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  1. Determination of fractional flow reserve (FFR) based on scaling laws: a simulation study

    International Nuclear Information System (INIS)

    Wong, Jerry T; Molloi, Sabee

    2008-01-01

    Fractional flow reserve (FFR) provides an objective physiological evaluation of stenosis severity. A technique that can measure FFR using only angiographic images would be a valuable tool in the cardiac catheterization laboratory. To perform this, the diseased blood flow can be measured with a first pass distribution analysis and the theoretical normal blood flow can be estimated from the total coronary arterial volume based on scaling laws. A computer simulation of the coronary arterial network was used to gain a better understanding of how hemodynamic conditions and coronary artery disease can affect blood flow, arterial volume and FFR estimation. Changes in coronary arterial flow and volume due to coronary stenosis, aortic pressure and venous pressure were examined to evaluate the potential use of flow and volume for FFR determination. This study showed that FFR can be estimated using arterial volume and a scaling coefficient corrected for aortic pressure. However, variations in venous pressure were found to introduce some error in FFR estimation. A relative form of FFR was introduced and was found to cancel out the influence of pressure on coronary flow, arterial volume and FFR estimation. The use of coronary flow and arterial volume for FFR determination appears promising

  2. The Impact of Objective Mathematical Analysis During Fractional Flow Reserve Measurement. Results from the OMA-FFR Study.

    Science.gov (United States)

    Sciola, Martina I; Morris, Paul D; Gosling, Rebecca; Lawford, Patricia V; Hose, D Rodney; Gunn, Julian P

    2018-02-13

    Fractional flow reserve (FFR), the reference-standard for guiding coronary revascularisation, is most commonly acquired during intravenous adenosine infusion. Results may be sensitive to system- and operator-dependent variability in how pressure data are analysed and interpreted. We developed a computational protocol to process the recorded pressure signals in a consistent manner to objectively quantify FFR. We studied the impact upon lesion (re)classification and compared this with the operator-selected FFR obtained during cardiac catheterisation. The algorithm used a moving average and Fourier transformation to identify the Pd/Pa ratio at its nadir (FFRmin) and during the stable hyperaemic period (FFRstable) in <2s with 100% repeatability, in 163 coronary stenoses (93 patients). The mean operator-selected FFR (FFRCL) was higher than FFRmin and lower than FFRstable (0.779 vs 0.762 vs 0.806, P=<0.01). Compared with FFRmin, FFRstable resulted in 16.5% of all lesions being re-classified, all from significant to non-significant (p<0.01). FFRCL classified lesion significance differently to both FFRstable and FFRmin (11.7% and 6.1% lesions reclassified respectively, p<0.01). Subtle differences in how pressure data are analysed and interpreted by the operator during adenosine infusion result in significant differences in the classification of physiological lesion significance. An algorithmic analysis may be helpful in standardising FFR analysis providing an objective and repeatable result.

  3. The use of the acute Pd/Pa drop after intracoronary nitroglycerin infusion to rule out significant FFR: CANICA (Can intracoronary nitroglycerin predict fractional flow reserve without adenosine?) multicenter study.

    Science.gov (United States)

    Martin-Reyes, R; de la Torre Hernandez, J M; Franco-Pelaez, J; Lopez-Palop, R; Telleria Arrieta, M; Amat Santos, I J; Carrillo Saez, P; Sanchez-Recalde, A; Sanmartin Pena, J C; Garcia Camarero, T; Brugaletta, S; Gimeno de Carlos, F; Pinero, A; Sorto Sanchez, D C; Frutos, A; Lasa Larraya, G; Navarro, F; Farre, J

    2016-02-01

    Functional assessment of coronary artery stenosis is performed by measuring the fractional flow reserve (FFR) under hyperemic conditions (Adenosine). However, the use of adenosine portends limitations. We sought to investigate the relationship and correlation between FFR and the Pd/Pa value obtained just after the intracoronary infusion (acute drop) of nitroglycerin (Pd/Pa-NTG) and if this parameter enhances diagnostic accuracy for FFR prediction compared to the resting baseline Pd/Pa. We conducted a multicenter study including prospectively patients presenting intermediate coronary artery stenosis (30-70%) evaluated with pressure wire. Resting baseline Pd/Pa, Pd/Pa-NTG and FFR were measured. 283 patients (335 lesions) were included. Resting baseline Pd/Pa value was 0.72 to 1.0 (0.93 ± 0.04), Pd/Pa-NTG was 0.60 to 1.0 (0.87 ± 0.07) and FFR 0.55 to 1.0 (0.83 ± 0.08). The ROC curves for resting baseline Pd/Pa and for Pd/Pa-NTG, using a FFR ≤ 0.80 showed an AUC of 0.88 (95% CI: 0.84-0.92, P values of resting baseline Pd/Pa and Pd/Pa-NTG for an FFR > 0.80, were >0.96 and >0.88, respectively. These values were present in a 29.8% (n = 100) and a 47.1% (n = 158), of the total lesions. Scatter plots showed a better correlation and agreement points with Pd/Pa-NTG than resting baseline Pd/Pa. The cutoff value of Pd/Pa-NTG > 0.88 showed an excellent NPV (96.2% for FFR > 0.8 and 100% for FFR > 0.75) and sensitivity (95% for FFR > 0.8 and 100% for FFR > 0.75) which were consistently high across all the subgroups analysis. The cutoff value of acute Pd/Pa-NTG > 0.88 has a high NPV meaning adenosine-FFR can be avoided in almost half of lesions. © 2015 Wiley Periodicals, Inc.

  4. The Multi-center Evaluation of the Accuracy of the Contrast MEdium INduced Pd/Pa RaTiO in Predicting FFR (MEMENTO-FFR) Study.

    Science.gov (United States)

    Leone, Antonio Maria; Martin-Reyes, Roberto; Baptista, Sergio B; Amabile, Nicolas; Raposo, Luis; Franco Pelaez, Juan Antonio; Trani, Carlo; Cialdella, Pio; Basile, Eloisa; Zimbardo, Giuseppe; Burzotta, Francesco; Porto, Italo; Aurigemma, Cristina; Rebuzzi, Antonio G; Faustino, Mariana; Niccoli, Giampaolo; Abreu, Pedro F; Slama, Michel S; Spagnoli, Vincent; Telleria Arrieta, Miren; Amat Santos, Ignacio J; de la Torre Hernandez, Jose M; Lopez Palop, Ramon; Crea, Filippo

    2016-08-20

    Adenosine administration is needed for the achievement of maximal hyperaemia fractional flow reserve (FFR) assessment. The objective was to test the accuracy of Pd/Pa ratio registered during submaximal hyperaemia induced by non-ionic contrast medium (contrast FFR [cFFR]) in predicting FFR and comparing it to the performance of resting Pd/Pa in a collaborative registry of 926 patients enrolled in 10 hospitals from four European countries (Italy, Spain, France and Portugal). Resting Pd/Pa, cFFR and FFR were measured in 1,026 coronary stenoses functionally evaluated using commercially available pressure wires. cFFR was obtained after intracoronary injection of contrast medium, while FFR was measured after administration of adenosine. Resting Pd/Pa and cFFR were significantly higher than FFR (0.93±0.05 vs. 0.87±0.08 vs. 0.84±0.08, ptime and costs.

  5. Value of FFR in clinical practice

    Directory of Open Access Journals (Sweden)

    Anil Mehra

    2015-01-01

    Full Text Available Fractional flow reserve is an important tool in the cardiac catheterization lab to assess the physiological significance of coronary lesions. This article discusses the basic concepts about FFR and its utility in clinical decision making.

  6. Diagnostic performance of a Lattice Boltzmann-based method for CT-based fractional flow reserve.

    Science.gov (United States)

    Giannopoulos, Andreas A; Tang, Anji; Ge, Yin; Cheezum, Michael K; Steigner, Michael L; Fujimoto, Shinichiro; Kumamaru, Kanako K; Chiappino, Dante; Della Latta, Daniele; Berti, Sergio; Chiappino, Sara; Rybicki, Frank J; Melchionna, Simone; Mitsouras, Dimitrios

    2018-02-20

    Fractional flow reserve (FFR) estimated from coronary computed tomography angiography (CT-FFR) offers non-invasive detection of lesion-specific ischaemia. We aimed to develop and validate a fast CT-FFR algorithm utilising the Lattice Boltzmann method for blood flow simulation (LBM CT-FFR). Sixty-four patients with clinically indicated CTA and invasive FFR measurement from three institutions were retrospectively analysed. CT-FFR was performed using an onsite tool interfacing with a commercial Lattice Boltzmann fluid dynamics cloud-based platform. Diagnostic accuracy of LBM CT-FFR ≤0.8 and percent diameter stenosis >50% by CTA to detect invasive FFR ≤0.8 were compared using area under the receiver operating characteristic curve (AUC). Sixty patients successfully underwent LBM CT-FFR analysis; 29 of 73 lesions in 69 vessels had invasive FFR ≤0.8. Total time to perform LBM CT-FFR was 40±10 min. Compared to invasive FFR, LBM CT-FFR had good correlation (r=0.64), small bias (0.009) and good limits of agreement (-0.223 to 0.206). The AUC of LBM CT-FFR (AUC=0.894, 95% confidence interval [CI]: 0.792-0.996) was significantly higher than CTA (AUC=0.685, 95% CI: 0.576-0.794) to detect FFR ≤0.8 (p=0.0021). Per-lesion specificity, sensitivity, and accuracy of LBM CT-FFR were 97.7%, 79.3%, and 90.4%, respectively. LBM CT-FFR has very good diagnostic accuracy to detect lesion-specific ischaemia (FFR ≤0.8) and can be performed in less than one hour.

  7. Hybrid Instantaneous Wave-Free Ratio–Fractional Flow Reserve versus Fractional Flow Reserve in the Real World

    Directory of Open Access Journals (Sweden)

    Kara Shuttleworth

    2017-05-01

    Full Text Available BackgroundThe instantaneous wave-free ratio (iFR is a novel method to assess the ischemic potential of coronary artery stenoses. Clinical trial data have shown that iFR has acceptable diagnostic agreement with fractional flow reserve (FFR, the reference standard for the functional assessment of coronary stenoses. This study compares iFR measurements with FFR measurements in a real world, single-center setting.Methods and resultsInstantaneous wave-free ratio and FFR were measured in 50 coronary artery lesions in 42 patients, with FFR ≤ 0.8 classified as functionally significant. An iFR-only technique, using a treatment cut-off value, iFR ≤ 0.89, provided a classification agreement of 84% with FFR ≤ 0.80. Use of a hybrid iFR–FFR technique, incorporating FFR measurement for lesions within the iFR gray zone of 0.86–0.93, would improve classification agreement with FFR to 94%, with diagnosis achieved without the need for hyperemia in 57% patients.ConclusionThis study in a real-world setting demonstrated good classification agreement between iFR and FFR. Use of a hybrid iFR–FFR technique would achieve high diagnostic accuracy while minimizing adenosine use, compared with routine FFR.

  8. Correlation between coronary computed tomographic angiography and fractional flow reserve

    DEFF Research Database (Denmark)

    Kristensen, Thomas Skaarup; Engstrøm, Thomas; Kelbæk, Henning

    2010-01-01

    Coronary CT angiography (CCTA) has become an important modality to evaluate the presence of coronary artery disease. Coronary artery stenosis of intermediate severity remains a therapeutic dilemma. Measurement of fractional flow reserve (FFR) during coronary angiography is the most established...

  9. Assessment of stent edge dissections by fractional flow reserve.

    Science.gov (United States)

    Chung, Ju-Hyun; Ann, Soe Hee; Koo, Bon-Kwon; Nam, Chang-Wook; Doh, Joon-Hyung; Singh, Gillian Balbir; Kim, Hyung Il; Shin, Eun-Seok

    2015-04-15

    Edge dissections after intervention have been studied with imaging techniques, however, functional assessment has not been studied yet. We investigated the relationship between fractional flow reserve (FFR) and the angiographic type of stent edge dissections and tried to assess the use of FFR-guided management for edge dissection. 51 edge dissections assessed by FFR were included in this prospective observational study. FFR was measured for each type of edge dissection and compared with quantitative coronary angiographic findings. Clinical outcomes were evaluated based on FFR measurements. Edge dissections were classified as type A (47.1%; 24/51), type B (41.2%; 21/51), type C (2.0%; 1/51) and type D (9.8%; 5/51). Mean FFR in type A dissection was 0.87 ± 0.09, in type B 0.86 ± 0.07, in type C 0.72 and in type D 0.57 ± 0.08. All type C and D dissections (6/51) had FFR ≤ 0.8 and were treated with additional stents. Among the 45 type A and B dissections, 8 had a FFR ≤ 0.8 (17.8%), and 50% received additional stenting. All dissections with FFR >0.8 were left untreated except one long dissection case. There was no death, myocardial infarction or target lesion revascularization during hospitalization or the follow-up period (median 152 days; IQR 42-352 days). FFR correlates well with an angiographic type of edge dissection. Angiographic findings are sufficient for deciding the treatment of severe dissections such as types C and D, while FFR-guided management may be safe and effective for mild edge dissections such as types A and B. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Coronary CT angiography-derived fractional flow reserve correlated with invasive fractional flow reserve measurements - initial experience with a novel physician-driven algorithm

    International Nuclear Information System (INIS)

    Baumann, Stefan; Wang, Rui; Schoepf, U.J.; Steinberg, Daniel H.; Spearman, James V.; Bayer, Richard R.; Hamm, Christian W.; Renker, Matthias

    2015-01-01

    The present study aimed to determine the feasibility of a novel fractional flow reserve (FFR) algorithm based on coronary CT angiography (cCTA) that permits point-of-care assessment, without data transfer to core laboratories, for the evaluation of potentially ischemia-causing stenoses. To obtain CT-based FFR, anatomical coronary information and ventricular mass extracted from cCTA datasets were integrated with haemodynamic parameters. CT-based FFR was assessed for 36 coronary artery stenoses in 28 patients in a blinded fashion and compared to catheter-based FFR. Haemodynamically relevant stenoses were defined by an invasive FFR ≤0.80. Time was measured for the processing of each cCTA dataset and CT-based FFR computation. Assessment of cCTA image quality was performed using a 5-point scale. Mean total time for CT-based FFR determination was 51.9 ± 9.0 min. Per-vessel analysis for the identification of lesion-specific myocardial ischemia demonstrated good correlation (Pearson's product-moment r = 0.74, p < 0.0001) between the prototype CT-based FFR algorithm and invasive FFR. Subjective image quality analysis resulted in a median score of 4 (interquartile ranges, 3-4). Our initial data suggest that the CT-based FFR method for the detection of haemodynamically significant stenoses evaluated in the selected population correlates well with invasive FFR and renders time-efficient point-of-care assessment possible. (orig.)

  11. Prognostic value of fractional flow reserve: linking physiologic severity to clinical outcomes.

    Science.gov (United States)

    Johnson, Nils P; Tóth, Gábor G; Lai, Dejian; Zhu, Hongjian; Açar, Göksel; Agostoni, Pierfrancesco; Appelman, Yolande; Arslan, Fatih; Barbato, Emanuele; Chen, Shao-Liang; Di Serafino, Luigi; Domínguez-Franco, Antonio J; Dupouy, Patrick; Esen, Ali M; Esen, Ozlem B; Hamilos, Michalis; Iwasaki, Kohichiro; Jensen, Lisette O; Jiménez-Navarro, Manuel F; Katritsis, Demosthenes G; Kocaman, Sinan A; Koo, Bon-Kwon; López-Palop, Ramón; Lorin, Jeffrey D; Miller, Louis H; Muller, Olivier; Nam, Chang-Wook; Oud, Niels; Puymirat, Etienne; Rieber, Johannes; Rioufol, Gilles; Rodés-Cabau, Josep; Sedlis, Steven P; Takeishi, Yasuchika; Tonino, Pim A L; Van Belle, Eric; Verna, Edoardo; Werner, Gerald S; Fearon, William F; Pijls, Nico H J; De Bruyne, Bernard; Gould, K Lance

    2014-10-21

    Fractional flow reserve (FFR) has become an established tool for guiding treatment, but its graded relationship to clinical outcomes as modulated by medical therapy versus revascularization remains unclear. The study hypothesized that FFR displays a continuous relationship between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization. Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR and revascularization status allowed for an outcomes-based threshold. A total of 9,173 (study-level) and 6,961 (patient-level) lesions were included with a median follow-up of 16 and 14 months, respectively. Clinical events increased as FFR decreased, and revascularization showed larger net benefit for lower baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p < 0.001). An FFR-assisted strategy led to revascularization roughly half as often as an anatomy-based strategy, but with 20% fewer adverse events and 10% better angina relief. FFR demonstrates a continuous and independent relationship with subsequent outcomes, modulated by medical therapy versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces events and increases freedom from angina with fewer procedures than an anatomy-based strategy. Copyright © 2014. Published by Elsevier Inc.

  12. Coronary angiographic characteristics that influence fractional flow reserve.

    Science.gov (United States)

    Natsumeda, Makoto; Nakazawa, Gaku; Murakami, Tsutomu; Torii, Sho; Ijichi, Takeshi; Ohno, Yohei; Masuda, Naoki; Shinozaki, Norihiko; Ogata, Nobuhiko; Yoshimachi, Fuminobu; Ikari, Yuji

    2015-01-01

    Percutaneous coronary intervention (PCI) guided with fractional flow reserve (FFR) has been shown to improve clinical outcome. Although coronary angiography is the standard method for PCI guidance, the visual severity of stenosis is not always correlated with functional severity, suggesting that there are additional angiographic factors that affect functional ischemia. To evaluate angiographic predictors of positive FFR in stenotic lesions, angiographic characteristics of 260 consecutive patients (362 lesions) who underwent FFR testing from April 2009 to September 2012 were analyzed. A scoring system (STABLED score) using these predictors was developed and compared with quantitative coronary angiography (QCA). %Diameter stenosis >50% (OR, 8.43; P20 mm (OR, 5.40; P=0.0002), and distance from ostium <20 mm (OR, 1.94; P=0.028) were determined as independent predictors of positive FFR. Area under the ROC curve for probability of positive FFR using the STABLED score (Stenosis 2 points, TAndem lesion 1 point, Bifurcation 1 point, LEsion length 1 point, Distance from ostium 1 point) was 0.85, higher than that for QCA stenosis alone (0.76). STABLED score ≥3 had 72.3% sensitivity and 83.6% specificity for predicting positive FFR, and PPV was 76.7%. Specific angiographic features are applicable for predicting functional ischemia. STABLED score correlates well with FFR.

  13. Differences between automatically detected and steady-state fractional flow reserve.

    Science.gov (United States)

    Härle, Tobias; Meyer, Sven; Vahldiek, Felix; Elsässer, Albrecht

    2016-02-01

    Measurement of fractional flow reserve (FFR) has become a standard diagnostic tool in the catheterization laboratory. FFR evaluation studies were based on pressure recordings during steady-state maximum hyperemia. Commercially available computer systems detect the lowest Pd/Pa ratio automatically, which might not always be measured during steady-state hyperemia. We sought to compare the automatically detected FFR and true steady-state FFR. Pressure measurement traces of 105 coronary lesions from 77 patients with intermediate coronary lesions or multivessel disease were reviewed. In all patients, hyperemia had been achieved by intravenous adenosine administration using a dosage of 140 µg/kg/min. In 42 lesions (40%) automatically detected FFR was lower than true steady-state FFR. Mean bias was 0.009 (standard deviation 0.015, limits of agreement -0.02, 0.037). In 4 lesions (3.8%) both methods lead to different treatment recommendations, in all 4 cases instantaneous wave-free ratio confirmed steady-state FFR. Automatically detected FFR was slightly lower than steady-state FFR in more than one-third of cases. Consequently, interpretation of automatically detected FFR values closely below the cutoff value requires special attention.

