Žiubrytė, Greta

Introduction Coronary CT angiography (CCTA) has become one of the main imaging modalities for stable coronary artery disease (CAD) [1]. The evaluation of atherosclerotic plaque can now be improved through detailed coronary artery plaque (CAP) analysis using dedicated CCTA software. Quantitative flow ratio (QFR) is a novel, angiography (ICA) based technique that allows for the evaluation of the functional significance of coronary artery stenosis [2].

Purpose The aim of this study was to compare detailed CAP features with QFR based functional analysis of the same lesion, with a long-term perspective on lesion revascularization (PCI).

Methods A total of 45 patients with no previous history of CAD were enrolled in this study. All patients underwent CCTA and were diagnosed with intermediate stenosis (IS) (defined as 50-69%), followed by ICA and QFR analysis. For CAP analysis in IS, a semi-automated, dedicated CCTA program (QAngio CT) was used. For the same IS lesion post-ICA QFR analysis was performed (QAngio XA-3D QFR analysis solution version 2.0). 7-year follow-up (FU) was conducted to evaluate the prognostic value of significant CAP features for IS PCI. QFR analysis was performed after the decision to proceed with IS PCI had been made (median time to PCI: 2178.0±747.40).

Results We studied 45 lesions and categorized them as non-significant (QFR-negative, QFR≥0.80; n=29) and functionally significant (QFR-positive, QFR<0.80, n=16) based on QFR values. CAP morphologic parameters (44 evaluated) did not differ significantly between the QFR groups. However, correlation analysis revealed a moderate positive correlation between QFR values and both lumen area (mm2) and mean lumen diameter (mm) at the site of maximal obstruction (Table 1). More than one-third of FU patients underwent IS PCI (37.8%). In whole-lesion analysis, lower lumen volume (mm3) and greater minimal plaque thickness (mm) were significantly associated with IS PCI. Additionally, analysis at the site of maximal obstruction showed that smaller lumen area, mean lumen diameter, and minimal diameter were significantly associated with PCI (Table 2). Significant predictors of PCI included lumen volume, lumen area, and mean lumen diameter (Table 3). Furthermore, the frequency of PCI was significantly higher in the QFR-positive group (Table 4) and QFR values were significantly lower in the PCI group compared to the no-PCI group (0.78 [0.076] vs. 0.90 [0.100], p<0.001).

Conclusion Our study demonstrated a moderate correlation between QFR and anatomical vessel parameters, suggesting that the functional severity of stenosis is associated with the anatomical narrowing. Over a 6-year FU period, both morphological and functional parameters emerged as significant predictors of IS PCI. These findings underscore the importance of integrating both types of measurements in clinical decision-making. Future studies with larger cohorts are warranted to validate these results.

Quantitative flow ratio (QFR) is a guideline-recommended angiography-based estimation of fractional flow reserve (FFR) for functional lesion evaluation. The FAVOR III Europe trial raised concerns regarding the safety and efficacy of QFR compared with FFR. Whether the poor clinical outcomes in the trial were attributable to software limitations or suboptimal in-procedure QFR analysis is unknown.

BACKGROUND Quantitative flow ratio (QFR) is a non-invasive angiographic tool that provides functional assessment of coronary stenosis without the need for pressure wires or hyperemia. This prospective study aimed to evaluate the procedural and inpatient treatment outcomes of QFR-guided percutaneous coronary intervention (PCI) compared with that of angiography-guided PCI in patients with ST-elevation myocardial infarction (STEMI) undergoing staged revascularization of non-culprit lesions. MATERIAL AND METHODS This randomized prospective single-center study was conducted at the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics (July 2020-June 2021). After successful culprit-lesion PCI for STEMI, 124 participants with residual angiographically significant non-culprit stenosis (50-75%) were randomized to QFR-guided (n=62) or angiography-guided PCI (n=62). Procedural characteristics, fluoroscopy time, contrast usage, stent number/length, and inpatient treatment outcomes were compared between groups using SPSS 28.0 software. RESULTS Compared with PCI guided by visual estimation alone, the QFR-guided PCI group showed significant reductions in fluoroscopy time (median 6.2 vs 8.0 min, P=0.009), contrast volume (median 100 vs 120 mL, P=0.038), number of stents implanted (median 1.5 vs 2.0, P=0.002), and stent length (median 28 vs 45 mm, P<0.001). No significant differences were found between the groups in terms of periprocedural complications or length of inpatient stay. CONCLUSIONS QFR-guided PCI of the non-culprit lesion resulted in shorter fluoroscopy time, lower contrast volume, and a smaller number and average length of implanted stents. These findings highlight the potential of QFR to enhance procedural efficiency and reduce unnecessary stenting in clinical practice without compromising patient outcomes.

