担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cardiovascular Revascularization Medicine  

Background Drug coated balloons (DCB) are a treatment option for lesions in small coronary arteries, with treatment using paclitaxel coated balloons (PCB) associated with less angiographic late lumen loss than sirolimus coated balloons (SCB). Methods This single-center sub-study of the TRANSFORM-I study compared quantitative optical coherence tomography (OCT) data in patients with de novo lesions in small coronary arteries treated with the MagicTouch (SCB) or SeQuent Please Neo (PCB). The relationship between the lumen volume of the treated segment immediately post procedure and at 6-month follow-up was evaluated. Late lumen volume loss (LLVL, mm³) was defined as the post-procedural lumen volume – lumen volume at 6 months. Results Serial OCT analysis was performed in 19 patients with 21 lesions (SCB: 9 patients/11 lesions; PCB: 10 patients/10 lesions). There was a significant decrease in lumen volume between post-procedure and 6 months in the SCB group (97.35 ± 71.09 mm³ vs 87.96 ± 61.48 mm³, p = 0.03), but not in the PCB group (69.67 ± 38.24 mm3 vs 71.64 ± 42.22 mm3, p = 0.64). The LLVL was 9.39 ± 12.76 mm³ and − 1.97 ± 12.90 mm³ in the SCB and PCB group, respectively (SCB vs PCB, p = 0.06). A trend for interaction between SCB and PCB was observed in the relationship between dissection volume and LLVL (SCB: LLVL = 1.28 ∗ dissection volume + 7.42, p = 0.37; PCB: LLVL = −2.84 ∗ dissection volume + 4.51, p = 0.12; p for interaction = 0.07). Conclusion In de novo lesions of small coronary arteries, treatment with an SCB lead to a significant decrease in lumen volume at 6-months compared to post-procedure, with no significant change observed after treatment with a PCB.

DOI： 10.1016/j.carrev.2025.03.025

Open Access

Scopus

PubMed

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Heart Journal  

The LANDMARK trial reported the non-inferiority of the Myval transcatheter heart valve (THV) series compared with the contemporary standard THV series (Sapien and Evolut) for a 30-day composite endpoint in patients with severe aortic stenosis. This exploratory study compared the performance of the Myval THV series with the contemporary THV series using the win ratio analysis.

DOI： 10.1016/j.ahj.2025.04.024

Open Access

Scopus

PubMed

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：American Heart Journal  

DOI： 10.1016/j.ahj.2025.04.008

Scopus

PubMed

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Catheterization and Cardiovascular Interventions  

Background: Accurate dimensional measurements are critical for quantitative coronary angiography (QCA) and serve as the first step in angiography-based fractional flow reserve (FFR) calculations. Aims: To compare minimum lumen diameter (MLD) measurements across multiple QCA or anigo-based FFR software programs using phantom models. Methods: Fourteen QCA and angio-based FFR programs were evaluated using six plexiglass phantoms, each containing three sequential bifurcations with known true values for the MLD of the proximal main, distal main, and side branch vessels. The accuracy and precision of MLD measurements were assessed by comparing software-measured values with true values across 54 MLD measurement points. No manual correction of the vessel contour was performed. The results of the 14 programs were reported anonymously. Results: The mean differences between the measured and true values were small (< 0.1 mm), however, in two angio-based FFR programs, the discrepancies were large (> 0.3 mm). The standard deviations of the differences were approximately 0.1 mm, except in one angio-based FFR program, where it exceeded 0.3 mm. Differences from true values were more pronounced in small (≦ 0.7 mm) compared to large (> 0.7 mm) true MLDs. The reproducibility of measurements was high (Pearson's correlation coefficient > 0.98) across all programs. Conclusion: Variations in MLD measurements were observed among different QCA and angio-based FFR programs. These variations may influence diagnostic performance and can seriously impact decisions made solely using angio-based FFR.

