Quantitative Ratio Research Articles

Quantitative Flow Ratio to Predict Non-Target-Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome.

The optimal time point of staged percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remains a matter of debate. Quantitative flow ratio (QFR) is a novel noninvasive method to assess the hemodynamic significance of coronary stenoses. We aimed to investigate whether QFR could refine the timing of staged PCI of non-target vessels (non-TVs) on top of clinical judgment for patients with ACS. For this cohort study, patients with ACS from Bern University Hospital, Switzerland, scheduled to undergo out-of-hospital non-TV staged PCI were eligible. The primary end point was the composite of non-TV myocardial infarction and urgent unplanned non-TV PCI before planned staged PCI. The association between lowest QFR per patient measured in the non-TV(from index angiogram) and the primary end point was assessed using multivariable adjusted Cox proportional hazards regressions with QFR included as linear or penalized spline (nonlinear) term. QFR was measured in 1093 of 1432 patients with ACS scheduled to undergo non-TV staged PCI. Median time to staged PCI was 28 days. The primary end point occurred in 5% of the patients. In multivariable analysis (1018 patients), there was no independent association between non-TV QFR and the primary end point (hazard ratio, 0.87 [95% CI, 0.69-1.05] per 0.1 increase; P=0.125; nonlinear P=0.648). In selected patients with ACS scheduled to undergo staged PCI at a median of 4 weeks after index PCI, QFR did not emerge as an independent predictor of non-TV events before planned staged PCI. Thus, this study does not provide conceptual evidence that QFR is helpful to refine the timing of staged PCI on top of clinical judgment. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02241291.

Number and ratio of metastatic lymph nodes impacts the prognosis of submandibular gland cancer.

This study aimed to assess the impact of the number and ratio of metastatic lymph nodes (LNs) on prognosis in submandibular gland cancer. To this end, patients were selected from the Surveillance, Epidemiology, and End Results database retrospectively. The effect of the number and ratio of metastatic LNs and the American Joint Committee on Cancer (AJCC) N stage on disease-specific survival (DSS) and overall survival (OS) was analyzed. In addition, prognostic models based on LN evaluation methods were developed to predict the OS and DSS. A total of 914 patients were included. Binary recursive partitioning analysis determined the optimal cut-off number of metastatic LNs (0 vs. 1-2. vs. 3+). The presence of 3+ metastatic LNs carried the greatest impact on prognosis, followed by 1-2 positive LNs occurrences. The ratio of metastatic LNs was an independent factor for DSS and OS. The model had a higher likelihood ratio and C-index than those in the Cox model based on the AJCC N stage. Quantitative LN burden and ratio of metastatic LNs provides better survival stratification than the AJCC N stage.

Impact of post-dilatation on post-procedural physiology, microcirculatory resistance, and target vessel failure in STEMI patients undergoing PPCI: A single-center experience

BackgroundSuboptimal stent deployment is frequently observed in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). This study sought to investigate whether these patients could benefit from post-dilatation with respect to post-procedural physiology, microcirculatory resistance, and long-term clinical outcomes. MethodsThis was a retrospective study of consecutive STEMI patients who underwent successful stent implantation during PPCI from February 2016 to November 2021. Post-procedural physiology and microcirculatory resistance were assessed by Murray law-based quantitative flow ratio (μQFR) and angiographic microcirculatory resistance (AMR), respectively. The primary outcome was target vessel failure (TVF), a composite of cardiac death, target vessel-oriented myocardial infarction, and clinically driven target vessel revascularization. ResultsA total of 671 patients (671 culprit vessels) were included. Post-dilatation was selectively performed in 430 (64.1%) culprit vessels, resulting in a 0.02 (interquartile range: 0.00–0.05, p < 0.001) increase in post-procedural μQFR but no significant impact on AMR. During a median follow-up of 2.8 years (interquartile range: 1.4–3.0 years), TVF occurred in 47 (7.0%) patients. Post-dilatation demonstrated a trend toward a reduction in TVF (5.3% vs. 10.0%; adjusted hazard ratio: 0.60, 95% confidence interval: 0.33–1.09, p = 0.094), mainly driven by a lower incidence of clinically driven target vessel revascularization (1.6% vs. 4.1%; adjusted hazard ratio: 0.32, 95% confidence interval: 0.11–0.90, p = 0.030). ConclusionsIn STEMI patients undergoing PPCI, selective post-dilatation was associated with improved post-procedural physiological results and a trend toward less TVF events without aggravating microcirculatory resistance.

Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance.

Revascularization guided by functional severity has presented improved outcomes compared with visual angiographic guidance. Quantitative flow ratio (QFR) is a reliable angiography-based method for functional assessment. We sought to investigate the prognostic value of discordance between QFR and visual estimation in coronary revascularization guidance. We performed offline QFR analysis on all-comers undergoing coronary angiography. Vessels with calculated QFR were divided into four groups based on the decision to perform or defer percutaneous coronary intervention (PCI) and on the QFR result, i.e.: Group A (PCI-, QFR > 0.8); Group B (PCI+, QFR ≤ 0.8); Group C (PCI+, QFR > 0.8); Group D (PCI-, QFR ≤ 0.8). Patients with at least one vessel falling within the disagreement groups formed the discordance group, whereas the remaining patients formed the concordance group. The primary endpoint was the composite endpoint of cardiovascular death, myocardial infarction, and ischaemia-driven revascularization. Overall, 546 patients were included in the study. Discordance between QFR and visual estimation was found in 26.2% of patients. After a median follow-up period of 2.5 years, the discordance group had a significantly higher rate of the composite outcome (hazard ratio: 3.34, 95% confidence interval 1.99-5.60, P < 0.001). Both disagreement vessel Groups C and D were associated with increased cardiovascular risk compared with agreement Groups A and B. Discordance between QFR and visual estimation in revascularization guidance was associated with a worse long-term prognosis. Our results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment.

Regulation of oxygen balance in the process of synthesis of explosives

The role of explosives in the modern world is immeasurable, both in wartime and in peacetime. Accordingly, the optimization of their main blasting characteristics is of great importance, such as, detonation speed, workability, brisance, etc. They include the quantitative ratio of the chemical elements that make up these substances and its influence on the energy and ecology of the explosion, which It is defined by ,,oxygen balance’’.&#x0D; Generally, the elemental composition and ,,architecture’’ of the molecules of substances, i.e. chemical structure, are the main determining factors of their physico-chemical characteristics. The same reasoning applies to explosives: basically, these two factors are the determinants of the energy of the explosion.&#x0D; The article is about the possibilities of approaching zero oxygen balance in the process of synthesis of explosives. Examples of well-known poly nitro aromatic compounds and transformation products synthesized by us from them – CT compounds are discussed, as well as formulas of compounds with zero oxygen balance unknown in the literature and the procedure for their composition. It can be said with convinction that the specificity of organic synthesis and a wide scope of operation allow purposeful creation of explosive substances with zero oxygen balance. The article proposes the possibility of creating two such real methodologies.

Quantitative flow ratio computed from invasive coronary angiography as a predictor for cardiac allograft vasculopathy after cardiac transplant.

Cardiac allograft vasculopathy (CAV) is a significant determinant of long-term survival in heart transplant recipients. Standard CAV screening typically utilizes invasive coronary angiography (ICA). Quantitative flow ratio (QFR) is a computational method for functional testing of coronary stenosis, and may add diagnostic value to ICA in assessing CAV. Consecutive subjects who received heart transplantation and underwent two separate routine coronary angiograms between January 2013 and April 2016 were enrolled. Coronary angiograms and IVUS were performed per local protocol at 1, 2, 3 and 5years post-transplant. QFR was calculated offline. CAV was assessed semi-quantitively based on coronary angiogram results. Twenty-two patients were enrolled. Mean time from transplant to first included ICA was 2.1years. QFR in at least 1 coronary vessel was interpretable in 19/22 (86%) of initial ICA (QFR1). QFR1 correlated well with the CAV score derived from the second ICA (CAV2) with a clustering of CAV at lower QFR values. In a receiver-operating characteristic (ROC) analysis, an optimal QFR threshold of 0.88 yielded 0.94 sensitivity and 0.67 specificity (AUC of 0.79) for at least non-obstructive subsequent CAV. Initial angiographically and intravascular ultrasound derived CAV severity poorly predicted subsequent CAV severity. QFR derived from invasive coronary angiography predicts subsequent development of CAV more accurately than angiography and intravascular ultrasound. This novel method of coronary flow assessment in recipients of heart transplantation may be useful to diagnose and predict subsequent CAV development.