  14. Coronary physiological assessment combining fractional flow reserve and index of microcirculatory resistance in patients undergoing elective percutaneous coronary intervention with grey zone fractional flow reserve.

    Science.gov (United States)

    Niida, Takayuki; Murai, Tadashi; Yonetsu, Taishi; Kanaji, Yoshihisa; Usui, Eisuke; Matsuda, Junji; Hoshino, Masahiro; Araki, Makoto; Yamaguchi, Masao; Hada, Masahiro; Ichijyo, Sadamitsu; Hamaya, Rikuta; Kanno, Yoshinori; Isobe, Mitsuaki; Kakuta, Tsunekazu

    2018-03-08

    The aim of this study is to investigate the association between fractional flow reserve (FFR) values and change in coronary physiological indices after elective percutaneous coronary intervention (PCI). Decision making for revascularization when FFR is 0.75-0.80 is controversial. A retrospective analysis was performed of 296 patients with stable angina pectoris who underwent physiological examinations before and after PCI. To investigate the differences of coronary flow improvement between territories with low-FFR (zone FFR (0.75-0.80), serial changes in physiological indices including mean transit time (Tmn), coronary flow reserve (CFR), and index of microcirculatory resistance (IMR) were compared between these two groups. Compared to low-FFR territories, grey-zone FFR territories showed significantly lower prevalence of Tmn shortening, CFR improvement, and decrease in IMR (Tmn shorting, 63.9% vs. 87.0%, P 51.3% vs. 63.3%, P = .040) and lower extent of their absolute changes (Tmn shorting, 0.06 (-0.03 to 0.16) vs. 0.22 (0.07-0.45), P zone FFR. Physiological assessment combining FFR and IMR may help identify patients who may benefit by PCI, particularly those in the grey zone. © 2018 Wiley Periodicals, Inc.

  15. Dynamic damping of the aortic pressure trace during hyperemia: the impact on fractional flow reserve measurement

    NARCIS (Netherlands)

    Lockie, Tim; Rolandi, M. Cristina; Piek, Jan J.

    2013-01-01

    We report on two cases that illustrate an important caveat in the measurement of fractional flow reserve (FFR) in coronary arteries. To obtain accurate FFR measurements, two fundamental requirements must be fulfilled. One is to minimize microvascular resistance; the other is that there is no damping

  16. Does the instantaneous wave-free ratio approximate the fractional flow reserve?

    NARCIS (Netherlands)

    Johnson, Nils P.; Kirkeeide, Richard L.; Asrress, Kaleab N.; Fearon, William F.; Lockie, Timothy; Marques, Koen M. J.; Pyxaras, Stylianos A.; Rolandi, M. Cristina; van 't Veer, Marcel; de Bruyne, Bernard; Piek, Jan J.; Pijls, Nico H. J.; Redwood, Simon; Siebes, Maria; Spaan, Jos A. E.; Gould, K. Lance

    2013-01-01

    This study sought to examine the clinical performance of and theoretical basis for the instantaneous wave-free ratio (iFR) approximation to the fractional flow reserve (FFR). Recent work has proposed iFR as a vasodilation-free alternative to FFR for making mechanical revascularization decisions. Its

  17. Repeatability of fractional flow reserve despite variations in systemic and coronary hemodynamics

    NARCIS (Netherlands)

    Johnson, N.P.; Johnson, D.T.; Kirkeeide, R.L.; Berry, C.; de Bruyne, B.; Fearon, W.F.; Oldroyd, K.G.; Pijls, N.H.J.; Gould, K. Lance

    2015-01-01

    Objectives This study classified and quantified the variation in fractional flow reserve (FFR) due to fluctuations in systemic and coronary hemodynamics during intravenous adenosine infusion. Background Although FFR has become a key invasive tool to guide treatment, questions remain regarding its

  18. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study

    DEFF Research Database (Denmark)

    Pijls, Nico H J; Fearon, William F; Tonino, Pim A L

    2010-01-01

    The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD).......The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD)....

  19. Fractional flow reserve in acute coronary syndromes: A review

    Directory of Open Access Journals (Sweden)

    Nikunj R. Shah

    2014-12-01

    Full Text Available Fractional flow reserve (FFR assessment provides anatomical and physiological information that is often used to tailor treatment strategies in coronary artery disease. Whilst robust data validates FFR use in stable ischaemic heart disease, its use in acute coronary syndromes (ACS is less well investigated. We critically review the current data surrounding FFR use across the spectrum of ACS including culprit and non-culprit artery analysis. With adenosine being conventionally used to induce maximal hyperaemia during FFR assessment, co-existent clinical conditions may preclude its use during acute myocardial infarction. Therefore, we include a current review of instantaneous wave free ratio as a novel vasodilator independent method of assessing lesion severity as an alternative strategy to guide revascularisation in ACS.

  20. The diagnostic performance of CT-derived fractional flow reserve for evaluation of myocardial ischaemia confirmed by invasive fractional flow reserve: a meta-analysis

    International Nuclear Information System (INIS)

    Li, S.; Tang, X.; Peng, L.; Luo, Y.; Dong, R.; Liu, J.

    2015-01-01

    Aim: To review the literature on the diagnostic accuracy of CT-derived fractional flow reserve (FFR CT ) for the evaluation of myocardial ischaemia in patients with suspected or known coronary artery disease, with invasive fractional flow reserve (FFR) as the reference standard. Materials and methods: A PubMed, EMBASE, and Cochrane cross-search was performed. The pooled diagnostic accuracy of FFR CT , with FFR as the reference standard, was primarily analysed, and then compared with that of CT angiography (CTA). The thresholds to diagnose ischaemia were FFR ≤0.80 or CTA ≥50% stenosis. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Results: Three multicentre studies (NXT Trial, DISCOVER-FLOW study and DeFACTO study) were included, examining 609 patients and 1050 vessels. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR−), and diagnostic odds ratio (DOR) for FFR CT were 89% (85–93%), 71% (65–75%), 70% (65–75%), 90% (85–93%), 3.31 (1.79–6.14), 0.16 (0.11–0.23), and 21.21 (9.15–49.15) at the patient-level, and 83% (78–63%), 78% (75–81%), 61% (56–65%), 92% (89–90%), 4.02 (1.84–8.80), 0.22 (0.13–0.35), and 19.15 (5.73–63.93) at the vessel-level. At per-patient analysis, FFR CT has similar sensitivity but improved specificity, PPV, NPV, LR+, LR−, and DOR versus those of CTA. At per-vessel analysis, FFR CT had a slightly lower sensitivity, similar NPV, but improved specificity, PPV, LR+, LR−, and DOR compared with those of CTA. The area under the summary receiver operating characteristic curves for FFR CT was 0.8909 at patient-level and 0.8865 at vessel-level, versus 0.7402 for CTA at patient-level. Conclusions: FFR CT , which was associated with improved diagnostic accuracy versus CTA, is a viable alternative to FFR for detecting coronary ischaemic lesions

  1. Comparison of different models for non-invasive FFR estimation

    Science.gov (United States)

    Mirramezani, Mehran; Shadden, Shawn

    2017-11-01

    Coronary artery disease is a leading cause of death worldwide. Fractional flow reserve (FFR), derived from invasively measuring the pressure drop across a stenosis, is considered the gold standard to diagnose disease severity and need for treatment. Non-invasive estimation of FFR has gained recent attention for its potential to reduce patient risk and procedural cost versus invasive FFR measurement. Non-invasive FFR can be obtained by using image-based computational fluid dynamics to simulate blood flow and pressure in a patient-specific coronary model. However, 3D simulations require extensive effort for model construction and numerical computation, which limits their routine use. In this study we compare (ordered by increasing computational cost/complexity): reduced-order algebraic models of pressure drop across a stenosis; 1D, 2D (multiring) and 3D CFD models; as well as 3D FSI for the computation of FFR in idealized and patient-specific stenosis geometries. We demonstrate the ability of an appropriate reduced order algebraic model to closely predict FFR when compared to FFR from a full 3D simulation. This work was supported by the NIH, Grant No. R01-HL103419.

  2. Fractional flow reserve: lessons from PLATFORM and future perspectives.

    Science.gov (United States)

    Pontone, Gianluca; Carità, Patrizia; Verdecchia, Massimo; Buccheri, Dario; Andreini, Daniele; Guaricci, Andrea I; Rabbat, Mark; Pepi, Mauro

    2017-06-01

    In the treatment of stable coronary artery disease (CAD) the identification of patients who may gain the highest benefit from further invasive treatments is of pivotal importance for the healthcare system. In this setting, it has been established that an ischemia-guided revascularization strategy yields improved clinical outcomes in a cost-effective fashion compared with anatomy-guided revascularization alone. Invasive fractional flow reserve (FFR) is considered the gold standard, especially in the intermediate-range atherosclerotic lesions, for assessing lesion specific ischemia at the time of invasive coronary angiography and has now become the standard of reference for studies assessing the diagnostic performance of the various non-invasive stress tests. Coronary computed tomography angiography (cCTA) is an increasingly utilized non-invasive test that enables direct anatomical visualization of CAD in the epicardial coronary arteries with excellent sensitivity and negative predictive value. However, cCTA alone has poor specificity with FFR. With advances in computational fluid dynamics, it is possible to derive FFR from cCTA datasets improving its positive predictive value and specificity. The aim of this review is to summarize the technical aspects of FFR-CT, clinical evidence and limitations behind the novel technology, with a special focus on the recent PLATFORM Trial analyzing the effectiveness, clinical outcomes and resource utilization of FFR-CT. Finally, the future perspective of FFR-CT will be presented.

  3. The effect of blood pressure on non-invasive fractional flow reserve derived from coronary computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kurata, Akira [Ehime University Graduate School of Medicine, Department of Radiology, Toon, Ehime (Japan); Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Coenen, Adriaan; Lubbers, Marisa M.; Nieman, Koen [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Erasmus University Medical Center, Departmenet of Cardiology, Rotterdam (Netherlands); Kido, Teruhito; Mochizuki, Teruhito [Ehime University Graduate School of Medicine, Department of Radiology, Toon, Ehime (Japan); Kido, Tomoyuki [Matsuyama Saiseikai Hospital, Department of Radiology, Matsuyama, Ehime (Japan); Yamashita, Natsumi [Clinical Research Center, National Hospital Organization Shikoku Cancer Center, Division of Clinical Biostatistics, Section of Cancer Prevention and Epidemiology, Matsuyama, Ehime (Japan); Watanabe, Kouki [Matsuyama Saiseikai Hospital, Department of Cardiology, Matsuyama, Ehime (Japan); Krestin, Gabriel P. [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands)

    2017-04-15

    The aim of this study is to assess the effect of blood pressure (BP) on coronary computed tomography angiography (CTA) derived computational fractional flow reserve (CTA-FFR). Twenty-one patients who underwent coronary CTA and invasive FFR were retrospectively identified. Ischemia was defined as invasive FFR ≤0.80. Using a work-in-progress computational fluid dynamics algorithm, CTA-FFR was computed with BP measured before CTA, and simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg respectively. Correlation between CTA-FFR and invasive FFR was assessed using Pearson test. The repeated measuring test was used for multiple comparisons of CTA-FFR values by simulated BP inputs. Twenty-nine vessels (14 with invasive FFR ≤0.80) were assessed. The average CTA-FFR for measured BP (134 ± 20/73 ± 12 mmHg) was 0.77 ± 0.12. Correlation between CTA-FFR by measured BP and invasive FFR was good (r = 0.735, P < 0.001). For simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg, the CTA-FFR increased: 0.69 ± 0.13, 0.73 ± 0.12, 0.75 ± 0.12, 0.77 ± 0.11, 0.79 ± 0.11, and 0.81 ± 0.10 respectively (P < 0.05). Measurement of the BP just before CTA is preferred for accurate CTA-FFR simulation. BP variations in the common range slightly affect CTA-FFR. However, inaccurate BP assumptions differing from the patient-specific BP could cause misinterpretation of borderline significant lesions. (orig.)

  4. The effect of blood pressure on non-invasive fractional flow reserve derived from coronary computed tomography angiography

    International Nuclear Information System (INIS)

    Kurata, Akira; Coenen, Adriaan; Lubbers, Marisa M.; Nieman, Koen; Kido, Teruhito; Mochizuki, Teruhito; Kido, Tomoyuki; Yamashita, Natsumi; Watanabe, Kouki; Krestin, Gabriel P.

    2017-01-01

    The aim of this study is to assess the effect of blood pressure (BP) on coronary computed tomography angiography (CTA) derived computational fractional flow reserve (CTA-FFR). Twenty-one patients who underwent coronary CTA and invasive FFR were retrospectively identified. Ischemia was defined as invasive FFR ≤0.80. Using a work-in-progress computational fluid dynamics algorithm, CTA-FFR was computed with BP measured before CTA, and simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg respectively. Correlation between CTA-FFR and invasive FFR was assessed using Pearson test. The repeated measuring test was used for multiple comparisons of CTA-FFR values by simulated BP inputs. Twenty-nine vessels (14 with invasive FFR ≤0.80) were assessed. The average CTA-FFR for measured BP (134 ± 20/73 ± 12 mmHg) was 0.77 ± 0.12. Correlation between CTA-FFR by measured BP and invasive FFR was good (r = 0.735, P < 0.001). For simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg, the CTA-FFR increased: 0.69 ± 0.13, 0.73 ± 0.12, 0.75 ± 0.12, 0.77 ± 0.11, 0.79 ± 0.11, and 0.81 ± 0.10 respectively (P < 0.05). Measurement of the BP just before CTA is preferred for accurate CTA-FFR simulation. BP variations in the common range slightly affect CTA-FFR. However, inaccurate BP assumptions differing from the patient-specific BP could cause misinterpretation of borderline significant lesions. (orig.)

  5. Fractional flow reserve-guided percutaneous coronary intervention: where to after FAME 2?

    Directory of Open Access Journals (Sweden)

    van de Hoef TP

    2015-12-01

    Full Text Available Tim P van de Hoef,1 Martijn Meuwissen,2 Jan J Piek1 1AMC Heartcentre, Academic Medical Center, University of Amsterdam, Amsterdam, 2Amphia Hospital, Breda, the Netherlands Abstract: Fractional flow reserve (FFR is a well-validated clinical coronary physiological parameter derived from the measurement of coronary pressures and has drastically changed revascularization decision-making in clinical practice. Nonetheless, it is important to realize that FFR is a coronary pressure-derived estimate of coronary blood flow impairment. It is thereby not the same as direct measures of coronary flow impairment that determine the occurrence of signs and symptoms of myocardial ischemia. This consideration is important, since the FAME 2 study documented a limited discriminatory power of FFR to identify stenoses that require revascularization to prevent adverse events. The physiological difference between FFR and direct measures of coronary flow impairment may well explain the findings in FAME 2. This review aims to address the physiological background of FFR, its ambiguities, and its consequences for the application of FFR in clinical practice, as well as to reinterpret the diagnostic and prognostic characteristics of FFR in the light of the recent FAME 2 trial outcomes. Keywords: fractional flow reserve, coronary flow, stable ischemic heart disease

  6. Quantification of disturbed coronary flow by disturbed vorticity index and relation with fractional flow reserve

    DEFF Research Database (Denmark)

    Chu, Miao; von Birgelen, Clemens; Li, Yingguang

    2018-01-01

    BACKGROUND AND AIMS: The relation between FFR and local coronary flow patterns is incompletely understood. We aimed at developing a novel hemodynamic index to quantify disturbed coronary flow, and to investigate its relationship with lesion-associated pressure-drop, and fractional flow reserve (F...

  7. Effects of caffeine on fractional flow reserve values measured using intravenous adenosine triphosphate.

    Science.gov (United States)

    Nakayama, Masafumi; Chikamori, Taishiro; Uchiyama, Takashi; Kimura, Yo; Hijikata, Nobuhiro; Ito, Ryosuke; Yuhara, Mikio; Sato, Hideaki; Kobori, Yuichi; Yamashina, Akira

    2018-04-01

    We investigated the effects of caffeine intake on fractional flow reserve (FFR) values measured using intravenous adenosine triphosphate (ATP) before cardiac catheterization. Caffeine is a competitive antagonist for adenosine receptors; however, it is unclear whether this antagonism affects FFR values. Patients were evenly randomized into 2 groups preceding the FFR study. In the caffeine group (n = 15), participants were given coffee containing 222 mg of caffeine 2 h before the catheterization. In the non-caffeine group (n = 15), participants were instructed not to take any caffeine-containing drinks or foods for at least 12 h before the catheterization. FFR was performed in patients with more than intermediate coronary stenosis using the intravenous infusion of ATP at 140 μg/kg/min (normal dose) and 170 μg/kg/min (high dose), and the intracoronary infusion of papaverine. FFR was followed for 30 s after maximal hyperemia. In the non-caffeine group, the FFR values measured with ATP infusion were not significantly different from those measured with papaverine infusion. However, in the caffeine group, the FFR values were significantly higher after ATP infusion than after papaverine infusion (P = 0.002 and P = 0.007, at normal and high dose ATP vs. papaverine, respectively). FFR values with ATP infusion were significantly increased 30 s after maximal hyperemia (P = 0.001 and P < 0.001 for normal and high dose ATP, respectively). The stability of the FFR values using papaverine showed no significant difference between the 2 groups. Caffeine intake before the FFR study affected FFR values and their stability. These effects could not be reversed by an increased ATP dose.

  8. CT Determination of Fractional Flow Reserve in Coronary Lesions

    Directory of Open Access Journals (Sweden)

    Mester András

    2016-12-01

    Full Text Available Invasively determined fractional flow reserve (FFR represents the gold-standard method for the functional evaluation of coronary lesions. Coronary computed tomography angiography (CCTA provides characterization of the coronary anatomy, with important morphological information on the atherosclerotic plaques, but does not offer a hemodynamic evaluation of coronary artery lesions. CT evaluation of FFR (FFRCT is a new noninvasive diagnostic method, which provides anatomical and functional assessment of the whole coronary tree, based on computational techniques, with no more radiation or hyperemic agent administration compared with routine CCTA. Recent studies demonstrated the safety and accuracy of FFRCT and its therapeutic use and cost benefits in real-world clinical use.

  9. Technical aspects and limitations of fractional flow reserve measurement.

    Science.gov (United States)

    Jerabek, Stepan; Kovarnik, Tomas

    2018-02-27

    The only indication for coronary revascularization is elimination of ischaemia. Invasive hemodynamic methods (fractional flow reserve - FFR and instantaneous wave-free ratio (iFR) are superior to coronary angiography in detection of lesions causing myocardial ischaemia. Current European guidelines for myocardial revascularization recommend using of FFR for detection of functional assessment of lesions severity in category IA and number of these procedures increases. However, routine usage of these methods requires knowledge of technical requirements and limitations. The aim of the study is to summarise good clinical practice for FFR and iFR measurements with explanation of possible technical challenges, that are necessary for increasing of measurement accuracy. Authors describe frequent technical mistakes and malpractice during invasive assessment of lesion severity in coronary arteries.

