Intracoronary Doppler andPressure Monitoring

Question 1

What does stress testing sensitivity and specificity depend on?

Answer 1

The test, study population, and incidence of CAD

CAD stands for Coronary Artery Disease.

Question 2

What does IVUS show in coronary disease assessment?

Answer 2

Diffuse disease and distribution

IVUS refers to Intravascular Ultrasound.

Question 3

What limitations does coronary angiography have?

Answer 3

Cannot identify intraluminal detail or provide information about vessel wall characteristics

Angiographic artifacts can complicate accurate identification of vessel segments.

Question 4

What is the physiologic significance of an intermediate coronary stenosis?

Answer 4

Cannot be accurately determined

Intermediate stenosis is defined as approximately 40% to 70% diameter narrowing.

Question 5

What does FFR reflect in coronary assessment?

Answer 5

Ischemic potential of the narrowing

FFR stands for Fractional Flow Reserve.

Question 6

What does CFR reflect in coronary assessment?

Answer 6

Status of both the conduit and the microvascular bed

CFR stands for Coronary Flow Reserve.

Question 7

In the presence of a near-normal FFR, what is likely the explanation for symptoms?

Answer 7

Microvascular disease

FFR is not lesion specific.

Question 8

What is the relationship between the amount of viable subtended myocardium and FFR?

Answer 8

Smaller territories are less likely to have a positive FFR

LAD refers to Left Anterior Descending artery.

Question 9

What does a stable hyperemic phase often generate?

Answer 9

A value significantly higher than the lowest Pd/Pa

Pd/Pa refers to distal to aortic pressure ratio.

Question 10

What is the optimal dose of IC adenosine for RCA?

Answer 10

100 mcg

This dose is associated with transient AV block in some cases.

Question 11

What does FFR during a wire pullback show?

Answer 11

Physiologic impact of the entire artery and any focal lesions

It assesses flow immediately distal to a stent.

Question 12

What does the FAME study conclude about FFR-guided revascularization?

Answer 12

It is superior to angiographic revascularization

It reduces MACE and material costs.

Question 13

What is the significance of using coronary CT with FFR?

Answer 13

High sensitivity and specificity for identifying ischemic lesions

It can be added without additional radiation or medications.

Question 14

What does the risk of clinical events with a coronary stenosis depend on?

Answer 14

Degree of ischemia present

The risk is not dichotomous around 0.80.

Question 15

Can FFR be used in the culprit infarct-related artery?

Answer 15

No, because the myocardial bed flow is dynamic

FFR is accurate in the nonculprit vessel during STEMI.

Question 16

What advantage does iFR have over FFR?

Answer 16

Avoidance of the need for adenosine hyperemia

iFR stands for instantaneous wave-free ratio.

Question 17

What is the best cutoff for a resting Pd/Pa to indicate FFR ≤ 0.80?

Answer 17

<0.92

A value of 0.86 is well within the range of ischemia.

Question 18

What is the best cutoff for a FFR to indicate ischemia?

Answer 18

FFR ≤ 0.80

A value of 0.86 is well within the range of ischemia.

Question 19

What percentage of maximal hyperemia of adenosine is achieved with 8 mL of iodinated contrast injected into a coronary artery?

Answer 19

Approximately 80%

This is relevant for assessing contrast-FFR values.

Question 20

What contrast-FFR value accurately predicts a FFR < 0.80?

Answer 20

Contrast-FFR value < 0.83

This indicates a significant likelihood of ischemia.

Question 21

What is the best estimator of FFR < 0.80?

Answer 21

iFR < 0.89

This is supported by clinical outcome studies validating its value.

Question 22

What was the main finding of the FAME2 study regarding PCI and optimal medical therapy?

Answer 22

68% reduction in composite endpoint of death, MI, or urgent revascularization with PCI

This was compared to OMT alone at 1 year.

Question 23

What did the landmark analysis of the FAME2 study suggest about PCI?

Answer 23

PCI may reduce death or MI, not just urgent revascularization

This analysis excluded the first 7 days of periprocedural MI.

Question 24

What does the COURAGE study suggest about OMT and PCI?

Answer 24

Equivalence between OMT and PCI in a low-risk population

This contrasts with the findings of the FAME2 study.

Question 25

Why is angiographic assessment of the left main particularly inaccurate?

Answer 25

Due to angulation and the presence of a bifurcation

The risk of overestimating or underestimating a left main stenosis approaches 60%.

Question 26

What assessments are important before high-risk revascularization by PCI or CABG of the left main?

Answer 26

IVUS or FFR assessment

These assessments help ensure accurate evaluation.

Question 27

When is FFR assessment best performed in relation to the left main?

Answer 27

Into the nondiseased LCx artery

This is crucial for accurate evaluation before revascularization.

Question 28

What must be true for LAD stenosis to significantly interact with left main FFR?

Answer 28

FFR combined < 0.65 and very severe stenosis proximal

This indicates a critical condition that needs careful management.

Question 29

What is a potential issue with stenting the LAD before measuring left main stenosis?

Answer 29

May lead to an unnecessary stent before CABG

This highlights the importance of sequential assessment.