Figure 1 Typical case example

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Date of download: 5/28/2016 Copyright © The American College of Cardiology. All rights reserved. From: Comprehensive Assessment of Coronary Artery Stenoses:

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Figure 1 Typical case example Figure 1 Typical case example. Invasive coronary angiography demonstrates a lesion in the mid-left anterior descending ... Figure 1 Typical case example. Invasive coronary angiography demonstrates a lesion in the mid-left anterior descending artery (A). Fractional flow reserve, obtained without the infusion catheter in situ, is measured to be 0.67. Myocardial mass distal to the lesion is derived from coronary computed tomography angiography using the Voronoi algorithm and is calculated to be 56.5 g (B). Positron emission tomography shows a perfusion defect in the left anterior descending artery territory with an average hyperaemic myocardial blood flow of 1.61 mL/min/g (C). After combining the information of these two imaging techniques, the non-invasively assessed absolute hyperaemic flow is determined to be 1.61 mL/min/g × 56.5 g = 91.0 mL/min. (D) The invasive measurement of absolute hyperaemic flow using continuous thermodilution. Absolute hyperaemic flow in the mid-left anterior descending artery is invasively quantified on 79 mL (D). Note however that the infusion catheter limits hyperaemic flow, since FFR during continuous thermodilution is lower compared to FFR obtained without the infusion catheter in situ. Maximal flow in the hypothetical absence of stenosis and infusion catheter (i.e. assuming an FFR of 1.00) is calculated to be 79 mL/min ÷ 0.65 = 122 mL/min. Absolute hyperaemic flow, corrected for the presence of the infusion catheter, is thereafter determined to be 0.67 × 122 mL/min = 81.7 mL/min. CCTA, coronary computed tomography angiography; FFR, fractional flow reserve; LAD, left anterior descending artery; LCx, left circumflex artery; MBF, myocardial blood flow; Q<sub>c</sub>, hyperaemic coronary flow corrected for presence of the infusion catheter; Q<sub>n</sub>, maximal flow in the hypothetical absence of coronary stenosis; RCA, right coronary artery. Unless provided in the caption above, the following copyright applies to the content of this slide: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Eur Heart J, ehz245, https://doi.org/10.1093/eurheartj/ehz245 The content of this slide may be subject to copyright: please see the slide notes for details.

Figure 2 Non-invasively and invasively assessed microvascular resistance. Scatter and Bland–Altman plots comparing ... Figure 2 Non-invasively and invasively assessed microvascular resistance. Scatter and Bland–Altman plots comparing non-invasively and invasively assessed microvascular resistance. In the Bland–Altman plot, the solid red line indicates the mean bias and the dashed black lines indicate the limits of agreement. HRU, hybrid resistance units; MVR, microvascular resistance. Unless provided in the caption above, the following copyright applies to the content of this slide: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Eur Heart J, ehz245, https://doi.org/10.1093/eurheartj/ehz245 The content of this slide may be subject to copyright: please see the slide notes for details.

Figure 3 Invasive measurements with and without adenosine Figure 3 Invasive measurements with and without adenosine. Scatterplots and corresponding Bland–Altman plots comparing ... Figure 3 Invasive measurements with and without adenosine. Scatterplots and corresponding Bland–Altman plots comparing invasive measurements of absolute hyperaemic flow (A) and microvascular resistance (B) obtained with and without adenosine. In the Bland–Altman plots, the solid red lines indicate the mean bias and the dashed black lines indicate the limits of agreement. HRU, hybrid resistance units; MVR, microvascular resistance. Unless provided in the caption above, the following copyright applies to the content of this slide: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Eur Heart J, ehz245, https://doi.org/10.1093/eurheartj/ehz245 The content of this slide may be subject to copyright: please see the slide notes for details.

Figure 4 Adenosine free invasive measurements and non-invasive measurements. Scatterplots and corresponding ... Figure 4 Adenosine free invasive measurements and non-invasive measurements. Scatterplots and corresponding Bland–Altman plots comparing invasive measurements of absolute hyperaemic flow (A) and microvascular resistance (B), obtained without adenosine, to non-invasive measurements. In the Bland–Altman plots, the solid red lines indicate the mean bias and the dashed black lines indicate the limits of agreement. HRU, hybrid resistance units; MVR, microvascular resistance. Unless provided in the caption above, the following copyright applies to the content of this slide: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Eur Heart J, ehz245, https://doi.org/10.1093/eurheartj/ehz245 The content of this slide may be subject to copyright: please see the slide notes for details.

Take home figure Patients with a single focal lesion on coronary computed tomography angiography underwent ... Take home figure Patients with a single focal lesion on coronary computed tomography angiography underwent [<sup>15</sup>O]H<sub>2</sub>O positron emission tomography (upper, middle) followed by invasive absolute flow measurements using continuous infusion of saline (upper, right). As positron emission tomography measures myocardial blood flow in mL/min/g and invasive flow measurements quantify absolute coronary flow in mL/min, subtending myocardial mass of the investigated coronary artery is required in order to compare the techniques. This was derived from positron emission tomography using the Voronoi segmentation algorithm (upper, left). Non-invasively assessed flow was subsequently calculated by multiplying positron emission tomography perfusion with the subtending myocardial mass. The scatter (lower, left) and Bland–Altman (lower, right) plots demonstrate a strong correlation and high agreement between non-invasively and invasively assessed absolute hyperaemic flow, both obtained during intravenous administration of adenosine. In the Bland–Altman plot, the solid red line indicates the mean bias and the dashed black lines indicate the limits of agreement. CCTA, coronary compute tomography angiography; PET, positron emission tomography. Unless provided in the caption above, the following copyright applies to the content of this slide: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) Eur Heart J, ehz245, https://doi.org/10.1093/eurheartj/ehz245 The content of this slide may be subject to copyright: please see the slide notes for details.