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Background: Revascularization of left main coronary artery (LMCA) stenosis is mostly based on angiography. Indices based on angiography might increase accuracy of the decision, although they have been scarcely used in LMCA. The objective of this study is to study the diagnostic agreement of QFR (quantitative flow ratio) with wire-based fractional flow reserve (FFR) in LMCA lesions and to compare with visual severity assessment., Methods: In a series of patients with invasive FFR assessment of intermediate LMCA stenoses we retrospectively compared the measured value of QFR with that of FFR and the estimate of significance from angiography., Results: 107 QFR studies were included. The QFR intra-observer and inter-observer agreement was 87% and 82% respectively. The mean QFR-FFR difference was 0.047 ± 0.05 with a concordance of 90.7%, sensitivity 88.1%, specificity 92.3%, positive predictive value 88.1% and negative predictive value 92.3%. All these values were superior to those observed with the visual estimation which showed an intra- and inter-observer agreement of 73% and 72% respectively, besides 78% with the FFR value. The low diagnostic performance of the visual estimation and the acceptable performance of the QFR index measurement were observed in all subgroups analysed., Conclusions: QFR allows an acceptable estimate of the FFR obtained with intracoronary pressure guidewire in intermediate LMCA lesions, and clearly superior to the assessment based on angiography alone. The decision to revascularize patients with moderate LMCA lesions should not be based solely on the degree of angiographic stenosis., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: The relationship between body size and cardiovascular events is complex. This study utilized the ADVANCE (Assessing Diagnostic Value of Noninvasive FFR CT in Coronary Care) Registry to investigate the association between body mass index (BMI), coronary artery disease (CAD), and clinical outcomes., Methods: The ADVANCE registry enrolled patients undergoing evaluation for clinically suspected CAD who had >30% stenosis on cardiac computed tomography angiography. Patients were stratified by BMI: normal <25 kg/m 2 , overweight 25-29.9 kg/m 2 , and obese ≥30 kg/m 2 . Baseline characteristics, cardiac computed tomography angiography and computed tomography fractional flow reserve (FFR CT ), were compared across BMI groups. Adjusted Cox proportional hazards models assessed the association between BMI and outcomes., Results: Among 5014 patients, 2166 (43.2%) had a normal BMI, 1883 (37.6%) were overweight, and 965 (19.2%) were obese. Patients with obesity were younger and more likely to have comorbidities, including diabetes and hypertension (all P <0.001), but were less likely to have obstructive coronary stenosis (65.2% obese, 72.2% overweight, and 73.2% normal BMI; P <0.001). However, the rate of hemodynamic significance, as indicated by a positive FFR CT , was similar across BMI categories (63.4% obese, 66.1% overweight, and 67.8% normal BMI; P =0.07). Additionally, patients with obesity had a lower coronary volume-to-myocardial mass ratio compared with patients who were overweight or had normal BMI (obese BMI, 23.7; overweight BMI, 24.8; and normal BMI, 26.3; P <0.001). After adjustment, the risk of major adverse cardiovascular events was similar regardless of BMI (all P >0.05)., Conclusions: Patients with obesity in the ADVANCE registry were less likely to have anatomically obstructive CAD by cardiac computed tomography angiography but had a similar degree of physiologically significant CAD by FFR CT and similar rates of adverse events. An exclusively anatomic assessment of CAD in patients with obesity may underestimate the burden of physiologically significant disease that is potentially due to a significantly lower volume-to-myocardial mass ratio., Competing Interests: Disclosures Dr Lowenstern reports consulting for Edwards Lifesciences. Dr Takagi reports speaking fees from HeartFlow Japan GK and consulting fee from HeartFlow Inc. Dr Koweek reports a research grant from HeartFlow. Dr Douglas reports a research grant from HeartFlow. Dr Pontone reports grants from GE Healthcare and HeartFlow and personal fees from GE, Bracco, and Medtronic. Dr Berman reports research support from HeartFlow. Dr de Bruyne reports grants from Abbott, St Jude Medical, and Medtronic, and other support from St Jude Medical, Boston Scientific, Opsens, Omega Pharma, Siemens, Edwards, GE, Sanofi, HeartFlow, and Bayer. Dr Bax reports grants from Boston Scientific, Medtronic, Biotronik, and Edwards Lifesciences. T. Akasaka reports grants from Daiichi-Sankyo, St. Jude Medical Japan, Boehringer Ingelheim Japan, Bayer, Pfizer Inc, Foundation for Biomedical Research and Innovation, Otsuka Pharmaceutical Co, Astellas Pharma, Terumo, Abbott Vascular Japan, Goodman Co, and Boston Scientific Japan and has served as a consultant for Daiichi-Sankyo, St. Jude Medical Japan, Boehringer Ingelheim Japan, Bayer, Pfizer Inc, Otsuka Pharmaceutical Co, Astellas Pharma Inc, Terumo, Abbott Vascular Japan, Goodman Co, Boston Scientific Japan, and HeartFlow Japan. Dr Nieman reports support from the National Institutes of Health (NIH R01–HL141712; NIH R01–HL146754) and reports unrestricted institutional research support from Siemens Healthineers, Bayer, HeartFlow Inc, Novartis unrelated to this work, consulting for Siemens Medical Solutions USA, and equity in Lumen Therapeutics. Dr Rogers reports receiving salary and equity in HeartFlow and is a full-time employee of HeartFlow; Dr Fairbairn is on the speaker’s bureau for HeartFlow. S. Mullen reports being an employee of and owning equity in HeartFlow. Dr Norgaard reports an unrestricted institutional research grant from HeartFlow Inc. Dr Patel reports research grants from Bayer, Janssen, HeartFlow, Novartis, the National Heart, Lung, and Blood Institute, and the Advisory Board/Consulting for Bayer, Janssen, HeartFlow, and Novartis. Dr Leipsic reports being a consultant and having stock options for Circle CVI and HeartFlow. The other authors report no conflicts.

Objectives: In this study we sought to evaluate coverage and apposition of Synergy™ stent at 3 and 6 months after implantation., Background: The Pt-Cr everolimus-eluting stent with abluminal bioabsorbable polymer (Synergy™) is a new generation drug-eluting stent with features potentially favoring an early healing process which could make safe a shorter period of dual antiplatelet-therapy treatment., Methods: Prospective, two-centers study enrolling patients with similar lesions treated with Synergy™ stents undergoing examination with OCT at 3 and 6 months in the respective centers. Blinded analysis was done at a core lab. Co-primary endpoints were proportion of struts with coverage and with apposition at 3 and 6 months., Results: Finally, 22 patients (30 stents) in the 3 months group and 20 patients (30 stents) in the 6 months group were included. There were no significant differences between groups regarding clinical, angiographic measurements, and procedural data. The rate of strut coverage was 94.5% at 3 months and 96.6% at 6 months (P < 0.001), the rates of apposition were 93.8% and 96.2%, respectively, (P < 0.001), the proportion of uncovered but apposed struts was 2.5% and 1.9% (P = 0.03) and the proportion of uncovered and malapposed struts was 3% and 1.8%, respectively (P < 0.001). The maximal area of malapposition related with uncovered struts was 0.43 ± 0.4 mm(2) at 3 months and 0.14 ± 0.2 mm(2) at 6 months (P = 0.001)., Conclusions: The everolimus-eluting stent with absorbable polymer, Synergy™, is associated to a high degree of intimal coverage and apposition at 3 months after implantation with additional increase at 6 months. © 2015 Wiley Periodicals, Inc., (© 2015 Wiley Periodicals, Inc.)