Amide proton transfer weighted combined with diffusion kurtosis imaging for predicting lymph node metastasis in cervical cancer

ObjectiveTo investigate the value of amide proton transfer weighted (APTw) combined with diffusion kurtosis imaging (DKI) in quantitative prediction of lymph node metastasis (LNM) in cervical carcinoma (CC). MethodsData of 19 LNM(+) and 50 LNM(−) patients with CC were retrospectively analyzed. 3.0 T MRI scan was performed before the operation, including APTw and DKI. After post-processing, quantitative magnetization transfer ratio asymmetric at 3.5 ppm [MTRasym (3.5 ppm)], mean kurtosis (MK), and mean diffusivity (MD) maps were obtained. The MTRasym(3.5 ppm), MK, and MD values were respectively measured by two observers, and intra-class correlation coefficients (ICC) were used to test the consistency of the results. The independent samples t-test or Mann-Whitney U test was used to compare the differences in the values of each parameter. The ROC curve was used to analyze the predictive performance of parameters with significant differences and their combination parameter. ResultsThe two observers had good agreement in the measurement of each data (ICC > 0.75). The MTRasym(3.5 ppm) and MK values of the LNM(+) group(3.260 ± 0.538% and 0.531 ± 0.202) were higher than those of the LNM(−) group(2.698 ± 0.597% and 0.401 ± 0.148) (P < 0.05), while there was no significant difference in MD values between the two groups(P > 0.05). The area under the curves (AUCs) of MTRasym(3.5 ppm), MK value, and MTRasym(3.5 ppm) + MK value were 0.763, 0.716, and 0.813, respectively, when predicting LNM status of CC. ConclusionAPTw and DKI can quantitatively predict LNM status of CC, which is of importance in clinical diagnosis and treatment.

Динамика нижних ярусов растительного покрова в антропогенно нарушенных сосновых ценозах Красноярской лесостепи

The dynamics of the understorey vegetation cover in anthropogenically transformed cenoses of common pine (Pinus sylvestris L.) in the period 2017–2020 was studied. The studies were conducted in a diverse herbaceous group of forest types of natural origin in the Krasnoyarsk forest-steppe zone. The forest stands are characterized by I–IV classes of bonitet, density 0.5–0.9 and IV–VII class of age. Vegetation cover was studied at each monitoring site on 30 (1 m2) survey plots: species composition, projective cover, species occurrence, horizontal and vertical structure of phytocenosis. The intensity of change in species composition over a 4-year period was identified using the Serensen-Chekanovsky coefficient. Species diversity was assessed using Shannon index, recreational transformation of living ground cover – synanthropization index. Based on the results of the study, the species composition of the undergrowth and living ground cover was determined, and the features of its change in the period 2017–2020 were described. Based on the analysis of changes in species diversity, composition and projective cover of dominants and co-dominants, quantitative ratio of ecological and cenotic groups, the stages of recreational transformation of the ground cover were determined. As a result of the increased recreational load, the stage of recreational transformation of the vegetation cover changed: in sample area 1 from undisturbed to the 1st (initial) phase I stage (weak transformation), in sample area 3 – from the 1st to the 2nd (final) phase I stage. Due to the absence of anthropogenic influence, the undisturbed vegetation cover was preserved in sample area 4, whereas in sample areas 2 and 5, due to the constant recreational load, the 2nd phase I stage of vegetation cover transformation observed in 2017 remained. To reduce the impact on the lower tiers of vegetation under the canopy of pine plantations (sample areas 1–3) and to preserve its species diversity, it is possible to recommend the arrangement of a specific road-trail network. For citation: Goncharova I.A., Skripalschikova L.N., Barchenkov A.P. Dynamics of Understory Vegetation Cover in Anthropogenically Disturbed Pine Cenoses of Krasnoyarsk Forest-Steppe. Lesnoy Zhurnal = Russian Forestry Journal, 2023, no. 6, pp. 204–214. (In Russ.). https://doi.org/10.37482/0536-1036-2023-6-204-214

