Integrated coronary physiology in percutaneous intervention: a new paradigm in interventional cardiology.
ABSTRACT Coronary angiography has provided an unrivalled appreciation of coronary anatomy fostering a far greater appreciation of the extent of atherosclerotic disease. However, the subjectivity of coronary angiography at determining the extent of plaque has been exposed with IVUS. Indices of coronary physiology have provided valuable adjunctive information as to the physiological importance of specific lesions. Fractional flow reserve is an established method for evaluating the significance of epicardial stenoses. Fractional flow reserve guided percutaneous coronary intervention is associated with improved outcomes when compared to a conventional angiographic guided strategy, particularly in intermediate lesions. The use of coronary physiology in the cath lab represents a new avenue to guide appropriate patient specific revascularisation strategies. This review examines the theory and evidence for fractional flow reserve and its use in percutaneous coronary intervention.
- [Show abstract] [Hide abstract]
ABSTRACT: In this article, a new scheme consisting of a combination of adaptive modulation, orthogonal frequency division multiplexing (OFDM), high order space-frequency block coding (SFBC), and antenna selection is presented. The proposed scheme, exploits the benefits of space-frequency block codes, OFDM and adaptive modulation to provide high quality of transmission for wireless communications over frequency selective fading channels. We examine the spectral efficiency and coding gain advantages of the proposed system. It is shown that antenna selection with adaptive modulation can greatly improve the performance of the conventional SFBC-OFDM systems.Vehicular Technology Conference, 2003. VTC 2003-Spring. The 57th IEEE Semiannual; 05/2003
- [Show abstract] [Hide abstract]
ABSTRACT: We performed a prospective study to investigate markers of percutaneous coronary intervention (PCI) related microvascular injury. Consecutive patients undergoing PCI for stable angina were studied. The index of microvascular resistance (IMR) was measured using a temperature and pressure sensing guidewire (TPSG) before and after single vessel PCI. Basal transit-time (TmnBase), that reflected non-hyperemic blood flow was also measured. Fasting bloods were taken to measure blood sugar, HbA1c and lipids. Asymmetric dimethylarginine (ADMA) was also measured as a marker of systemic endothelial function. 55 patients were included in the study. Mean age was 59.9±11.2, 74.1% male. There was no significant difference in IMR post PCI compared with pre PCI values (IMR pre PCI=16.96 [11.5,25.38] vs. IMR post PCI 14.2 [10.37,26.25] p=0.96). IMR post PCI was higher in diabetic (DM) patients compared with non-diabetics [IMR post DM=22.72 (13.35,42.91) vs. no DM=13.9 (10.18,21.45), p=0.02]. Fasting blood sugar, HbA1c and IMR pre PCI were correlated with post PCI IMR. IMR pre PCI, HbA1C and fasting glucose were higher in patients who developed PCI related microvascular dysfunction. The strongest independent predictor of post PCI IMR was the pre PCI IMR. The baseline status of the microcirculation is an important determinant of post PCI microvascular function. Diabetics appear to have higher post PCI IMR.International journal of cardiology 09/2013; · 6.18 Impact Factor