  10. Noninvasive FFR derived from coronary CT angiography in the management of coronary artery disease: technology and clinical update

    Directory of Open Access Journals (Sweden)

    Nakanishi R

    2016-06-01

    Full Text Available Rine Nakanishi, Mathew J Budoff Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA Abstract: After a decade of clinical use of coronary computed tomographic angiography (CCTA to evaluate the anatomic severity of coronary artery disease, new methods of deriving functional information from CCTA have been developed. These methods utilize the anatomic information provided by CCTA in conjunction with computational fluid dynamics to calculate fractional flow reserve (FFR values from CCTA image data sets. Computed tomography-derived FFR (CT-FFR enables the identification of lesion-specific drop noninvasively. A three-dimensional CT-FFR modeling technique, which provides FFR values throughout the coronary tree (HeartFlow FFRCT analysis, has been validated against measured FFR and is now approved by the US Food and Drug Administration for clinical use. This technique requires off-site supercomputer analysis. More recently, a one-dimensional computational analysis technique (Siemens cFFR, which can be performed on on-site workstations, has been developed and is currently under investigation. This article reviews CT-FFR technology and clinical evidence for its use in stable patients with suspected coronary artery disease. Keywords: fractional flow reserve, coronary computed tomographic angiography, FFRCT, cFFR

  11. Fractional Flow Reserve Assessment of a Significant Coronary Stenosis Masked by a Downstream Serial Lesion

    Directory of Open Access Journals (Sweden)

    Lawrence Yu-Min Liu

    2016-01-01

    Full Text Available Fractional flow reserve (FFR has been recognized as an effective tool to determine functional significance in intermediate coronary lesions and FFR-guided percutaneous coronary intervention (PCI improves clinical outcomes. However, hemodynamic interaction between serial stenoses within one coronary artery complicates the assessment of functional severity of each individual lesion. We present a case in which FFR measurement by intracoronary bolus injection of adenosine helps to make appropriate revascularization decision in serial stenoses when the procedures are performed systemically and properly.

  12. Coronary Computed Tomographic Angiography-Derived Fractional Flow Reserve for Therapeutic Decision Making.

    Science.gov (United States)

    Tesche, Christian; Vliegenthart, Rozemarijn; Duguay, Taylor M; De Cecco, Carlo N; Albrecht, Moritz H; De Santis, Domenico; Langenbach, Marcel C; Varga-Szemes, Akos; Jacobs, Brian E; Jochheim, David; Baquet, Moritz; Bayer, Richard R; Litwin, Sheldon E; Hoffmann, Ellen; Steinberg, Daniel H; Schoepf, U Joseph

    2017-12-15

    This study investigated the performance of coronary computed tomography angiography (cCTA) with cCTA-derived fractional flow reserve (CT-FFR) compared with invasive coronary angiography (ICA) with fractional flow reserve (FFR) for therapeutic decision making in patients with suspected coronary artery disease (CAD). Seventy-four patients (62 ± 11 years, 62% men) with at least 1 coronary stenosis of ≥50% on clinically indicated dual-source cCTA, who had subsequently undergone ICA with FFR measurement, were retrospectively evaluated. CT-FFR values were computed using an on-site machine-learning algorithm to assess the functional significance of CAD. The therapeutic strategy (optimal medical therapy alone vs revascularization) and the appropriate revascularization procedure (percutaneous coronary intervention vs coronary artery bypass grafting) were selected using cCTA-CT-FFR. Thirty-six patients (49%) had a functionally significant CAD based on ICA-FFR. cCTA-CT-FFR correctly identified a functionally significant CAD and the need of revascularization in 35 of 36 patients (97%). When revascularization was deemed indicated, the same revascularization procedure (32 percutaneous coronary interventions and 3 coronary artery bypass grafting) was chosen in 35 of 35 patients (100%). Overall, identical management strategies were selected in 73 of the 74 patients (99%). cCTA-CT-FFR shows excellent performance to identify patients with and without the need for revascularization and to select the appropriate revascularization strategy. cCTA-CT-FFR as a noninvasive "one-stop shop" has the potential to change diagnostic workflows and to directly inform therapeutic decision making in patients with suspected CAD. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis

    Directory of Open Access Journals (Sweden)

    Paul D. Morris, PhD

    2017-08-01

    Full Text Available Fractional flow reserve (FFR-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel “pseudotransient” analysis protocol for computing virtual fractional flow reserve (vFFR based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis using a desktop PC, with <1% error relative to that of full-transient computational fluid dynamics analysis. Sensitivity analysis demonstrated that physiological lesion significance was influenced less by coronary or lesion anatomy (33% and more by microvascular physiology (59%. If coronary microvascular resistance can be estimated, vFFR can be accurately computed in less time than it takes to make invasive measurements.

  14. Fractional Flow Reserve-guided Percutaneous Coronary Intervention: Standing the Test of Time

    Directory of Open Access Journals (Sweden)

    Frederik M. Zimmermann, MD

    2016-05-01

    Full Text Available Percutaneous coronary intervention (PCI improves symptoms and prognosis in ischemia-inducing, functionally significant, coronary lesions. Use of fractional flow reserve allows physicians to investigate the ischemia-inducing potential of a specific lesion and can be used to guide coronary revascularization, especially in multivessel coronary artery disease. Fractional flow reserve-guided PCI has been extensively investigated. Results show that deferral of stenting in non-significant lesions is safe, whereas deferral of stenting in functionally significant lesions worsens outcome. FFR-guided PCI improves outcome in multivessel disease over angiography-guided PCI. Until recently, there was little known about the long-term outcome of FFR-guided revascularization and its validity in acute coronary syndromes. This review aims to address the new evidence regarding long-term appropriateness of FFR-guided PCI, the need for hyperemia to evaluate functional severity, and the use of FFR in acute coronary syndromes.

  15. Resting Pd/Pa and haemodynamic relevance of coronary stenosis as evaluated by fractional flow reserve.

    Science.gov (United States)

    De Luca, Giuseppe; Verdoia, Monica; Barbieri, Lucia; Marino, Paolo; Suryapranata, Harry

    2018-03-01

    Fractional flow reserve (FFR) currently represents the gold standard in the evaluation of the haemodynamic relevance of coronary stenoses. However, both intracoronary and intravenous adenosine may be tolerated poorly by some patients. Therefore, considerable interest had been focused in the last few years on new adenosine-free indexes to define the haemodynamic relevance of coronary stenoses. So far, few data have been reported on resting Pd/Pa and its correlation with FFR as evaluated with high-dose intracoronary adenosine administration, which is the aim of the current study. FFR was assessed in 120 patients with 137 intermediate lesions during cardiac catheterization by a pressure-recording guidewire (PrimeWire). FFR was calculated as the ratio of the distal coronary pressure to the aortic pressure at hyperaemia. Intracoronary doses of adenosine were administered up to 720 μg as intracoronary boli. Exclusion criteria were as follows: (a) allergy to adenosine; (b) baseline bradycardia (heart rate values and increased the percentage of patients showing an FFR less than 0.80. Resting Pd/Pa showed good accuracy in the identification of patients with significant FFR values (value in the prediction of a positive FFR value. A value up to 0.88 was associated with a 100% positive predictive value, whereas a value of at least 0.95 was associated with a 95% negative predictive value. This study showed that in intermediate lesions, resting Pd/Pa was related linearly to FFR. We identified 0.93 as the best cut-off value in the prediction of haemodynamically significant coronary stenosis as evaluated by FFR. However, cut-off values of 0.88 and 0.95 could provide the maximal predictive positive and negative values, suggesting the additional use of FFR only in patients with resting values within this range.

  16. Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve

    Energy Technology Data Exchange (ETDEWEB)

    Mouden, Mohamed [Isala klinieken, Department of Cardiology, Zwolle (Netherlands); Isala klinieken, Department of Nuclear Medicine, Zwolle (Netherlands); Ottervanger, Jan Paul; Timmer, Jorik R. [Isala klinieken, Department of Cardiology, Zwolle (Netherlands); Knollema, Siert; Reiffers, Stoffer; Oostdijk, Ad H.J.; Jager, Pieter L. [Isala klinieken, Department of Nuclear Medicine, Zwolle (Netherlands); Boer, Menko-Jan de [University Medical Centre Nijmegen, Department of Cardiology, Nijmegen (Netherlands)

    2014-05-15

    Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease. Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR. The mean age of the patients was 64 ± 11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR ≥0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT. Only 20 - 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization. (orig.)

  17. Comparison of fractional flow reserve measurements using intracoronary adenosine versus intracoronary sodium nitroprusside infusions in moderately stenotic coronary artery lesions

    Energy Technology Data Exchange (ETDEWEB)

    Safi, Morteza; Namazi, Mohammad Hasan; Fooladi, Esfandiar; Vakili, Hossein; Parsa, Saeed Alipour; Khaheshi, Isa [Cardiovascular Research Center, Modarres hospital, Shahid Beheshti University of Medical Sciences, Tehran (Iran, Islamic Republic of); Abbasi, Mohammad Amin [Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran (Iran, Islamic Republic of); Movahed, Mohammad Reza, E-mail: rmova@aol.com [CareMore, Arizona, Tucson, AZ (United States); University of Arizona, Sarver Heart Center, Tucson, AZ (United States)

    2016-10-15

    Introduction: The aim of this study was to investigate the efficacy and safety of intracoronary (IC) sodium nitroprusside infusion in comparison to IC adenosine for fractional flow reserve (FFR) measurement in moderately diseased coronary artery lesions for functional assessment. Methods: During a nine month period, a consecutive of 98 patients with suspected or known coronary artery disease with moderate stenosis found during angiography (40% to 70% stenosis), were enrolled in this study. Hyperemia was induced by bolus doses of IC adenosine followed by sodium nitroprusside for FFR measurement. Results: Both IC adenosine and IC sodium nitroprusside induced similar and significant reduction in FFR. There was no statistically difference in FFR values between adenosine vs sodium nitroprusside infusions (mean FFR 84.3 ± 6.3 vs 85.7 ± 6.2, p = 0.1) respectively. Furthermore, comparing different FFR cut-off points between the groups (FFR < 0.75, 0.75–0.8 and > 0.8) showed no significant differences (p value = 0.7). Conclusion: An IC bolus of sodium nitroprusside (0.6 μg/kg) infusion induces a similar degree of hyperemia to IC bolus of 100–300 μg of adenosine. Therefore, IC sodium nitroprusside could be considered as an alternative drug to adenosine for FFR measurement with lower side effect profile. - Highlights: • Intracoronary (IC) sodium nitroprusside was compared with IC adenosine for FFR test. • IC adenosine and IC sodium nitroprusside induced similar reduction in FFR. • Different FFR cut-off points between the groups showed no significant differences. • IC sodium nitroprusside could be considered as an alternative to adenosine for FFR.

  18. Association of coronary ischemia estimated by fractional flow reserve and psychological characteristics of patients

    Directory of Open Access Journals (Sweden)

    Miodrag Jovan Sreckovic

    2017-05-01

    Full Text Available Introduction : Psychological characteristics of patients, depression, stress and anxiety are recognized as important confounding risk factors for ischemic heart disease. However, the impact of psychological characteristics on coronary ischemia and vice versa remain poorly understood. Aim: To demonstrate the interplay of psychological characteristics, depression, stress and anxiety with coronary ischemia estimated with fractional flow reserve (FFR. Material and methods : From 2014 to 2016, 147 patients who were planned for FFR measurement were included in this study. Psychological characteristics of patients were evaluated using the Depression, Anxiety and Stress Scale 21 items (DASS 21 self-report questionnaire. Results : Comparing the FFR ischemic vs. FFR non-ischemic groups, a significant difference was observed regarding results achieved for the depression, anxiety and stress scales. Multivariate logistic regression analysis was used to model the correlation between FFR and the DAS scale. It was clear, when controlling for previous myocardial infarction, that FFR was significant in all analyses. However, when the Canadian Cardiovascular Society grading of angina pectoris (CCS class was entered in the model, FFR was not a significant predictor of anxiety, but was significant in other analysis. Conclusions : Higher degrees of the psychological characteristics depression, stress and anxiety were observed in the group of patients with coronary ischemia, corresponding to lower fractional flow values.

  19. Relationship between instantaneous wave-free ratio and fractional flow reserve in patients receiving hemodialysis.

    Science.gov (United States)

    Morioka, Yuta; Arashi, Hiroyuki; Otsuki, Hisao; Yamaguchi, Junichi; Hagiwara, Nobuhisa

    2017-06-22

    Instantaneous wave-free ratio (iFR) is a vasodilator-free index and is reported to have a good correlation with fractional flow reserve (FFR). Hemodialysis patients exhibit left ventricular hypertrophy, reduced arterial compliance, and impaired microcirculation. Such a coronary flow condition in these patients may influence the relationship between iFR and FFR. This study assessed the impact of hemodialysis on the relationship between iFR and FFR. The study enrolled 196 patients with 265 stenoses who underwent assessment via iFR, FFR assessment, and right heart catheterization. A good correlation between iFR and FFR was observed in hemodialysis patients. iFR in the hemodialysis group was significantly lower than in the non-hemodialysis group (0.81 ± 0.13 vs. 0.86 ± 0.13, p = 0.005), although no significant difference was found in FFR and percentage diameter stenosis. An iFR value of 0.84 was found to be equivalent to an FFR value of 0.8 in hemodialysis patients, which was lower than the standard predictive iFR range for ischemia. Vasodilator-free assessment by iFR could be beneficial in evaluating intermediate coronary stenosis in patients receiving hemodialysis. However, the threshold for iFR abnormality needs adjustment in hemodialysis patients, and larger clinical trials are required to confirm the results in this specific subset.

  20. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study

    DEFF Research Database (Denmark)

    Pijls, Nico H J; Fearon, William F; Tonino, Pim A L

    2010-01-01

    The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD)....

  1. Multicenter core laboratory comparison of the instantaneous wave-free ratio and resting Pd/Pa with fractional flow reserve: the RESOLVE study

    NARCIS (Netherlands)

    Jeremias, Allen; Maehara, Akiko; Généreux, Philippe; Asrress, Kaleab N.; Berry, Colin; de Bruyne, Bernard; Davies, Justin E.; Escaned, Javier; Fearon, William F.; Gould, K. Lance; Johnson, Nils P.; Kirtane, Ajay J.; Koo, Bon-Kwon; Marques, Koen M.; Nijjer, Sukhjinder; Oldroyd, Keith G.; Petraco, Ricardo; Piek, Jan J.; Pijls, Nico H.; Redwood, Simon; Siebes, Maria; Spaan, Jos A. E.; van 't Veer, Marcel; Mintz, Gary S.; Stone, Gregg W.

    2014-01-01

    This study sought to examine the diagnostic accuracy of the instantaneous wave-free ratio (iFR) and resting distal coronary artery pressure/aortic pressure (Pd/Pa) with respect to hyperemic fractional flow reserve (FFR) in a core laboratory-based multicenter collaborative study. FFR is an index of

  2. Fractional Flow Reserve Measurement by Coronary Computed Tomography Angiography: A Review with Future Directions

    Directory of Open Access Journals (Sweden)

    Asim Rizvi

    2016-12-01

    Full Text Available Invasive fractional flow reserve (FFR measurement is currently the gold standard for coronary intervention. FFR measurement by coronary computed tomography angiography (FFRCT is a novel and promising imaging technology that permits noninvasive assessment of physiologically significant coronary lesions. FFRCT is capable of combining the anatomic information provided by coronary computed tomography angiography with computational fluid dynamics to compute FFR. To date, several studies have reported the diagnostic performance of FFRCT compared with invasive FFR measurement as the reference standard. Further studies are now being implemented to determine the clinical feasibility and economic implications of FFRCT techniques. This article provides an overview and discusses the available evidence as well as potential future directions of FFRCT.

  3. Safety and Efficacy of a Novel Technique in the Use of Fractional Flow Reserve in Complex Coronary Artery Lesions

    Directory of Open Access Journals (Sweden)

    Wen-Ming He

    2015-01-01

    Full Text Available Background: Fractional flow reserve (FFR has become an increasingly important index when making decisions with respect to revascularization of coronary artery stenosis. However, the pressure guidewire used in obtaining FFR measurements is difficult to control and manipulate in certain complex coronary artery lesions, resulting in increased fluoroscopy time and contrast dye usage. This study examined a novel (NOV technique for obtaining FFR measurements in hope of easing the difficulties associated with evaluating and treating complex coronary artery lesions. Methods: Fifty-six patients with complex coronary artery lesions were assigned to a conventional (CON FFR technique group or a NOV FFR technique group. The NOV technique involved the use of a balloon and wire exchange within the coronary artery. The fluoroscopy time, contrast dye usage, and FFR-related complications were assessed after completing the FFR measurement procedure for each patient. Results: The median time required for fluoroscopy in the NOV technique group was significantly less than that in the CON technique group; additionally, lesser amounts of contrast dye were used in the NOV technique group (both P 0.05. Conclusions: Compared to the CON technique used for measuring FFR, the new technique reduced the fluoroscopy time and amount of contrast dye used when evaluating complex coronary artery lesions. The new technique did not increase the risk of operation or decrease the success rate.

  4. Coronary plaque quantification and fractional flow reserve by coronary computed tomography angiography identify ischaemia-causing lesions

    DEFF Research Database (Denmark)

    Gaur, Sara; Øvrehus, Kristian Altern; Dey, Damini

    2016-01-01

    AIMS: Coronary plaque characteristics are associated with ischaemia. Differences in plaque volumes and composition may explain the discordance between coronary stenosis severity and ischaemia. We evaluated the association between coronary stenosis severity, plaque characteristics, coronary computed...... tomography angiography (CTA)-derived fractional flow reserve (FFRCT), and lesion-specific ischaemia identified by FFR in a substudy of the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). METHODS AND RESULTS: Coronary CTA stenosis, plaque volumes, FFRCT, and FFR were assessed...

  5. Fractional flow reserve-guided management in stable coronary disease and acute myocardial infarction: recent developments

    Science.gov (United States)

    Berry, Colin; Corcoran, David; Hennigan, Barry; Watkins, Stuart; Layland, Jamie; Oldroyd, Keith G.

    2015-01-01

    Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, and improvements in the diagnosis and treatment of CAD can reduce the health and economic burden of this condition. Fractional flow reserve (FFR) is an evidence-based diagnostic test of the physiological significance of a coronary artery stenosis. Fractional flow reserve is a pressure-derived index of the maximal achievable myocardial blood flow in the presence of an epicardial coronary stenosis as a ratio to maximum achievable flow if that artery were normal. When compared with standard angiography-guided management, FFR disclosure is impactful on the decision for revascularization and clinical outcomes. In this article, we review recent developments with FFR in patients with stable CAD and recent myocardial infarction. Specifically, we review novel developments in our understanding of CAD pathophysiology, diagnostic applications, prognostic studies, clinical trials, and clinical guidelines. PMID:26038588

  6. Pooled comparison of regadenoson versus adenosine for measuring fractional flow reserve and coronary flow in the catheterization laboratory

    Energy Technology Data Exchange (ETDEWEB)

    Stolker, Joshua M., E-mail: jstolker@yahoo.com [Mercy Heart and Vascular, 901 Patients First Drive, Washington, MO 63090 (United States); Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110 (United States); Lim, Michael J., E-mail: limmj@slu.edu [Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110 (United States); Shavelle, David M., E-mail: david.shavelle@med.usc.edu [University of Southern California, 1510 San Pablo St, Suite 322, Los Angeles, CA 90033 (United States); Morris, D. Lynn, E-mail: morrisdl@einstein.edu [Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141 (United States); Angiolillo, Dominick J., E-mail: dominick.angiolillo@jax.ufl.edu [University of Florida Health-Jacksonville, 655 West 8th St, Jacksonville, FL 32209 (United States); Guzman, Luis A., E-mail: luis.guzman@jax.ufl.edu [University of Florida Health-Jacksonville, 655 West 8th St, Jacksonville, FL 32209 (United States); Kennedy, Kevin F., E-mail: kfkennedy@saint-lukes.org [Saint Luke' s Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111 (United States); Weber, Elizabeth, E-mail: eweber1@slu.edu [Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110 (United States); Zareh, Meena, E-mail: meena.zareh@med.usc.edu [University of Southern California, 1510 San Pablo St, Suite 322, Los Angeles, CA 90033 (United States); Neumayr, Robert H., E-mail: robneumayr@gmail.com [Mercy Heart and Vascular, 901 Patients First Drive, Washington, MO 63090 (United States); Saint Louis University, 3635 Vista Ave, St. Louis, MO 63110 (United States); Zenni, Martin M., E-mail: martin.zenni@jax.ufl.edu [University of Florida Health-Jacksonville, 655 West 8th St, Jacksonville, FL 32209 (United States)

    2015-07-15

    Background: Adenosine is the gold standard for augmenting coronary flow during fractional flow reserve (FFR) testing of intermediate coronary stenoses. However, intravenous infusion is time-consuming and intracoronary injection is subject to variability. Regadenoson is a newer adenosine alternative administered as a single intravenous bolus during nuclear stress testing, but its efficacy and safety during FFR testing have been evaluated only in small, single-center studies. Methods: We pooled data from 5 academic hospitals, in which patients undergoing clinically-indicated FFR prospectively underwent comparison of intravenous adenosine infusion (140–175 mcg/kg/min) versus regadenoson bolus (400 mcg). Hemodynamics and symptoms with adenosine were recorded until maximal hyperemia occurred, and after returning to baseline hemodynamics, regadenoson was administered and monitoring was repeated. In a subset of patients with coronary flow data, average peak velocity (APV) at the distal flow sensor was recorded. Results: Of 149 patients enrolled, mean age was 59 ± 9 years, 76% were male, and 54% underwent testing of the left anterior descending artery. Mean adenosine-FFR and regadenoson-FFR were identical (0.82 ± 0.10) with excellent correlation of individual values (r = 0.96, p < 0.001) and no difference in patient-reported symptoms. Four patients (2.6%) had discrepancies between the 2 drugs for the clinical decision-making cutoff of FFR ≤ 0.80. Coronary flow responses to adenosine and regadenoson were similar (APV at maximal hyperemia 36 cm/s for both, p = 0.81). Conclusions: Regadenoson single-bolus administration has comparable FFR, symptoms, and coronary flow augmentation when compared with standard intravenous adenosine infusion. With its greater ease of administration, regadenoson may be a more “user-friendly” option for invasive ischemic testing.

