Intracoronary Doppler andPressure Monitoring Flashcards
What does stress testing sensitivity and specificity depend on?
The test, study population, and incidence of CAD
CAD stands for Coronary Artery Disease.
What does IVUS show in coronary disease assessment?
Diffuse disease and distribution
IVUS refers to Intravascular Ultrasound.
What limitations does coronary angiography have?
Cannot identify intraluminal detail or provide information about vessel wall characteristics
Angiographic artifacts can complicate accurate identification of vessel segments.
What is the physiologic significance of an intermediate coronary stenosis?
Cannot be accurately determined
Intermediate stenosis is defined as approximately 40% to 70% diameter narrowing.
What does FFR reflect in coronary assessment?
Ischemic potential of the narrowing
FFR stands for Fractional Flow Reserve.
What does CFR reflect in coronary assessment?
Status of both the conduit and the microvascular bed
CFR stands for Coronary Flow Reserve.
In the presence of a near-normal FFR, what is likely the explanation for symptoms?
Microvascular disease
FFR is not lesion specific.
What is the relationship between the amount of viable subtended myocardium and FFR?
Smaller territories are less likely to have a positive FFR
LAD refers to Left Anterior Descending artery.
What does a stable hyperemic phase often generate?
A value significantly higher than the lowest Pd/Pa
Pd/Pa refers to distal to aortic pressure ratio.
What is the optimal dose of IC adenosine for RCA?
100 mcg
This dose is associated with transient AV block in some cases.
What does FFR during a wire pullback show?
Physiologic impact of the entire artery and any focal lesions
It assesses flow immediately distal to a stent.
What does the FAME study conclude about FFR-guided revascularization?
It is superior to angiographic revascularization
It reduces MACE and material costs.
What is the significance of using coronary CT with FFR?
High sensitivity and specificity for identifying ischemic lesions
It can be added without additional radiation or medications.
What does the risk of clinical events with a coronary stenosis depend on?
Degree of ischemia present
The risk is not dichotomous around 0.80.
Can FFR be used in the culprit infarct-related artery?
No, because the myocardial bed flow is dynamic
FFR is accurate in the nonculprit vessel during STEMI.
What advantage does iFR have over FFR?
Avoidance of the need for adenosine hyperemia
iFR stands for instantaneous wave-free ratio.
What is the best cutoff for a resting Pd/Pa to indicate FFR ≤ 0.80?
<0.92
A value of 0.86 is well within the range of ischemia.
What is the best cutoff for a FFR to indicate ischemia?
FFR ≤ 0.80
A value of 0.86 is well within the range of ischemia.
What percentage of maximal hyperemia of adenosine is achieved with 8 mL of iodinated contrast injected into a coronary artery?
Approximately 80%
This is relevant for assessing contrast-FFR values.
What contrast-FFR value accurately predicts a FFR < 0.80?
Contrast-FFR value < 0.83
This indicates a significant likelihood of ischemia.
What is the best estimator of FFR < 0.80?
iFR < 0.89
This is supported by clinical outcome studies validating its value.
What was the main finding of the FAME2 study regarding PCI and optimal medical therapy?
68% reduction in composite endpoint of death, MI, or urgent revascularization with PCI
This was compared to OMT alone at 1 year.
What did the landmark analysis of the FAME2 study suggest about PCI?
PCI may reduce death or MI, not just urgent revascularization
This analysis excluded the first 7 days of periprocedural MI.
What does the COURAGE study suggest about OMT and PCI?
Equivalence between OMT and PCI in a low-risk population
This contrasts with the findings of the FAME2 study.
Why is angiographic assessment of the left main particularly inaccurate?
Due to angulation and the presence of a bifurcation
The risk of overestimating or underestimating a left main stenosis approaches 60%.
What assessments are important before high-risk revascularization by PCI or CABG of the left main?
IVUS or FFR assessment
These assessments help ensure accurate evaluation.
When is FFR assessment best performed in relation to the left main?
Into the nondiseased LCx artery
This is crucial for accurate evaluation before revascularization.
What must be true for LAD stenosis to significantly interact with left main FFR?
FFR combined < 0.65 and very severe stenosis proximal
This indicates a critical condition that needs careful management.
What is a potential issue with stenting the LAD before measuring left main stenosis?
May lead to an unnecessary stent before CABG
This highlights the importance of sequential assessment.