Специфіка фейлетонів журналу «Кіно» за 1926 рік

The purpose of the article is to find out the specifics of the feuilletons printed in the magazine "Kino" for 1926.Methodology.Descriptive, systematic methods, methods of analysis, synthesis, statistical methods, and hermeneutic methods were used in the research process. Information necessary for the coverage of the topic of the scientific article was recorded using the descriptive method. The content and form of feuilletons were comprehensively analyzed using the systematic method. The method of analysis made it possible to single out compositional techniques and elements, means of psychologism from the texts. The method of synthesis presents the functional features of the form-content elements. Thanks to the hermeneutic method, original interpretations of the analyzed texts are offered.Thanks to the statistical method, the quantitative ratio of the used compositional elements and techniques, psychological tools for modeling the images of the characters or the collective image of the audience was clarified.Research results. In 1926, 4 feuilletons were printed in the magazine "Kino", which discussed current problems, the emergence of which was caused by the specifics of the development of cinematography at that time, determined by cultural and socio-political factors.Conclusions. The topics and problems of the feuilletons are revealed more deeply with the help of creolization of the texts, in particular, it is about the use in all feuilletons of illustrations, which are characterized by multifunctionality, with text quotes. The plot of feuilletons, the compositional features of which are the division of texts into parts, the use of compositional framing, the compositional technique "story within a story", film advertising, and descriptions, is presented with the help of either extra-diegetic or homodiegetic narrators, as well as due to their contamination. To model the figurative system of feuilletons, the authors used various means of psychology, visual, sound, olfactory details, and artistic means that give feuilletons dynamism, and expressiveness, and increase the humorous and satirical effect.

Modeling of the “grain – binding shell” system for refractory concretes structure

AbstractAmong with the fundamentally new concepts toward of the refractory concretes thermal‐shock resistance increasing is obtaining products with specified properties by controlling their structural parameters. The structure of refractory materials is one of the most important and common features and is characterized by the distribution of structural elements (grains, bond, macro‐ and microdefects), their quantitative ratio and relationship.Industrial refractory concretes are made of relatively large grains (up to 4 mm) and dispersed particles (less than 0.06 mm), the quantitative ratio, chemical and mineralogical composition of which varies within enough wide limits. As a result, the concrete structure is formed with a high degree of heterogeneity, different thermo‐mechanical properties of its several components, as well as with a significant content of pores and microcracks. In addition, a change in temperature causes the appearance of significant internal stresses and general deformation or destruction of the concrete.

Preprocedural physiological assessment of coronary disease patterns to predict haemodynamic outcomes post-PCI.

Even with intracoronary imaging-guided stent optimisation, suboptimal haemodynamic outcomes post-percutaneous coronary intervention (PCI) can be related to residual lesions in non-stented segments. Preprocedural assessment of pathophysiological coronary artery disease (CAD) patterns could help predict the physiological response to PCI. The aim of this study was to assess the relationship between preprocedural pathophysiological haemodynamic patterns and intracoronary imaging findings, as well as their association with physiological outcomes immediately post-PCI. Data from 206 patients with chronic coronary syndrome enrolled in the ASET-JAPAN study were analysed. Pathophysiological CAD patterns were characterised using Murray law-based quantitative flow ratio (μQFR)-derived indices acquired from pre-PCI angiograms. The diffuseness of CAD was defined by the pullback pressure gradient (PPG) index. Intracoronary imaging in stented segments after stent optimisation was also analysed. In the multivariable analysis, diffuse disease - defined by the pre-PCI μQFR-PPG index - was an independent factor for predicting a post-PCI μQFR <0.91 (per 0.1 decrease of PPG index, odds ratio 1.57, 95% confidence interval: 1.07-2.34; p=0.022), whereas the stent expansion index (EI) was not associated with a suboptimal post-PCI μQFR. Among vessels with an EI ≥80% and post-PCI μQFR <0.91, 84.0% of those vessels had a diffuse pattern preprocedure. There was no significant difference in EI between vessels with diffuse disease and those with focal disease. The average plaque burden in the stented segment was significantly larger in vessels with a preprocedural diffuse CAD pattern. A physiological diffuse pattern preprocedure was an independent factor in predicting unfavourable immediate haemodynamic outcomes post-PCI, even after stent optimisation using intracoronary imaging. Preprocedural assessment of CAD patterns could identify patients who are likely to exhibit superior immediate haemodynamic outcomes following PCI.

