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.

Left Main Stem Compression by Intrapericardial Paraganglioma Associated With Succinate Dehydrogenase Mutation.

Paragangliomas are rare extra-adrenal tumors originating from chromaffin cells. We discovered a large intrapericardial mass confirmed to be a primary cardiac paraganglioma encasing the left main stem coronary artery in a 38-year-old woman who presented with dyspnea and subscapular pain. Genetic predisposition related to succinate dehydrogenase A mutation was identified.

The Impact of Virtual Fractional Flow Reserve and Virtual Coronary Intervention on Treatment Decisions in the Cardiac Catheter Laboratory.

Background: Using fractional flow reserve (FFR) to guide percutaneous coronary intervention for patients with coronary artery disease (CAD) improves clinical decision making but remains underused. Virtual FFR (vFFR), computed from angiographic images, permits physiologic assessment without a pressure wire and can be extended to virtual coronary intervention (VCI) to facilitate treatment planning. This study investigated the effect of adding vFFR and VCI to angiography in patient assessment and management.

Study of Two Dose Regimens of Ticagrelor Compared With Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention for Stable Coronary Artery Disease.

Background: Ticagrelor has superior efficacy to clopidogrel in the management of acute coronary syndromes but has not been assessed in patients undergoing percutaneous coronary intervention for stable coronary artery disease. We compared the pharmacodynamic effects of ticagrelor and clopidogrel in this stable population.

Methods: One hundred eighty aspirin-treated stable coronary artery disease patients, who were planned to undergo elective percutaneous coronary intervention in a single center, were randomized 1:1:1 to either a standard clopidogrel regimen or 1 of 2 regimens of ticagrelor, either 90 mg (T90) or 60 mg twice daily (T60), both with a 180 mg loading dose.

Pharmacodynamic Effects of a 6-Hour Regimen of Enoxaparin in Patients Undergoing Primary Percutaneous Coronary Intervention (PENNY PCI Study).

Delayed onset of action of oral P2Y inhibitors in ST-elevation myocardial infarction (STEMI) patients may increase the risk of acute stent thrombosis. Available parenteral anti-thrombotic strategies, to deal with this issue, are limited by added cost and increased risk of bleeding. We investigated the pharmacodynamic effects of a novel regimen of enoxaparin in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Assessing Coronary Blood Flow Physiology in the Cardiac Catheterisation Laboratory.

Background: Contemporary management of coronary disease focuses on the treatment of stenoses in the major epicardial vessels. However, myocardial blood flow is known to be contingent on a range of factors in addition to the patency of the epicardial vessels. These include anatomical and physiological factors such as the extent of myocardium supplied by the vessel, systemic blood pressure, the natural variation in vascular tone in response to physiological needs which allows for coronary autoregulation and pathological factors such as the presence of downstream obstruction to flow due to disease of the small coronary vessels or myocardium.

Cardiovascular Outcomes Following Rotational Atherectomy: A UK Multicentre Experience.

Objectives: To identify factors associated with outcomes following rotational atherectomy (RA).

Background: RA is an effective way to mechanically modify heavily calcified lesions before stenting; however its outcomes are not well defined.

Methods And Results: Retrospective evaluation of all patients who underwent RA in three large UK centers (Leeds General Infirmary (LGI), Royal Infirmary of Edinburgh (RIE) and University Hospital of North Staffordshire (UHNS)) from March 2005 to January 2013.

Coronary artery disease: myocardial perfusion MR imaging with sensitivity encoding versus conventional angiography.

Purpose: To evaluate the technical performance of sensitivity encoding (SENSE)-accelerated myocardial perfusion magnetic resonance (MR) imaging and prospectively assess the diagnostic accuracy of this examination for depiction of significant coronary artery disease (CAD).

Materials And Methods: All 102 subjects provided written informed consent, and the local ethics committee approved the study. A saturation-recovery segmented k-space gradient-echo pulse sequence was combined with SENSE to allow dynamic acquisition of myocardial perfusion data on four parallel short-axis MR image sections at every heartbeat.