DOI： 10.1002/ccd.31670

Open Access

Scopus

PubMed

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Structural Heart  

DOI： 10.1016/j.shj.2024.100394

Open Access

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Eurointervention  

BACKGROUND: There are limited head-to-head randomised trials comparing the performance of different transcatheter heart valves (THVs). AIMS: We aimed to evaluate the non-inferiority of the balloon-expandable Myval THV series compared to the balloon-expandable SAPIEN THV series or the self-expanding Evolut THV series. METHODS: The LANDMARK trial randomised 768 patients in a 1:1 ratio, (Myval THV series [n=384] vs contemporary series with 50% SAPIEN THV series [n=192] and 50% Evolut THV series [n=192]). The non-inferiority of Myval over the SAPIEN or Evolut THV series in terms of the 30-day primary composite safety and effectiveness endpoint as per the third Valve Academic Research Consortium (VARC-3) was tested in an intention-to-treat population with a predefined statistical power of 80% (1-sided alpha of 5%) for a non-inferiority margin of 10.44%. RESULTS: The Myval THV series achieved non-inferiority for the primary composite endpoint over the SAPIEN THV series (24.7% vs 24.1%, risk difference [95% confidence interval {CI}]: 0.6% [not applicable {NA} to 8.0]; p=0.0033) and the Evolut THV series (24.7% vs 30.0%, risk difference [95% CI]: –5.3% [NA to 2.5]; p<0.0001). The incidences of pacemaker implantation were comparable (Myval THV series: 15.0%, SAPIEN THV series: 17.3%, Evolut THV series: 16.8%). At 30 days, the mean pressure gradient and effective orifice area were significantly better with the Myval THV series compared to the SAPIEN THV series (p<0.0001) and better with the Evolut THV series than with the Myval THV series (p<0.0001). At 30 days, the proportion of moderate to severe prosthetic valve regurgitation was numerically higher with the Evolut THV series compared to the Myval THV series (7.4% vs 3.4%; p=0.06), while not significantly different between the Myval THV series and the SAPIEN THV series (3.4% vs 1.6%; p=0.32). CONCLUSIONS: The Myval THV series is non-inferior to the SAPIEN THV series and the Evolut THV series in terms of the primary composite endpoint at 30 days.

DOI： 10.4244/EIJ-D-24-00951

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Jacc Asia  

Background Focal stenotic coronary lesions, as defined by the invasive pullback pressure gradient index (PPGI) measured before percutaneous coronary intervention (PCI), are associated with less residual angina than diffuse lesions as assessed by the Seattle Angina Questionnaire (SAQ). Objectives This study aims to investigate the interaction between a lesion’s baseline functional phenotype (focal vs diffuse) and the physiological success of PCI, as defined by a post-procedural Murray-based angiography-derived flow ratio (μFR) above 0.90 (adequacy of flow [AOF]), in correlation with angina status at 2 years. Methods The ASET-Japan study enrolled 203 patients with chronic coronary syndrome. The baseline functional disease pattern and the achievement of AOF (post-PCI μFR > 0.90) were analyzed as potential factors influencing the rate of residual angina at 2 years. Results SAQ scores were obtained in 186 patients. The median follow-up duration was 771 days (Q1-Q3: 752-805). AOF was achieved in in 61.3% (114 of 186; 95% CI: 54.1-68.0), with the μFR post-PCI differing significantly by the lesion’s baseline phenotype (diffuse 0.92 ± 0.06 vs focal 0.94 ± 0.04; P < 0.001). At 2-year follow-up, patients in the AOF group with preprocedural focal vs diffuse disease had significantly better angina frequency scores (99.2 ± 3.3 vs 94.8 ± 11.7; P = 0.007), and less frequent residual angina (6.7%; 4 of 60; 95% CI: 2.6-16.2 vs 22.0%; 11 of 50; 95% CI: 12.5-34.9; P = 0.040). Conclusions In patients who achieve AOF during PCI, the baseline functional phenotype of treated lesions in patients with or without angina at follow-up is significantly different. A global physiological assessment integrating AOF and the baseline functional pattern of disease is potentially useful to accurately predict residual angina post-PCI. (Acetyl Salicylic Elimination Trial Japan: The ASET Japan Pilot Study [ASET-JAPAN], NCT05117866 )