CAROTENOIDS AND CHLOROPHYLLS WHEN PRESENT TOGETHER: ANALYTICAL AND TECHNOLOGICAL FEATURES

Relevance.An analytical approach to choosing the direction of technological research has always been relevant, and taking into account the produc-tion of drugs using “green” extractants, the justification of technological parameters of extraction and its analytical support on models of already known, widely studied and used plant objects, for example, stinging nettle (Urtica dioica L.), can be considered as rational. The purpose of the study is an analytical study of carotenoids and chlorophylls in the co-presence of stinging nettle leaves and the rationale for the temperature regime for obtaining an oil extract from this plant, taking into account the co-presence of pigments in the extracts. Material and methods. The content of carotenoids and chlorophylls in raw materials and oil extracts was determined by spectrophotometry. Oil ex-tracts were obtained by fractional maceration at two temperature conditions: 25 °C and 50 °C. Results. The content of carotenoids and chlorophylls when jointly present in stinging nettle leaves was determined by spectrophotometry. When ob-taining six model oil extracts of stinging nettle leaves, the temperature regime was experimentally optimized at 50 °C; the optimization parameter was the quantitative content of carotenoids and chlorophylls. Conclusion. A detailed determination of the content of chlorophyll a, chlorophyll b, their sum and carotenoids in the presence of chlorophylls gives a detailed idea of the quantitative ratio of these types of pigments in the raw material and makes it possible to eliminate the overlap of absorption bands of carotenoids and chlorophylls. This approach made it possible to optimize the temperature conditions for obtaining the oil extract of nettle leaves. The applied analytical approach can be used to control the content of carotenoids and chlorophylls when present together to optimize the technological pa-rameters of oil extracts obtained from other types of medicinal plant raw materials.

Effect of hemoglobin A1c management levels on coronary physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention.

The coronary physiology and prognosis of patients with different hemoglobin A1c (HbA1c) levels after percutaneous coronary intervention (PCI) are currently unknown. The aim of this study was to assess the effect of different levels of HbA1c control on coronary physiology in patients who underwent PCI for coronary heart disease combined with type 2 diabetes mellitus by quantitative flow ratio (QFR). Patients who successfully underwent PCI and completed 1-year coronary angiographic follow up were enrolled, clinical data were collected, and QFR at immediate and 1-year follow up after PCI was retrospectively analyzed. A total of 257 patients (361 vessels) were finally enrolled and divided into the hemoglobin A1c (HbA1c)-compliance group (103 patients, 138 vessels) and non-HbA1c-compliance group (154 patients, 223 vessels) according to the HbA1c cut-off value of 7%. We compared the results of QFR analysis and clinical outcomes between the two groups. At 1-year follow up after PCI, the QFR was significantly higher (0.94 ± 0.07 vs 0.92 ± 0.10, P = 0.019) and declined less (0.014 ± 0.066 vs 0.033 ± 0.095, P = 0.029) in the HbA1c-compliance group. Meanwhile, the incidence of physiological restenosis was lower in the HbA1c-compliance group (2.9% vs 8.5%, P = 0.034). Additionally, the target vessel revascularization rate was lower in the HbA1c-compliance group (6.8% vs 16.9%, P = 0.018). Furthermore, HbA1c ≥7% (OR 2.113, 95% confidence interval 1.081-4.128, P = 0.029) and QFR decline (OR 2.215, 95% confidence interval 1.147-4.277, P = 0.018) were independent risk factors for target vessel revascularization. Patients with well-controlled HbA1c levels have better coronary physiological benefits and the incidence of adverse clinical outcome events might be reduced.

Application of AMR in evaluating microvascular dysfunction after ST-elevation myocardial infarction.

A guidewire-free angiography-derived microcirculatory resistance (AMR) derived from Quantitative flow ratio (QFR) exhibits good diagnostic accuracy for assessing coronary microvascular dysfunction (CMD), but there are no relevant studies supporting the specific application of AMR in patients with ST-elevation myocardial infarction (STEMI). The study aims to evaluate CMD in patients with STEMI using the AMR index. This study included patients with STEMI who underwent percutaneous coronary intervention (PCI) from June 1, 2020 to September 28, 2021. All patients were divided into two groups: the CMD (n = 215) and non-CMD (n = 291) groups. After matching, there were 382 patients in both groups.1-year follow-up major adverse cardiac events (MACEs) were evaluated. After matching, the primary endpoint was achieved in 41 patients (10.7%), with 27 and 14 patients in the CMD and non-CMD groups, respectively (HR 1.954 [95% CI 1.025-3.726]; 14.1% versus 7.3%, p = .042). Subgroup analysis revealed that 18 patients (4.7%) were readmitted for heart failure, with 15 and 3 in the CMD and non-CMD groups, respectively (HR 5.082 [95% CI 1.471-17.554]; 7.9% versus 1.6%, p = .010). Post-PCI AMR ≥ 250 was significantly associated with a higher risk of the primary endpoint and was its independent predictor (HR 2.265 [95% CI 1.136-4.515], p = .020). The retrospective use of AMR with a cutoff value of ≥250 after PCI in patients with STEMI can predict a significant difference in the 1-year MACE rates when compared with a propensity score-matched group with normal AMR.

