Publications by authors named "Tremmel J"
Chapter 13.0. FFR, iFR, CFR, and IMR: Results from clinical trials.
Cardiovasc Revasc Med
December 2024
In this review article, we provide an overview of the definition and application of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), coronary flow reserve (CFR), and index of microvascular resistance (IMR) in the diagnosis, prognosis, and management of coronary microvascular dysfunction. We discuss their respective limitations as it relates to microvascular dysfunction. In each section, we review the most recent evidence supporting their use in microvascular and epicardial coronary artery disease.
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- * The DISCOVER INOCA registry aims to enroll 500 patients to study the prevalence of different INOCA phenotypes and their relationship with atherosclerosis over a follow-up period of five years, assessing both short-term and long-term health outcomes.
- * This study is the first to prospectively combine anatomical and physiological data to better understand INOCA and its effects on long-term cardiovascular health, potentially improving diagnosis and treatment strategies.
A Systematic Approach to the Evaluation of the Coronary Microcirculation Using Bolus Thermodilution: CATH CMD.
J Soc Cardiovasc Angiogr Interv
July 2024
Article Synopsis
- Coronary microvascular dysfunction (CMD) can lead to chest pain (angina) even when there are no blockages in the major coronary arteries (ANOCA).
- The thermodilution technique is a useful method for measuring microvascular resistance, from which two key indices (coronary flow reserve and index of microcirculatory resistance) can be derived to assess coronary microcirculation.
- The text presents the bolus thermodilution method and an algorithm (CATH CMD) to standardize measurements and improve the diagnosis of CMD.
Background: Invasive CFT is the gold standard for diagnosing coronary vasomotor dysfunction in patients with ANOCA. Most institutions recommend only testing the left coronary circulation. Therefore, it is unknown whether testing multiple coronary territories would increase diagnostic yield.
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- Drug-coated balloons, specifically paclitaxel-coated balloons, show promise for treating coronary in-stent restenosis but previously lacked approval for U.S. use.
- A clinical trial, involving 600 participants across 40 centers, compared the effectiveness of paclitaxel-coated balloons to uncoated ones in preventing target lesion failure one year post-treatment.
- Results indicated that patients receiving the paclitaxel-coated balloon had significantly lower rates of target lesion revascularization and myocardial infarction compared to those with uncoated balloons, demonstrating the coated balloon's superiority (17.9% vs 28.6% failure rate).
Article Synopsis
- Centers focused on coronary function testing play an essential role in diagnosing and treating angina with nonobstructive coronary arteries (ANOCA).
- Utilizing a mix of lifestyle changes, medications, and devices can significantly enhance the quality of life for patients suffering from ANOCA.
- The success of treatment programs relies on multidisciplinary teams that personalize care, alongside collaborative research efforts that standardize assessments and data collection for future clinical trials.
Article Synopsis
- Angina with nonobstructive coronary arteries (ANOCA) affects nearly 50% of patients undergoing coronary angiography and includes issues like microvascular dysfunction and coronary spasms.
- Patients often struggle to get diagnosed, leading to repeated medical visits and feelings of invalidation, which can contribute to anxiety and depression.
- Recent advancements in diagnostic testing, specifically coronary function testing (CFT), allow for better, noninvasive evaluation of ANOCA, aiding in the identification of specific coronary issues.
Background Hypertensive disorders of pregnancy, gestational diabetes, and having a small-for-gestational-age baby are known to substantially increase a woman's risk of cardiovascular disease. Despite this, evidence for models of care that mitigate cardiovascular disease risk in women with these pregnancy-related conditions is lacking. Methods and Results A 6-month prospective cohort study assessed the effectiveness of a multidisciplinary Women's Heart Clinic on blood pressure and lipid control in women aged 30 to 55 years with a past pregnancy diagnosis of hypertensive disorders of pregnancy, gestational diabetes, or a small-for-gestational age baby in Melbourne, Australia.
View Article and Find Full Text PDFObjectives: This study aimed to explore the impact of myocardial bridging (MB) on early development of cardiac allograft vasculopathy and long-term graft survival after heart transplantation.
Background: MB has been reported to be associated with acceleration of proximal plaque development and endothelial dysfunction in native coronary atherosclerosis. However, its clinical significance in heart transplantation remains unclear.
We present Stanford's experience with patients post-arterial switch operation presenting with chest pain found to have hemodynamically significant myocardial bridging. The evaluation of symptomatic patients post-arterial switch should not only include assessment for coronary ostial patency but also for nonobstructive coronary conditions such as myocardial bridging. ().
View Article and Find Full Text PDFCardiovascular disease is the leading cause of pregnancy mortality. Socioeconomic and racial disparities in pregnancy are well established. Despite this, little is known about the impact of social determinants of health in pregnant patients with heart disease.
View Article and Find Full Text PDFBackground: Heterogeneity in diagnostic criteria and provocation protocols has posed challenges in understanding the safety of coronary provocation testing with intracoronary acetylcholine (ACh) for the contemporary diagnosis of epicardial and microvascular spasm.
Objectives: We examined the safety of testing and subgroup differences in procedural risks based on ethnicity, diagnostic criteria, and provocation protocols.
Methods: PubMed and Embase were searched in November 2021 to identify original articles reporting procedural complications associated with intracoronary ACh administration.
Colocalization of Coronary Plaque with Wall Shear Stress in Myocardial Bridge Patients.
Cardiovasc Eng Technol
October 2022
Purpose: Patients with myocardial bridges (MBs) have a higher prevalence of atherosclerosis. Wall shear stress (WSS) has previously been correlated with plaque in coronary artery disease patients, but such correlations have not been investigated in symptomatic MB patients. The aim of this paper was to use a multi-scale computational fluid dynamics (CFD) framework to simulate hemodynamics in MB patient, and investigate the co-localization of WSS and plaque.
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