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This study aimed to evaluate the feasibility and utility of using motorized pullback of the pressure guidewire to provide a graphic assessment and prediction of the benefits of coronary intervention. Fractional flow reserve (FFR) measurements were performed with motorized pullback imaging in 20 patients who underwent successful percutaneous coronary intervention (PCI) of the left anterior descending artery. Physiological lesion length (PLL) was calculated using frame counts to determine stent length. FFR area was calculated by integrating the FFR values recorded during pullback tracing (FFRarea). The percentage increase in FFR area (%FFRarea) was defined as the ratio of the difference between the pre- and post-intervention FFRarea to the total frame count. The average FFR values were enhanced following PCI, from 0.64 to 0.82, and the median value of the difference between pre- and post-interventional FFR values (D-FFR) and %FFRarea were 0.13 and 10.6%, respectively. The %FFRarea demonstrated a significant positive correlation with D-FFR (R2, 0.61; p < 0.01). PLL tended to be longer and the %FFRarea was smaller in lesions with a gradual pressure-drop pattern than those with an abrupt pressure-drop pattern (35.37 vs. 20.40 mm, p = 0.07; 5.78 vs. 16.21%, p < 0.05, respectively). Motorized pullback tracing was able to identify the extent and location of stenosis and help in appropriate stent implantation, in addition to visualizing and quantifying the improvement in FFR following PCI. [ABSTRACT FROM AUTHOR]

Background: Myocardial perfusion single-photon emission-computed tomography (SPECT) can predict cardiac events in patients with coronary artery disease with high accuracy; however, pseudo-negative cases sometimes occur. Heart Risk View, which is based on the prospective cohort study (J-ACCESS), is a software for evaluating cardiac event probability. Objectives: We examined whether Heart Risk View was useful to evaluate the cardiac risk in patients with normal myocardial perfusion SPECT (MPS). Methods and Results: We studied 3461 consecutive patients who underwent MPS to detect myocardial ischemia and those who had normal MPS were enrolled in this study (n = 698). We calculated cardiac event probability by Heart Risk View and followed-up for 3.8 ± 2.4 years. The cardiac events were defined as cardiac death, non-fatal myocardial infarction, and heart failure requiring hospitalization. During the follow-up period, 21 patients (3.0 %) had cardiac events. The event probability calculated by Heart Risk View was higher in the event group (5.5 ± 2.6 vs. 2.9 ± 2.6 %, p < 0.001). According to the receiver-operating characteristics curve, the cut-off point of the event probability for predicting cardiac events was 3.4 % (sensitivity 0.76, specificity 0.72, and AUC 0.85). Kaplan-Meier curves revealed that a higher event rate was observed in the high-event probability group by the log-rank test (p < 0.001). Conclusion: Although myocardial perfusion SPECT is useful for the prediction of cardiac events, risk estimation by Heart Risk View adds more prognostic information, especially in patients with normal MPS. [ABSTRACT FROM AUTHOR]

We investigated changes of the complexity of coronary artery disease (CAD) after drug-eluting stent (DES) implantation using SYNTAX score and the predictor of worsened SYNTAX score at follow-up. 116 consecutive patients who underwent de novo PCI with first-generation DES were enrolled. SYNTAX scores were obtained from coronary angiography before PCI, just after final PCI and at follow-up after 6-8 months and investigated. SYNTAX score changed from 19.8 ± 11.9 before PCI to 13.7 ± 10.6 after PCI and to 15.0 ± 11.7 at follow-up. SYNTAX score before PCI was significantly correlated with a difference of SYNTAX score between before and after PCI [acute improved score (AIS)] and between after PCI and at follow-up ( r = 0.5, p < 0.0001, r = 0.3, p = 0.002, respectively). At follow-up, SYNTAX score improved from just after PCI in 6.0 % of the subjects, did not change in 60.3 % and worsened in 33.6 %. In-stent restenosis occurred in 43.8 % of the patients with worsened score, and progression of lesion occurred in 62.5 %. On multivariate analysis for worsened score, only diabetes was a significant independent predictor (OR 3.0, 95 %CI 1.3-7.2, p = 0.01); however, SYNTAX scores both before PCI and AIS were not predictors. With regard to re-exacerbation of the complexity of CAD after PCI with DES, we need to exhibit caution in diabetic patients and there is no need to consider the complexity of CAD before PCI or the degree of acute improvement of complexity of CAD with PCI. [ABSTRACT FROM AUTHOR]