This document discusses fractional flow reserve (FFR) guided coronary interventions. It begins by outlining challenges in daily practice when treating patients with recent myocardial infarction or stable angina. It then defines FFR as a ratio used to assess the physiologic consequences of coronary obstructions. Values less than 0.75 are considered functionally ischemic. The document discusses applications of FFR for single-vessel disease, left main stenosis, tandem lesions, and multi-vessel coronary artery disease. It also compares FFR to intravascular ultrasound and discusses the DEFER study and FAME 2 study which evaluated outcomes of FFR-guided versus angiography-guided interventions.
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Today, in addition to measurement of left ventricular ejection fraction, the simple 12-lead surface ECG remains the only evidence-based means of identifying patients who may obtain the substantial benefits of CRT
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
Significant, defined as a greater than 50 percent narrowing, left main coronary artery disease is found in 4 to 6 percent of all patients who undergo coronary arteriography. When present, it is associated with multivessel coronary artery disease about 70 percent of the time
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
Based on the principle that the distal coronary pressure measured during vasodilation is directly proportional to maximum vasodilated perfusion.
FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow in the same artery if there were no stenosis.
FFR is simply calculated as a ratio of mean pressure distal to a stenosis (Pd) to the mean pressure proximal stenosis, that is the mean pressure in the aorta (Pa), during maximal hyperaemia.
Speckle tracking echocardiography (STE) is an echocardiographic imaging technique that analyzes the motion of tissues in the heart by using the naturally occurring speckle pattern in the myocardium or blood when imaged by ultrasound.
preop TEE assessment of atrial septal defect is very important for making decision for device closure, properly assessed adequate rims of ASD will reduce risk of device embolization to almost nil.
Today, in addition to measurement of left ventricular ejection fraction, the simple 12-lead surface ECG remains the only evidence-based means of identifying patients who may obtain the substantial benefits of CRT
A lecture on the echocardiographic evaluation of hypertrophic cardiomyopathy. Starts with an overview of the topic then a systematic approach to diagnosis and then a differential diagnosis followed by take-home messages and conclusion.
Significant, defined as a greater than 50 percent narrowing, left main coronary artery disease is found in 4 to 6 percent of all patients who undergo coronary arteriography. When present, it is associated with multivessel coronary artery disease about 70 percent of the time
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
Based on the principle that the distal coronary pressure measured during vasodilation is directly proportional to maximum vasodilated perfusion.
FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow in the same artery if there were no stenosis.
FFR is simply calculated as a ratio of mean pressure distal to a stenosis (Pd) to the mean pressure proximal stenosis, that is the mean pressure in the aorta (Pa), during maximal hyperaemia.
Fractional Flow Reserve during CAG, Radiofrequency ablation during EP study, Shunt calculation by right heart catheterization, and equation for pulmonary venous resistance
Various coronary physiological measurements can be made in the cardiac catheterization laboratory using sensor-tipped guidewires; they include the measurement of poststenotic absolute coronary flow reserve, the relative coronary flow reserve, and the pressure-derived fractional flow reserve of the myocardium. Ambiguity regarding abnormal microcirculation has been reduced or eliminated with measurements of relative coronary flow reserve and fractional flow reserve. The role of microvascular flow impairment can be separately determined with coronary flow velocity reserve measurements. In addition to lesion assessment before and after intervention, emerging applications of coronary physiology include the determination of physiological responses to new pharmacological agents, such as glycoprotein IIb/IIIa blockers, in patients with acute myocardial infarction. Measurements of coronary physiology in the catheterization laboratory provide objective data that complement angiography for clinical decision-making
Arteriovenous Malformations are one of the toughest cerebral pathologies to manage with high post op mortality and morbidity. this powerpoint contains classification, grading and managment of various severity of AVMs
cardiac bio markers are important diagnostic and prognostic tool in acute coronary syndrome. several new emerging bio markers are coming with more sensitivity and specificity.
differentiating between supraventicular tachycardia and ventricular tachycardia in wide complex rhythm is always confusing and management is totally different. correct diagnosis will make dramatic difference in patient management.