DOI： 10.1016/j.jacasi.2026.03.023

Open Access

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Heart  

Background: Coronary microvascular dysfunction (CMD) is common among patients with angina with non-obstructive coronary artery disease (ANOCA) and leads to poorer clinical outcomes. Exercise stress testing (EST) was shown to have a high specificity for detecting CMD. However, the relationship between diagnosing CMD using different invasive physiological parameters and thresholds and the association between EST findings and the endotype of CMD remains unknown. Methods: This multicentre, prospective cohort study enrolled 117 patients with ANOCA who underwent EST prior to invasive coronary angiography with functional assessment to measure coronary flow reserve (CFR), the index of microvascular resistance (IMR) and microvascular resistance reserve (MRR)=(CFR/FFR)×(P<inf>a rest</inf>/P<inf>a hyper</inf>). CMD was classified using multiple criteria, including MRR <3.0, CFR <2.5 and CFR <2.0 or IMR ≥25. Diagnostic sensitivity and specificity and the accuracy of EST findings (exercise-induced chest discomfort, ischaemic ECG changes and exercise intolerance) for diagnosing CMD were assessed. Results: The prevalence of CMD was similar under all three definitions. However, structural CMD was more common using MRR <3.0. Ischaemic ECG changes during EST showed an excellent diagnostic accuracy of 86.3% (78.7–92.0%) for detecting CMD, with a sensitivity and specificity of 86.2% (68.3–96.1%) and 86.4% (77.4–92.8%), respectively. Exercise-induced chest discomfort also had a good diagnostic accuracy of 76.1% (95% CI 67.3% to 83.5%); however, it offered no additional value when added to ischaemic ECG changes. EST preferentially identified structural CMD, while functional CMD was more frequently missed. Conclusions: Ischaemic ECG changes during EST performed immediately before invasive functional assessment demonstrated excellent diagnostic accuracy for identifying patients with CMD, particularly the structural endotype. Trial registration number: NCT05841485.

DOI： 10.1136/heartjnl-2025-325769

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本内科学会  

DOI： 10.2169/internalmedicine.6500-25

Open Access

Web of Science

PubMed

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Jacc Cardiovascular Interventions  

Background Coronary microvascular dysfunction should be assessed in patients with angina and nonobstructive coronary arteries. However, established indexes, such as the pressure wire–derived index of microvascular resistance (PW-IMR) and continuous thermodilution–derived absolute hyperemic microvascular resistance (R<inf>micro</inf>) remain underused, driving development of the wire-free angiography-derived index of microvascular resistance (angio-IMR). Objectives The aim of this study was to conduct a core laboratory comparison of 5 angio-IMR methods. Methods Five angio-IMR methods derived from 3 software platforms (QAngio XA 3D, FlashAngio, and AngioPlus Core) were compared against PW-IMR in 270 patients (274 vessels) and R<inf>micro</inf> in 42 patients (109 vessels) in a blinded fashion. Diagnostic performance was assessed on a per-vessel basis using receiver-operating characteristic (ROC) curves, Bland-Altman plots, and confusion matrices. Results The median PW-IMR was 19.02 (Q1-Q3: 12.79-28.08), with 81 of 274 vessels (29.6%) having PW-IMR ≥25. The median R<inf>micro</inf> was 387.50 Wood units (WU) (Q1-Q3: 312.00-501.00 WU), with 33 of 109 vessels (30.3%) having R<inf>micro</inf> ≥475 WU. The correlations among angio-IMR, PW-IMR, and R<inf>micro</inf> were poor across all methods. Three of the 5 methodologies overestimated PW-IMR (mean bias −20.72 to −26.36), with all exhibiting large random errors. ROC analysis using angio-IMR for discriminating PW-IMR ≥25 showed areas under the ROC curve ranging from 0.530 to 0.576 ( P > 0.05 for all), while 3 methods (methods A, B, and D) showed significantly better areas under the ROC curve to discriminate R<inf>micro</inf> ≥ 475 WU. When using the prespecified angio-IMR ≥25 threshold, only method E demonstrated acceptable accuracies of 61.4% and 62.0% to identify PW-IMR ≥25 and R<inf>micro</inf> ≥475 WU, respectively. Conclusions All 5 angio-IMR methods demonstrated poor diagnostic accuracy compared with PW-IMR and R<inf>micro</inf>, highlighting significant limitations in their clinical utility.

