Mina Ghobrial, Hazel Haley, Rebecca Gosling, Daniel James Taylor, James Richardson, Kenneth Morgan, David Barmby, Javaid Iqbal, Arvindra Krishnamurthy, Rajender Singh, Dwayne Conway, Ian Hall, Zulfiquar Adam, Nigel Wheeldon, Ever D Grech, Robert F Storey, Alexander Rothman, Gillian Payne, Muhammad Naeem Tahir, Simon Smith, Justin Cooke, Steven Hunter, Neil Cartwright, Syed Sadeque, Norman Paul Briffa, Abdallah Al-Mohammad, Laurence O'Toole, Dominic Rogers, Patricia V Lawford, David R Hose, Julian Gunn, Paul D Morris
{"title":"虚拟分数血流储备对冠状动脉造影患者的影响模型(VIRTU-4)。","authors":"Mina Ghobrial, Hazel Haley, Rebecca Gosling, Daniel James Taylor, James Richardson, Kenneth Morgan, David Barmby, Javaid Iqbal, Arvindra Krishnamurthy, Rajender Singh, Dwayne Conway, Ian Hall, Zulfiquar Adam, Nigel Wheeldon, Ever D Grech, Robert F Storey, Alexander Rothman, Gillian Payne, Muhammad Naeem Tahir, Simon Smith, Justin Cooke, Steven Hunter, Neil Cartwright, Syed Sadeque, Norman Paul Briffa, Abdallah Al-Mohammad, Laurence O'Toole, Dominic Rogers, Patricia V Lawford, David R Hose, Julian Gunn, Paul D Morris","doi":"10.1136/heartjnl-2024-324039","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The practical application of 'virtual' (computed) fractional flow reserve (vFFR) based on invasive coronary angiogram (ICA) images is unknown. The objective of this cohort study was to investigate the potential of vFFR to guide the management of unselected patients undergoing ICA. The hypothesis was that it changes management in >10% of cases.</p><p><strong>Methods: </strong>vFFR was computed using the Sheffield VIRTUheart system, at five hospitals in the North of England, on 'all-comers' undergoing ICA for non-ST-elevation myocardial infarction acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The cardiologists' management plan (optimal medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass surgery or 'more information required') and confidence level were recorded after ICA, and again after vFFR disclosure.</p><p><strong>Results: </strong>517 patients were screened; 320 were recruited: 208 with ACS and 112 with CCS. The median vFFR was 0.82 (0.70-0.91). vFFR disclosure did not change the mean number of significantly stenosed vessels per patient (1.16 (±0.96) visually and 1.18 (±0.92) with vFFR (p=0.79)). A change in intended management following vFFR disclosure occurred in 22% of all patients; in the ACS cohort, there was a 62% increase in the number planned for medical management, and in the CCS cohort, there was a 31% increase in the number planned for PCI. In all patients, vFFR disclosure increased physician confidence from 8 of 10 (7.33-9) to 9 of 10 (8-10) (p<0.001).</p><p><strong>Conclusion: </strong>The addition of vFFR to ICA changed intended management strategy in 22% of patients, provided a detailed and specific 'all-in-one' anatomical and physiological assessment of coronary artery disease, and was accompanied by augmentation of the operator's confidence in the treatment strategy.</p>","PeriodicalId":12835,"journal":{"name":"Heart","volume":null,"pages":null},"PeriodicalIF":5.1000,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287621/pdf/","citationCount":"0","resultStr":"{\"title\":\"Modelled impact of virtual fractional flow reserve in patients undergoing coronary angiography (VIRTU-4).\",\"authors\":\"Mina Ghobrial, Hazel Haley, Rebecca Gosling, Daniel James Taylor, James Richardson, Kenneth Morgan, David Barmby, Javaid Iqbal, Arvindra Krishnamurthy, Rajender Singh, Dwayne Conway, Ian Hall, Zulfiquar Adam, Nigel Wheeldon, Ever D Grech, Robert F Storey, Alexander Rothman, Gillian Payne, Muhammad Naeem Tahir, Simon Smith, Justin Cooke, Steven Hunter, Neil Cartwright, Syed Sadeque, Norman Paul Briffa, Abdallah Al-Mohammad, Laurence O'Toole, Dominic Rogers, Patricia V Lawford, David R Hose, Julian Gunn, Paul D Morris\",\"doi\":\"10.1136/heartjnl-2024-324039\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The practical application of 'virtual' (computed) fractional flow reserve (vFFR) based on invasive coronary angiogram (ICA) images is unknown. The objective of this cohort study was to investigate the potential of vFFR to guide the management of unselected patients undergoing ICA. The hypothesis was that it changes management in >10% of cases.