Brugada Syndrome is a inherited sodium channel disorder leading to life threatening ventricular fibrillation in young population. diagnosis and ICD therapy could be life saving.
kawasaki disease is disease of pediatric age group leading to involvement of coronaries in 25% of case. some of presented as fetal complication. early diagnosis and treatment useful measure to prevent complications.
takayasu arteritis is inflammatory disorder of medium sized arteries of unknown etiology, prevent in young female. lead to life threatening complication and long lasting morbidity. early diagnosis and treatment prevent complication and improve quality of life
Trans catheter intervention is emerging field in cardiac intervention. due to complex anatomy of mitral valve understanding of anatomy and three dimensional imaging is most important aspect of successful intervention and could be life saving in high risk surgical candidate
RHD is prevalent in India, many patients requires valve replacement. understanding of prosthetic valve anatomy, morphology and early detection of valve related complication is very important for saving life. TTE and TEE are important tool for identifying these complications.
there are several limitation in VKA,to over come these problem NOACs came in picture but still limited indication for NOACs currently,required further study inter and intra comparison between anticoagulants.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
ebstein anomaly is rare congenital disorder,with variable presentation in neonate to adults,early diagnosis and timely take decision make remarkable difference in patients life.
diabetes is most prevalent disease in asia, incidence of heart failure is also increasing in diabetic population, understanding the pathophysiology is very important to deal with these cases.
atherosclerosis is one of most common cause of aortic ds,screening of abdominal aorta in vulnerable population is very useful for prevention and early detection of future omplication.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. Challenges in daily practice
• Patients with recent myocardial infarction , questions pertain to
lesions not responsible for symptoms or infarct—so called “non
culprit” lesions .
• Subsequent cardiovascular events appear equally likely in non
culprit lesions following MI .
• Patients with stable angina, questions surround the choice
between medical therapy and revascularization
• Difficulty is identifying specific lesions that are functionally
significant or that will likely lead to adverse events.
• Frequent occurrence of multivessel disease poses additional
challenges.
• Noninvasive tests may lack sensitivity and specificity to detect
multivessel disease and treatment decisions can be complex .
3.
4.
5. Fractional flow reserve
• FFR is used to assess the physiologic consequences of
obstruction with a goal of predicting benefit from
revascularization or which lesions should be treated .
• Derived from the ratio of the mean distal coronary artery
pressure (Pd) to the mean aortic pressure (Pa) during the
period of maximum hyperemia.
• Fractional flow reserve is not affected by changes in the
hemodynamic conditions or microcirculation.
• ‘‘normal’’ ratio is expected to be 1.
• Values less than 0.75 to 0.80 are considered functionally
ischemic, while those 0.94 to 1.0 normal.
6. What Fractional Flow Reserve Value
Defines Ischemia?
FFR value <0.75 was associated with reversible ischemia on
noninvasive stress testing (exercise stress test, nuclear scan,
and dobutamine stress echocardiogram) with 88%sensitivity,
100% specificity, 100% positive predictive value, 88% negative
predictive value, and 93% accuracy.
DEFER study and other studies have used an FFR value of
<0.75 as the cutoff for ischemia.
FFR value >0.80 has been shown to exclude an ischemia-
producing lesions, with predictive value of >95%.
7. • Coronary stenosis can be arbitrarily classified into 3 groups on
the basis of FFR values:
a. non–ischemic stenosis with FFR >0.80
b. ischemia-producing stenosis with FFR <0.75.
c. gray zone with FFR values between 0.75 and 0.80.
8. Applications for Fractional Flow Reserve in Coronary
Artery Disease
• Single-Vessel Disease-
• DEFER study has shown that patients with single vessel stenosis and FFR
>0.75 who did not undergo PCI had excellent outcomes.
• The risk of cardiac death or myocardial infarction (MI) related to the
stenosis was <1% per year and was not reduced with PCI.
• patients with single-vessel stenosis and FFR <0.75 are 5× more likely to
experience cardiac death or MI within 5 years, despite undergoing
revascularization.
• medical treatment of patients with proximal left anterior descending
stenosis and FFR >0.80had excellent5-year outcomes
9. • patients with small coronary arteries (diameter <2.8 mm), FFR can
safely determine stenosis that necessitate revascularization.
• In the Physiologic and Anatomical Evaluation Prior to and After
Stent Implantation in Small Coronary Vessels (PHANTOM) trial, 60
patients with small coronary arteries underwent FFR.
