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Non-hyperaemic pressure ratios to guide percutaneous coronary intervention

The use of fractional flow reserve (FFR) in guiding revascularisation improves patient outcomes and has been well-established in clinical guidelines. Despite this, the uptake of FFR has been limited, likely attributable to the perceived increase in procedural time and use of hyperaemic agents that c...

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Autores principales: Michail, Michael, Thakur, Udit, Mehta, Ojas, Ramzy, John M, Comella, Andrea, Ihdayhid, Abdul Rahman, Cameron, James D, Nicholls, Stephen J, Hoole, Stephen P, Brown, Adam J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534727/
https://www.ncbi.nlm.nih.gov/pubmed/33004619
http://dx.doi.org/10.1136/openhrt-2020-001308
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author Michail, Michael
Thakur, Udit
Mehta, Ojas
Ramzy, John M
Comella, Andrea
Ihdayhid, Abdul Rahman
Cameron, James D
Nicholls, Stephen J
Hoole, Stephen P
Brown, Adam J
author_facet Michail, Michael
Thakur, Udit
Mehta, Ojas
Ramzy, John M
Comella, Andrea
Ihdayhid, Abdul Rahman
Cameron, James D
Nicholls, Stephen J
Hoole, Stephen P
Brown, Adam J
author_sort Michail, Michael
collection PubMed
description The use of fractional flow reserve (FFR) in guiding revascularisation improves patient outcomes and has been well-established in clinical guidelines. Despite this, the uptake of FFR has been limited, likely attributable to the perceived increase in procedural time and use of hyperaemic agents that can cause patient discomfort. This has led to the development of instantaneous wave-free ratio (iFR), an alternative non-hyperaemic pressure ratio (NHPR). Since its inception, the use of iFR has been supported by an increasing body of evidence and is now guideline recommended. More recently, other commercially available NHPRs including diastolic hyperaemia-free ratio and resting full-cycle ratio have emerged. Studies have demonstrated that these indices, in addition to mean distal coronary artery pressure to mean aortic pressure ratio, are mathematically analogous (with specific nuances) to iFR. Additionally, there is increasing data demonstrating the equivalent diagnostic performance of alternative NHPRs in comparison with iFR and FFR. These NHPRs are now integral within most current pressure wire systems and are commonly available in the catheter laboratory. It is therefore key to understand the fundamental differences and evidence for NHPRs to guide appropriate clinical decision-making.
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spelling pubmed-75347272020-10-07 Non-hyperaemic pressure ratios to guide percutaneous coronary intervention Michail, Michael Thakur, Udit Mehta, Ojas Ramzy, John M Comella, Andrea Ihdayhid, Abdul Rahman Cameron, James D Nicholls, Stephen J Hoole, Stephen P Brown, Adam J Open Heart Interventional Cardiology The use of fractional flow reserve (FFR) in guiding revascularisation improves patient outcomes and has been well-established in clinical guidelines. Despite this, the uptake of FFR has been limited, likely attributable to the perceived increase in procedural time and use of hyperaemic agents that can cause patient discomfort. This has led to the development of instantaneous wave-free ratio (iFR), an alternative non-hyperaemic pressure ratio (NHPR). Since its inception, the use of iFR has been supported by an increasing body of evidence and is now guideline recommended. More recently, other commercially available NHPRs including diastolic hyperaemia-free ratio and resting full-cycle ratio have emerged. Studies have demonstrated that these indices, in addition to mean distal coronary artery pressure to mean aortic pressure ratio, are mathematically analogous (with specific nuances) to iFR. Additionally, there is increasing data demonstrating the equivalent diagnostic performance of alternative NHPRs in comparison with iFR and FFR. These NHPRs are now integral within most current pressure wire systems and are commonly available in the catheter laboratory. It is therefore key to understand the fundamental differences and evidence for NHPRs to guide appropriate clinical decision-making. BMJ Publishing Group 2020-10-01 /pmc/articles/PMC7534727/ /pubmed/33004619 http://dx.doi.org/10.1136/openhrt-2020-001308 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Interventional Cardiology
Michail, Michael
Thakur, Udit
Mehta, Ojas
Ramzy, John M
Comella, Andrea
Ihdayhid, Abdul Rahman
Cameron, James D
Nicholls, Stephen J
Hoole, Stephen P
Brown, Adam J
Non-hyperaemic pressure ratios to guide percutaneous coronary intervention
title Non-hyperaemic pressure ratios to guide percutaneous coronary intervention
title_full Non-hyperaemic pressure ratios to guide percutaneous coronary intervention
title_fullStr Non-hyperaemic pressure ratios to guide percutaneous coronary intervention
title_full_unstemmed Non-hyperaemic pressure ratios to guide percutaneous coronary intervention
title_short Non-hyperaemic pressure ratios to guide percutaneous coronary intervention
title_sort non-hyperaemic pressure ratios to guide percutaneous coronary intervention
topic Interventional Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534727/
https://www.ncbi.nlm.nih.gov/pubmed/33004619
http://dx.doi.org/10.1136/openhrt-2020-001308
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