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001-es BibID:	BIBFORM123877
035-os BibID:	(WOS)001248398300001 (Scopus)85196196047
Első szerző:	Ágoston András
Cím:	The pressure-derived microvascular resistance reserve and its correlation to Doppler MRR measurement - a proof of concept study / András Ágoston, Azzaya Dorj, Áron Üveges, Balázs Tar, Gábor Tamás Szabó, Judit Barta, Tibor Szűk, Michael Kest, Réka Méhész, András Komócsi, Dániel Czuriga, Benjámin Csippa, Zsolt Piróth, Emanuele Barbato, Zsolt Kőszegi
Dátum:	2024
ISSN:	2297-055X
Megjegyzések:	Background: Microvascular resistance reserve (MRR) is a recently introduced specific index of coronary microcirculation. MRR calculation can utilize parameters deriving from coronary flow reserve (CFR) assessment, provided that intracoronary pressure data are also available. The previously proposed pressure-bounded CFR (CFRpb) defines the possible CFR interval on the basis of resting and hyperemic pressure gradients in the epicardial vessel, however, its correlation to the Doppler wire measurement was reported to be rather poor without the correction for hydrostatic pressure. Purpose: We aimed to determine the pressure-bounded coronary MRR interval with hydrostatic pressure correction according to the previously established equations of CFRpb adapted for the MRR concept. Furthermore, we also aimed to design a prediction model using the actual MRR value within the pressure-bounded interval and validate the results against the gold-standard Doppler wire technique. Methods: Hydrostatic pressure between the tip of the catheter and the sensor of the pressure wire was calculated by height difference measurement from a lateral angiographic view. In the derivation cohort the pressure-bounded MRR interval (between MRRpbmin and MRRpbmax) was determined solely from hydrostatic pressure-corrected intracoronary pressure data. The actual MRR was calculated by simple hemodynamic equations incorporating the anatomical data of the three-dimensionally reconstructed coronary artery (MRRp?3D). These results were analyzed by regression analyses to find relations between the MRRpb bounds and the actual MRRp?3D. Results: In the derivation cohort of 23 measurements, linear regression analysis showed a tight relation between MRRpbmax and MRRp?3D (r2= 0.74, p < 0.0001). Using this relation (MRRp?3D = 1.04 + 0.51 ? MRRpbmax), the linear prediction of the MRR was tested in the validation cohort of 19 measurements against the gold standard Doppler wire technique. A significant correlation was found between the linearly predicted and the measured values (r = 0.54, p = 0.01). If the area stenosis (AS%) was included to a quadratic prediction model, the correlation was improved (r = 0.63, p = 0.004). Conclusions: The MRR can be predicted reliably to assess microvascular function by our simple model. After the correction for hydrostatic pressure error, the pressure data during routine FFR measurement provides a simultaneous physiological assessment of the macro- and microvasculature. 2024 Ágoston, Dorj, Üveges, Tar, Szabó, Barta, Szűk, Kest, Méhész, Komócsi, Czuriga, Csippa, Piróth, Barbato and Kőszegi.
Tárgyszavak:	Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk coronary flow reserve (CFR) coronary microvascular dysfunction (CMD) fractional flow reserve (FFR) hydrostatic pressure (HP) microvascular resistance reserve (MRR)
Megjelenés:	Frontiers in Cardiovascular Medicine. - 11 (2024), p. 1-11. -
További szerzők:	Dorj, Azzaya Üveges Áron (1993-) (orvos) Tar Balázs (1970-) (orvos) Szabó Gábor Tamás (1982-) (kardiológus) Barta Judit (1975-) (kardiológus) Szűk Tibor (1967-) (kardiológus) Kest, Michael Méhész Réka Komócsi András Czuriga Dániel (1982-) (kardiológus) Csippa Benjamin Piroth Zsolt Barbato, Emanuele Kőszegi Zsolt (1962-) (kardiológus, belgyógyász)
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001-es BibID:	BIBFORM100404
035-os BibID:	(cikkazonosító)784220
Első szerző:	Kőszegi Zsolt (kardiológus, belgyógyász)
Cím:	Anatomical Assessment vs. Pullback REsting full-cycle rAtio (RFR) Measurement for Evaluation of Focal and Diffuse CoronarY Disease : rationale and Design of the "READY Register" / Kőszegi Zsolt, Berta Balázs, Tóth Gábor G., Tar Balázs, Üveges Áron, Ágoston András, Szücs Attila, Szabó Gábor Tamás, Barta Judit, Szük Tibor, Czuriga Dániel, Komócsi András, Ruzsa Zoltán
Dátum:	2021
ISSN:	2297-055X 2297-055X
Megjegyzések:	Background: The morphology and functional severity of coronary stenosis show poor correlation. However, in clinical practice, the visual assessment of the invasive coronary angiography is still the most common means for evaluating coronary disease. The fractional flow reserve (FFR), the coronary flow reserve (CFR), and the resting full-cycle ratio (RFR) are established indices to determine the hemodynamic significance of a coronary stenosis. Design/Methods: The READY register (NCT04857762) is a prospective, multicentre register of patients who underwent invasive intracoronary FFR and RFR measurement. The main aim of the registry is to compare the visual estimate of coronary lesions and the functional severity of the stenosis assessed by FFR, as well as the RFR pullback. Characterizations of the coronary vessel for predominantly focal, diffuse, or mixed type disease according to visual vs. RFR pullback determination will be compared. The secondary endpoint of the study is a composite of major adverse cardiac events, including death, myocardial infarction, and repeat coronary revascularization at 1 year. These endpoints will be compared in patients with non-ischemic FFR in the subgroup of cases where the local pressure drop indicates a focal lesion according to the definition of ?RFR > 0.05 (for <25 mm segment length) and in the subgroup without significant ?RFR. In case of an FFR value above 0.80, an extended physiological analysis is planned to diagnose or exclude microvascular disease using the CFR/FFR index. This includes novel flow dynamic modeling for CFR calculation (CFRp-3D). Conclusion: The READY register will define the effect of RFR measurement on visual estimation-based clinical decision-making. It can identify a prognostic value of ?RFR during RFR pullback, and it would also explore the frequency of microvascular disease in the patient population with FFR > 0.80. Clinical Trial Registration: ClinicalTrials.gov (NCT04857762).
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk resting full-cycle ratio (RFR) microvascular coronary disease fractional flow reserve (FFR) coronary flow reserve (CFR) coronary artery disease
Megjelenés:	Frontiers in Cardiovascular Medicine. - 8 (2021), p. 1-7. -
További szerzők:	Berta Balázs Tóth Gábor G. Tar Balázs (1970-) (orvos) Üveges Áron (1993-) (orvos) Ágoston András Szücs Attila Szabó Gábor Tamás (1982-) (kardiológus) Barta Judit (1975-) (kardiológus) Szűk Tibor (1967-) (kardiológus) Czuriga Dániel (1982-) (kardiológus) Komócsi András Ruzsa Zoltán
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