45 research outputs found
Non-invasive fractional flow reserve using computed tomographic angiography: where are we now and where are we going?
No full textPhysiology-guided management of serial coronary artery disease a review
No full textImportance: Ischemia-guided revascularization is the cornerstone of contemporary management of coronary artery disease and has evolved from noninvasive functional evaluation to real-time assessment with invasive physiological indices during diagnostic catheterization. However, serial/diffuse disease is common, and revascularization decisions often need to be made about individual lesions within the same vessel. It is unclear whether current physiological techniques, such as fractional flow reserve, can be reliably used to discern the individual contribution of lesions within a serially diseased vessel with erroneous measurements, potentially leading to suboptimal revascularization decisions. This review addresses the application of physiological techniques to serial coronary disease, highlighting challenges and potential solutions.Observations: Physiological indices, such as fractional flow reserve, are well validated and correlated with clinical outcomes; however, the challenging physiology of serial stenoses makes it difficult to apply conventional techniques to identify the physiological significance of individual lesions. The 2 methods are most accurate in assessing serial disease are the manual pullback, with treatment of the greatest pressure gradient, or adopting the use of a large disease-free side branch to isolate the significance of the proximal lesion in the context of serial disease involving the left main coronary artery. In addition, resting indices, such as instantaneous wave-free ratio, have theoretical benefits that may make them more reliable in serial disease, with further data awaited.Conclusions and Relevance: Serial coronary artery disease is common, and physiological assessment is prone to errors. The future, whether it be in improving the interpretation of fractional flow reserve, using resting indices such as instantaneous wave-free ratio, or examining novel flow-based resistance indices, will hopefully improve our management of this common yet unresolved clinical conundrum. In the meantime, revascularisation decisions in this challenging scenario should focus on clinical presentation and physiologic evaluation using a pressure-wire pullback maneuver and left main disease-free side branch where appropriate.</p
Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial
No full textBackground: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. Methods: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. Results: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82-1.30]; P=0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. Conclusions: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. Registration: URL: https://www. Clinicaltrials: gov; Unique identifier: NCT01920048.https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.123.065300?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.or
Author Experiences with the IS Journal Review Process
No full textResearch publication in peer-reviewed journals is an important avenue for knowledge dissemination. However, information on journal review process metrics are often not available to prospective authors, which may preclude effective targeting of their research work to appropriate outlets. We study these metrics for information systems (IS) researchers through a survey of actual author experiences of the IS journal review process. Our results provide a knowledge base of the length and quality of the review process in various journals; responsiveness of the journal office and publication delay; and correlations of metrics with published studies of journal rankings. The data should enable authors to make effective submission decisions, as well as help to benchmark journal review processes among competing journals
Preoperative Starvation in Elective General Surgery
No full textObjective Study preoperative fasting times of adult elective surgical patients. Methods Fasting times for food and clear fluids, and the information used by patients to decide when to start fasting were studied. Results Among 200 patients, median fasting times were 2–4 times the guideline recommendations. Most patients used hospital written instructions but many started fasting substantially earlier than the instructions stipulated. Discussion Improved communication with patients could improve fasting times. </jats:sec
A Comparative Analysis of Taguchi Methodology and Shainin System DoE in the Optimization of Injection Molding Process Parameters
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Randomized Comparison of Fractional Flow Reserve and Instantaneous Wave Free Ratio in Serial Disease
No full textBackground: Fractional flow reserve (FFR) and the instantaneous wave-free ratio (iFR) identify arteries that benefit from percutaneous coronary intervention (PCI). FFR or iFR gradients on pullback are often used to predict the physiological result (FFR Δ or iFR Δ), but this approach is unvalidated. Objectives: The aim of this study was to compare the accuracy of FFR Δ, iFR Δ and FFR calc (a mathematical solution incorporating interaction between lesions) for predicting post-PCI physiology in serial or diffuse disease. Methods: Patients with a focal target lesion and either a second focal lesion or a diffusely diseased segment in the same vessel were randomized to FFR- vs iFR-guided PCI (ISRCTN18106869). FFR and iFR pullbacks were performed, with operators blinded to one modality. Following target lesion PCI, FFR and iFR were remeasured. The primary outcome was the error in predicted post-PCI physiology compared with actual values. Results: A total of 87 patients were randomized to FFR (n = 45) or iFR (n = 42). Median FFR and iFR were 0.70 (Q1-Q3: 0.62 to 0.78) and 0.81 (Q1-Q3: 0.68 to 0.90) at baseline and 0.82 (Q1-Q3: 0.74 to 0.87) and 0.89 (Q1-Q3: 0.83 to 0.93) after target lesion PCI. The predictive errors were 12% (6% to 17%) for FFR Δ, 4% (0% to 9%; P < 0.001) for iFR Δ, and −5% (−18% to 8%; P = 0.427) for FFR calc. Significant residual disease was missed in 36% of cases with FFR Δ, 34% with iFR Δ, and 14% with FFR calc. Conclusions: FFR and iFR pullback gradients overestimate the benefit of target lesion PCI and can miss residual ischemia in one-third of patients. FFR or iFR should be routinely repeated post-PCI in serial disease.</p
