Publications
181 results found
Petraco R, Sen S, Nijjer S, et al., 2013, How would I treat? THE INVITED EXPERTS' OPINION, EUROINTERVENTION, Vol: 9, Pages: 160-161, ISSN: 1774-024X
Petraco R, Sen S, Nijjer S, et al., 2013, Baseline coronary pressures, instant wave-free ratio (iFR) and Pd/Pa: making the most of available information REPLY, EUROINTERVENTION, Vol: 9, Pages: 170-172, ISSN: 1774-024X
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- Citations: 5
Sen S, Nijjer S, Petraco R, et al., 2013, The Effect of Adenosine on Coronary Microvascular Resistance Is More Consistent During the Diastolic Wave-free Period: Should We Continue to Use the Complete Cardiac Cycle for Stenosis Assessment?, 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 100B-101B, ISSN: 0002-9149
Nijjer SS, Sen S, Petraco R, et al., 2013, Instantaneous Wave-free Ratio Can Assess Improvement in Coronary Haemodynamics After Percutaneous Intervention., 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 100B-100B, ISSN: 0002-9149
Sen S, Petraco R, Nijjer S, et al., 2013, The Instant Wave-free Ratio, a Vasodilator Free Index; Provides Lower Microvascular Resistance Than That During Adenosine Mediated Fractional Flow Reserve in a Significant Proportion of Patients., 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 101B-101B, ISSN: 0002-9149
Nijjer SS, Eshtehardi P, Corban MT, et al., 2013, Resting Coronary Haemodynamics are Stable and Reproducible When Retested After 6 Months in Patients with Non-obstructive Coronary Artery Disease., 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 101B-101B, ISSN: 0002-9149
Petraco R, Van de Hoef TP, Nijjer S, et al., 2013, Safety and Prognostic Value of Baseline Hemodynamic Indices of Coronary Disease Severity: Insights from an Estimated Agreement of Stenosis Classification with Fractional Flow Reserve in The DEFER and FAME Studies., 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 53B-53B, ISSN: 0002-9149
Petraco R, Sen S, Nijjer S, et al., 2013, Implications of The Biological Variability of Fractional Flow Reserve on Coronary Revascularization Decisions., 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 51B-51B, ISSN: 0002-9149
Sen S, Asrress K, Nijjer S, et al., 2013, Fractional Flow Reserve and The Instant Wave-free Ratio Have Equivalent Agreement with Flow Based Indices Across the Entire Spectrum of Stenosis Severity: Results of CLARIFY (The Classification Accuracy of Pressure-only Ratios Against Indices Using Flow Study)., 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 53B-53B, ISSN: 0002-9149
Petraco R, Park JJ, Sen S, et al., 2013, Hybrid Ifr-FFR Decision-Making Strategy: Implications for Enhancing Universal Adoption of Physiology-Guided Coronary Revascularization., 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 54B-54B, ISSN: 0002-9149
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- Citations: 4
Sen S, Petraco R, Nijjer S, et al., 2013, The Trans-stenotic Pressure Gradient During the Diastolic Wave-free Period Is Proportional to Flow: the Physiological Basis of the Instant-wave-free Ratio., 18th Angioplasty Summit Transcatheter Cardiovascular Therapeutics Asia Pacific (TCTAP), Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 100B-100B, ISSN: 0002-9149
Petraco R, Sen S, Nijjer S, 2013, Fractional flow reserve-guided revascularization: practical implications of a diagnostic gray zone and measurement variability on clinical decisions (vol 6, pg 222, 2013), JACC-CARDIOVASCULAR INTERVENTIONS, Vol: 6, Pages: 431-431, ISSN: 1936-8798
Jabs A, Hink U, Fineschi M, et al., 2013, How should I treat a patient with typical angina, typical angiography, negative FFR?, EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Vol: 9, Pages: 157-161, ISSN: 1969-6213