  7. Case Report of First Angiography-Based On-Line FFR Assessment during Coronary Catheterization.

    Science.gov (United States)

    Kornowski, Ran; Vaknin-Assa, Hana

    2017-01-01

    Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from hyperemic pressure measurements and requires a pressure-monitoring guide wire and hyperemic stimulus. Although it has become the standard of reference for decision-making regarding coronary revascularization, the procedure remains underutilized due to its invasive nature. FFR angio is a novel technology that uses the patient's hemodynamic data and routine angiograms to generate a complete three-dimensional coronary tree, with color-coded display of the FFR values at each point along the vessels. After being proven to be as accurate as invasive FFR measurements in an off-line study, this case report presents the first on-line application of the system in the catheterization lab. Here too, a high concordance between FFR angio and invasive FFR was observed. In light of the demonstrated capabilities of the FFR angio system, it should emerge as an important tool for clinical decision-making regarding revascularization in patients with coronary artery disease.

  8. Navvus FFR to reduce CONTRAst, Cost and radiaTion (CONTRACT); insights from a single-centre clinical and economical evaluation with the RXi Rapid-Exchange FFR device.

    Science.gov (United States)

    Masdjedi, Kaneshka; Van Mieghem, Nicolas M; Diletti, Roberto; van Geuns, Robert-Jan; de Jaegere, Peter; Regar, Evelyn; Zijlstra, Felix; van Domburg, Ron T; Daemen, Joost

    2017-04-15

    To assess whether the RXi Navvus system compared to the use of standard Fractional Flow Reserve (FFR) wires reduces total contrast volume, radiation and overall study cost in a real world patient population referred for coronary angiography or percutaneous coronary intervention. FFR is the mainstay of functional hemodynamic assessment of coronary artery lesions. The RXi Navvus system (ACIST Medical Systems, Eden Prairie, MN) is a monorail microcatheter with FFR-measurement capability through optical pressure sensor technology. This is an investigator-initiated, prospective, single-center, observational cohort study. A total of 238 patients were enrolled, 97 patients with Navvus and 141 with conventional pressure-wire based FFR (PW-FFR). Final analyses were performed on the cohort in which only 1 device was used (82 Navvus procedures vs. 136 PW-FFR procedures). No significant differences were found in the total amount of contrast used (150±77 vs 147±79ml; p=0.81), radiation use (6200±4601 vs. 5076±4655 centiG∗cm 2 ; p=0.09) or costs (€1994,- vs. €1930,-; p=0.32) in the Navvus vs. PW-FFR groups respectively. No significant differences were found in the amount of contrast used, total procedural costs or radiation when the Navvus system was used as compared to conventional FFR wires. CONTRACT is an investigator-initiated, prospective, single-center, observational cohort study that evaluated whether the RXi Navvus system compared to the use of standard Fractional Flow Reserve (FFR) wires reduces total contrast volume, radiation and overall study cost in a real world patient population referred for coronary angiography or percutaneous coronary intervention. Use of the RXi Navvus system was associated with comparable procedural costs, amount of radiation and contrast used as compared to PW-FFR systems. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  9. Computed Tomography Fractional Flow Reserve Can Identify Culprit Lesions in Aortoiliac Occlusive Disease Using Minimally Invasive Techniques.

    Science.gov (United States)

    Ward, Erin P; Shiavazzi, Daniele; Sood, Divya; Marsden, Allison; Lane, John; Owens, Erik; Barleben, Andrew

    2017-01-01

    Currently, the gold standard diagnostic examination for significant aortoiliac lesions is angiography. Fractional flow reserve (FFR) has a growing body of literature in coronary artery disease as a minimally invasive diagnostic procedure. Improvements in numerical hemodynamics have allowed for an accurate and minimally invasive approach to estimating FFR, utilizing cross-sectional imaging. We aim to demonstrate a similar approach to aortoiliac occlusive disease (AIOD). A retrospective review evaluated 7 patients with claudication and cross-sectional imaging showing AIOD. FFR was subsequently measured during conventional angiogram with pull-back pressures in a retrograde fashion. To estimate computed tomography (CT) FFR, CT angiography (CTA) image data were analyzed using the SimVascular software suite to create a computational fluid dynamics model of the aortoiliac system. Inlet flow conditions were derived based on cardiac output, while 3-element Windkessel outlet boundary conditions were optimized to match the expected systolic and diastolic pressures, with outlet resistance distributed based on Murray's law. The data were evaluated with a Student's t-test and receiver operating characteristic curve. All patients had evidence of AIOD on CT and FFR was successfully measured during angiography. The modeled data were found to have high sensitivity and specificity between the measured and CT FFR (P = 0.986, area under the curve = 1). The average difference between the measured and calculated FFRs was 0.136, with a range from 0.03 to 0.30. CT FFR successfully identified aortoiliac lesions with significant pressure drops that were identified with angiographically measured FFR. CT FFR has the potential to provide a minimally invasive approach to identify flow-limiting stenosis for AIOD. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Coronary Computed Tomography Angiography Derived Fractional Flow Reserve and Plaque Stress

    DEFF Research Database (Denmark)

    Nørgaard, Bjarne Linde; Leipsic, Jonathon; Koo, Bon-Kwon

    2016-01-01

    Fractional flow reserve (FFR) measured during invasive coronary angiography is an independent prognosticator in patients with coronary artery disease and the gold standard for decision making in coronary revascularization. The integration of computational fluid dynamics and quantitative anatomic...... and physiologic modeling now enables simulation of patient-specific hemodynamic parameters including blood velocity, pressure, pressure gradients, and FFR from standard acquired coronary computed tomography (CT) datasets. In this review article, we describe the potential impact on clinical practice...... and the science behind noninvasive coronary computed tomography (CT) angiography derived fractional flow reserve (FFRCT) as well as future applications of this technology in treatment planning and quantifying forces on atherosclerotic plaques....

  11. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME)

    DEFF Research Database (Denmark)

    van Nunen, Lokien X; Zimmermann, Frederik M; Tonino, Pim A L

    2015-01-01

    BACKGROUND: In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study...... was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up. METHODS: The FAME study was a multicentre trial done in Belgium, Denmark, Germany, the Netherlands, Sweden, the UK, and the USA. Patients (aged ≥ 18 years) with multivessel coronary...... artery disease were randomly assigned to undergo angiography-guided PCI or FFR-guided PCI. Before randomisation, stenoses requiring PCI were identified on the angiogram. Patients allocated to angiography-guided PCI had revascularisation of all identified stenoses. Patients allocated to FFR-guided PCI had...

  12. Qualitative Resting Coronary Pressure Wave Form Analysis to Predict Fractional Flow Reserve.

    Science.gov (United States)

    Matsumura, Mitsuaki; Maehara, Akiko; Johnson, Nils P; Fearon, William F; De Bruyne, Bernard; Oldroyd, Keith G; Pijls, Nico H J; Jenkins, Paul; Ali, Ziad A; Mintz, Gary S; Stone, Gregg W; Jeremias, Allen

    2018-03-27

    To evaluate the predictability of resting distal coronary pressure wave forms for fractional flow reserve (FFR). Resting coronary wave forms were qualitatively evaluated for the presence of (i) dicrotic notch; (ii) diastolic dipping; and (iii) ventricularization. In a development cohort (n=88) a scoring system was developed that was then applied to a validation cohort (n=428) using a multivariable linear regression model to predict FFR and receiver operating characteristics (ROC) to predict FFR ≤0.8. In the development cohort, all 3 qualitative parameters were independent predictors of FFR. However, in a multivariable linear regression model in the validation cohort, qualitative wave form analysis did not further improve the ability of resting distal coronary to aortic pressure ratio (Pd/Pa) (p=0.80) or instantaneous wave-free ratio (iFR) (p=0.26) to predict FFR. Using ROC, the area under the curve of resting Pd/Pa (0.86 versus 0.86, P=0.08) and iFR (0.86 versus 0.86, P=0.26) did not improve by adding qualitative analysis. Qualitative coronary wave form analysis showed moderate classification agreement in predicting FFR but did not add substantially to the resting pressure gradients Pd/Pa and iFR; however, when discrepancies between quantitative and qualitative analyses are observed, artifact or pressure drift should be considered.

  13. Three dimensional quantitative coronary angiography can detect reliably ischemic coronary lesions based on fractional flow reserve.

    Science.gov (United States)

    Chung, Woo-Young; Choi, Byoung-Joo; Lim, Seong-Hoon; Matsuo, Yoshiki; Lennon, Ryan J; Gulati, Rajiv; Sandhu, Gurpreet S; Holmes, David R; Rihal, Charanjit S; Lerman, Amir

    2015-06-01

    Conventional coronary angiography (CAG) has limitations in evaluating lesions producing ischemia. Three dimensional quantitative coronary angiography (3D-QCA) shows reconstructed images of CAG using computer based algorithm, the Cardio-op B system (Paieon Medical, Rosh Ha'ayin, Israel). The aim of this study was to evaluate whether 3D-QCA can reliably predict ischemia assessed by myocardial fractional flow reserve (FFR) < 0.80. 3D-QCA images were reconstructed from CAG which also were evaluated with FFR to assess ischemia. Minimal luminal diameter (MLD), percent diameter stenosis (%DS), minimal luminal area (MLA), and percent area stenosis (%AS) were obtained. The results of 3D-QCA and FFR were compared. A total of 266 patients was enrolled for the present study. FFR for all lesions ranged from 0.57 to 1.00 (0.85 ± 0.09). Measurement of MLD, %DS, MLA, and %AS all were significantly correlated with FFR (r = 0.569, 0609, 0.569, 0.670, respectively, all P < 0.001). In lesions with MLA < 4.0 mm(2), %AS of more than 65.5% had a 80% sensitivity and a 83% specificity to predict FFR < 0.80 (area under curve, AUC was 0.878). 3D-QCA can reliably predict coronary lesions producing ischemia and may be used to guide therapeutic approach for coronary artery disease.

  14. The New Frontier of Cardiac Computed Tomography Angiography: Fractional Flow Reserve and Stress Myocardial Perfusion.

    Science.gov (United States)

    Pontone, Gianluca; Muscogiuri, Giuseppe; Andreini, Daniele; Guaricci, Andrea I; Guglielmo, Marco; Mushtaq, Saima; Baggiano, Andrea; Conte, Edoardo; Beltrama, Virginia; Annoni, Andrea; Formenti, Alberto; Mancini, Elisabetta; Rabbat, Mark G; Pepi, Mauro

    2016-12-01

    The increased number of patients with coronary artery disease (CAD) in developed countries is of great clinical relevance and involves a large burden of the healthcare system. The management of these patients is focused on relieving symptoms and improving clinical outcomes. Therefore the ideal test would provide the correct diagnosis and actionable information. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography (ICA), but their diagnostic yield remains low with limited accuracy when compared to obstructive CAD at the time of ICA or invasive fractional flow reserve (FFR). Invasive FFR is considered the gold standard for the evaluation of functionally relevant CAD. Therefore, an urgent need for non-invasive techniques that evaluate both the functional and morphological severity of CAD is growing. Coronary computed tomography angiography (CCTA) has emerged as a unique non-invasive technique providing coronary artery anatomic imaging. More recently, the evaluation of FFR with CCTA (FFR CT ) has demonstrated high diagnostic performance compared to invasive FFR. Additionally, stress myocardial computed tomography perfusion (CTP) represents a novel tool for the diagnosis of ischemia with high diagnostic accuracy. Compared to nuclear imaging and cardiac magnetic resonance imaging, both FFR CT and stress-CTP, allow us to integrate the anatomical evaluation of coronary arteries with the functional relevance of coronary artery lesions having the potential to revolutionize the diagnostic paradigm of suspected CAD. FFR CT and stress-CTP could be assimilated in diagnostic pathways of patients with stable CAD and will likely result in a decrease of invasive diagnostic procedures and costs. The current review evaluates the technical aspects and clinical experience of FFR CT and stress-CTP in the evaluation of functionally relevant CAD discussing the strengths and weaknesses of each approach.

  15. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Tonino, Pim A L; De Bruyne, Bernard; Pijls, Nico H J

    2009-01-01

    of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes. METHODS: In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug......BACKGROUND: In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio...

  16. An angiographic technique for coronary fractional flow reserve measurement: in vivo validation.

    Science.gov (United States)

    Takarada, Shigeho; Zhang, Zhang; Molloi, Sabee

    2013-03-01

    Fractional flow reserve (FFR) is an important prognostic determinant in a clinical setting. However, its measurement currently requires the use of invasive pressure wire, while an angiographic technique based on first-pass distribution analysis and scaling laws can be used to measure FFR using only image data. Eight anesthetized swine were instrumented with flow probe on the proximal segment of the left anterior descending (LAD) coronary arteries. Volumetric blood flow from the flow probe (Qp), coronary pressure (Pa) and right atrium pressure (Pv) were continuously recorded. Flow probe-based FFR (FFRq) was measured from the ratio of flow with and without stenosis. To determine the angiography-based FFR (FFRa), the ratio of blood flow in the presence of a stenosis (QS) to theoretically normal blood flow (QN) was calculated. A region of interest in the LAD arterial bed was drawn to generate time-density curves using angiographic images. QS was measured using a time-density curve and the assumption that blood was momentarily replaced with contrast agent during the injection. QN was estimated from the total coronary arterial volume using scaling laws. Pressure-wire measurements of FFR (FFRp), which was calculated from the ratio of distal coronary pressure (Pd) divided by proximal pressure (Pa), were continuously obtained during the study. A total of 54 measurements of FFRa, FFRp, and FFRq were taken. FFRa showed a good correlation with FFRq (FFRa = 0.97 FFRq +0.06, r(2) = 0.80, p < 0.001), although FFRp overestimated the FFRq (FFRp = 0.657 FFRq + 0.313, r(2) = 0.710, p < 0.0001). Additionally, the Bland-Altman analysis showed a close agreement between FFRa and FFRq. This angiographic technique to measure FFR can potentially be used to evaluate both anatomical and physiological assessments of a coronary stenosis during routine diagnostic cardiac catheterization that requires no pressure wires.

  17. [Value of fractional flow reserve measurement in endovascular therapy for patients with Stanford B type aortic dissection complicated with renal blood flow injury].

    Science.gov (United States)

    Guo, Xi; Li, Peng; Liu, Guangrui; Huang, Xiaoyong; Yong, Qiang; Wang, Guoqin; Huang, Lianjun

    2015-10-01

    To analyze the value of fractional flow reserve (FFR) measurement on endovascular therapy for patients with renal artery stenosis. Clinical data of 12 patients with Stanford B type aortic dissection complicated with renal blood flow injury in Anzhen hospital hospitalized from May 2013 to February 2014 were retrospectively analyzed. Renal artery angiography was performed and fractional flow reserve (FFR) was measured before Thoracic endovascular aortic repair. After operation, renal artery FFR was measured again, and renal artery stenting was performed in patients with FFR ≤ 0.90 or average pressure difference between proximal and distal of renal artery > 20 mmHg (1 mmHg = 0.133 kPa) and not applied for patients with FFR > 0.90.The patients were then subsequently followed up clinically. Kidney function were measured after 1 month, and contrast-enhanced ultrasonography data were obtained at 1 and 3 months later, respectively. The FFR of 1 patient was 0.90, while the FFR of other patients were less than 0.90 before thoracic endovascular aortic repair. After the procedure,the angiography showed that the blood flow of renal artery in 8 patients were fluency, and the FFR index was over 0.90. There were 4 patients with FFR less than 0.90. After renal artery stenting, the FFR of these 4 patients were all above 0.90. Compared with pre-procedure, blood urea nitrogen ((8.84 ± 3.99) mmol/L vs. (5.18 ± 1.69) mmol/L, P = 0.011) and uric acid ((359.3 ± 77.3) µmol/L vs. (276.9 ± 108.3) µmol/L, P = 0.008) decreased significantly after 1 month, and there was no significant difference in serum creatinine (P = 0.760). Contrast-enhanced ultrasonography results showed that blood flow of renal artery were fluency after 1 month and 3 months. In patients with aortic dissection complicating renal blood flow injury, the FFR measurement is meaningful in evaluating the blood flow status of target organs and guide the endovascular revascularization.

  18. Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve

    Directory of Open Access Journals (Sweden)

    Costantino Roberto Frack Costantini

    Full Text Available Abstract Background: Functional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR has become the most widely used. Objective: To evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction. Methods: Retrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments estimated by quantitative coronary angiography (QCA and intracoronary ultrasound (ICUS. All cases presented ischemia in one of the noninvasive studies. Results: All 96 patients presented ischemia (100% in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed. Conclusion: Coronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.

  19. Fractional flow reserve derived from coronary CT angiography in stable coronary disease: a new standard in non-invasive testing?

    International Nuclear Information System (INIS)

    Noergaard, B.L.; Jensen, J.M.; Leipsic, J.

    2015-01-01

    Fractional flow reserve (FFR) measured during invasive coronary angiography is the gold standard for lesion-specific decisions on coronary revascularization in patients with stable coronary artery disease (CAD). Current guidelines recommend non-invasive functional or anatomic testing as a gatekeeper to the catheterization laboratory. However, the ''holy grail'' in non-invasive testing of CAD is to establish a single test that quantifies both coronary lesion severity and the associated ischemia. Most evidence to date of such a test is based on the addition of computational analysis of FFR to the anatomic information obtained from standard-acquired coronary CTA data sets at rest (FFR CT ). This review summarizes the clinical evidence for the use of FFR CT in stable CAD in context to the diagnostic performance of other non-invasive testing modalities. (orig.)

  20. Effects of high doses of intracoronary adenosine on the assessment of fractional flow reserve

    Directory of Open Access Journals (Sweden)

    Ahmed Khashaba

    2014-03-01

    Conclusions: Intracoronary adenosine, at doses higher than currently suggested, lows obtaining FFR values similar to IV adenosine. Intravenous adenosine, which remains the gold standard, might thus be reserved for those lesions with equivocal FFR values.

  1. Fractional flow reserve guided percutaneous coronary intervention results in reduced ischemic myocardium and improved outcomes.