DOI： 10.1016/j.jcin.2025.10.027

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/eurheartj/ehag174

Open Access

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：一般社団法人 日本循環器学会  

Background: In the presence of a potent P2Y12 inhibitor such as prasugrel, the additional clinical antithrombotic benefit of aspirin is unclear. The feasibility of prasugrel monotherapy without aspirin after percutaneous coronary intervention (PCI) has been demonstrated in chronic coronary syndrome, but is yet to be assessed in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) and low anatomical complexity. Methods and Results: ASET-Japan is a single-arm study investigating the safety of prasugrel 12-month monotherapy with a locally approved dose (loading 20mg; maintenance 3.75mg), started immediately after successful PCI using platinum-chromium everolimus-eluting SYNERGY stents. The primary ischemic endpoint is a composite of cardiac death, spontaneous target vessel myocardial infarction, or definite stent thrombosis; the primary bleeding endpoint is Bleeding Academic Research Consortium (BARC) Type 3 and 5 bleeding. ASET-Japan recruited 101 NSTE-ACS patients from 11 Japanese sites. The mean (±SD) age was 69.1±12.3 years and 36.6% had a PRECISE-DAPT score >25. The mean anatomical SYNTAX score was 7.9±4.7. At 1 year, the primary ischemic endpoint occurred in 1 patient (1.0%; cardiac death). Two BARC Type 3a bleeding events occurred (2.0%): 1 due to a gastric ulcer and 1 to a descending colon malignancy. Conclusions: Low-dose (3.75mg/day) prasugrel monotherapy started immediately after SYNERGY stent deployment was feasible and safe in selected NSTE-ACS patients.

DOI： 10.1253/circj.CJ-25-0356

Open Access

Scopus

PubMed

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Eurointervention  

Pharmacological treatment remains vital in the effective management of atherosclerotic cardiovascular disease (ASCVD). Low-density lipoprotein (LDL) cholesterol-lowering therapies, such as statins, have consistently demonstrated robust efficacy in the primary and secondary prevention of cardiovascular events. The introduction of ezetimibe, bempedoic acid, and proprotein convertase subtilisin/kexin type 9 inhibitors have further strengthened the effectiveness of LDL cholesterol management, particularly in patients who are statin intolerant or who remain at high risk despite maximal tolerated statin therapy. In addition to managing LDL cholesterol, addressing residual lipid risk by targeting elevated triglyceride and lipoprotein(a) levels and low high-density lipoprotein cholesterol levels has emerged as a potentially important therapeutic consideration, as these are increasingly recognised as independent cardiovascular risk factors. Concurrently, inflammation is increasingly acknowledged as a significant contributor to atherogenesis and subsequent cardiovascular events. Clinical trials examining anti-inflammatory therapies, such as colchicine and interleukin-1β inhibitors (e.g., canakinumab), have demonstrated beneficial effects in reducing cardiovascular events independent of lipid modification. This narrative review provides an updated overview targeted specifically at physicians performing coronary artery bypass grafting or percutaneous coronary intervention. It summarises current evidence regarding established lipid-lowering therapies, emerging therapeutic approaches to address residual lipid risk, and the evolving role of anti-inflammatory interventions in the comprehensive management of ASCVD.

DOI： 10.4244/EIJ-D-25-00598

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of the Society for Cardiovascular Angiography and Interventions  

DOI： 10.1016/j.jscai.2025.104055

Open Access

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Cardiovascular Computed Tomography  

Background: Diagnostic concordance among Fractional Flow Reserve derived from computed tomography (FFR<inf>CT</inf>), and the Quantitative flow ratio (QFR) and Murray's Law-based QFR (μFR) derived from invasive coronary angiography (ICA) is implicitly assumed. Methods: Coronary CT angiography (CCTA) and ICA were analyzed in a central imaging core lab in this post-hoc imaging sub-study of the FASTTRACK CABG trial that enrolled 114 patients with de-novo three-vessel and/or left-main coronary artery disease. FFR<inf>CT</inf>, QFR, and μFR were analyzed at corresponding bifurcation points on CCTA and ICA, and virtual pullback pressure gradient index (PPGi) and FFR derivatives (dFFR/ds) were assessed to patho-physiologically categorize the lesion phenotype into diffuse or focal. Results: In 199 vessels, mean distal estimates of FFR<inf>CT</inf> (0.70), QFR (0.71), and μFR (0.69) were similar (p ​= ​0.127). QFR was significantly higher than FFR<inf>CT</inf> (p ​< ​0.01) and μFR (p ​< ​0.01) in the main branches of the two most proximal bifurcations. Concordance between FFR<inf>CT</inf> and QFR, and FFR<inf>CT</inf> and μFR was 76.3 ​% (kappa ​= ​0.451) and 80.3 ​% (kappa ​= ​0.544), respectively, when using a cut-off of ≤0.80. Concordance in the pathophysiological lesion phenotype (diffuse or focal) as derived from virtual PPGi was poor between FFR<inf>CT</inf> vs QFR (k ​= ​0.04) and FFR<inf>CT</inf> vs μFR (k ​= ​0.16). QFR (20.9 ​%) tended to identify focal lesions more frequently than FFR<inf>CT</inf> (13.4 ​%) and μFR (7.5 ​%). Conclusions: In the two most proximal bifurcations, QFR values were higher than FFR<inf>CT</inf> and μFR, resulting in lesion severity being underestimated, which may impact revascularization decisions. The pathophysiological phenotype classification was poorly correlated among FFR<inf>CT</inf>, QFR, and μFR. Trial registration number: NCT04142021.