Sen S, Nijjer S, Petraco R, et al., 2013, Instantaneous Wave-Free Ratio, Journal of the American College of Cardiology, Vol: 62, ISSN: 0735-1097
Sen S, Escaned J, Petraco R, et al., 2013, Reply, Journal of the American College of Cardiology, Vol: 62, Pages: 943-945, ISSN: 0735-1097
Foin N, Mari JM, Nijjer S, et al., 2013, Intracoronary imaging using attenuation-compensated optical coherence tomography allows better visualisation of coronary artery diseases, Cardiovascular revascularization medicine: including molecular interventions, ISSN: 1878-0938
PURPOSE: To allow an accurate diagnosis of coronary artery diseases by enhancing optical coherence tomography (OCT) images of atheromatous plaques using a novel automated attenuation compensation technique. BACKGROUND: One of the major drawbacks of coronary OCT imaging is the rapid attenuation of the OCT signal, limiting penetration in tissue to only few millimetres. Visualisation of deeper anatomy is however critical for accurate assessment of plaque burden in-vivo. METHODS: A compensation algorithm, previously developed to correct for light attenuation in soft tissues and to enhance contrast in ophthalmic OCT images, was applied to intracoronary plaque imaging using spectral-domain OCT. RESULTS: Application of the compensation algorithm significantly increased tissue contrast in the vessel wall and atherosclerotic plaque boundaries. Contrast enhancement allows a better differentiation of plaque morphology, which is particularly important for the identification of lipid rich fibro atheromatous plaques and to guide decision on treatment strategy. CONCLUSION: The analysis of arterial vessel structure clinically captured with OCT is improved when used in conjunction with automated attenuation compensation. This approach may improve the OCT-based interpretation of coronary plaque morphology in clinical practice.
Sen S, Davies J, Nijjer S, et al., 2013, FRACTIONAL FLOW RESERVE AND THE INSTANT WAVE–FREE RATIO HAVE EQUIVALENT AGREEMENT WITH FLOW–BASED INDICES ACROSS THE ENTIRE SPECTRUM OF STENOSIS SEVERITY RESULTS OF THE CLARIFY STUDY RESULTS OF CLARIFY (THE CLASSIFICATION ACCURACY OF PRESSURE–ONLY RATIOS AGAINST INDICES USING FLOW STUDY), ISSN: 0735-1097
Petraco da Cunha R, van de Hoef T, Nijjer S, et al., 2013, THE PERFORMANCE OF BASELINE HAEMODYNAMIC INDICES OF CORONARY DISEASE SEVERITY IN THE DEFER AND FAME STUDIES: AN ESTIMATED AGREEMENT OF STENOSES CLASSIFICATION WITH FRACTIONAL FLOW RESERVE, ISSN: 0735-1097
Petraco da Cunha R, Park JJ, Sen S, et al., 2013, A HYBRID DECISION-MAKING STRATEGY WITH INSTANTANEOUS WAVE-FREE RATIO AND FRACTIONAL FLOW RESERVE COULD ENHANCE ADOPTION OF PHYSIOLOGY-GUIDED CORONARY REVASCULARISATION, ISSN: 0735-1097
Nijjer S, Sen S, Cunha RPD, et al., 2013, INSTANTANEOUS WAVE–FREE RATIO (IFR) CAN DETECT IMPROVEMENT IN CORONARY HAEMODYNAMICS AFTER PCI, ISSN: 0735-1097
Sen S, Petraco R, Nijjer S, et al., 2013, THE TRANS–STENOTIC PRESSURE GRADIENT DURING THE DIASTOLIC WAVE–FREE PERIOD IS PROPORTIONAL TO FLOW: THE PHYSIOLOGICAL BASIS OF THE INSTANT–WAVE–FREE RATIO, ISSN: 0735-1097
Sen S, Nijjer S, Petraco R, et al., 2013, THE EFFECT OF ADENOSINE ON CORONARY MICROVASCULAR RESISTANCE IS MORE CONSISTENT DURING THE DIASTOLIC WAVE–FREE PERIOD: SHOULD WE CONTINUE TO USE THE COMPLETE CARDIAC CYCLE FOR STENOSIS ASSESSMENT?, ISSN: 0735-1097
Petraco R, Sen S, Nijjer S, et al., 2013, Fractional flow reserve-guided revascularization: practical implications of a diagnostic gray zone and measurement variability on clinical decisions, JACC. Cardiovascular interventions, Vol: 6, Pages: 222-225, ISSN: 1876-7605