    Science.gov (United States)

    Sawant, Abhishek C; Bhardwaj, Aishwarya; Banerjee, Kinjal; Jobanputra, Yash; Kumar, Arnav; Parikh, Parth; Kandregula, Krishna C; Poddar, Kanhaiya; Ellis, Stephen G; Nair, Ravi; Corbelli, John; Kapadia, Samir

    2018-02-06

    To determine if fractional flow reserve guided percutaneous coronary intervention (FFR-guided PCI) is associated with reduced ischemic myocardium compared with angiography-guided PCI. Although FFR-guided PCI has been shown to improve outcomes, it remains unclear if it reduces the extent of ischemic myocardium at risk compared with angiography-guided PCI. We evaluated 380 patients (190 FFR-guided PCI cases and 190 propensity-matched controls) who underwent PCI from 2009 to 2014. Clinical, laboratory, angiographic, stress testing, and major adverse cardiac events [MACE] (all-cause mortality, recurrence of MI requiring PCI, stroke) data were collected. Mean age was 63 ± 11 years; the majority of patients were males (76%) and Caucasian (77%). Median duration of follow up was 3.4 [Range: 1.9, 5.0] years. Procedural complications including coronary dissection (2% vs. 0%, P = .12) and perforation (0% vs. 0%, P = 1.00) were similar between FFR-guided and angiography-guided PCI patients. FFR-guided PCI patients had lower unadjusted (14.7% vs. 23.2%, P = .04) and adjusted [OR = 0.58 (95% CI: 0.34-0.98)] risk of repeat revascularization at one year. FFR-guided PCI patients were less likely (23% vs. 32%, P = .02) to have ischemia and had lower (5.9% vs. 21.1%, P guided PCI, FFR-guided PCI results in less repeat revascularization and a lower incidence of post PCI ischemia translating into improved survival, without an increase in complications. © 2018 Wiley Periodicals, Inc.

  2. Advanced computed tomographic anatomical and morphometric plaque analysis for prediction of fractional flow reserve in intermediate coronary lesions

    International Nuclear Information System (INIS)

    Opolski, Maksymilian P.; Kepka, Cezary; Achenbach, Stephan; Pregowski, Jerzy; Kruk, Mariusz; Staruch, Adam D.; Kadziela, Jacek; Ruzyllo, Witold; Witkowski, Adam

    2014-01-01

    Objective: To determine the application of advanced coronary computed tomography angiography (CCTA) plaque analysis for predicting invasive fractional flow reserve (FFR) in intermediate coronary lesions. Methods: Sixty-one patients with 71 single intermediate coronary lesions (≥50–80% stenosis) on CCTA prospectively underwent coronary angiography and FFR. Advanced anatomical and morphometric plaque analysis was performed based on CCTA data set to determine optimal criteria for significant flow impairment. A significant stenosis was defined as FFR ≤ 0.80. Results: FFR averaged 0.85 ± 0.09, and 19 lesions (27%) were functionally significant. FFR correlated with minimum lumen area (MLA) (r = 0.456, p < 0.001), minimum lumen diameter (MLD) (r = 0.326, p = 0.006), reference lumen diameter (RLD) (r = 0.245, p = 0.039), plaque burden (r = −0.313, p = 0.008), lumen area stenosis (r = −0.305, p = 0.01), lesion length (r = −0.692, p < 0.001), and plaque volume (r = −0.668, p < 0.001). There was no relationship between FFR and CCTA morphometric plaque parameters. By multivariate analysis the independent predictors of FFR were lesion length (beta = −0.581, p < 0.001), MLA (beta = 0.360, p = 0.041), and RLD (beta = −0.255, p = 0.036). The optimal cutoffs for lesion length, MLA, MLD, RLD, and lumen area stenosis were >18.5 mm, ≤3.0 mm 2 , ≤2.1 mm, ≤3.2 mm, and >69%, respectively (max. sensitivity: 100% for MLA, max. specificity: 79% for lumen area stenosis). Conclusions: CCTA predictors for FFR support the mathematical relationship between stenosis pressure drop and coronary flow. CCTA could prove to be a useful rule-out test for significant hemodynamic effects of intermediate coronary stenoses

  3. Physiome approach for the analysis of vascular flow reserve in the heart and brain.

    Science.gov (United States)

    Lee, Kyung Eun; Ryu, Ah-Jin; Shin, Eun-Seok; Shim, Eun Bo

    2017-06-01

    This work reviews the key aspects of coronary and neurovascular flow reserves with an emphasis on physiomic modeling characteristics by the use of a variety of numerical approaches. First, we explain the definition of fractional flow reserve (FFR) in coronary artery and introduce its clinical significance. Then, computational researches for obtaining FFR are reviewed, and their clinical outcomes are compared. In the case of cerebrovascular reserve (CVR), in spite of substantial progress in the simulation of cerebral hemodynamics, only a few computational studies exist. Thus, we discuss the limitations of CVR simulation study and suggest the challenging issue to overcome these. Also, the future direction of physiomic researches for the flow reserves in coronary arteries and cerebral arteries is described. Also, we introduce a machine learning algorithm trained by the existing physiomic simulation data of flow reserve and suggest a prospective research direction related to this.

  4. Physiologic assessment of coronary artery disease: Focus on fractional flow reserve

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Do Yeon; Koo, Bon Kwon [Dept. of Radiology, Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul (Korea, Republic of); Lee, Joo Myung [Dept. of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2016-06-15

    The presence of myocardial ischemia is the most important prognostic factor in patients with ischemic heart disease. Fractional flow reserve (FFR) is a gold standard invasive method used to detect the stenosis-specific myocardial ischemia. FFR-guided revascularization strategy is superior to angiography-guided strategy. The recently developed hyperemia-free index, instantaneous wave free ratio is being actively investigated. A non-invasive FFR derived from coronary CT angiography is now used in clinical practice. Due to rapid expansion of invasive and non-invasive physiologic assessment, comprehensive understanding of the role and potential pitfalls of each modality are required for its application. In this review, we focus on the basic and clinical aspects of physiologic assessment in ischemic heart disease.

  5. Physiologic assessment of coronary artery disease: Focus on fractional flow reserve

    International Nuclear Information System (INIS)

    Hwang, Do Yeon; Koo, Bon Kwon; Lee, Joo Myung

    2016-01-01

    The presence of myocardial ischemia is the most important prognostic factor in patients with ischemic heart disease. Fractional flow reserve (FFR) is a gold standard invasive method used to detect the stenosis-specific myocardial ischemia. FFR-guided revascularization strategy is superior to angiography-guided strategy. The recently developed hyperemia-free index, instantaneous wave free ratio is being actively investigated. A non-invasive FFR derived from coronary CT angiography is now used in clinical practice. Due to rapid expansion of invasive and non-invasive physiologic assessment, comprehensive understanding of the role and potential pitfalls of each modality are required for its application. In this review, we focus on the basic and clinical aspects of physiologic assessment in ischemic heart disease

  6. A novel patient-specific model to compute coronary fractional flow reserve.

    Science.gov (United States)

    Kwon, Soon-Sung; Chung, Eui-Chul; Park, Jin-Seo; Kim, Gook-Tae; Kim, Jun-Woo; Kim, Keun-Hong; Shin, Eun-Seok; Shim, Eun Bo

    2014-09-01

    The fractional flow reserve (FFR) is a widely used clinical index to evaluate the functional severity of coronary stenosis. A computer simulation method based on patients' computed tomography (CT) data is a plausible non-invasive approach for computing the FFR. This method can provide a detailed solution for the stenosed coronary hemodynamics by coupling computational fluid dynamics (CFD) with the lumped parameter model (LPM) of the cardiovascular system. In this work, we have implemented a simple computational method to compute the FFR. As this method uses only coronary arteries for the CFD model and includes only the LPM of the coronary vascular system, it provides simpler boundary conditions for the coronary geometry and is computationally more efficient than existing approaches. To test the efficacy of this method, we simulated a three-dimensional straight vessel using CFD coupled with the LPM. The computed results were compared with those of the LPM. To validate this method in terms of clinically realistic geometry, a patient-specific model of stenosed coronary arteries was constructed from CT images, and the computed FFR was compared with clinically measured results. We evaluated the effect of a model aorta on the computed FFR and compared this with a model without the aorta. Computationally, the model without the aorta was more efficient than that with the aorta, reducing the CPU time required for computing a cardiac cycle to 43.4%. Copyright © 2014. Published by Elsevier Ltd.

  7. Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis: Results From the VIRTU-Fast Study.

    Science.gov (United States)

    Morris, Paul D; Silva Soto, Daniel Alejandro; Feher, Jeroen F A; Rafiroiu, Dan; Lungu, Angela; Varma, Susheel; Lawford, Patricia V; Hose, D Rodney; Gunn, Julian P

    2017-08-01

    Fractional flow reserve (FFR)-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel "pseudotransient" analysis protocol for computing virtual fractional flow reserve (vFFR) based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis) using a desktop PC, with <1% error relative to that of full-transient computational fluid dynamics analysis. Sensitivity analysis demonstrated that physiological lesion significance was influenced less by coronary or lesion anatomy (33%) and more by microvascular physiology (59%). If coronary microvascular resistance can be estimated, vFFR can be accurately computed in less time than it takes to make invasive measurements.

  8. Long-term outcome of FFR-guided PCI for stable coronary artery disease in daily clinical practice

    DEFF Research Database (Denmark)

    De Backer, Ole; Biasco, Luigi; Lønborg, Jacob

    2016-01-01

    AIMS: Our aim was to investigate the strength of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) for stable coronary artery disease (CAD) in daily practice. METHODS AND RESULTS: For this study, 3,512 patients with stable CAD and at least one 50-89% coronary stenosis...... were identified; those patients thought to require PCI (n=1,716) were selected. Of these, 962 (56%) were treated based on angiography (XA) alone, whereas 754 patients (44%) had an FFR-guided treatment. In the latter group, 321 patients (43%) were reallocated to another treatment, predominantly medical...... treatment. After propensity score matching, the number of indicated lesions was 957 in the XA-guided group and 947 in the FFR-guided group. FFR guidance resulted in PCI deferral in 462 lesions (48.8%). In a seven-day landmark analysis, the rate of periprocedural myocardial infarction (MI) was less than half...

  9. Cost benefit for assessment of intermediate coronary stenosis with fractional flow reserve in public and private sectors in australia.

    Science.gov (United States)

    Murphy, J C; Hansen, P S; Bhindi, R; Figtree, G A; Nelson, G I C; Ward, M R

    2014-09-01

    Fractional Flow Reserve (FFR) is a proven technology for guiding percutaneous coronary intervention (PCI), but is not reimbursed despite the fact that it is frequently used to defer PCI. Costs incurred with use of FFR were compared in both the public and private sectors with the costs that would have been incurred if the technology was not available using consecutive cases over a two year period in a public teaching hospital and its co-located private hospital. FFR was performed on 143 lesions in 120 patients. FFR was cost of $A1200 per wire, FFR actually saved money. Mean savings in the public sector were $1200 per patient while in the private sector the savings were $5000 per patient. FFR use saves money for the Federal Government in the public sector and for the Private Health Funds in the private sector. These financial benefits are seen in addition to the improved outcomes seen with this technology. Copyright © 2014. Published by Elsevier B.V.

  10. Advanced 2-dimensional quantitative coronary angiographic analysis for prediction of fractional flow reserve in intermediate coronary stenoses.

    Science.gov (United States)

    Opolski, Maksymilian P; Pregowski, Jerzy; Kruk, Mariusz; Kepka, Cezary; Staruch, Adam D; Witkowski, Adam

    2014-07-01

    The widespread clinical application of coronary computed tomography angiography (CCTA) has resulted in increased referral patterns of patients with intermediate coronary stenoses to invasive coronary angiography. We evaluated the application of advanced quantitative coronary angiography (A-QCA) for predicting fractional flow reserve (FFR) in intermediate coronary lesions detected on CCTA. Fifty-six patients with 66 single intermediate coronary lesions (≥ 50% to 80% stenosis) on CCTA prospectively underwent coronary angiography and FFR. A-QCA including calculation of the Poiseuille-based index defined as the ratio of lesion length to the fourth power of the minimal lumen diameter (MLD) was performed. Significant stenosis was defined as FFR ≤ 0.80. The mean FFR was 0.86 ± 0.09, and 18 lesions (27%) were functionally significant. FFR correlated with lesion length (R=-0.303, P=0.013), MLD (R=0.527, P44%, and >69%, respectively (maximum negative predictive value of 94% for MLA, maximum positive predictive value of 58% for diameter stenosis). The Poiseuille-based index was the most accurate (C statistic 0.86, sensitivity 100%, specificity 71%, positive predictive value 56%, and negative predictive value 100%) predictor of FFR ≤ 0.80, but showed the lowest interobserver agreement (intraclass correlation coefficient 0.37). A-QCA might be used to rule out significant ischemia in intermediate stenoses detected by CCTA. The diagnostic application of the Poiseuille-based angiographic index is precluded by its high interobserver variability.

  11. Determining the haemodynamic significance of arterial stenosis: the relationship between CT angiography, computational fluid dynamics, and non-invasive fractional flow reserve

    International Nuclear Information System (INIS)

    Pang, C.L.; Alcock, R.; Pilkington, N.; Reis, T.; Roobottom, C.

    2016-01-01

    Coronary artery disease causes significant morbidity and mortality worldwide. Invasive coronary angiography (ICA) is currently the reference standard investigation. Fractional flow reserve (FFR) complements traditional ICA by providing extra information on blood flow, which has convincingly led to better patient management and improved cost-effectiveness. Computed tomography coronary angiography (CTCA) is suitable for the investigation of chest pain, especially in the low- and intermediate-risk groups. FFR generated using CT data (producing FFR_C_T) may improve the positive predictive value of CTCA. The basic science of FFR_C_T is like a “black box” to most imaging professionals. A fundamental principle is that good quality CTCA is likely to make any post-processing easier and more reliable. Both diagnostic and observational studies have suggested that the accuracy and the short-term outcome of using FFR_C_T are both comparable with FFR in ICA. More multidisciplinary research with further refined diagnostic and longer-term observational studies will hopefully pinpoint the role of FFR_C_T in existing clinical pathways.

  12. Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve.

    Science.gov (United States)

    Papafaklis, Michail I; Muramatsu, Takashi; Ishibashi, Yuki; Bourantas, Christos V; Fotiadis, Dimitrios I; Brilakis, Emmanouil S; Garcia-Garcia, Héctor M; Escaned, Javier; Serruys, Patrick W; Michalis, Lampros K

    2018-03-01

    Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4-95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (pvirtual resting Pd/Pa and FFR (r=0.69, pVirtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  13. Metaanalysis of Diagnostic Performance of Computed Coronary Tomography Angiography, Computed Tomography Perfusion and Computed Tomography-Fractional Flow Reserve in Functional Myocardial Ischemia Assessment versus Invasive Fractional Flow Reserve

    Science.gov (United States)

    Gonzalez, Jorge A.; Lipinski, Michael J.; Flors, Lucia F.; Shaw, Peter; Kramer, Christopher M.; Salerno, Michael

    2015-01-01

    We sought to compare the diagnostic performance of computed coronary tomography angiography (CCTA), computed tomography perfusion (CTP) and computed tomography fractional flow reserve (CT-FFR) for assessing the functional significance of coronary stenosis as defined by invasive fractional flow reserve (FFR), in patients with known or suspected coronary artery disease. CCTA has proven clinically useful for excluding obstructive CAD due to its high sensitivity and negative predictive value (NPV), however the ability of CTA to identify functionally significant CAD has remained challenging. We searched PubMed/Medline for studies evaluating CCTA, CTP or CT-FFR for the non-invasive detection of obstructive CAD as compared to catheter-derived FFR as the reference standard. Pooled sensitivity, specificity, PPV, NPV, likelihood ratios (LR), odds ratio (OR) of all diagnostic tests were assessed. Eighteen studies involving a total of 1535 patients were included. CTA demonstrated a pooled sensitivity of 0.92, specificity 0.43, PPV of 0.56 and NPV of 0.87 on a per-patient level. CT-FFR and CTP increased the specificity to 0.72 and 0.77 respectively (P=0.004 and P=0.0009)) resulting in higher point estimates for PPV 0.70 and 0.83 respectively. There was no improvement in the sensitivity. The CTP protocol involved more radiation (3.5 mSv CCTA VS 9.6 mSv CTP) and a higher volume of iodinated contrast (145 mL). In conclusion, CTP and CT-FFR improve the specificity of CCTA for detecting functionally significant stenosis as defined by invasive FFR on a per-patient level; both techniques could advance the ability to non-invasively detect the functional significance of coronary lesions. PMID:26347004

  14. A machine-learning approach for computation of fractional flow reserve from coronary computed tomography.

    Science.gov (United States)

    Itu, Lucian; Rapaka, Saikiran; Passerini, Tiziano; Georgescu, Bogdan; Schwemmer, Chris; Schoebinger, Max; Flohr, Thomas; Sharma, Puneet; Comaniciu, Dorin

    2016-07-01

    Fractional flow reserve (FFR) is a functional index quantifying the severity of coronary artery lesions and is clinically obtained using an invasive, catheter-based measurement. Recently, physics-based models have shown great promise in being able to noninvasively estimate FFR from patient-specific anatomical information, e.g., obtained from computed tomography scans of the heart and the coronary arteries. However, these models have high computational demand, limiting their clinical adoption. In this paper, we present a machine-learning-based model for predicting FFR as an alternative to physics-based approaches. The model is trained on a large database of synthetically generated coronary anatomies, where the target values are computed using the physics-based model. The trained model predicts FFR at each point along the centerline of the coronary tree, and its performance was assessed by comparing the predictions against physics-based computations and against invasively measured FFR for 87 patients and 125 lesions in total. Correlation between machine-learning and physics-based predictions was excellent (0.9994, P machine-learning algorithm with a sensitivity of 81.6%, a specificity of 83.9%, and an accuracy of 83.2%. The correlation was 0.729 (P assessment of FFR. Average execution time went down from 196.3 ± 78.5 s for the CFD model to ∼2.4 ± 0.44 s for the machine-learning model on a workstation with 3.4-GHz Intel i7 8-core processor. Copyright © 2016 the American Physiological Society.

  15. Online Angiography Image-Based FFR Assessment During Coronary Catheterization: A Single-Center Study.

    Science.gov (United States)

    Kornowski, Ran; Vaknin-Assa, Hana; Assali, Abid; Greenberg, Gabriel; Valtzer, Orna; Lavi, Ifat

    2018-03-15

    To assess the diagnostic performance of angiography-derived fractional flow reserve (FFRangio) measurements in patients with stable coronary artery disease when used online in the catheterization laboratory during routine coronary angiography. FFR, an index of the hemodynamic severity of coronary stenosis, is derived from invasive measurements using a pressure-monitoring guidewire and hyperemic stimulus. While FFR is the gold standard, it remains under-utilized. FFRangio may have several advantages owing to the reduced operator time, no wire-related or procedural complications, and no need for administration of vasodilators. FFRangio is a novel technology that uses a patient's hemodynamic data and routine angiograms to generate FFR values at each point along the coronary tree. We present the online application of the system where FFRangio was successfully used in the catheterization laboratory during routine coronary angiography and compared to invasive FFR. Fifty-three patients (79% men) and 60 coronary lesions were analyzed. Values derived using FFRangio ranged from 0.58-0.96 and correlated closely (Pearson's correlation coefficient, r=0.91; Psystem. In this single-center experience, FFRangio values showed high correlation rates to invasive FFR.

  16. Patients with coronary stenosis and a fractional flow reserve of ≥0.75 measured in daily practice at the VU University Medical Center

    Science.gov (United States)

    Oud, N.; Marques, K.M.; Bronzwaer, J.G.F.; Brinckman, S.; Allaart, C.P.; de Cock, C.C.; Appelman, Y.