DOI： 10.1016/j.jcct.2025.09.001

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Atherosclerosis  

Background and aims: Millions of survivors from severe COVID-19 infection suffer from residual symptoms including anginal chest pain. The pathophysiological mechanisms, particularly the role of coronary microvascular dysfunction (CMD), however, remain elusive. We compared the incidence and endotypes of CMD in patients with angina without obstructive coronary artery disease (ANOCA) between those who had a history of severe COVID-19 infection (COVID group, defined as COVID patients needing supplemental oxygen therapy with SpO2 < 90 % on room air), versus those who didn't (Control group). Methods: This multicentre, prospective cohort study enrolled 117 ANOCA patients (COVID group n = 59, Control group n = 58). All participants underwent exercise stress testing and invasive coronary physiology assessment to measure coronary flow reserve (CFR), and the index of microvascular resistance (IMR). CMD was defined as CFR<2.0 or IMR≥25. Patients also completed the modified Seattle Angina Questionnaire (SAQ-7) after invasive functional assessment. Results: CMD was diagnosed in 42 patients (35.9 %): 47.5 % in the COVID group and 24.1 % in the Control group (p = 0.015). The prevalence of structural CMD was significantly higher in the COVID group (28.8 % vs. 5.2 %, p < 0.001). The median IMR was significantly higher in the COVID versus the Control group (20.00 [15.00, 42.00] vs. 17.00 [12.00, 21.00], p = 0.002) while no significant differences were observed in CFR and FFR. The SAQ-7 summary scores (54.44 vs. 59.44, p = 0.003) and physical limitation and quality-of-life domain scores were all significantly lower in the COVID group. Conclusions: The incidence of CMD, particularly structural CMD, was higher in ANOCA patients with a history of severe COVID-19 infection, suggesting a link between persistent angina and CMD in this population.

DOI： 10.1016/j.atherosclerosis.2025.120389

Open Access

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Cardiology  

Background: Intravascular ultrasound (IVUS) reveals the location and burden of coronary artery disease (CAD) but is traditionally limited to segment-level analysis. We introduced the cumulative plaque burden index (CPBi), derived from AI-powered quantitative IVUS analysis, to characterize CAD morphological patterns across the entire vessel. Methods: In this ASET JAPAN sub-study, pre- and post-percutaneous coronary intervention (PCI) IVUS and angiography were analyzed. Plaque burden was quantified per millimeter on the pre-PCI IVUS. After filtering out plaque burden <40 %, CPB curves were generated to visualize morphological patterns. CPBi, a continuous metric derived from the CPB curves, was calculated to represent morphological patterns, with lower values indicating diffuse disease. Physiological CAD patterns were characterized by Murray law-based quantitative flow ratio (μFR)-derived pullback pressure gradient (PPG). Percentage reclassification was analyzed by comparing CPBi-derived CAD patterns with those derived from visual assessment and μFR-derived PPG. Results: CPB analysis was feasible in 130 out of 138 vessels, quantifying 8101 mm of plaque burden. The Median CPB index (CPBi) was 0.45[0.32–0.58], significantly correlating with μFR-derived PPG (r = 0.35, p < 0.001). Diffuse morphological pattern (low CPBi tertile) was associated with higher percent atheroma volume, longer segments with ≥40 % plaque burden, and longer stents. CPBi reclassified 55.4 % of visually assessed and 46.2 % of μFR-derived CAD patterns. Conclusions: AI enables quantitative plaque burden analysis of the entire IVUS pullback, allowing visualization of morphological patterns via CPB curves and quantification with CPBi, which is associated with atherosclerosis severity and hemodynamics. Future studies need to validate the clinical implications of CPB analysis.