MORPHOMETRIC CHARACTERIZATION OF THE STRUCTURAL COMPONENTS OF THE THYROID GLAND UNDER CONDITIONS OF MODELED THERMAL SKIN INJURY

The key organ of the peripheral endocrine system, the thyroid gland, shows the ability to adapt and restructure at diff erent levels of structural and cellular organization under the infl uence of various factors. The aim of the study was to determine morphometric changes in the parameters of the structural components of the thyroid gland. The experiment was modeled on 42 male laboratory mature white rats. The burn was modeled with copper plates heated in water at a temperature of 97-100 °C. The size of the aff ected area was 20 % of the animal’s body area, which, according to the current classifi cation, corresponds to a seconddegree burn. Changes in various parameters were studied by morphometric analysis of the obtained histologic sections. Statistical processing of digital data was carried out using the software «Excel» and «STATISTICA» 10.0 using parametric and nonparametric methods of data evaluation. Morphometrically, it was found that the organ contains follicles of three types – large, medium and small, and their quantitative ratio is 1.4: 4,7: 3,9. It was found that the average value of the area of a small follicle is (2342.5498.43) μm2, medium – (3722.53130.44) μm2, large – (5733.77203.67) μm2. The average value of thyrocyte height is (11.430.41) μm. The follicular- colloid index of the thyroid gland of intact animals is the highest for small follicles and is 1.940.08, for medium follicles – 1.81 0.04 and for large follicles – 1.730.05. The average value of the colloid accumulation index for small follicles is the lowest and is 2.600.12, for medium follicles – 4.18 0.19, and for large follicles – 6.270.29. At the light- optical level, on day 7 of the experiment, an increase in the number (1.58 times (p&lt;0.001) compared to the intact index) of large follicles was noted, which are located mainly on the periphery of the lobules and fi lled with a compacted colloid. A decrease in thyrocyte height (1.29 times (p&lt;0.001) compared to the normal value), a signifi cant decrease in the follicular- colloid index and an increase in the colloid accumulation index detected in the early toxemia stage indicate a decrease in functional activity in the organ, disruption of adaptive processes in it and the onset of destructive changes. At the later stages of burn injury (14 and 21 days of the experiment), against the background of a statistically signifi cant (p&lt;0.001) increase in endogenous intoxication, there is a development of deep destructive changes in thyrocytes, organ vessels, proliferation of connective tissue layers, impaired synthesis and secretion of hormones. These conditions are manifested by the dominance of large, overstretched follicles in the parenchyma of the thyroid gland, lined with fl at, degenerating thyrocytes, the height of which at day 21 is 3.31 times signifi cantly (p&lt;0.001) lower than the intact value; a statistically signifi cant decrease in the follicular- colloid index; a signifi cant increase in the colloid accumulation index, as well as a signifi cant deviation from the normal level of pituitary- thyroid system homones, which indicates organ hypofunction.

Effects of percutaneous coronary intervention and diabetes mellitus on short- and long-term prognosis assessed by the three-vessel quantitative flow ratio

AimsWe aimed to investigate the impact of percutaneous coronary intervention (PCI) and diabetes mellitus (DM) on short- and long-term prognosis in patients with coronary artery disease using three-vessel quantitative flow ratio (3 V-QFR) assessment. MethodsA retrospective analysis of 2440 vessels in 1181 patients who underwent PCI was performed. The patients were categorized according to the presence or absence of DM and the median 3 V-QFR. The primary outcome was the occurrence of major adverse cardiac events (MACE), defined as a combination of cardiovascular death, myocardial infarction, and ischemia-driven revascularization, over a 5-year period. ResultsThe pre-PCI and post-PCI 3 V-QFR values for the entire population were 2.37 (2.04–2.56) and 2.94 (2.82–3.00), respectively. Landmark analysis showed that the incidence of MACE was comparable among all groups within the first year (log-rank p = 0.088). Over the course of 2 years, the incidence of MACE was higher in both groups with a post-PCI 3 V-QFR < 2.94 (log-rank p < 0.001). However, from 2 to 5 years, patients with DM had higher rates of MACE (log-rank p = 0.013). ConclusionsIn the short term, a low post-PCI 3 V-QFR is a predictor of high risk for MACE. However, in the long term, DM emerges as the dominant risk factor.

