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Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes
The current management of acute coronary syndromes (ACS) is with an invasive strategy to guide treatment. However, identifying the lesions which are physiologically significant can be challenging. Non-invasive imaging is generally not appropriate or timely in the acute setting, so the decision is ge...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8569111/ https://www.ncbi.nlm.nih.gov/pubmed/34746253 http://dx.doi.org/10.3389/fcvm.2021.735008 |
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author | Haley, Hazel Arfah Ghobrial, Mina Morris, Paul D. Gosling, Rebecca Williams, Gareth Mills, Mark T. Newman, Tom Rammohan, Vignesh Pederzani, Giulia Lawford, Patricia V. Hose, Rodney Gunn, Julian P. |
author_facet | Haley, Hazel Arfah Ghobrial, Mina Morris, Paul D. Gosling, Rebecca Williams, Gareth Mills, Mark T. Newman, Tom Rammohan, Vignesh Pederzani, Giulia Lawford, Patricia V. Hose, Rodney Gunn, Julian P. |
author_sort | Haley, Hazel Arfah |
collection | PubMed |
description | The current management of acute coronary syndromes (ACS) is with an invasive strategy to guide treatment. However, identifying the lesions which are physiologically significant can be challenging. Non-invasive imaging is generally not appropriate or timely in the acute setting, so the decision is generally based upon visual assessment of the angiogram, supplemented in a small minority by invasive pressure wire studies using fractional flow reserve (FFR) or related indices. Whilst pressure wire usage is slowly increasing, it is not feasible in many vessels, patients and situations. Limited evidence for the use of FFR in non-ST elevation (NSTE) ACS suggests a 25% change in management, compared with traditional assessment, with a shift from more to less extensive revascularisation. Virtual (computed) FFR (vFFR), which uses a 3D model of the coronary arteries constructed from the invasive angiogram, and application of the physical laws of fluid flow, has the potential to be used more widely in this situation. It is less invasive, fast and can be integrated into catheter laboratory software. For severe lesions, or mild disease, it is probably not required, but it could improve the management of moderate disease in 'real time' for patients with non-ST elevation acute coronary syndromes (NSTE-ACS), and in bystander disease in ST elevation myocardial infarction. Its practicability and impact in the acute setting need to be tested, but the underpinning science and potential benefits for rapid and streamlined decision-making are enticing. |
format | Online Article Text |
id | pubmed-8569111 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-85691112021-11-06 Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes Haley, Hazel Arfah Ghobrial, Mina Morris, Paul D. Gosling, Rebecca Williams, Gareth Mills, Mark T. Newman, Tom Rammohan, Vignesh Pederzani, Giulia Lawford, Patricia V. Hose, Rodney Gunn, Julian P. Front Cardiovasc Med Cardiovascular Medicine The current management of acute coronary syndromes (ACS) is with an invasive strategy to guide treatment. However, identifying the lesions which are physiologically significant can be challenging. Non-invasive imaging is generally not appropriate or timely in the acute setting, so the decision is generally based upon visual assessment of the angiogram, supplemented in a small minority by invasive pressure wire studies using fractional flow reserve (FFR) or related indices. Whilst pressure wire usage is slowly increasing, it is not feasible in many vessels, patients and situations. Limited evidence for the use of FFR in non-ST elevation (NSTE) ACS suggests a 25% change in management, compared with traditional assessment, with a shift from more to less extensive revascularisation. Virtual (computed) FFR (vFFR), which uses a 3D model of the coronary arteries constructed from the invasive angiogram, and application of the physical laws of fluid flow, has the potential to be used more widely in this situation. It is less invasive, fast and can be integrated into catheter laboratory software. For severe lesions, or mild disease, it is probably not required, but it could improve the management of moderate disease in 'real time' for patients with non-ST elevation acute coronary syndromes (NSTE-ACS), and in bystander disease in ST elevation myocardial infarction. Its practicability and impact in the acute setting need to be tested, but the underpinning science and potential benefits for rapid and streamlined decision-making are enticing. Frontiers Media S.A. 2021-10-22 /pmc/articles/PMC8569111/ /pubmed/34746253 http://dx.doi.org/10.3389/fcvm.2021.735008 Text en Copyright © 2021 Haley, Ghobrial, Morris, Gosling, Williams, Mills, Newman, Rammohan, Pederzani, Lawford, Hose and Gunn. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Haley, Hazel Arfah Ghobrial, Mina Morris, Paul D. Gosling, Rebecca Williams, Gareth Mills, Mark T. Newman, Tom Rammohan, Vignesh Pederzani, Giulia Lawford, Patricia V. Hose, Rodney Gunn, Julian P. Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes |
title | Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes |
title_full | Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes |
title_fullStr | Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes |
title_full_unstemmed | Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes |
title_short | Virtual (Computed) Fractional Flow Reserve: Future Role in Acute Coronary Syndromes |
title_sort | virtual (computed) fractional flow reserve: future role in acute coronary syndromes |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8569111/ https://www.ncbi.nlm.nih.gov/pubmed/34746253 http://dx.doi.org/10.3389/fcvm.2021.735008 |
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