OBJECTIVES: This study sought to evaluate the effects of fractional flow reserve (FFR) measurement variability on FFR-guided treatment strategy. BACKGROUND: Current appropriateness guidelines recommend the utilization of FFR to guide coronary revascularization based on a fixed cut-off of 0.8. This rigid approach does not take into account the intrinsic biological variability of a single FFR result and the clinical judgment of experienced interventionists. METHODS: FFR reproducibility data from the landmark Deferral Versus Performance of PTCA in Patients Without Documented Ischemia (DEFER) trial was analyzed (two repeated FFR measurements in the same lesion, 10 min apart) and the standard deviation of the difference (SDD) between repeated measurements was calculated. The measurement certainty (probability that the FFR-guided revascularization strategy will not change if the test is repeated 10 min later) was subsequently established across the whole range of FFR values, from 0.2 to 1. RESULTS: Outside the [0.75 to 0.85] FFR range, measurement certainty of a single FFR result is >95%. However, closer to its cut-off, certainty falls to less than 80% within 0.77 to 0.83, reaching a nadir of 50% around 0.8. In clinical practice, that means that each time a single FFR value falls between 0.75 and 0.85, there is a chance that the FFR-derived revascularization recommendation will change if the measurement is repeated 10 min later, with this chance increasing the closer the FFR result is to 0.8. CONCLUSIONS: A measurement FFR gray-zone is found between 0.75 and 0.85]. Therefore, clinicians should make revascularization decisions based on broadened clinical judgment when a single FFR result falls within this uncertainty zone, particularly between 0.77 and 0.83, when measurement certainty falls to less than 80%.
Sen S, Asrress KN, Nijjer S, et al., 2013, Diagnostic Classification of the Instantaneous Wave-Free Ratio Is Equivalent to Fractional Flow Reserve and Is Not Improved With Adenosine Administration, Journal of the American College of Cardiology, Vol: 61, Pages: 1409-1420, ISSN: 0735-1097
Petraco R, Park JJ, Sen S, et al., 2013, Hybrid iFR-FFR decision-making strategy: implications for enhancing universal adoption of physiology-guided coronary revascularisation, EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Vol: 8, Pages: 1157-1165, ISSN: 1969-6213
AIMS: Adoption of fractional flow reserve (FFR) remains low (6-8%), partly because of the time, cost and potential inconvenience associated with vasodilator administration. The instantaneous wave-Free Ratio (iFR) is a pressure-only index of stenosis severity calculated without vasodilator drugs. Before outcome trials test iFR as a sole guide to revascularisation, we evaluate the merits of a hybrid iFR-FFR decision-making strategy for universal physiological assessment. METHODS AND RESULTS: Coronary pressure traces from 577 stenoses were analysed. iFR was calculated as the ratio between Pd and Pa in the resting diastolic wave-free window. A hybrid iFR-FFR strategy was evaluated, by allowing iFR to defer some stenoses (where negative predictive value is high) and treat others (where positive predictive value is high), with adenosine being given only to patients with iFR in between those values. For the most recent fixed FFR cut-off (0.8), an iFR of <0.86 could be used to confirm treatment (PPV of 92%), whilst an iFR value of >0.93 could be used to defer revascularisation (NPV of 91%). Limiting vasodilator drugs to cases with iFR values between 0.86 to 0.93 would obviate the need for vasodilator drugs in 57% of patients, whilst maintaining 95% agreement with an FFR-only strategy. If the 0.75-0.8 FFR grey zone is accounted for, vasodilator drug requirement would decrease by 76%. CONCLUSION: A hybrid iFR-FFR decision-making strategy for revascularisation could increase adoption of physiology-guided PCI, by more than halving the need for vasodilator administration, whilst maintaining high classification agreement with an FFR-only strategy.