• group with FFR <0.75 underwent revascularization.
• At 1 year, there was no occurrence of MI or death in either group.
• patients with FFR <0.75, 24% underwent a repeat PCI, but only
2.6% of patients with FFR >0.75 underwent revascularization.
10. Left Main Stenosis
• Nonischemic FFR values (>0.80) in left main lesions are associated with
excellent long-term outcomes.
• accurate LM FFR reflects flow through both the LAD and the CFX.
• myocardial bed for the LM is the summed territories of both the LAD and
the CFX.
• LM bed can be even larger if the RCA is occluded and there is collateral
supply from the left coronary system.
• isolated LM narrowing with no LAD, CFX, or RCA stenosis reflects the
physiologic significance of just the LM narrowing.
• LM narrowing plus LAD stenosis could produce a higher LM FFR because
the LM bed is reduced in size.
• LM FFR alone cannot be accurately measured just as when there are serial
lesions.
11. • Tandem Lesions-
• Tandem lesions are defined as 2 separate lesions with >50%stenosis each
in the same coronary artery, separated by an angiographically normal
segment.
• If the FFR is<0.75 PCI for the stenosis that showed marked narrowing
first and then repeating the FFR measurement.
• If the FFR remains<0.75,the other stenosis was revascularized as well ,in
contrast, if the FFR value of the first lesion increased after PCI to >0.75,
then these second lesion was treated only medically.
16. Exclusion criteria
• angiographically significant left main coronary artery
disease
• previous coronary artery bypass surgery
• cardiogenic shock
• extremely tortuous or calcified coronary arteries
• a life expectancy of 2 years
• pregnancy
• contraindication to DES placement.
17.
18.
19.
20.
21.
22.
23. • Discussion
• Multi vessel CAD, favorable of FFR during PCI as compared to PCI
guided by angiography alone is maintained at 2-year follow up.
• combined rate of death and myocardial infarction were significantly
lower among patients in the FFR-guided group.
• composite end point of death, need for revascularization was no
longer significantly lower in FFR-guided group.
• outcome in initially deferred lesions on the basis of FFR 0.80 was
excellent, underscoring the safety of the FFR guided approach.
• incidence of all types of adverse events was consistently reduced by
roughly 30%.
• The absolute risk for MACE was reduced by 4.5%.
24. Natural Course of Lesions Deferred on
PCI-Based FFR Measurements
• Randomized trial to address this concern is the DEFER (FFR to
Determine Appropriateness of Angioplasty in Moderate
Coronary Stenosis) study was done
25.
26.
27. • 5-year event-free survival rates similar in the deferred and
PCI groups .
• Composite rates of cardiac death and acute myocardial
infarction in the deferred, PCI, and reference groups were
3.3%, 7.9%, and 15.7%, respectively.
• Functionally nonsignificant coronary stenosis, regardless of
angiographic stenosis, could be safely deferred for up to 5
years.
30. • IVUS cannot directly estimate the functional significance of
coronary stenosis.
• Strong correlations have been observed between IVUS-
measured minimal lumen area (MLA) and inducible ischemia
as determined by myocardial SPECT imaging, coronary flow
reserve, and FFR.
• An IVUS MLA of 4 mm2 is theoretically large enough to affect
coronary blood flow.
• It is generally accepted that 50% diameter stenosis, which
corresponds to 75% area stenosis, is significant.
31.
32.
33.
34. • FFR values of lesions with MLA 4 mm2 were widely scattered
• 66% of analyzed lesions had MLA 4 mm2 but FFR 0.80.
• Using our new, stricter criteria of MLA, 2.4 mm2, 30% of
analyzed lesions had MLA 2.4 mm2 but FFR 0.80.
• use of our new IVUS MLA criteria may avoid unnecessary
procedures in 36% of coronary lesions investigated.
• IVUS MLA criteria alone cannot predict the result of FFR
measurement.
• The FFR value and IVUS-measured parameters are
complementary and not competitive.
35. Other study
• FAME 2 Study
• conclusively address the question of whether performing PCI
in lesions with abnormal FFR results leads to better outcome
compared with deferring PCI, a subsequent clinical study,
FAME 2, was conducted.