    2010-01-01

    Objectives. The aim of this study was to analyse the rate of major adverse clinical events in patients with coronary artery disease and a fractional flow reserve (FFR) of ≥0.75 and deferred for coronary intervention in daily practice. Methods. From 1 January to 31 December 2006, FFR measurement was initiated in 122 patients (5%) out of 2444 patients referred for coronary angiography. In two patients FFR measurement failed and in one patient the FFR value could no longer be traced in the documents. Thus, 119 patients (84 men, 64 years, range 41-85) were included in the evaluation (145 lesions). Major adverse clinical events (death, myocardial infarction, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG)) and the presence of angina were evaluated at follow-up. Furthermore a cost-effectiveness analysis was performed. Results. In 93 patients (76%) the FFR value was ≥0.75. Seventy of these 93 patients (76%) were treated with medication alone or underwent PCI for a different lesion (medical treatment group). Average duration of follow-up of all 119 patients was 22 months (range 4 days to 30 months). In the medical treatment group seven patients (10%) experienced a major adverse clinical event related to the FFR-evaluated lesion during follow-up. In this study population, the use of FFR measurement is cost-reducing provided that at least 65% of the patients in the medical treatment group has had a PCI with stent implantation when the use of FFR measurement is impossible. In this case, the decision to use PCI with stent implantation is purely based on the angiogram. Conclusions. In patients with a coronary stenosis based on visual assessment and an FFR of ≥0.75 deferral of PCI or CABG is safe in daily clinical practice and saves money. (Neth Heart J 2010;18:402–7.) PMID:20862234

  17. Prognostic value of fractional flow reserve

    DEFF Research Database (Denmark)

    Johnson, Nils P; Tóth, Gábor G; Lai, Dejian

    2014-01-01

    between its numeric value and prognosis, such that lower FFR values confer a higher risk and therefore receive larger absolute benefits from revascularization. METHODS: Meta-analysis of study- and patient-level data investigated prognosis after FFR measurement. An interaction term between FFR...... baseline FFR values. Outcomes-derived FFR thresholds generally occurred around the range 0.75 to 0.80, although limited due to confounding by indication. FFR measured immediately after stenting also showed an inverse relationship with prognosis (hazard ratio: 0.86, 95% confidence interval: 0.80 to 0.93; p...... versus revascularization. Lesions with lower FFR values receive larger absolute benefits from revascularization. Measurement of FFR immediately after stenting also shows an inverse gradient of risk, likely from residual diffuse disease. An FFR-guided revascularization strategy significantly reduces...

  18. The acute changes of fractional flow reserve in DK (double kissing), crush, and 1-stent technique for true bifurcation lesions.

    Science.gov (United States)

    Ye, Fei; Zhang, Jun-Jie; Tian, Nai-Liang; Lin, Song; Liu, Zhi-Zhong; Kan, Jing; Xu, Hai-Mei; Zhu, Zhongsheng; Chen, Shao-Liang

    2010-08-01

    While many studies confirmed the importance of fractional flow reserve (FFR) in guiding complex percutaneous coronary interventions (PCI), data regarding the significance of FFR for bifurcation lesions are still lacking. Between October 2008 and October 2009, 51 patients with true bifurcation lesions were consecutively enrolled and randomized into double kissing (DK) crush (n = 25), and provisional 1-stent (n = 26) groups. FFR measurements at baseline and hyperemia were measured at pre-PCI, post-PCI, and at 8-month follow-up. Clinical follow-ups were available in 100% of patients while only 33% of patients underwent angiographic follow-up. Baseline clinical and angiographic characteristics were matched between the 2 groups. Pre-PCI FFR of the main branch (MB) in the DK group was 0.76 +/- 0.15, which was significantly lower than in the provisional 1-stent group (0.83 +/- 0.10, P = 0.029). This difference disappeared after the PCI procedure (0.92 +/- 0.04 vs. 0.92 +/- 0.05, P = 0.58). There were no significant differences in terms of baseline, angiographic, procedural indexes, and FFR of side branch (SB) between the 2 treatment arms. However, immediately after PCI, the patient with DK crush had higher FFR in the SB as compared to the provisional 1-stent group (0.94 +/- 0.03 vs. 0.90 +/- 0.08, P = 0.028, respectively) and also they had lower diameter stenosis (8.59 +/- 6.41% vs. 15.62 +/- 11.69%, P = 0.015, respectively). In the acute phase, immediately after PCI for bifurcation lesion, DK crush stenting was associated with higher FFR and lower residual diameter stenosis in the SB, as compared with the provisional 1-stent group.

  19. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial.

    Science.gov (United States)

    van Nunen, Lokien X; Zimmermann, Frederik M; Tonino, Pim A L; Barbato, Emanuele; Baumbach, Andreas; Engstrøm, Thomas; Klauss, Volker; MacCarthy, Philip A; Manoharan, Ganesh; Oldroyd, Keith G; Ver Lee, Peter N; Van't Veer, Marcel; Fearon, William F; De Bruyne, Bernard; Pijls, Nico H J

    2015-11-07

    In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up. The FAME study was a multicentre trial done in Belgium, Denmark, Germany, the Netherlands, Sweden, the UK, and the USA. Patients (aged ≥ 18 years) with multivessel coronary artery disease were randomly assigned to undergo angiography-guided PCI or FFR-guided PCI. Before randomisation, stenoses requiring PCI were identified on the angiogram. Patients allocated to angiography-guided PCI had revascularisation of all identified stenoses. Patients allocated to FFR-guided PCI had FFR measurements of all stenotic arteries and PCI was done only if FFR was 0·80 or less. No one was masked to treatment assignment. The primary endpoint was major adverse cardiac events at 1 year, and the data for the 5-year follow-up are reported here. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00267774. After 5 years, major adverse cardiac events occurred in 31% of patients (154 of 496) in the angiography-guided group versus 28% (143 of 509 patients) in the FFR-guided group (relative risk 0·91, 95% CI 0·75-1·10; p=0·31). The number of stents placed per patient was significantly higher in the angiography-guided group than in the FFR-guided group (mean 2·7 [SD 1·2] vs 1·9 [1·3], pPCI in patients with multivessel disease. A strategy of FFR-guided PCI resulted in a significant decrease of major adverse cardiac events for up to 2 years after the index procedure. From 2 years to 5 years, the risks for both groups developed similarly. This clinical outcome in the FFR-guided group was achieved with a lower number of stented arteries

  20. Atherosclerotic Plaque Characteristics by CT Angiography Identify Coronary Lesions That Cause Ischemia: a Direct Comparison to Fractional Flow Reserve

    Science.gov (United States)

    Park, Hyung-Bok; Heo, Ran; Hartaigh, Bríain ó; Cho, Iksung; Gransar, Heidi; Nakazato, Ryo; Leipsic, Jonathon; Mancini, G.B. John; Koo, Bon-Kwon; Otake, Hiromasa; Budoff, Matthew J.; Berman, Daniel S.; Erglis, Andrejs; Chang, Hyuk-Jae; Min, James K.

    2014-01-01

    Objective We evaluated the association between atherosclerotic plaque characteristics (APCs) by coronary CT angiography (CT) and lesion ischemia by fractional flow reserve (FFR). Background FFR is the gold standard for determining lesion ischemia. While APCs by CT—including aggregate plaque volume % (%APV), positive remodeling (PR), low attenuation plaque (LAP) and spotty calcification (SC)—are associated with future coronary syndromes, their relationship to lesion ischemia is unclear. Methods 252 patients (17 centers, 5 countries) [mean age 63 years, 71% males] underwent CT, with FFR performed for 407 coronary lesions. CT was interpreted for 50% stenosis, with the latter considered obstructive. APCs by CT were defined as: (1) PR, lesion diameter/reference diameter >1.10; (2) LAP, any voxel 50% but not for 50%. PMID:25592691

  1. Rapid exchange ultra-thin microcatheter using fibre-optic sensing technology for measurement of intracoronary fractional flow reserve.

    Science.gov (United States)

    Diletti, Roberto; Van Mieghem, Nicolas M; Valgimigli, Marco; Karanasos, Antonis; Everaert, Bert R C; Daemen, Joost; van Geuns, Robert-Jan; de Jaegere, Peter P; Zijlstra, Felix; Regar, Evelyn

    2015-08-01

    The present report describes a novel coronary fractional flow reserve (FFR) system which allows FFR assessment using a rapid exchange microcatheter (RXi). The RXi microcatheter is compatible with standard 0.014" coronary guidewires facilitating lesion negotiation and FFR assessment in a wide range of coronary anatomies. In case of serial lesions, a microcatheter would have the important advantage of allowing multiple pullbacks while maintaining wire access to the vessel. The RXi is a fibre-optic sensor technology-based device. This technology might allow reduction in signal drift. The RXi microcatheter's fibre-optic sensor is located 5 mm from the distal tip. The microcatheter profile at the sensor site is 0.027"0.036". The segment of the catheter which is intended to reside within the target lesion is proximal to the sensor and has dimensions decreased to 0.020"0.025"; these dimensions are comparable to a 0.022" circular-shaped wire. The RXi microcatheter FFR system represents a novel technology that could allow easier lesion negotiation, maintaining guidewire position, facilitating pullbacks for assessment of serial lesions and simplifying the obtainment of post-intervention FFR measurements. The optical sensing technology could additionally result in less signal drift. Further investigations are required to evaluate the clinical value of this technology fully.

  2. Navvus FFR to reduce CONTRAst, Cost and radiaTion (CONTRACT); insights from a single-centre clinical and economical evaluation with the RXi Rapid-Exchange FFR device

    NARCIS (Netherlands)

    Masdjedi, K.; Mieghem, N.M. van; Diletti, R.; Geuns, R.J.M. van; Jaegere, P. De; Regar, E.; Zijlstra, F.; Domburg, R.T. van; Daemen, J.

    2017-01-01

    OBJECTIVES: To assess whether the RXi Navvus system compared to the use of standard Fractional Flow Reserve (FFR) wires reduces total contrast volume, radiation and overall study cost in a real world patient population referred for coronary angiography or percutaneous coronary intervention.

  3. Fractional flow reserve is not associated with inflammatory markers in patients with stable coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Jan-Willem E M Sels

    Full Text Available BACKGROUND: Atherosclerosis is an inflammatory condition and increased blood levels of inflammatory biomarkers have been observed in acute coronary syndromes. In addition, high expression of inflammatory markers is associated with worse prognosis of coronary artery disease. The presence and extent of inducible ischemia in patients with stable angina has previously been shown to have strong prognostic value. We hypothesized that evidence of inducible myocardial ischemia by local lesions, as measured by fractional flow reserve (FFR, is associated with increased levels of blood based inflammatory biomarkers. METHODS: Whole blood samples of 89 patients with stable angina pectoris and 16 healthy controls were analyzed. The patients with stable angina pectoris underwent coronary angiography and FFR of all coronary lesions. We analyzed plasma levels of cytokines IL-6, IL-8 and TNF-α and membrane expression of Toll-like receptor 2 and 4, CD11b, CD62L and CD14 on monocytes and granulocytes as markers of inflammation. Furthermore, we quantified the severity of hemodynamically significant coronary artery disease by calculating Functional Syntax Score (FSS, an extension of the Syntax Score. RESULTS: For the majority of biomarkers, we observed lower levels in the healthy control group compared with patients with stable angina who underwent coronary catheterization. We found no difference for any of the selected biomarkers between patients with a positive FFR (≤ 0.75 and negative FFR (>0.80. We observed no relationship between the investigated biomarkers and FSS. CONCLUSION: The presence of local atherosclerotic lesions that result in inducible myocardial ischemia as measured by FFR in patients with stable coronary artery disease is not associated with increased plasma levels of IL-6, IL-8 and TNF-α or increased expression of TLR2 and TLR4, CD11b, CD62L and CD14 on circulating leukocytes.

  4. Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS–NSTEMI randomized trial

    Science.gov (United States)

    Layland, Jamie; Oldroyd, Keith G.; Curzen, Nick; Sood, Arvind; Balachandran, Kanarath; Das, Raj; Junejo, Shahid; Ahmed, Nadeem; Lee, Matthew M.Y.; Shaukat, Aadil; O'Donnell, Anna; Nam, Julian; Briggs, Andrew; Henderson, Robert; McConnachie, Alex; Berry, Colin; Hannah, Andrew; Stewart, Andrew; Metcalfe, Malcolm; Norrie, John; Chowdhary, Saqib; Clark, Andrew; Henderson, Robert; Balachandran, Kanarath; Berry, Colin; Baird, Gordon; O'Donnell, Anna; Sood, Arvind; Curzen, Nick; Das, Raj; Ford, Ian; Layland, Jamie; Junejo, Shahid; Oldroyd, Keith

    2015-01-01

    Aim We assessed the management and outcomes of non-ST segment elevation myocardial infarction (NSTEMI) patients randomly assigned to fractional flow reserve (FFR)-guided management or angiography-guided standard care. Methods and results We conducted a prospective, multicentre, parallel group, 1 : 1 randomized, controlled trial in 350 NSTEMI patients with ≥1 coronary stenosis ≥30% of the lumen diameter assessed visually (threshold for FFR measurement) (NCT01764334). Enrolment took place in six UK hospitals from October 2011 to May 2013. Fractional flow reserve was disclosed to the operator in the FFR-guided group (n = 176). Fractional flow reserve was measured but not disclosed in the angiography-guided group (n = 174). Fractional flow reserve ≤0.80 was an indication for revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The median (IQR) time from the index episode of myocardial ischaemia to angiography was 3 (2, 5) days. For the primary outcome, the proportion of patients treated initially by medical therapy was higher in the FFR-guided group than in the angiography-guided group [40 (22.7%) vs. 23 (13.2%), difference 95% (95% CI: 1.4%, 17.7%), P = 0.022]. Fractional flow reserve disclosure resulted in a change in treatment between medical therapy, PCI or CABG in 38 (21.6%) patients. At 12 months, revascularization remained lower in the FFR-guided group [79.0 vs. 86.8%, difference 7.8% (−0.2%, 15.8%), P = 0.054]. There were no statistically significant differences in health outcomes and quality of life between the groups. Conclusion In NSTEMI patients, angiography-guided management was associated with higher rates of coronary revascularization compared with FFR-guided management. A larger trial is necessary to assess health outcomes and cost-effectiveness. PMID:25179764

  5. Measurement of fractional flow reserve to guide decisions for percutaneous coronary intervention.

    Science.gov (United States)

    Siebert, Uwe; Bornschein, Bernhard; Schnell-Inderst, Petra; Rieber, Johannes; Pijls, Nico; Wasem, Jürgen; Klauss, Volker

    2008-08-27

    Coronary artery disease (CAD) is one of the leading causes of premature death in Germany. Percutaneous coronary interventions (PCI) are frequently performed in patients with angiographically intermediate stenoses. However, the necessity of PCI has not been proven for all patients. Pressure-based fractional flow reserve (FFR) is an invasive test that can be used to assess the functional significance of intermediate coronary stenoses in order to guide decisions on PCI. This health technology assessment (HTA) aims to evaluate (1) the diagnostic accuracy, (2) the risk-benefit trade-off and (3) the long-term cost-effectiveness of FFR measurement to guide the decision on PCI in patients with stable angina pectoris and intermediate coronary stenoses. We performed a literature search in medical and HTA databases. We used the DIMDI instruments (DIMDI = Deutsches Institut für Medizinische Dokumentation und Information/German Institute for Medical Information and Documentation) to assess study quality and to extract and summarize the information in evidence tables. We performed a meta-analysis to calculate the pooled overall estimate for sensitivity and specificity of FFR with 95% confidence intervals (95% CI). Individual studies' case numbers were used as weights. The influence of single studies and important covariates on the results was tested in sensitivity analyses. We developed the German Coronary Artery Disease Outcome Model (German CADOM), a decision-analytic Markov model, to estimate the long-term effectiveness and cost-effectiveness of FFR measurement in the context of the German healthcare system. Our literature search identified twelve studies relevant to this HTA-report including ten diagnostic accuracy studies of FFR measurement, one randomized clinical trial (RCT) investigating the clinical benefits of this technique as well as one economic evaluation. Pooled estimates for sensitivity and specificity were 81.7% (95% CI: 77.0-85.7%) and 78.7% (95% CI: 74

  6. Measurement of fractional flow reserve to guide decisions for percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2008-08-01

    Full Text Available Background: Coronary artery disease (CAD is one of the leading causes of premature death in Germany. Percutaneous coronary interventions (PCI are frequently performed in patients with angiographically intermediate stenoses. However, the necessity of PCI has not been proven for all patients. Pressure-based fractional flow reserve (FFR is an invasive test that can be used to assess the functional significance of intermediate coronary stenoses in order to guide decisions on PCI. Objectives: This health technology assessment (HTA aims to evaluate (1 the diagnostic accuracy, (2 the risk-benefit trade-off and (3 the long-term cost-effectiveness of FFR measurement to guide the decision on PCI in patients with stable angina pectoris and intermediate coronary stenoses. Methods: We performed a literature search in medical and HTA databases. We used the DIMDI instruments (DIMDI = Deutsches Institut für Medizinische Dokumentation und Information/German Institute for Medical Information and Documentation to assess study quality and to extract and summarize the information in evidence tables. We performed a meta-analysis to calculate the pooled overall estimate for sensitivity and specificity of FFR with 95% confidence intervals (95% CI. Individual studies’ case numbers were used as weights. The influence of single studies and important covariates on the results was tested in sensitivity analyses. We developed the German Coronary Artery Disease Outcome Model (German CADOM, a decision-analytic Markov model, to estimate the long-term effectiveness and cost-effectiveness of FFR measurement in the context of the German healthcare system. Results: Our literature search identified twelve studies relevant to this HTA-report including ten diagnostic accuracy studies of FFR measurement, one randomized clinical trial (RCT investigating the clinical benefits of this technique as well as one economic evaluation. Pooled estimates for sensitivity and specificity were 81

  7. Measurement of the blood flow rate and velocity in coronary artery stenosis using intracoronary frequency domain optical coherence tomography: Validation against fractional flow reserve.

    Science.gov (United States)

    Zafar, Haroon; Sharif, Faisal; Leahy, Martin J

    2014-12-01

    The main objective of this study was to assess the blood flow rate and velocity in coronary artery stenosis using intracoronary frequency domain optical coherence tomography (FD-OCT). A correlation between fractional flow reserve (FFR) and FD-OCT derived blood flow velocity is also included in this study. A total of 20 coronary stenoses in 15 patients were assessed consecutively by quantitative coronary angiography (QCA), FFR and FD-OCT. A percutaneous coronary intervention (PCI) optimization system was used in this study which combines wireless FFR measurement and FD-OCT imaging in one platform. Stenoses were labelled severe if FFR ≤ 0.8. Blood flow rate and velocity in each stenosis segment were derived from the volumetric analysis of the FD-OCT pull back images. The FFR value was ≤ 0.80 in 5 stenoses (25%). The mean blood flow rate in severe coronary stenosis ( n  = 5) was 2.54 ± 0.55 ml/s as compared to 4.81 ± 1.95 ml/s in stenosis with FFR > 0.8 ( n  = 15). A good and significant correlation between FFR and FD-OCT blood flow velocity in coronary artery stenosis ( r  = 0.74, p  < 0.001) was found. The assessment of stenosis severity using FD-OCT derived blood flow rate and velocity has the ability to overcome many limitations of QCA and intravascular ultrasound (IVUS).

  8. Case Report of First Angiography-Based On-Line FFR Assessment during Coronary Catheterization

    Directory of Open Access Journals (Sweden)

    Ran Kornowski

    2017-01-01

    Full Text Available Fractional flow reserve (FFR, an index of the hemodynamic severity of coronary stenoses, is derived from hyperemic pressure measurements and requires a pressure-monitoring guide wire and hyperemic stimulus. Although it has become the standard of reference for decision-making regarding coronary revascularization, the procedure remains underutilized due to its invasive nature. FFRangio is a novel technology that uses the patient’s hemodynamic data and routine angiograms to generate a complete three-dimensional coronary tree, with color-coded display of the FFR values at each point along the vessels. After being proven to be as accurate as invasive FFR measurements in an off-line study, this case report presents the first on-line application of the system in the catheterization lab. Here too, a high concordance between FFRangio and invasive FFR was observed. In light of the demonstrated capabilities of the FFRangio system, it should emerge as an important tool for clinical decision-making regarding revascularization in patients with coronary artery disease.

