Publications
207 results found
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, 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
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.
Sen S, Francis D, Petraco R, et al., 2012, Is There Sufficient Evidence To Discourage The Use Of Multi-Vessel Angioplasty During STEMI? An Analysis of 35,008 Patients, Transcatheter Cardiovascular Therapeutics (TCT) Symposium, Publisher: ELSEVIER SCIENCE INC, Pages: B152-B152, ISSN: 0735-1097
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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Sen S, Petraco R, Nijjer S, et al., 2012, The Diastolic Wave-Free Period Is The Most Suitable Period In The Cardiac Cycle For The Assessment Of A Coronary Stenosis: Implications For The Accurate Calculation Of The Instantaneous Wave-Free Ratio (iFR), Transcatheter Cardiovascular Therapeutics (TCT) Symposium, Publisher: ELSEVIER SCIENCE INC, Pages: B68-B68, ISSN: 0735-1097
Foin N, Viceconte N, Sen S, et al., 2012, Impact of Stent Structural Design and Deployment Pressure on Strut Apposition and Recoil, Transcatheter Cardiovascular Therapeutics (TCT) Symposium, Publisher: ELSEVIER SCIENCE INC, Pages: B188-B188, ISSN: 0735-1097
Foin N, Sen S, Petraco R, et al., 2012, Investigation of Fractional Flow Reserve Correlation with Direct Anatomical Parameters Using a Percutaneous Model of Coronary Artery Stenosis, Transcatheter Cardiovascular Therapeutics (TCT) Symposium, Publisher: ELSEVIER SCIENCE INC, Pages: B67-B67, ISSN: 0735-1097
Ricardo Petraco, Francisco Leyva, 2012, Landmark Papers in Cardiovascular Medicine, Landmark Papers in Cardiovascular Medicine, Editors: Myat, Gershlick, Publisher: OUP Oxford, ISBN: 9780199594764
Landmark Papers in Cardiovascular Medicine provides a thorough and wide-ranging analysis of core examples of novel research, clinical trials and seminal papers that have paved the way for breakthroughs in the management of the entire ...
Sen S, Escaned J, Malik I, et al., 2012, DEVELOPMENT AND VALIDATION OF A NOVEL PRESSURE-ONLY INTRA-CORONARY INDEX OF CORONARY STENOSIS SEVERITY, Annual Conference of the British-Cardiovascular-Society (BCS), Publisher: B M J PUBLISHING GROUP, Pages: A13-A13, ISSN: 1355-6037
Petraco R, Dimopoulos K, Gatzoulis MA, 2012, Tricuspid Valvar Regurgitation in Congenital Absence of the Pericardium, JOURNAL OF HEART VALVE DISEASE, Vol: 21, Pages: 270-271, ISSN: 0966-8519
Petraco R, Escaned J, Sen S, et al., 2012, Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry, EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, ISSN: 1969-6213
Aims: To evaluate the classification agreement between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with angiographic intermediate coronary stenoses. Methods and results: Three hundred and twelve patients (339 stenoses) with angiographically intermediate stenoses were included in this international clinical registry. The iFR was calculated using fully automated algorithms. The receiver operating characteristic (ROC) curve was used to identify the iFR optimal cut-point corresponding to FFR 0.8. The classification agreement of coronary stenoses as significant or non-significant was established between iFR and FFR and between repeated FFR measurements for each 0.05 quantile of FFR values, from 0.2 to 1. Close agreement was observed between iFR and FFR (area under ROC curve= 86%). The optimal iFR cut-off (for an FFR of 0.80) was 0.89. After adjustment for the intrinsic variability of FFR, the classification agreement (accuracy) between iFR and FFR was 94%. Amongst the stenoses classified as non-significant by iFR (>0.89) and as significant by FFR (≤0.8), 81% had associated FFR values located within the FFR "grey-zone" (0.75-0.8) and 41% within the 0.79-0.80 FFR range. Conclusions: In a population of intermediate coronary stenoses, the classification agreement between iFR and FFR is excellent and similar to that of repeated FFR measurements in the same sample. Vasodilator-independent assessment of intermediate stenosis seems applicable and may foster adoption of coronary physiology in the catheterisation laboratory.