The benefits of intravascular imaging-guided percutaneous coronary interventions (PCI) are well established. Intravascular imaging guidance improves short- and long-term outcomes, especially in complex PCI. Optical coherence tomography (OCT) has a higher resolution than intravascular ultrasound. However, the usage of OCT is mainly limited by the need to use contrast for flushing injections, which increases the risk of contrast-induced acute kidney injury, especially in patients with underlying chronic kidney disease. The aim of this study was to prove that flushing techniques with normal saline instead of contrast can be used in OCT imaging and can generate high-quality images.

Fractional flow reserve (FFR) or non-hyperaemic pressure ratios are recommended to assess functional relevance of intermediate coronary stenosis. Both diagnostic methods require the placement of a pressure wire in the coronary artery during invasive coronary angiography. Quantitative flow ratio (QFR) is an angiography-based computational method for the estimation of FFR that does not require the use of pressure wires. We aimed to investigate whether a QFR-based diagnostic strategy yields a non-inferior 12-month clinical outcome compared with an FFR-based strategy.

Background. Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models.
Methods. This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July–November 2014) and GlobalSurg-2 (January–July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator (‘LASSO’)) and machine learning (extreme gradient boosting (‘XGBoost’)). Final model selection was based on prognostic accuracy and clinical utility.
Results. There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept −0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models. Conclusion. The ‘Global Surgical-Site Infection’ score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm.

Įžanga Pasaulyje daugiau nei 200 milijonų žmonių serga vainikinių arterijų liga (VAL) [1]. Tai ne tik gyvenimo kokybę prastinanti, bet ir tiesioginę grėsmę pacientų gyvybei kelianti patologija, kurios valdymas reikalauja tikslių diagnostikos metodų ir optimalios gydymo taktikos parinkimo. Įrodyta, jog vainikinių arterijų (VA) stenozių fiziologinis įvertinimas atliekant invazinius tyrimus, tokius kaip frakcinis tėkmės rezervas (FTR) ar ramybės indeksai, yra veiksmingas būdas priimti klinikinius sprendimus dėl perkutaninės VA intervencijos atlikimo (ypač esant lėtinei VAL ir ribinėms VA stenozėms) bei yra rekomenduojamas tiek Europos [2], tiek Amerikos ekspertų [3]. Nepaisant metodų tikslumo, dėl didėjančios komplikacijų rizikos, ilgėjančios procedūros trukmės ir didelių sveikatos sistemos kaštų poreikio fiziologiniai invaziniai tyrimai klinikinėje praktikoje naudojami retai. Dėl šios priežasties vis daugiau dėmesio kreipiama į potencialią invazinių tyrimų alternatyvą – kiekybinį tėkmės santykį (KTS). KTS – tai neinvazinis, kompiuterizuotas VA hemodinamikos vertinimo metodas, atliekamas panaudojant įprastos vainikinės arterijų angiografijos (VAA) metu gautus vaizdus ir dėl to nekeliantis papildomos rizikos pacientams bei nedidinantis kaštų poreikio [4]. Deja, šiai dienai vis dar trūksta tyrimų, kurie įrodytų KTS ir FTR atitikimą bei patvirtintų KTS pritaikomumą kasdieninėje klinikinėje praktikoje vertinant VA stenozių hemodinaminį reikšmingumą. [...].

AIMS:

This study aims to assess the agreement between numerical values and clinical judgment of QFR and FFR measurements in intermediate (35-75%) lesions for patients with chronic coronary artery disease.