  9. Diagnostic value of thallium-201 myocardial perfusion IQ-SPECT without and with computed tomography-based attenuation correction to predict clinically significant and insignificant fractional flow reserve: A single-center prospective study.

    Science.gov (United States)

    Tanaka, Haruki; Takahashi, Teruyuki; Ohashi, Norihiko; Tanaka, Koichi; Okada, Takenori; Kihara, Yasuki

    2017-12-01

    The aim of this study was to clarify the predictive value of fractional flow reserve (FFR) determined by myocardial perfusion imaging (MPI) using thallium (Tl)-201 IQ-SPECT without and with computed tomography-based attenuation correction (CT-AC) for patients with stable coronary artery disease (CAD).We assessed 212 angiographically identified diseased vessels using adenosine-stress Tl-201 MPI-IQ-SPECT/CT in 84 consecutive, prospectively identified patients with stable CAD. We compared the FFR in 136 of the 212 diseased vessels using visual semiquantitative interpretations of corresponding territories on MPI-IQ-SPECT images without and with CT-AC.FFR inversely correlated most accurately with regional summed difference scores (rSDS) in images without and with CT-AC (r = -0.584 and r = -0.568, respectively, both P system can predict FFR at an optimal cut-off of reserved.

  10. Impact of microvascular obstruction on the assessment of coronary flow reserve, index of microcirculatory resistance, and fractional flow reserve after ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Cuculi, Florim; De Maria, Giovanni Luigi; Meier, Pascal; Dall'Armellina, Erica; de Caterina, Alberto R; Channon, Keith M; Prendergast, Bernard D; Choudhury, Robin P; Choudhury, Robin C; Forfar, John C; Kharbanda, Rajesh K; Banning, Adrian P

    2014-11-04

    Invasive assessment of coronary physiology (IACP) offers important prognostic insights in ST-segment elevation myocardial infarction (STEMI) but the dynamics of coronary recovery are poorly understood. This study sought to examine the evolution of coronary flow reserve (CFR), index of microcirculatory resistance (IMR), ratio of distal coronary pressure (Pd) to mean aortic pressure (Pa), and fractional flow reserve (FFR) in patients undergoing primary percutaneous coronary intervention (PPCI). 82 patients with STEMI underwent IACP at PPCI. Repeat IACP was performed in 61 patients (74%) at day 1 and in 46 patients (56%) at 6 months. Contrast-enhanced cardiac magnetic resonance imaging (CMR) was performed in 45 patients (55%) at day 1 and in 41 patients (50%) at 6 months. Changes in IACP were compared between patients with and without microvascular obstruction (MVO) on CMR. MVO was present in 21 of 45 patients (47%). Patients with MVO had lower CFR at PPCI and day 1 (p < 0.05) and a trend toward higher IMR values (p = 0.07). At 6 months, CFR and IMR were not significantly different between the groups. Baseline flow and Pd/Pa remained stable over time but FFR reduced significantly between PPCI and 6 months (p = 0.008); this reduction was mainly observed in patients with MVO (p = 0.006) but not in those without MVO (p = 0.21). In PPCI-treated patients with STEMI, coronary microcirculation begins to recover within 24 h and recovery progresses further by 6 months. FFR significantly reduces from baseline to 6 months. The presence of MVO indicates a highly dysfunctional microcirculation. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Multicenter core laboratory comparison of the instantaneous wave-free ratio and resting Pd/Pa with fractional flow reserve: The RESOLVE study

    NARCIS (Netherlands)

    Jeremias, Allen; Maehara, Akiko; Généreux, Philippe; Asrress, Kaleab N.; Berry, Colin; Bruyne, de B. (Bernard); Davies, Justin E.; Escaned, Javier; Fearon, W.F. (William); Gould, K. Lance; Johnson, Nils P.; Kirtane, Ajay J.; Koo, Bon Kwon; Marques, Koen M.; Nijjer, Sukhjinder; Oldroyd, K.G. (Keith); Petraco, Ricardo; Piek, Jan J.; Pijls, Nico H.; Redwood, Simon; Siebes, M.; Spaan, J.A.E.; van 't Veer, Marcel; Mintz, Gary S.; Stone, Gregg W.

    2014-01-01

    Objectives This study sought to examine the diagnostic accuracy of the instantaneous wave-free ratio (iFR) and resting distal coronary artery pressure/aortic pressure (Pd/Pa) with respect to hyperemic fractional flow reserve (FFR) in a core laboratory-based multicenter collaborative study.

  12. A patient-specific virtual stenotic model of the coronary artery to analyze the relationship between fractional flow reserve and wall shear stress.

    Science.gov (United States)

    Lee, Kyung Eun; Kim, Gook Tae; Lee, Jeong Sang; Chung, Ju-Hyun; Shin, Eun-Seok; Shim, Eun Bo

    2016-11-01

    As the stenotic severity of a patient increases, fractional flow reserve (FFR) decreases, whereas the maximum wall shear stress (WSSmax) increases. However, the way in which these values can change according to stenotic severity has not previously been investigated. The aim of this study is to devise a virtual stenosis model to investigate variations in the coronary hemodynamic parameters of patients according to stenotic severity. To simulate coronary hemodynamics, a three-dimensional (3D) coronary artery model of computational fluid dynamics is coupled with a lumped parameter model of the coronary micro-vasculature and venous system. To validate the present method, we first simulated 13 patient-specific models of the coronary arteries and compared the results with those obtained clinically. Then, virtually narrowed coronary arterial models derived from the patient-specific cases were simulated to obtain the WSSmax and FFR values. The variations in FFR and WSSmax against the percentage of diameter stenosis in clinical cases were reproducible by the virtual stenosis models. We also found that the simulated FFR values were linearly correlated with the WSSmax values, but the linear slope varied by patient. We implemented 130 additional virtual models of stenosed coronary arteries based on data from 13 patients and obtained statistically meaningful results that were identical to the large-scale clinical studies. And the slope of the correlation line between FFR and WSSmax may help clinicians to design treatment plans for patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Physiological assessment of coronary lesion severity: fractional flow reserve versus nonhyperaemic indices.

    Science.gov (United States)

    Robertson, Keith E; Hennigan, Barry; Berry, Colin; Oldroyd, Keith G

    2015-08-01

    Coronary angiography alone cannot accurately identify the haemodynamic impact of a coronary artery stenosis. Current international guidelines for myocardial revascularization recommend that inducible ischaemia should be demonstrated before the consideration of percutaneous coronary intervention. Invasive physiological assessment of coronary stenosis severity has increasingly been utilized for this purpose and use of the best validated technique, fractional flow reserve (FFR), has been shown to improve clinical outcomes in patients with stable and unstable coronary artery disease. This has led to the use of FFR being recommended in international revascularization guidelines, despite which, clinical uptake has been limited. One potential reason for slow adoption has been the requirement for maximal hyperaemia at the time of FFR measurement, usually achieved by the administration of pharmacological vasodilators such as adenosine. In some healthcare systems, adenosine is expensive and, in addition, its use can be associated with significant, albeit transient, adverse effects that patients (and some operators) find uncomfortable. Consequently, several methods of nonhyperaemic lesion assessment and their potential role in decision making have been reported. In this review we will review and discuss the current evidence for hyperaemic and nonhyperaemic methods of lesion assessment. We will also look at hybrid strategies that utilize both hyperaemic and nonhyperaemic methods as a means of potentially maintaining diagnostic accuracy while minimizing the requirement for adenosine administration and discuss whether or not they represent viable clinical alternatives.

  14. Fractional flow reserve in patients with intermediate values of Duke Treadmill Score and borderline coronary lesions

    Directory of Open Access Journals (Sweden)

    Simić I.

    2013-01-01

    Full Text Available Despite the wide usage of exercise ECG tests and Duke Treadmill Score (DTS in clinical practice, no comparison between this scoring system and Fractional Flow Reserve (FFR has yet been made, particularly in cases of angiographically verified borderline lesions. Thirty patients with single coronary lesions and angiographically assessed borderline stenosis (between 30-70% and previously calculated intermediate values of DTS between -10 to +4 were examined using FFR. Adequate specificity and sensitivity (0.769 and 0.556, respectively were in a more narrow range of -0.5 to -10. Sex and age did not have an influence on the DTS values. There was a correlation between the values of FFR and age (r=0.395, p=0.031 and between angiographic assessment of stenosis and quantitative coronary angiography (QCA (r=0.648, p<0.0001. In the study population, a decision on revascularization could not be based solely on angiographic or QCA assessment of the artery or on the values of DTS.

  15. SPECT myocardial perfusion versus fractional flow reserve for evaluation of functional ischemia: A meta analysis

    International Nuclear Information System (INIS)

    Zhou, Tao; Yang, Lin-feng; Zhai, Ji-liang; Li, Jiang; Wang, Qi-meng; Zhang, Rui-jie; Wang, Sen; Peng, Zhao-hui; Li, Min; Sun, Gang

    2014-01-01

    Purpose: The present meta-analysis illustrates the accuracy of myocardial perfusion SPECT (MPS) to diagnose functional stenotic coronary artery disease (CAD) with fractional flow reserve (FFR) as standard reference. Methods: All investigators screened and selected studies that compared MPS with FFR in symptomatic patients with suspected CAD. Patients and study characteristics were independently extracted by two investigators; differences were resolved by consensus. Results: 13 articles, including 1,017 patients, 699 vessels were included in the study. No significant publication bias was detected (P = 0.65). At the patient level, the summary sensitivity and specificity were 77% (95% confidence interval [CI], 70–83%) and 77% (95%CI, 67–84%) for MPS. Vessel-level pooled sensitivity was 66% (95%CI, 57–74%) and specificity was 81% (95%CI, 70–89%). The overall diagnostic performance of MPS was moderate. [The area under the summary receiver operating characteristic (sROC) curve was 0.83]. No study influenced the pooled results larger than 0.03. Conclusions: The accuracy between FFR and MPS SPECT was moderate

  16. SPECT myocardial perfusion versus fractional flow reserve for evaluation of functional ischemia: A meta analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Tao; Yang, Lin-feng [Department of Medical Imaging, Jinan Military General Hospital, No, 25, Shifan Road, Jinan, Shandong Province, China. 250031 (China); Zhai, Ji-liang [Department of Medical Imaging, The Branch of TaiAn Central Hospital, Middle of Changcheng Road, Shandong Province, China. 271000 (China); Li, Jiang [Department of Medical Imaging, Affiliated Hospital of Taishan Medical University, No, 706, Taishan Road, Shandong Province, China. 271000 (China); Wang, Qi-meng [Department of Medical Imaging, Taishan Hospital of Traditional Chinese Medicine, No, 216, Yingxuan Street, Shandong Province, China. 271000. (China); Zhang, Rui-jie; Wang, Sen; Peng, Zhao-hui [Department of Medical Imaging, Jinan Military General Hospital, No, 25, Shifan Road, Jinan, Shandong Province, China. 250031 (China); Li, Min, E-mail: liminyingxiang@163.com [Department of Medical Imaging, Jinan Military General Hospital, No, 25, Shifan Road, Jinan, Shandong Province, China. 250031 (China); Sun, Gang, E-mail: cjr.sungang@vip.163.com [Department of Medical Imaging, Jinan Military General Hospital, No, 25, Shifan Road, Jinan, Shandong Province, China. 250031 (China)

    2014-06-15

    Purpose: The present meta-analysis illustrates the accuracy of myocardial perfusion SPECT (MPS) to diagnose functional stenotic coronary artery disease (CAD) with fractional flow reserve (FFR) as standard reference. Methods: All investigators screened and selected studies that compared MPS with FFR in symptomatic patients with suspected CAD. Patients and study characteristics were independently extracted by two investigators; differences were resolved by consensus. Results: 13 articles, including 1,017 patients, 699 vessels were included in the study. No significant publication bias was detected (P = 0.65). At the patient level, the summary sensitivity and specificity were 77% (95% confidence interval [CI], 70–83%) and 77% (95%CI, 67–84%) for MPS. Vessel-level pooled sensitivity was 66% (95%CI, 57–74%) and specificity was 81% (95%CI, 70–89%). The overall diagnostic performance of MPS was moderate. [The area under the summary receiver operating characteristic (sROC) curve was 0.83]. No study influenced the pooled results larger than 0.03. Conclusions: The accuracy between FFR and MPS SPECT was moderate.

  17. The diagnostic performance of CT-derived fractional flow reserve for evaluation of myocardial ischaemia confirmed by invasive fractional flow reserve: a meta-analysis.

    Science.gov (United States)

    Li, S; Tang, X; Peng, L; Luo, Y; Dong, R; Liu, J

    2015-05-01

    To review the literature on the diagnostic accuracy of CT-derived fractional flow reserve (FFRCT) for the evaluation of myocardial ischaemia in patients with suspected or known coronary artery disease, with invasive fractional flow reserve (FFR) as the reference standard. A PubMed, EMBASE, and Cochrane cross-search was performed. The pooled diagnostic accuracy of FFRCT, with FFR as the reference standard, was primarily analysed, and then compared with that of CT angiography (CTA). The thresholds to diagnose ischaemia were FFR ≤0.80 or CTA ≥50% stenosis. Data extraction, synthesis, and statistical analysis were performed by standard meta-analysis methods. Three multicentre studies (NXT Trial, DISCOVER-FLOW study and DeFACTO study) were included, examining 609 patients and 1050 vessels. The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) for FFRCT were 89% (85-93%), 71% (65-75%), 70% (65-75%), 90% (85-93%), 3.31 (1.79-6.14), 0.16 (0.11-0.23), and 21.21 (9.15-49.15) at the patient-level, and 83% (78-63%), 78% (75-81%), 61% (56-65%), 92% (89-90%), 4.02 (1.84-8.80), 0.22 (0.13-0.35), and 19.15 (5.73-63.93) at the vessel-level. At per-patient analysis, FFRCT has similar sensitivity but improved specificity, PPV, NPV, LR+, LR-, and DOR versus those of CTA. At per-vessel analysis, FFRCT had a slightly lower sensitivity, similar NPV, but improved specificity, PPV, LR+, LR-, and DOR compared with those of CTA. The area under the summary receiver operating characteristic curves for FFRCT was 0.8909 at patient-level and 0.8865 at vessel-level, versus 0.7402 for CTA at patient-level. FFRCT, which was associated with improved diagnostic accuracy versus CTA, is a viable alternative to FFR for detecting coronary ischaemic lesions. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  18. Computed tomography myocardial perfusion vs {sup 15}O-water positron emission tomography and fractional flow reserve

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Michelle C.; Dweck, Marc R.; Golay, Saroj K. [University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh (United Kingdom); Mirsadraee, Saeed; Weir, Nicholas W.; Fletcher, Alison; Lucatelli, Christophe; Reid, John H. [University of Edinburgh, Clinical Research Imaging Centre, Edinburgh (United Kingdom); MacGillivray, Tom; Van Beek, Edwin J.R.; Newby, David E. [University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh (United Kingdom); University of Edinburgh, Clinical Research Imaging Centre, Edinburgh (United Kingdom); Cruden, Nicholas L.; Henriksen, Peter A.; Uren, Neal [Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom); McKillop, Graham; Patel, Dilip [Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom); Lima, Joao A.C. [Johns Hopkins Hospital, Departments of Medicine and Radiology, Baltimore, MD (United States)

    2017-03-15

    Computed tomography (CT) can perform comprehensive cardiac imaging. We compared CT coronary angiography (CTCA) and CT myocardial perfusion (CTP) with {sup 15}O-water positron emission tomography (PET) and invasive coronary angiography (ICA) with fractional flow reserve (FFR). 51 patients (63 (61-65) years, 80 % male) with known/suspected coronary artery disease (CAD) underwent 320-multidetector CTCA followed by ''snapshot'' adenosine stress CTP. Of these 22 underwent PET and 47 ICA/FFR. Obstructive CAD was defined as CTCA stenosis >50 % and CTP hypoperfusion, ICA stenosis >70 % or FFR <0.80. PET hyperaemic myocardial blood flow (MBF) was lower in obstructive than non-obstructive territories defined by ICA/FFR (1.76 (1.32-2.20) vs 3.11 (2.44-3.79) mL/(g/min), P < 0.001) and CTCA/CTP (1.76 (1.32-2.20) vs 3.12 (2.44-3.79) mL/(g/min), P < 0.001). Baseline and hyperaemic CT attenuation density was lower in obstructive than non-obstructive territories (73 (71-76) vs 86 (84-88) HU, P < 0.001 and 101 (96-106) vs 111 (107-114) HU, P 0.001). PET hyperaemic MBF corrected for rate pressure product correlated with CT attenuation density (r = 0.579, P < 0.001). There was excellent per-patient sensitivity (96 %), specificity (85 %), negative predictive value (90 %) and positive predictive value (94 %) for CTCA/CTP vs ICA/FFR. CT myocardial attenuation density correlates with {sup 15}O-water PET MBF. CTCA and CTP can accurately identify obstructive CAD. (orig.)

  19. Correlation between thallium-201 myocardial perfusion defects and the functional severity of coronary artery stenosis as assessed by pressure-derived myocardial fractional flow reserve

    International Nuclear Information System (INIS)

    Yanagisawa, Hidefumi; Chikamori, Taishiro; Tanaka, Nobuhiro

    2002-01-01

    Although a relationship between the coronary pressure-derived fractional flow reserve (FFR) and the presence of myocardial ischemia as demonstrated by radionuclide imaging has been reported in a select group of patients, it remains to be established whether this relation also holds true in actual clinical settings with a heterogeneous group of patients. Accordingly, 194 coronary vessels and their supply territories were evaluated in 165 consecutive patients with suspected or known coronary artery disease. An FFR 201 Tl (p 201 Tl reversibility score (r=-0.62; p<0.0001). These results suggest that the FFR has a significant relationship with scintigraphic evidence of myocardial ischemia and can be regarded as a marker of its presence or absence in patients in actual clinical settings. (author)

  20. Identification of the State of Maximal Hyperemia in the Assessment of Coronary Fractional Flow Reserve Using Non-Invasive Electrical Velocimetry.

    Science.gov (United States)

    Murasawa, Takahide; Takahashi, Masao; Myojo, Masahiro; Kiyosue, Arihiro; Oguri, Atsushi; Ando, Jiro; Komuro, Issei

    2017-05-31

    Previous research revealed that, in patients with coronary pressure-derived fractional flow reserve (FFR) in the 'grey zone' (0.75-0.85), repeated FFR assessments sometimes yield conflicting results. One of the causes of the fluctuations in FFR values around the grey zone may be imprecise identification of the point where maximal hyperemia is achieved. Identification of the state of maximal hyperemia during assessment of FFR can be challenging. This study aimed to determine whether non-invasive electrical velocimetry (EV) can be used to identify the state of maximal hyperemia.Stroke volume (SV), SV variation (SVV), and systemic vascular resistance index (SVRI) were determined by EV in 15 patients who underwent FFR assessment. Time intervals from initiation of adenosine infusion to achieving maximal hyperemia (time mFRR ), as well as to achieving maximal cardiac output (CO), SV, SVV, and SVRI (time mCO , time mSV , time mSVV , and time mSVRI , respectively), were determined. Time mCO and time mSVV were closer to time mFRR than other values (time mSVV /time mFRR versus time mSVRI /time mFRR = 1.03 ± 0.2 versus 1.36 ± 0.4, P state of maximal hyperemia.