Sen S, Nijjer S, Petraco R, et al., 2012, STABILITY OF THE DIASTOLIC WAVE-FREE PERIOD AFTER PHARAMOCOLOGICAL PROVOCATION, AND DURING HAEMODYNAMIC PERTURBATIONS: IMPLICATIONS FOR THE CLINICAL APPLICABILITY OF THE INSTANTANEOUS WAVE-FREE RATIO (IFR), ISSN: 0735-1097
Sen S, Francis D, Petraco R, et al., 2012, SHOULD WE DISCOURAGE THE USE OF MULTI-VESSEL ANGIOPLASTY DURING STEMI OR THE USE OF REGISTRY DATA IN COMPARATIVE EFFICACY RESEARCH? AN ANALYSIS OF 35,008 PATIENTS, ISSN: 0735-1097
Sen S, Escaned J, Malik IS, et al., 2012, Development and Validation of a New Adenosine-Independent Index of Stenosis Severity From Coronary Wave–Intensity Analysis, Journal of the American College of Cardiology, Vol: 59, Pages: 1392-1402, ISSN: 0735-1097
Petraco R, Davies JE, 2011, Flow Limitation in Coronary Artery Disease, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 108, Pages: 1687-1687, ISSN: 0002-9149
Dimopoulos K, Giannakoulas G, Bendayan I, et al., 2011, Cardiothoracic ratio from postero-anterior chest radiographs: A simple, reproducible and independent marker of disease severity and outcome in adults with congenital heart disease, International Journal of Cardiology
Ricardo Petraco, Michael Frenneaux, 2011, Challenging Concepts in Cardiovascular Medicine, Challenging Concepts in Cardiovascular Medicine, Editors: Myat, Haldar, Redwood, Publisher: Oxford University Press, ISBN: 9780199695546
This book contains a series of challenging concepts in cardiovascular medicine covering all subspecialty areas including general cardiology, intervention, cardiac imaging, electrophysiology, heart failure and cardiomyopathies, cardiac ...
Rossi RI, Manica JLL, Petraco R, et al., 2011, Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis Using the Femoral and the Carotid Artery Approach: A 16-Year Experience from a Single Center, CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Vol: 78, Pages: 84-90, ISSN: 1522-1946
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- Citations: 20
Dimopoulos K, Diller G-P, Petraco R, et al., 2010, Hyponatraemia: a strong predictor of mortality in adults with congenital heart disease, EUROPEAN HEART JOURNAL, Vol: 31, Pages: 595-601, ISSN: 0195-668X
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- Citations: 42
Dimopoulos K, Diller G-P, Giannakoulas G, et al., 2009, Anemia in Adults With Congenital Heart Disease Relates to Adverse Outcome, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 54, Pages: 2093-2100, ISSN: 0735-1097
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- Citations: 52
Ricardo Petraco, 2008, ECG and congenital heart disease, ECG Diagnosis in Clinical Practice, Editors: Vecht, Gatzoulis, Peters, Publisher: Springer, ISBN: 9781848003118
ECG Diagnosis in Clinical Practice has been written for those taking Board examinations, but the simplicity of approach and high quality images represent a valuable source of reference material for the more experienced cardiovascular ...
Dimopoulos K, Diller GP, Petraco R, et al., 2008, Hyponatremia in adults with congenital heart disease: prevalence and relation to outcome, EUROPEAN HEART JOURNAL, Vol: 29, Pages: 744-744, ISSN: 0195-668X
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- Citations: 2
Petraco R, Dimopoulos K, Rubens M, et al., 2008, Bronchial artery embolization for pulmonary arterial hypertension and recurrent hemoptysis?, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 101, Pages: 1064-1065, ISSN: 0002-9149
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- Citations: 9
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