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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...

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Autores principales: 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.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
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.
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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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