p. 18 |
Introduction to invasive assessment of the coronary circulation | p. 25 |
Morphological approaches | p. 25 |
Quantitative coronary angiography | p. 25 |
Intracoronary ultrasound | p. 30 |
Intracoronary angioscopy | p. 33 |
Functional approaches | p. 34 |
Myocardial videodensitometry | p. 34 |
Coronary flow velocity measurement | p. 35 |
Coronary pressure measurement | p. 40 |
Fractional flow reserve (From Coronary Pressure to Coronary Flow) | p. 51 |
Introduction | p. 51 |
Prerequisites for coronary pressure measurement | p. 52 |
Myocardial Fractional Flow Reserve | p. 53 |
Unique features of Myocardial Fractional Flow Reserve | p. 61 |
Coronary Fractional Flow Reserve and fractional collateral blood flow | p. 62 |
Limitations of Fractional Flow Reserve | p. 71 |
Microvascular disease | p. 71 |
Extravascular compression, zero-flow pressure, and vascular capacitance | p. 72 |
Coronary steal | p. 72 |
Left ventricular hypertrophy and previous myocardial infarction | p. 74 |
Mathematical derivation and scientific background of the pressure-flow equations | p. 75 |
Practical set-up of coronary pressure measurement | p. 83 |
Set-up in the catheterization laboratory | p. 83 |
Pressure transducers | p. 83 |
Medications | p. 84 |
Catheters | p. 85 |
Pressure-monitoring guide wires | p. 85 |
Fluid-filled pressure-monitoring guide wires | p. 85 |
Micromanometer-tipped guide wires | p. 87 |
Performance of the procedure | p. 91 |
Verification of equal pressures in the ascending aorta | p. 91 |
Crossing the stenosis | p. 92 |
Induction of maximum hyperemia | p. 93 |
Pull-back curve | p. 95 |
PTCA and stenting | p. 95 |
Control for drift or other mistakes | p. 97 |
Maximum hyperemic stimuli | p. 97 |
Intracoronary versus intravenous stimuli | p. 97 |
Intracoronary papaverine | p. 101 |
Intracoronary adenosine | p. 101 |
Intravenous adenosine | p. 103 |
Intracoronary ATP | p. 105 |
Intravenous ATP | p. 105 |
Intravenous dipyridamole | p. 106 |
Intravenous dobutamide | p. 107 |
Influence of the presence of a guide wire across the lesion on stenosis hemodynamics | p. 107 |
Safety of intracoronary pressure measurement | p. 111 |
Pitfalls in coronary pressure measurement | p. 115 |
Use of balloon catheters or hypotubes instead of wires | p. 115 |
Incorrect height of the pressure transducer | p. 119 |
Use of a guide wire introducer | p. 119 |
Damping of pressure by the guiding catheter | p. 121 |
Guiding catheter with side-holes | p. 122 |
Signaldrift during procedure | p. 125 |
Proportionality of P[subscript d] and P[subscript a] | p. 128 |
Reversed or paradoxical gradient | p. 128 |
Inadequate registration of aortic pressure by the guiding catheter | p. 129 |
Validation of fractional flow reserve in animals | p. 131 |
Introduction | p. 131 |
Methods | p. 132 |
The pressure-flow model | p. 132 |
Animal instrumentation | p. 133 |
Experimental protocol | p. 136 |
Data processing and statistical analysis | p. 136 |
Results | p. 137 |
Hemodynamic observations and the relation between mean arterial pressure and coronary wedge pressure | p. 137 |
Calculated versus measured FFR and contribution of collateral flow to total flow | p. 138 |
Discussion | p. 143 |
Advantages of fractional flow reserve | p. 143 |
From coronary pressure to coronary flow | p. 144 |
Limitations of the model | p. 145 |
Clinical implications | p. 148 |
Validation of fractional flow reserve in humans | p. 153 |
Study design | p. 153 |
Rationale for validating pressure-derived fractional flow reserve by PET measurements of relative flow reserve | p. 156 |
Feasibility of fractional flow reserve calculation | p. 161 |
Myocardial flow by PET versus pressure-derived indexes | p. 161 |
Myocardial blood flow versus quantitative coronary angiography | p. 163 |
Conclusions | p. 165 |
Independence of fractional flow reserve of hemodynamic loading conditions | p. 167 |
Study design | p. 167 |
Feasibility of the measurements | p. 170 |
Reproducibility under basal hemodynamic conditions | p. 171 |
Effects of hemodynamic changes | p. 173 |
Changes in heart rate | p. 173 |
Changes in blood pressure | p. 173 |
Changes in contractility | p. 177 |
Reproducibility of translesional pressure gradients | p. 178 |
Comments | p. 179 |
Fractional flow reserve and the fluid dynamic equation | p. 182 |
Clinical implications | p. 187 |
Fractional flow reserve in normal coronary arteries | p. 191 |
Introduction | p. 191 |
Fractional flow reserve innormal coronary arteries | p. 192 |
FFR[subscript myo] in apparently normal contralateral coronary arteries in patients with remote coronary artery disease | p. 198 |
Fractional flow reserve to distinguish significant stenosis: use at diagnostic catheterization (Cut-off values do detect reversible ischemia) | p. 201 |
Rationale for cut-off values of invasive indexes | p. 201 |
Relation between FFR[subscript myo] and exercise-induced myocardial ischemia. Part I: Lower Threshold value of FFR[subscript myo], not associated with inducible ischemia | p. 206 |