DOI： 10.1016/j.ijcard.2025.133173

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Jacc Cardiovascular Interventions  

Background: Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are discordant in approximately 20% of cases, and it is unclear whether this is influenced by the physiological pattern of coronary artery disease (CAD). The pull back pressure gradient index (PPGi) can objectively characterize the physiological pattern of CADs. Objectives: The aim of this study was to evaluate whether PPGi differed in discordant groups (FFR+/iFR− vs FFR−/iFR+). Methods: The study enrolled 355 patients (390 vessels) with chronic coronary syndrome who had ≥1 epicardial coronary artery lesion with 40% to 90% diameter stenosis by visual assessment on invasive coronary angiography and had analyzable FFR, iFR, and PPGi derived from quantitative flow ratio. Cutoffs for hemodynamic significance were FFR ≤0.80 and iFR ≤0.89. Vessels were classified as FFR+/iFR+ (n = 103 [26.4%]), FFR−/iFR+ (n = 27 [6.9%]), FFR+/iFR− (n = 38 [9.7%]), and FFR−/iFR− (n = 222 [57%]) groups. Results: Median FFR, iFR, and quantitative flow ratio were 0.84 (Q1-Q3: 0.77-0.90), 0.92 (Q1-Q3: 0.88-0.97), and 0.83 (Q1-Q3: 0.73-0.90), respectively. FFR disagreed with iFR in 16.7% of cases (65 of 390). The median PPGi was 0.75 (Q1-Q3: 0.67-0.85). The physiological pattern of CAD was classified according to the PPGi as predominantly physiologically focal (PPGi ≥0.75) in 209 of 390 vessels (53.6%) or diffuse (PPGi < 0.75) in 181 of 390 vessels (46.4%). The median PPGi was significantly lower in FFR−/iFR+ vs FFR+/iFR− vessels (0.65 [Q1-Q3: 0.60-0.69] vs 0.82 [Q1-Q3: 0.75-0.85]; P < 0.001). Predominantly physiologically focal disease was significantly associated with FFR+/iFR− (76.3% [29 of 38]), while predominantly physiologically diffuse disease was significantly associated with FFR−/iFR+ (96.3% [26 of 27] [P < 0.001] for pattern of CAD between FFR+/iFR− and FFR−/iFR+ groups). Conclusions: The physiological pattern of CAD is an important influencing factor in FFR/iFR discordance. (Radiographic Imaging Validation and Evaluation for Angio iFR [REVEAL iFR]; NCT03857503)

DOI： 10.1016/j.jcin.2024.12.017

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Cardiology  

Background: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for chronic coronary syndromes (CCS) improves outcomes compared with angiography-guided PCI, however cardiac events still occur during long-term follow-up of FFR-negative patients. In the PREVENT study preventive PCI reduced cardiac-events in lesions which were FFR-negative (FFR > 0.80) and had intracoronary imaging defined vulnerable plaque. Coronary computed tomography angiography (CTA)-defined high risk plaque (HRP) is known to predict future cardiac events. We hypothesized that CTA defined HRP would identify which FFR-negative patients were at greatest risk of future cardiac events. Methods and results: We examined 373 consecutive CCS patients undergoing CTA followed not more than 90 days later by invasive FFR. Cardiac events were defined as cardiac death, non-fatal acute coronary syndromes, and ischemia-driven revascularization. Clinical follow-up was performed in all patients at a median of 32 months. Revascularization was performed in 131 of the 373 patients due to an FFR ≤ 0.80 (Treat group), with the remaining 242 having revascularization deferred (Defer group) due to an FFR > 0.80. In the Treat group the cardiac event rates between patients with and without HRP on CTA were similar (9.4 % versus 10.1 %, p = 0.90), whilst in the Defer group they were higher in patients with HRP (21.1 % versus 4.7 %, Log-rank-p < 0.0001). In multivariate Cox hazard analysis the presence of HRP (Hazard-ratio 12.79, 95 %confidence-intervals: 3.57–45.83, p < 0.0001) was an independent predictor for cardiac events in the Defer group. Conclusions: HRP on CTA was associated with future cardiac events in patients in whom revascularization was deferred due to a negative invasive-FFR (UMIN000054067; CAPTURE).