Foin N, Sen S, Allegria E, et al., 2013, Maximal expansion capacity with current DES platforms: a critical factor for stent selection in the treatment of left main bifurcations?, EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Vol: 8, Pages: 1315-1325, ISSN: 1969-6213
AIMS: Left main stenting is increasingly performed and often involves deployment of a single stent across vessels with marked disparity in diameters. Knowing stent expansion capacity is critical to ensure adequate strut apposition after post-dilatation of the stent has been performed. Coronary stents are usually manufactured in only two or three different model designs with each design having a different maximal expansion capacity. Information about the different workhorse designs and their maximal achievable diameter is not commonly provided by manufacturers but, in the absence of this critically important information, stents implanted in segments with major changes in vessel diameter have the potential to become grossly overstretched and to remain incompletely apposed. METHODS AND RESULTS: We examined the differences in workhorse designs of six commercially available drug-eluting stents (DES): the PROMUS Element, Taxus Liberté, XIENCE Prime, Resolute Integrity, BioMatrix Flex and Cypher Select stents. Using micro-computed tomography, we tested oversizing capabilities above nominal pressures for the different workhorse designs of the six DES using 4.0, 5.0 and 6.0 mm post-dilatation balloons inflated to 14 atmospheres. MLD could be increased significantly in all stents, only restricted by workhorse design limitations. Minimal inner lumen diameter (MLD) achieved after two successive 6.0 mm post-dilatations of the largest design (4.0 mm stent) was 5.7 mm for the Element, 5.6 mm for the XIENCE Prime, 6.0 mm for the Taxus, 5.4 mm for the Resolute Integrity, 5.9 mm for the BioMatrix and 5.8 mm for the Cypher stent. Significant deformations were observed during stent oversizing with large changes in terms of cell opening and crowns expansion. These are affected by design structure and reveal important differences among all stents tested. Such extensive deformations may alter the functional ability of an individual stent to scaffold a lesion and prevent restenosis.
Foin N, Alegria E, Sen S, et al., 2013, Importance of knowing stent design threshold diameters and post-dilatation capacities to optimise stent selection and prevent stent overexpansion/incomplete apposition during PCI, International journal of cardiology, Vol: 166, Pages: 755-758, ISSN: 1874-1754
Nijjer SS, Pabari PA, Stegemann B, et al., 2012, The Limit of Plausibility for Predictors of Response: Application to Biventricular Pacing (vol 5, pg 1046, 2012), JACC-CARDIOVASCULAR IMAGING, Vol: 5, Pages: 1190-1190, ISSN: 1936-878X
Sen S, Nijjer S, Petraco R, et al., 2012, The Instantaneous Wave-Free Ratio (iFR) and Fractional Flow Reserve (FFR) Have Equivalent Diagnostic Categorisation When Compared To Flow Based Indices, Transcatheter Cardiovascular Therapeutics (TCT) Symposium, Publisher: ELSEVIER SCIENCE INC, Pages: B68-B69, ISSN: 0735-1097
Sen S, Asrress K, Petraco R, et al., 2012, Does Adenosine Administration Improve Diagnostic Classification Of The Instantaneous Wave-Free Ratio (iFR)?, Transcatheter Cardiovascular Therapeutics (TCT) Symposium, Publisher: ELSEVIER SCIENCE INC, Pages: B69-B69, ISSN: 0735-1097
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- Citations: 2
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