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Use of fractional flow reserve in patients with coronary artery disease: The right choice for the right outcome Jae Yoon Park, MD, Amir Lerman, MD, Joerg Herrmann, MD Trends in Cardiovascular Medicine Volume 27, Issue 2, Pages (February 2017) DOI: /j.tcm Copyright © 2016 Elsevier Inc. Terms and Conditions
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Fig. 1 Trends in utilization of FFR, FFR-guided PCI, and PCI in the United State (2008–2012). (Adapted with permission from Pothineni et al. [9]). Trends in Cardiovascular Medicine , DOI: ( /j.tcm ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Fig. 2 Factors that influence FFR. Ao, aortic pressure; Pa, arterial pressure proximal to stenosis; Pd, coronary pressure distal to epicardial stenosis; Pv, venous pressure; Qc, collateral blood flow; Rc, collateral resistance; Rs, epicardial coronary stenosis; FFR, fractional flow reserve; IMR, index of microvascular resistance; CFR, coronary flow reserve. (Adapted with permission from Berry et al. [100]). Trends in Cardiovascular Medicine , DOI: ( /j.tcm ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Fig. 3 Correlation between angiographic diameter stenosis and FFR for nonleft main coronary artery lesions (A) and left main coronary artery lesions (B). (Adapted with permission from Park et al. [25]). Trends in Cardiovascular Medicine , DOI: ( /j.tcm ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Fig. 4 Influence of lesion morphology and myocardial bed size on FFR. An intermediate lesion of 50% can yield a low FFR if long in length and/or supplying a large territory of myocardium (top). Also with greater lesion complexity, there is greater flow separation and friction and thus greater pressure loss. On the contrary, a severe stenosis can yield a higher FFR if short, eccentric and/or supplying a small myocardial territory (i.e., more likely with non-LAD lesions). In a patient with acute myocardial infarction the lower panel might represent the acute phase and the upper panel the recovery phase changing decision making for nonculprit lesions, especially in the infarct-related artery. Trends in Cardiovascular Medicine , DOI: ( /j.tcm ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Fig. 5 Proportion of change (A) and final management strategy (B) after completion of FFR by initially considered therapy approach (Aapted with permission from Van Belle et al. [29]). Trends in Cardiovascular Medicine , DOI: ( /j.tcm ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Fig. 6 Correlation of two FFR measurements taken 10min apart (A) with emphasis of the variation at the 0.8 level (shaded oval area and classification certainty of a single FFR measurement from 0.7 to 0.9) (B). (Adapted with permission from Petraco et al. [31]). Trends in Cardiovascular Medicine , DOI: ( /j.tcm ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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Fig. 7 Four quadrants of disease entities are identified by applying clinically applicable cutoff values for fractional flow reserve (FFR, 0.80) coronary flow reserve (CFR, 2.0) (A). (Adapted with permission from van de Hoef et al. [104]). Average CFR and FFR values before and after percutaneous coronary intervention (PCI), which reduces focal disease but does not alter diffuse or small-vessel disease. Accordingly, CFR may remain impaired despite successful epicardial revascularization (B). (Adapted with permission from Johnson et al. [103]). Trends in Cardiovascular Medicine , DOI: ( /j.tcm ) Copyright © 2016 Elsevier Inc. Terms and Conditions
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