Relation between FFR[subscript myo] and exercise-induced myocardial ischemia. Part II: Upper threshold value of FFR[subscript myo] associated with inducible ischemia | p. 212 |
Comparison of dobutamine stress-echocardiography and fractional flow reserve | p. 221 |
Practical use of the cut-off value of 0.75 in diagnostic catheterization | p. 225 |
The cut-off value of 0.75 in a physiologic perspective | p. 226 |
Fractional flow reserve to assess intermediate stenosis (Comparison to non-invasive tests) | p. 231 |
The limited accuracy of non-invasive tests to identify inducible ischemia | p. 231 |
Design of the study | p. 232 |
Study population | p. 232 |
Outlines of the study protocol | p. 232 |
Exercise testing ant thallium scintigraphy | p. 233 |
Dobutamine stress echocardiography | p. 234 |
Pressure measurements and calculation of FFR[subscript myo] | p. 234 |
On-line clinical decision making, based upon FFR[subscript myo] | p. 234 |
Definition of a gold standard of inducible ischemia by combination of the non-invasive tests | p. 235 |
Results | p. 236 |
Procedural and clinical results | p. 236 |
Comparison of myocardial fractional flow reserve to the ischemic gold standard | p. 236 |
Follow-up of the patients with FFR[subscript myo][greater than or equal]0.75 | |
Discussion | p. 240 |
The reliability of FFR[subscript myo] for clinical decision making | p. 240 |
Methodological considerations for the composite ischemic standard | p. 242 |
Clinical implications | p. 243 |
FFR in some specific conditions | p. 247 |
FFR[subscript myo] after myocardial infarction | p. 248 |
FFR[subscript myo] in the presence of microvascular disease | p. 253 |
FFR[subscript myo] in case of left ventricular hypertrophy | p. 254 |
Multiple stenoses within one coronary artery | p. 255 |
Definitions and mathematical model | p. 255 |
Animal validation | p. 258 |
Human validation | p. 258 |
Comments | p. 262 |
FFR and exercise-induced spasm | p. 267 |
FFR in long lesions and diffuse disease | p. 268 |
Fractional flow reserve for evaluation of coronary interventions | p. 271 |
Fractional flow reserve after balloon angioplasty | p. 271 |
Fractional flow reserve after stent implantation | p. 285 |
Comparison of QCA, IVUS, and coronary pressure measurement to assess optimum stent deployment | p. 286 |
Stent database | p. 298 |
Guidelines and recommendations for using coronary pressure in monitoring coronary interventions | p. 302 |
Fractional flow reserve and clinical outcome | p. 307 |
Introduction | p. 307 |
Retrospective analysis of patients outcome after deferred angioplasty based on FFR | p. 308 |
Prospective analysis of FFR[subscript myo] based decision-making to perform or defer a coronary intervention: The DEFER study | p. 315 |
FFR and clinical outcome in patients with intermediate left main stenosis | p. 319 |
Practical consequences for routine use in the catheterization laboratory | p. 324 |
Assessment of collateral blood flow by coronary pressure measurement | p. 327 |
Assessment of collateral circulation | p. 327 |
Fractional collateral blood flow | p. 327 |
Calculation of fractional collateral blood flow in clinical practice | p. 330 |
Some further aspects of fractional collateral flow | p. 334 |
The constant relation between P[subscript a], P[subscript v], and P[subscript w] | p. 334 |
Maximum hyperemia at coronary occlusion | p. 334 |
Is it necessary to measure venous pressure for collateral flow assessment? | p. 335 |
Collateral flow at different degrees of stenosis | p. 336 |
Potential of recruitable collateral blood flow to predict future ischemic events | p. 337 |
Clinical cases | p. 353 |
Intermediate stenosis: case 1, 2, 3, 4 | p. 354 |
Long lesion: case 5 | p. 362 |
Difficult coronary anatomy: case 6, 7 | p. 364 |
Identification of the culprit lesion: case 8, 9 | p. 368 |
Left main disease: case 10, 11, 12 | p. 374 |
Epicardial versus microvascular disease: case 13 | p. 380 |
Previous myocardial infarction: case 14, 15 | p. 382 |
Diffuse disease: case 16, 17 | p. 386 |
Serial stenosis: case 18, 19 | p. 390 |
Collaterals: case 20, 21 | p. 394 |
Evaluation of PTCA: case 22, 23 | p. 399 |
Evaluation of adequate stent deployment: case 24 | p. 405 |
Unmasking of proximal gradient by stenting a distal stenosis: case 25 | p. 408 |
Conclusions and perspectives for the future | p. 411 |
Index | p. 419 |
Table of Contents provided by Syndetics. All Rights Reserved. |
ISBN: 9780792361701
ISBN-10: 0792361709
Series: DEVELOPMENTS IN CARDIOVASCULAR MEDICINE
Published: 29th February 2000
Format: Hardcover
Language: English
Number of Pages: 448
Audience: General Adult
Publisher: Springer Nature B.V.
Country of Publication: NL
Edition Number: 2
Edition Type: Revised
Dimensions (cm): 23.39 x 15.6 x 2.54
Weight (kg): 0.78
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