Utility of angiography–physiology coregistration maps during percutaneous coronary intervention in clinical practice

Figures

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  Fig. 1. Representative physiological maps of cases before and after PCI generated using SyncVision. Case 1: the left coronary angiogram revealed a tandem lesion in the LCx. However, the iFR physiological map showed a physiologically significant lesion in the distal portion with an iFR of 0.60 and an FFR value of 0.67. Virtual PCI predicted the post-intervention iFR, which was defined as the iFRpred, as 1.0, assuming that stent implantation could remove an iFR drop of 0.4 (a). After stenting in the distal segment, the iFR increased to 1.0, as predicted using SyncVision, while the FFR value was 0.89 (b). This case was assigned to the good concordance group. Case 2: the left coronary angiogram revealed a focal stenotic lesion extending from the distal portion of the LMT to the proximal portion of the LAD, and the iFR map also showed a focal physiologically significant segment corresponding to angiographical stenosis with an iFR of 0.73 and an FFR value of 0.63. Virtual PCI was performed with crossover LMT stenting, which eliminated an iFR drop of 0.25, and the iFRpred was 0.98. After LMT–LAD crossover stenting according to the iFR map, the post-intervention iFR was 0.92, which was lower…

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  Fig. 2. Changes in angiographic lesion classification using SyncVision. Angiographic lesion classification changed to other types of physiological lesion classifications in 26 (37%) of the total lesions

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  Fig. 3. Scatter plot showing the relationship between iFRpred and actual post-iFR (a). Bland–Altman plots of differences against the means are displayed. The zero line is displayed in black. The mean bias is represented by the solid red line (with the 95% confidence interval represented by the dashed black line) (b). post-iFR post-intervention instantaneous wave-free ratio, iFRpred predicted instantaneous wave-free ratio

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  Fig. 4. Distribution of iFR gap locations after stent implantation. The iFR gap was most commonly located along the vessel length (a). Distribution of new iFR occurrences after coronary intervention (b). A new iFR gradient after stenting occurred in 11 patients (15.7%) and was commonly distal to the stent. distal ref. distal reference vessel, proximal ref. proximal reference vessel, iFR instantaneous wave-free ratio

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  Fig. 5. Changes in the heart rate, systolic blood pressure (BP), diastolic BP, and double product after percutaneous coronary intervention in the poor concordance group (black boxes) and in the good concordance group (open boxes). For statistical evaluation, see Table 5. NS not significant, BP blood pressure