Effect of alirocumab on quantitative flow ratio and diameter stenosis in non-infarct related arteries from patients with acute myocardial infarction: a PACMAN-AMI randomized clinical trial substudy

Abstract Introduction Treating hypercholesterolemia with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors on top of statins leads to plaque regression and stabilization. The effects of PCSK9 inhibitors on coronary physiology and angiographic diameter stenosis (DS%) are unknown. Quantitative Flow Ratio (QFR) is a novel method to assess coronary hemodynamics. Purpose We aimed to investigate the effects of the PCSK9 inhibitor alirocumab on QFR and 3D-Quantitative Coronary Angiography (3D-QCA) DS% in non-infarct-related arteries (non-IRA) among acute myocardial infarction (AMI) patients. Methods This was a pre-specified substudy of the PACMAN trial, a randomized, double-blind, placebo-controlled trial comparing alirocumab vs. placebo on top of high-intensity rosuvastatin among AMI patients. QFR and 3D-QCA were assessed at baseline and 1-year follow-up in any non-infarct related artery (non-IRA) with ≥2.0mm diameter and &amp;gt;25% 3D-QCA DS%. The pre-specified primary endpoint was the number of patients with mean QFR increase from baseline to follow-up, and the secondary endpoint the change in 3D-QCA DS%. Results Of 300 enrolled patients, 265 had serial follow-up, of which 193 underwent serial QFR/3D-QCA analysis in 282 non-IRA. Baseline mean QFR was 0.96[IQR 0.91-0.98] and mean DS% 36.96±7.88% in the alirocumab group vs. 0.96[IQR 0.91-0.99] (p=0.593) and 36.63±8.46% (p=0.742) in the placebo group. At 1-year, QFR increased in 50/94 (53.2%) patients with alirocumab vs. 40/99 (40.4%) with placebo (Δ12.8%; OR=1.7, 95%CI 0.9-3.0; p=0.076). When excluding non-IRA with QFR &amp;gt;0.95, QFR increased in 37/57 (64.9%) patients with alirocumab vs. 22/50 (44.0%) with placebo (Δ20.9%; OR=2.4, 95%CI 1.1-5.2; p=0.031). DS% decreased by -1.03±7.28% with alirocumab and increased by +1.70±8.27% with placebo (Δ-2.54%, 95%CI -4.51 to -0.57; p=0.012). Conclusions Treatment of AMI patients with alirocumab vs. placebo for 1 year resulted in a significant regression in angiographic DS%. While no overall improvement of coronary hemodynamics was observed with alirocumab as compared to placebo, potential benefits were found in alirocumab treated patients with baseline QFR ≤0.95.Figure 1.Flowchart and primary endpointFigure 2.Secondary endpoint

Functional Syntax score based on quantitative flow ratio vs. anatomical Syntax score

Abstract Background/Introduction Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score takes into consideration only the anatomy of the coronary network, while the Functional Syntax Score based on Quantitative Flow Ratio (FSSQFR) combines all the information derived from both anatomy and physiology of coronary arteries. Purpose To investigate the level of agreement between anatomical SYNTAX Score I (SS) and FSSQFR and its possible impact on risk re-stratification of patients and on revascularization options. Methods We performed an offline QFR analysis in consecutive patients who underwent coronary angiography in a single Greek center. A total of 410 patients with accountable FSSQFR were included. The latter was counted by summing the individual points only of physiologically significant lesions (vessel QFR ≤0.8). Patients were divided into low-, intermediate- and high risk according to SS and FSS with the same cutoff. The primary endpoint was the estimation of the predictive value of FSSQFR for the composite outcome of cardiovascular death, myocardial infarction and ischemia-driven revascularization at follow-up. Results FSSQFR and SS were estimated for all patients. After calculating the FSSQFR, 12% (48/410) of study patients changed the risk group. Most of them moved from higher-risk group by SS to lower-risk group and only three of them presented the opposite movement. Moreover, 5.9% (24/410) of patients, for whom coronary artery bypass grafting would be recommended according to SS, converted to favor percutaneous coronary intervention after FSSQFR calculation. After a median 30.2 (25.7-33.7) months follow-up period, the cumulative incidence of a composite of cardiac death, myocardial infarction or ischemia-driven revascularization was 4.6%, 10.7%, and 24.1%, in the low, intermediate, and high FSSQFR group correspondingly (log-rank P&amp;lt;0.001) (Figure 1). After multivariate regression analysis, FSSQFR was an independent predictor of the primary endpoint after adjustment for age, gender, smoking, and hypertension (adjusted OR: 1.08 [95% CI, 1.05–1.12]; P&amp;lt;0.001). The area under the curve for FSSQFR to predict the 2-year composite endpoint was higher than that of the classic anatomic SYNTAX score (0.711 vs. 0.706; p&amp;lt;0.001) (Figure 2). Conclusions In our study, FSSQFR found to be an independent predictor of higher cardiovascular adverse events. Also, compared with SS, FSSQFR significantly improved risk classification of patients with coronary disease widening the possible therapeutic options.