DOI： 10.1016/j.ijcard.2024.132895

Open Access

Web of Science

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Reports  

Diffuse coronary artery disease (CAD) impacts the immediate hemodynamic and clinical outcomes of percutaneous coronary intervention (PCI). We evaluated whether the diffuse pattern of CAD derived from angiographic Quantitative flow ratio (QFR) impacts the immediate hemodynamic outcome post-PCI and the medium term predicted vessel-oriented composite endpoint (VOCE). Paired pre-procedure QFRs were assessed in 503 patients and 1022 vessels in the Multivessel TALENT (MVT) trial. The pathophysiological pattern of CAD was defined as “predominantly diffuse” or “focal” according to a virtual QFR pullback pressure gradient (PPG) index < 0.78 and ≥ 0.78, respectively. Physiological “focal severity” was assessed using the QFR gradient per mm (dQFR/ds), with a value ≥ 0.025/mm the threshold for a “major gradient”. A post-PCI QFR ≥ 0.91 was considered optimal. Median pre-PCI PPG index was 0.70 (IQR 0.59–0.80). The prevalence of “predominantly diffuse” CAD and “major gradient” were 68.6% and 85.8%, respectively. A “Predominantly diffuse” pattern with a major gradient had a higher risk of a post-PCI QFR < 0.91 (OR 1.52,95%CI 1.47–1.58). In multivariable analysis, low QFR PPG index (diffuse disease) was an independent determinant of a post-PCI QFR < 0.91 (per 0.1 decrease of QFR PPG index, OR:9.8, 95% CI 3.0–32.2, p < 0.001). Based on post-PCI QFR the predicted 2-year VOCE, a powered endpoint in the MVT trial, was 6.1% and 4.2% in diffuse and focal lesions, respectively. A pre-procedure physiological pattern of diffuse CAD is an independent determinant of an unfavourable immediate hemodynamic outcome post-PCI, and detrimentally affects the predicted 2-year VOCE. Clinical Trial Registration URL: https://www.clinicaltrials.gov/ct2/show/NCT04390672 Unique Identifier: NCT04390672 (registration date 15/05/2020)

DOI： 10.1038/s41598-025-85872-9

Open Access

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Cardiovascular Revascularization Medicine  

Background: There are different definitions of periprocedural myocardial infarction (PPMI) both in terms of thresholds for cardiac biomarkers and the ancillary criteria for myocardial ischemia. Cardiac Troponin I (cTnI) and cardiac Troponin T (cTnT) are used interchangeably to diagnose PPMI. Objectives: This study evaluated the frequency of periprocedural myocardial injury and infarction as defined by the Society of Cardiovascular Angiography & Interventions (SCAI), the Academic Research Consortium-2 (ARC-2), and the 4th Universal definition of MI (4UDMI) stratified using cTnT versus cTnI, among patients with chronic coronary syndrome (CCS) and unstable angina. Results: Among 830 patients, PPMI rates according to the SCAI, ARC2 and 4UDMI criteria were 4.34 %, 2.05 %, and 4.94 % respectively, with higher rates seen for all definitions when using cTnI versus cTnT (SCAI: 9.84 % vs. 1.91 %, p < 0.001; ARC 2: 3.15 % vs. 1.56 %, p = 0.136; and 4UDMI 5.91 % vs. 4.51 %, p = 0.391). Minor and major periprocedural myocardial injury was respectively observed in 58.31 % and 27.10 % of patients, with rates of both significantly higher when using cTnI versus cTnT (Minor: 69.29 % vs. 53.47 %, p < 0.001, Major: 49.21 % vs. 17.36 %, p < 0.001). Conclusions: Among patients with CCS and unstable angina, PPMIs defined by SCAI occurred more frequently when using cTnI as opposed to cTnT, whereas the type of troponin had no impact on the incidence of PPMIs according to the ARC-2 and 4UDMI.

DOI： 10.1016/j.carrev.2024.05.022

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/ehjimp/qyaf017

Open Access

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Kardiologia Polska  

DOI： 10.33963/v.phj.104603

Open Access

Scopus

PubMed