</p><p><strong>Methods: </strong>vFFR was computed using the Sheffield VIRTUheart system, at five hospitals in the North of England, on 'all-comers' undergoing ICA for non-ST-elevation myocardial infarction acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The cardiologists' management plan (optimal medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass surgery or 'more information required') and confidence level were recorded after ICA, and again after vFFR disclosure.</p><p><strong>Results: </strong>517 patients were screened; 320 were recruited: 208 with ACS and 112 with CCS. The median vFFR was 0.82 (0.70-0.91). vFFR disclosure did not change the mean number of significantly stenosed vessels per patient (1.16 (±0.96) visually and 1.18 (±0.92) with vFFR (p=0.79)). A change in intended management following vFFR disclosure occurred in 22% of all patients; in the ACS cohort, there was a 62% increase in the number planned for medical management, and in the CCS cohort, there was a 31% increase in the number planned for PCI. In all patients, vFFR disclosure increased physician confidence from 8 of 10 (7.33-9) to 9 of 10 (8-10) (p<0.001).</p><p><strong>Conclusion: </strong>The addition of vFFR to ICA changed intended management strategy in 22% of patients, provided a detailed and specific 'all-in-one' anatomical and physiological assessment of coronary artery disease, and was accompanied by augmentation of the operator's confidence in the treatment strategy.</p>\",\"PeriodicalId\":12835,\"journal\":{\"name\":\"Heart\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.1000,\"publicationDate\":\"2024-07-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11287621/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Heart\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/heartjnl-2024-324039\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Heart","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/heartjnl-2024-324039","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Modelled impact of virtual fractional flow reserve in patients undergoing coronary angiography (VIRTU-4).
Background: The practical application of 'virtual' (computed) fractional flow reserve (vFFR) based on invasive coronary angiogram (ICA) images is unknown. The objective of this cohort study was to investigate the potential of vFFR to guide the management of unselected patients undergoing ICA. The hypothesis was that it changes management in >10% of cases.
Methods: vFFR was computed using the Sheffield VIRTUheart system, at five hospitals in the North of England, on 'all-comers' undergoing ICA for non-ST-elevation myocardial infarction acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The cardiologists' management plan (optimal medical therapy, percutaneous coronary intervention (PCI), coronary artery bypass surgery or 'more information required') and confidence level were recorded after ICA, and again after vFFR disclosure.
Results: 517 patients were screened; 320 were recruited: 208 with ACS and 112 with CCS. The median vFFR was 0.82 (0.70-0.91). vFFR disclosure did not change the mean number of significantly stenosed vessels per patient (1.16 (±0.96) visually and 1.18 (±0.92) with vFFR (p=0.79)). A change in intended management following vFFR disclosure occurred in 22% of all patients; in the ACS cohort, there was a 62% increase in the number planned for medical management, and in the CCS cohort, there was a 31% increase in the number planned for PCI. In all patients, vFFR disclosure increased physician confidence from 8 of 10 (7.33-9) to 9 of 10 (8-10) (p<0.001).
Conclusion: The addition of vFFR to ICA changed intended management strategy in 22% of patients, provided a detailed and specific 'all-in-one' anatomical and physiological assessment of coronary artery disease, and was accompanied by augmentation of the operator's confidence in the treatment strategy.
期刊介绍:
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.