Quantitative flow ratio for non culprit lesions in ST elevation myocardial infarction and multi vessel disease - a direct comparison with fractional flow reserve

Abstract Objectives In acute myocardial infarction and multivessel disease (MVD), current guidelines recommend treatment of the culprit lesion followed by staged full revascularization of functionally relevant stenoses. We sought to analyze the hemodynamic relevance of intermediate stenoses using quantitative flow ratio (QFR, an angiography-derived fractional flow reserve [FFR]) in a population presenting with ST elevation myocardial infarction (STEMI) and MVD on index procedure. Methods We retrospectively analyzed 36 coronary lesions in 34 Patients presenting with STEMI and MVD from January 2017 to September 2022. 31 (86%) patients were male, mean age 63 ± 7, mean ejection fraction (EF %) 50 ± 8, arterial hypertension 30 (88%), diabetes 13 (38%). The non culprit lesion location was left anterior descending (LAD) in 24 (67%), circumflex artery (RCX) in 8 (22%) and right coronary artery (RCA) in 4 (11%). All patients received an invasive assessment of non culprit lesions using FFR within 3 months after STEMI. A QFR assessment of non culprit lesions in an acute invasive coronary angiography has been compared with FFR results in a staged procedure. Results QFR showed an excellent accuracy in ruling out functionally relevant stenosis with no false negative results (sensitivity 100% compared to FFR). Three coronary lesions (8,3%) were graded false positive (functionally relevant). Due to poor image acquisition, we were unable to perform QFR analysis in ten coronary lesions (28%). Overall specificity (56,5%) was lower than reported in previous trials. After excluding the lesions that could not be analyzed due to poor acquisition we achieved specificity of 81,2% (Fig. 1). Concusion: QFR showed an excellent correlation with FFR (Fig. 1). Performing QFR in STEMI Patients with MVD could reduce the need of repeated invasive coronary angiographies and optimize the clinical therapy management in this high-risk population. Further studies on diagnostic performance and outcomes are needed.Fig. 1: Correlation plot

Association between quantitative flow ratio and non-target-vessel-related events before planned staged percutaneous coronary intervention in patients with acute coronary syndrome

Abstract Introduction The optimal timepoint of non-target-vessel (non-TV) percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remains a matter of debate. Quantitative Flow Ratio (QFR) is a novel, non-invasive, vasodilator-free method to assess the hemodynamic significance of coronary stenoses. Purpose We aimed to investigate the association between non-TV QFR and non-TV-related events occurring prior to planned staged PCI (sPCI), to derive first conceptual knowledge, whether QFR could be useful to determine the optimal timepoint of sPCI. Methods Between 2009-2017, all ACS patients scheduled to undergo out-of-hospital sPCI within 6 months from index PCI at Bern University Hospital, Switzerland, were eligible for QFR measurement. The primary endpoint was non-TV myocardial infarction (MI) and urgent (unplanned) non-target-vessel PCI occurring before planned sPCI. QFR was measured using the index presentation angiogram in the non-TV planned for sPCI. The association between lowest QFR per patient (per 0.1) and the occurrence of the primary endpoint was assessed with a multivariable Cox proportional hazards regression including a penalized spline term for QFR and the variables age, sex, diabetes mellitus, renal failure, and diameter stenosis (DS%) (per 5%). Results Out of 8657 ACS patients, 1432 were scheduled to undergo sPCI, and 1093 patients (1262 vessels) were analyzed by QFR. At baseline, mean QFR was 0.73±0.17 and mean DS% 54.8±11.2%. sPCI was planned with median 28 days after the index PCI. In multivariable analysis (1018 patients, 51 events), there was no independent association between QFR and the primary endpoint (HR 0.87, 95% CI 0.69-1.05, p=0.125; QFR non-linear p=0.648). Conclusions In this cohort study of ACS patients scheduled to undergo out-of-hospital sPCI within median 28 days, QFR did not emerge as a predictor of non-TV events prior to planned sPCI. Thus, this study does not support the concept, that QFR would be helpful to determine the optimal timepoint of sPCI.Figure 1.Primary endpointTable 1.Cox model primary endpoint