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      The relationship between coronary artery distensibility and fractional flow reserve

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          Abstract

          Discordance between angiography-based anatomical assessment of coronary stenosis severity and fractional flow reserve (FFR) has been attributed to several factors including lesion length and irregularity, and the myocardial territory supplied by the target vessel. We sought to examine if coronary arterial distensibility is an independent contributor to this discordance. There were two parts to this study. The first consisted of “in silico” models of 26 human coronary arteries. Computational fluid dynamics-derived FFR was calculated for fully rigid, partially distensible and fully distensible models of the 26 arteries. The second part of the study consisted of 104 patients who underwent coronary angiography and FFR measurement. Distensibility at the lesion site (Distensibility MLA) and for the reference vessel (Distensibility Ref) was determined by analysing three-dimensional angiography images during end-systole and end-diastole. Computational fluid dynamics-derived FFR was 0.67±0.19, 0.70±0.18 and 0.75±0.17 (P<0.001) in the fully rigid, partially distensible and fully distensible models respectively. FFR correlated with both Distensibility MLA (r = 0.36, P<0.001) and Distensibility Ref (r = 0.44, P<0.001). Two-way ANCOVA analysis revealed that Distensibility MLA (F (1, 100) = 4.17, p = 0.031) and percentage diameter stenosis (F (1, 100) = 60.30, p < 0.01) were both independent predictors of FFR. Coronary arterial distensibility is a novel, independent determinant of FFR, and an important factor contributing to the discordance between anatomical and functional assessment of stenosis severity.

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          Two-equation eddy-viscosity turbulence models for engineering applications

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            Lessons From Sudden Coronary Death

            Arteriosclerosis, Thrombosis, and Vascular Biology, 20(5), 1262-1275
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              From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I.

              Atherosclerotic cardiovascular disease results in >19 million deaths annually, and coronary heart disease accounts for the majority of this toll. Despite major advances in treatment of coronary heart disease patients, a large number of victims of the disease who are apparently healthy die suddenly without prior symptoms. Available screening and diagnostic methods are insufficient to identify the victims before the event occurs. The recognition of the role of the vulnerable plaque has opened new avenues of opportunity in the field of cardiovascular medicine. This consensus document concludes the following. (1) Rupture-prone plaques are not the only vulnerable plaques. All types of atherosclerotic plaques with high likelihood of thrombotic complications and rapid progression should be considered as vulnerable plaques. We propose a classification for clinical as well as pathological evaluation of vulnerable plaques. (2) Vulnerable plaques are not the only culprit factors for the development of acute coronary syndromes, myocardial infarction, and sudden cardiac death. Vulnerable blood (prone to thrombosis) and vulnerable myocardium (prone to fatal arrhythmia) play an important role in the outcome. Therefore, the term "vulnerable patient" may be more appropriate and is proposed now for the identification of subjects with high likelihood of developing cardiac events in the near future. (3) A quantitative method for cumulative risk assessment of vulnerable patients needs to be developed that may include variables based on plaque, blood, and myocardial vulnerability. In Part I of this consensus document, we cover the new definition of vulnerable plaque and its relationship with vulnerable patients. Part II of this consensus document focuses on vulnerable blood and vulnerable myocardium and provide an outline of overall risk assessment of vulnerable patients. Parts I and II are meant to provide a general consensus and overviews the new field of vulnerable patient. Recently developed assays (eg, C-reactive protein), imaging techniques (eg, CT and MRI), noninvasive electrophysiological tests (for vulnerable myocardium), and emerging catheters (to localize and characterize vulnerable plaque) in combination with future genomic and proteomic techniques will guide us in the search for vulnerable patients. It will also lead to the development and deployment of new therapies and ultimately to reduce the incidence of acute coronary syndromes and sudden cardiac death. We encourage healthcare policy makers to promote translational research for screening and treatment of vulnerable patients.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: MethodologyRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                25 July 2017
                2017
                : 12
                : 7
                : e0181824
                Affiliations
                [1 ] Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
                [2 ] ANZAC Research Institute, The University of Sydney, Sydney, New South Wales, Australia
                [3 ] Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, New South Wales, Australia
                [4 ] Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, United States of America
                [5 ] South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
                [6 ] Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
                Medstar Washington Hospital Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Article
                PONE-D-17-18244
                10.1371/journal.pone.0181824
                5526528
                28742827
                740bc006-3e28-495b-b9db-1d705fca3e3d
                © 2017 Yong et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 May 2017
                : 9 July 2017
                Page count
                Figures: 10, Tables: 1, Pages: 16
                Funding
                Associate Professor Yong was supported by a National Heart Foundation of Australia Future Leader Fellowship (ID 100448) and a Sir Roy McCaughey Research Establishment Grant from the RACP. Professor Kritharides was supported by a National Health and Medical Research Council program grant (ID 1037903). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Stenosis
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Stenosis
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                Anatomy
                Cardiovascular Anatomy
                Blood Vessels
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                Coronary Arteries
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                All relevant data are within the paper and its Supporting Information files.

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