METHODS AND RESULTS:

In total, 784 vessels of 680 patients treated due to chronic coronary syndrome (CCS) in our hospital between 1 November 2018 and 31 December 2023 have been prospectively included in this single-center study. For all included patients, an invasive coronary artery angiography revealing intermediate coronary artery lesions (lumen stenosis 35-75%) accompanied by invasive physiology evaluation by QFR and FFR was performed. An online QFR analysis was performed, and the decision was confirmed by FFR measurement. The same experienced QFR observer performed all QFR analyses. A numerical agreement between those two measurements was assessed by the Bland-Altman plot, and clinical judgment agreement was evaluated by Chi-square test using the software package SPSS 28.0 with the chosen level of significance p < 0.001. Of all included arteries, 517 (65.9%) were left anterior descending (LAD), 90 (11.5%) were left circumflex (LCx), and 177 (22.6%) were right coronary arteries (RCA). A strong correlation between FFR and QFR measurement and clinical judgment made by those measurements were found, r=0.971 and 0.964, p<0.001, respectively. There were no statistically significant differences between numerical values of FFR and QFR (M=0.0028, SD=0.0183), t(783) = 4.321, p < 0.001.The clinical judgment based on FFR and QFR measurements also did not differ, X2 (1, N=784) = 728.53, p < 0.001, V=0.964)

CONCLUSION:

This is the first long-term numerous prospective study proving an excellent agreement between numerical values and clinical judgment based on either FFR or QFR. Quantitative Flow Ratio is a fully reliable method for intermediate coronary artery lesions physiological evaluation in chronic coronary syndrome patients. It might be a cheaper, faster, and utterly reliable alternative for invasive physiological significance evaluation methods used in everyday clinical practice

AIMS:

The primary aim of this study was to investigate the differences between patients chosen for surgical myectomy and transcatheter alcohol septal ablation methods. This study's secondary outcome included the permanent pacemaker's prevalence requirement, postprocedural ventricular events, and LVOT obstruction gradient reduction.

METHODS AND RESULTS:

In total, 34 patients diagnosed with HCMP with severe LVOT obstruction (>50 mmHg) and treated in our hospital between the 1st of January in 2016 and the 1st of January in 2023 have been included in our single-centre study. Of all, 11 (32.35%) were alcohol septal ablation (ASA), and the rest, 23 (67.65%), were surgical septal myectomy (SM). For all patients, baseline and six-month follow-up echocardiograms were performed by experienced physicians. Clinical data were collected from medical records. For statistical analysis, the SPSS 28.0 statistical software package was used with the chosen significance level of p < 0.05. The preprocedural data analysis revealed that the SM group had a statistically significant age difference of almost ten years compared to the ASA group (p = .02). Furthermore, the ASA group exhibited a more significant preprocedural left ventricle ejection fraction, left ventricular outflow tract (LVOT) systolic gradient, and a higher occurrence of systolic anterior motion (SAM) compared to the SM group (p = .02, p = .02, and p = .04, respectively). Additionally, advanced angina symptoms were more frequently observed in the SM group (p<.001), while non-sustained ventricular tachycardia and periprocedural complete atrioventricular block were more frequently diagnosed in the ASA group (p = .04). No other significant differences were observed between the two groups (as presented in Table 1). Regarding procedural outcomes, the analysis revealed a statistically significant reduction in LVOT systolic gradient in the ASA group compared to the SM group (p = .03). The frequencies of pacemaker implantation after the procedure did not differ significantly between the two groups (p = .53).

CONCLUSION:

Despite both alcohol septal ablation and surgical myectomy being considered safe options for managing hypertrophic cardiomyopathy with left ventricular outflow tract obstruction in highly experienced centers, this study revealed that alcohol septal ablation resulted in a more significant reduction in systolic gradient compared to surgical myectomy, with no substantial differences observed in the need for permanent pacemaker implantation.

Introduction Hypertrophic cardiomyopathy (HCMP) is a genetic heart condition, marked by asymmetrical abnormal hypertrophy of the left ventricular muscle, accompanied by the absence of left ventricle dilation [1], observed in approximately 0.2 % of the global adult population [2]. Left ventricular outflow tract (LVOT) obstruction is an integral component of HCMP, defined by a peak instantaneous pressure gradient of ⩾30 mmHg in LVOT [3]. 10% of individuals continue to experience significant symptoms despite receiving appropriate medical treatment. Two primary HCMP treatments – alcohol septal ablation (ASA) and surgical septal myectomy (SM) – necessitate a thorough contemporary comparison to enhance understanding of their benefits, risks, and overall efficacy in managing HCMP. [...].