  1. Diagnostic value of thallium-201 myocardial perfusion IQ-SPECT without and with computed tomography-based attenuation correction to predict clinically significant and insignificant fractional flow reserve

    Science.gov (United States)

    Tanaka, Haruki; Takahashi, Teruyuki; Ohashi, Norihiko; Tanaka, Koichi; Okada, Takenori; Kihara, Yasuki

    2017-01-01

    Abstract The aim of this study was to clarify the predictive value of fractional flow reserve (FFR) determined by myocardial perfusion imaging (MPI) using thallium (Tl)-201 IQ-SPECT without and with computed tomography-based attenuation correction (CT-AC) for patients with stable coronary artery disease (CAD). We assessed 212 angiographically identified diseased vessels using adenosine-stress Tl-201 MPI-IQ-SPECT/CT in 84 consecutive, prospectively identified patients with stable CAD. We compared the FFR in 136 of the 212 diseased vessels using visual semiquantitative interpretations of corresponding territories on MPI-IQ-SPECT images without and with CT-AC. FFR inversely correlated most accurately with regional summed difference scores (rSDS) in images without and with CT-AC (r = −0.584 and r = −0.568, respectively, both P system can predict FFR at an optimal cut-off of <0.80, and we propose a novel application of CT-AC to MPI-IQ-SPECT for predicting clinically significant and insignificant FFR even in nonobese patients. PMID:29390486

  2. An Improved FFR Design with a Ventilation Fan: CFD Simulation and Validation.

    Science.gov (United States)

    Zhang, Xiaotie; Li, Hui; Shen, Shengnan; Rao, Yu; Chen, Feng

    2016-01-01

    This article presents an improved Filtering Facepiece Respirator (FFR) designed to increase the comfort of wearers during low-moderate work. The improved FFR aims to lower the deadspace temperature and CO2 level by an active ventilation fan. The reversing modeling is used to build the 3D geometric model of this FFR; the Computational Fluid Dynamics (CFD) simulation is then introduced to investigate the flow field. Based on the simulation result, the ventilation fan of the improved FFR can fit the flow field well when placed in the proper blowing orientation; streamlines from this fan show a cup-shape distribution and are perfectly matched to the shape of the FFR and human face when the fan blowing inward. In the deadspace of the improved FFR, the CO2 volume fraction is controlled by the optimized flow field. In addition, an experimental prototype of the improved FFR has been tested to validate the simulation. A wireless temperature sensor is used to detect the temperature variation inside the prototype FFR, deadspace temperature is lowered by 2 K compared to the normal FFR without a fan. An infrared camera (IRC) method is used to elucidate the temperature distribution on the prototype FFR's outside surface and the wearer's face, surface temperature is lowered notably. Both inside and outside temperature results from the simulation are in agreement with experimental results. Therefore, adding an inward-blowing fan on the outer surface of an N95 FFR is a feasible approach to reducing the deadspace CO2 concentration and improve temperature comfort.

  3. When should fractional flow reserve be performed to assess the significance of borderline coronary artery lesions: Derivation of a simplified scoring system.

    Science.gov (United States)

    Matar, Fadi A; Falasiri, Shayan; Glover, Charles B; Khaliq, Asma; Leung, Calvin C; Mroue, Jad; Ebra, George

    2016-11-01

    To derive a simplified scoring system (SSS) that can assist in selecting patients who would benefit from the application of fractional flow reserve (FFR). Angiographers base decisions to perform FFR on their interpretation of % diameter stenosis (DS), which is subject to variability. Recent studies have shown that the amount of myocardium at jeopardy is an important factor in determining the degree of hemodynamic compromise. We conducted a retrospective multivariable analysis to identify independent predictors of hemodynamic compromise in 289 patients with 317 coronary vessels undergoing FFR. A SSS was derived using the odds ratios as a weighted factor. The receiver operator characteristics curve was used to identify the optimal cutoff (≥3) to discern a functionally significant lesion (FFR≤0.8). Male gender, left anterior descending artery apical wrap, disease proximal to lesion, minimal lumen diameter and % DS predicted abnormal FFR (≤0.8) and lesion location in the left circumflex predicted a normal FFR. Using a cutoff score of ≥3 on the SSS, a specificity of 90.4% (95% CI: 83.0-95.3) and a sensitivity of 38.0% (95% CI: 31.5-44.9) was generated with a positive predictive value of 89.0% (95% CI: 80.7%-94.6%) and negative predictive value of 41.6% (95% CI: 35.1%-48.3%). The decision to use FFR should be based not only on the % DS but also the size of the myocardial mass jeopardized. A score of ≥3 on the SSS should prompt further investigation with a pressure wire. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Instantaneous wave-free ratio as an alternative to fractional flow reserve in assessment of moderate coronary stenoses: A meta-analysis of diagnostic accuracy studies.

    Science.gov (United States)

    Maini, Rohit; Moscona, John; Katigbak, Paul; Fernandez, Camilo; Sidhu, Gursukhmandeep; Saleh, Qusai; Irimpen, Anand; Samson, Rohan; LeJemtel, Thierry

    2017-12-27

    Fractional flow reserve (FFR) remains underutilized due to practical concerns related to the need for hyperemic agents. These concerns have prompted the study of instantaneous wave-free ratio (iFR), a vasodilator-free index of coronary stenosis. Non-inferior cardiovascular outcomes have been demonstrated in two recent randomized clinic trials. We performed this meta-analysis to provide a necessary update of the diagnostic accuracy of iFR referenced to FFR based on the addition of eight more recent studies and 3727 more lesions. We searched the PubMed, EMBASE, Central, ProQuest, and Web of Science databases for full text articles published through May 31, 2017 to identify studies addressing the diagnostic accuracy of iFR referenced to FFR≤0.80. The following keywords were used: "instantaneous wave-free ratio" OR "iFR" AND "fractional flow reserve" OR "FFR." In total, 16 studies comprising 5756 lesions were identified. Pooled diagnostic accuracy estimates of iFR versus FFR≤0.80 were: sensitivity, 0.78 (95% CI, 0.76-0.79); specificity, 0.83 (0.81-0.84); positive likelihood ratio, 4.54 (3.85-5.35); negative likelihood ratio, 0.28 (0.24-0.32); diagnostic odds ratio, 17.38 (14.16-21.34); area under the summary receiver-operating characteristic curve, 0.87; and an overall diagnostic accuracy of 0.81 (0.78-0.84). In conclusion, iFR showed excellent agreement with FFR as a resting index of coronary stenosis severity without the undesired effects and cost of hyperemic agents. When considering along with its clinical outcome data and ease of application, the diagnostic accuracy of iFR supports its use as a suitable alternative to FFR for physiology-guided revascularization of moderate coronary stenoses. We performed a meta-analysis of the diagnostic accuracy of iFR referenced to FFR. iFR showed excellent agreement with FFR as a resting index of coronary stenosis severity without the undesired effects and cost of hyperemic agents. This supports its use as a suitable

  5. Comparing treatment outcomes of fractional flow reserve-guided and angiography-guided percutaneous coronary intervention in patients with multi-vessel coronary artery diseases: a systematic review and meta-analysis.

    Science.gov (United States)

    Xiu, Jiancheng; Chen, Gangbin; Zheng, Hua; Wang, Yuegang; Chen, Haibin; Liu, Xuewei; Wu, Juefei; Bin, Jianping

    2016-02-01

    Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is used to assess the need for angioplasty in vessels with intermediate blockages. The treatment outcomes of FFR-guided vs. conventional angiography-guided PCI were evaluated in patients with multi-vessel coronary artery disease (CAD). Prospective and retrospective studies comparing FFR-guided vs. angiography-guided PCI in patients with multi-vessel CAD were identified from medical databases by two independent reviewers using the terms "percutaneous coronary intervention, fractional flow reserve, angiography, coronary heart disease, major adverse cardiac events (MACE) and myocardial infarction". The primary outcome was the number of stents placed, and the secondary outcomes were procedure time, mortality, myocardial infarction (MI) and MACE rates. Seven studies (three retrospective and four prospective), which included 49,517 patients, were included in this review. A total of 4,755 patients underwent FFR, while 44,697 received angiography-guided PCI. The mean patient age ranged from 58 to 71.7 years. The average number of stents used in FFR patients ranged from 0.3-1.9, and in angiography-guided PCI patients ranged from 0.7-2.7. Analysis indicated there was a greater number of stents placed in the angiography-guided group compared with the FFR group (pooled difference in means: -0.64, 95% confidence interval [CI]: -0.81 to -0.47, P < 0.001). There were no differences in the secondary outcomes between the two groups. Both procedures produce similar clinical outcomes, but the fewer number of stents used with FFR may have clinical as was as cost implications.

  6. TU-G-204-01: BEST IN PHYSICS (IMAGING): Dynamic CT Myocardial Perfusion Measurement and Its Comparison to Fractional Flow Reserve

    Energy Technology Data Exchange (ETDEWEB)

    Ziemer, B; Hubbard, L; Groves, E; Sadeghi, B; Javan, H; Lipinski, J; Molloi, S [University of California, Irvine, CA (United States)

    2015-06-15

    Purpose: To evaluate a first pass analysis (FPA) technique for CT perfusion measurement in a swine animal and its validation using fractional flow reserve (FFR) as a reference standard. Methods: Swine were placed under anesthesia and relevant physiologic parameters were continuously recorded. Intra-coronary adenosine was administered to induce maximum hyperemia. A pressure wire was advanced distal to the first diagonal branch of the left anterior descending (LAD) artery for FFR measurements and a balloon dilation catheter was inserted over the pressure wire into the proximal LAD to create varying levels of stenosis. Images were acquired with a 320-row wide volume CT scanner. Three main coronary perfusion beds were delineated in the myocardium using arteries extracted from CT angiography images using a minimum energy hypothesis. The integrated density in the perfusion bed was used to calculate perfusion using the FPA technique. The perfusion in the LAD bed over a range of stenosis severity was measured. The measured fractional perfusion was compared to FFR and linear regression was performed. Results: The measured fractional perfusion using the FPA technique (P-FPA) and FFR were related as P-FPA = 1.06FFR – 0.06 (r{sup 2} = 0.86). The perfusion measurements were calculated with only three to five total CT volume scans, which drastically reduces the radiation dose as compared with the existing techniques requiring 15–20 volume scans. Conclusion: The measured perfusion using the first pass analysis technique showed good correlation with FFR measurements as a reference standard. The technique for perfusion measurement can potentially make a substantial reduction in radiation dose as compared with the existing techniques.

  7. TU-G-204-01: BEST IN PHYSICS (IMAGING): Dynamic CT Myocardial Perfusion Measurement and Its Comparison to Fractional Flow Reserve

    International Nuclear Information System (INIS)

    Ziemer, B; Hubbard, L; Groves, E; Sadeghi, B; Javan, H; Lipinski, J; Molloi, S

    2015-01-01

    Purpose: To evaluate a first pass analysis (FPA) technique for CT perfusion measurement in a swine animal and its validation using fractional flow reserve (FFR) as a reference standard. Methods: Swine were placed under anesthesia and relevant physiologic parameters were continuously recorded. Intra-coronary adenosine was administered to induce maximum hyperemia. A pressure wire was advanced distal to the first diagonal branch of the left anterior descending (LAD) artery for FFR measurements and a balloon dilation catheter was inserted over the pressure wire into the proximal LAD to create varying levels of stenosis. Images were acquired with a 320-row wide volume CT scanner. Three main coronary perfusion beds were delineated in the myocardium using arteries extracted from CT angiography images using a minimum energy hypothesis. The integrated density in the perfusion bed was used to calculate perfusion using the FPA technique. The perfusion in the LAD bed over a range of stenosis severity was measured. The measured fractional perfusion was compared to FFR and linear regression was performed. Results: The measured fractional perfusion using the FPA technique (P-FPA) and FFR were related as P-FPA = 1.06FFR – 0.06 (r 2 = 0.86). The perfusion measurements were calculated with only three to five total CT volume scans, which drastically reduces the radiation dose as compared with the existing techniques requiring 15–20 volume scans. Conclusion: The measured perfusion using the first pass analysis technique showed good correlation with FFR measurements as a reference standard. The technique for perfusion measurement can potentially make a substantial reduction in radiation dose as compared with the existing techniques

  8. Transient integral boundary layer method to calculate the translesional pressure drop and the fractional flow reserve in myocardial bridges

    Directory of Open Access Journals (Sweden)

    Möhlenkamp Stefan

    2006-06-01

    Full Text Available Abstract Background The pressure drop – flow relations in myocardial bridges and the assessment of vascular heart disease via fractional flow reserve (FFR have motivated many researchers the last decades. The aim of this study is to simulate several clinical conditions present in myocardial bridges to determine the flow reserve and consequently the clinical relevance of the disease. From a fluid mechanical point of view the pathophysiological situation in myocardial bridges involves fluid flow in a time dependent flow geometry, caused by contracting cardiac muscles overlying an intramural segment of the coronary artery. These flows mostly involve flow separation and secondary motions, which are difficult to calculate and analyse. Methods Because a three dimensional simulation of the haemodynamic conditions in myocardial bridges in a network of coronary arteries is time-consuming, we present a boundary layer model for the calculation of the pressure drop and flow separation. The approach is based on the assumption that the flow can be sufficiently well described by the interaction of an inviscid core and a viscous boundary layer. Under the assumption that the idealised flow through a constriction is given by near-equilibrium velocity profiles of the Falkner-Skan-Cooke (FSC family, the evolution of the boundary layer is obtained by the simultaneous solution of the Falkner-Skan equation and the transient von-Kármán integral momentum equation. Results The model was used to investigate the relative importance of several physical parameters present in myocardial bridges. Results have been obtained for steady and unsteady flow through vessels with 0 – 85% diameter stenosis. We compare two clinical relevant cases of a myocardial bridge in the middle segment of the left anterior descending coronary artery (LAD. The pressure derived FFR of fixed and dynamic lesions has shown that the flow is less affected in the dynamic case, because the distal

  9. Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting (PREFER study).

    Science.gov (United States)

    Kądziela, Jacek; Januszewicz, Andrzej; Prejbisz, Aleksander; Michałowska, Ilona; Januszewicz, Magdalena; Florczak, Elżbieta; Kalińczuk, Łukasz; Norwa-Otto, Bożena; Warchoł, Ewa; Witkowski, Adam

    2013-01-01

    The aim of our study was to determine a potential relationship between resting translesional pressures ratio (Pd/Pa ratio), renal fractional flow reserve (rFFR) and blood pressure response after renal artery stenting. Thirty five hypertensive patients (49% males, mean age 64 years) with at least 60% stenosis in angiography, underwent renal artery stenting. Translesional systolic pressure gradient (TSPG), Pd/Pa ratio (the ratio of mean distal to lesion and mean proximal pressures) and hyperemic rFFR - after intrarenal administration of papaverine - were measured before stent implantation. Ambulatory blood pressure measurements (ABPM) were recorded before the procedure and after 6 months. The ABPM results were presented as blood pressure changes in subgroups of patients with normal (≥ 0.9) vs. abnormal (renal artery stenting. Median changes of 24-h systolic/diastolic blood pressure were comparable in patients with abnormal vs. normal Pd/Pa ratio (-4/-3 vs. 0/2 mm Hg; p = NS) and with abnormal vs. normal rFFR (-2/-1 vs. -2/-0.5 mm Hg, respectively). Physiological assessment of renal artery stenosis using Pd/Pa ratio and papaverine- induced renal fractional fl ow reserve did not predict hypertension response after renal artery stenting.

  10. Fast virtual functional assessment of intermediate coronary lesions using routine angiographic data and blood flow simulation in humans: comparison with pressure wire - fractional flow reserve.

    Science.gov (United States)

    Papafaklis, Michail I; Muramatsu, Takashi; Ishibashi, Yuki; Lakkas, Lampros S; Nakatani, Shimpei; Bourantas, Christos V; Ligthart, Jurgen; Onuma, Yoshinobu; Echavarria-Pinto, Mauro; Tsirka, Georgia; Kotsia, Anna; Nikas, Dimitrios N; Mogabgab, Owen; van Geuns, Robert-Jan; Naka, Katerina K; Fotiadis, Dimitrios I; Brilakis, Emmanouil S; Garcia-Garcia, Héctor M; Escaned, Javier; Zijlstra, Felix; Michalis, Lampros K; Serruys, Patrick W

    2014-09-01

    To develop a simplified approach of virtual functional assessment of coronary stenosis from routine angiographic data and test it against fractional flow reserve using a pressure wire (wire-FFR). Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by wire-FFR (reference standard: ≤0.80). The 3D-QCA models were processed with computational fluid dynamics (CFD) to calculate the lesion-specific pressure gradient (ΔP) and construct the ΔP-flow curve, from which the virtual functional assessment index (vFAI) was derived. The discriminatory power of vFAI for ischaemia- producing lesions was high (area under the receiver operator characteristic curve [AUC]: 92% [95% CI: 86-96%]). Diagnostic accuracy, sensitivity and specificity for the optimal vFAI cut-point (≤0.82) were 88%, 90% and 86%, respectively. Virtual-FAI demonstrated superior discrimination against 3D-QCA-derived % area stenosis (AUC: 78% [95% CI: 70- 84%]; p<0.0001 compared to vFAI). There was a close correlation (r=0.78, p<0.0001) and agreement of vFAI compared to wire-FFR (mean difference: -0.0039±0.085, p=0.59). We developed a fast and simple CFD-powered virtual haemodynamic assessment model using only routine angiography and without requiring any invasive physiology measurements/hyperaemia induction. Virtual-FAI showed a high diagnostic performance and incremental value to QCA for predicting wire-FFR; this "less invasive" approach could have important implications for patient management and cost.

  11. Diagnostic performance of a novel cadmium-zinc-telluride gamma camera system assessed using fractional flow reserve.

    Science.gov (United States)

    Tanaka, Hirokazu; Chikamori, Taishiro; Tanaka, Nobuhiro; Hida, Satoshi; Igarashi, Yuko; Yamashita, Jun; Ogawa, Masashi; Shiba, Chie; Usui, Yasuhiro; Yamashina, Akira

    2014-01-01

    Although the novel cadmium-zinc-telluride (CZT) camera system provides excellent image quality, its diagnostic value using thallium-201 as assessed on coronary angiography (CAG) and fractional flow reserve (FFR) has not been validated. METHODS AND RESULTS: To evaluate the diagnostic accuracy of the CZT ultrafast camera system (Discovery NM 530c), 95 patients underwent stress thallium-201 single-photon emission computed tomography (SPECT) and then CAG within 3 months. Image acquisition was performed in the supine and prone positions after stress for 5 and 3 min, respectively, and in the supine position at rest for 10 min. Significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or a lesion with <90% and ≥50% stenosis and FFR ≤0.75. To detect individual coronary stenosis, the respective sensitivity, specificity, and accuracy were 90%, 64%, and 78% for left anterior descending coronary artery stenosis, 78%, 84%, and 81% for left circumflex stenosis, and 83%, 47%, and 60% for right coronary artery (RCA) stenosis. The combination of prone and supine imaging had a higher specificity for RCA disease than supine imaging alone (65% vs. 47%), with an improvement in accuracy from 60% to 72%. Using thallium-201 with short acquisition time, combined with prone imaging, CZT SPECT had a high diagnostic yield in detecting significant coronary stenosis as assessed using FFR.

  12. Transthoracic ultrasonic tissue indices identify patients with severe left anterior descending artery stenosis. Correlation with fractional flow reserve. Pilot study.

    Science.gov (United States)

    Dobrowolski, Piotr; Kowalski, Mirosław; Rybicka, Justyna; Lech, Agnieszka; Tyczyński, Paweł; Witkowski, Adam; Hoffman, Piotr

    2016-01-01

    The aim of this study was to evaluate the potential clinical application of ultrasonic tissue indices, with a focus on systolic strain (SS) and systolic strain rate (SSR) parameters derived from transthoracic echocardiography, in the assessment of left anterior descending artery (LAD) stenosis. The data of 30 patients with significant LAD stenosis were analysed. All patients underwent transthoracic echocardiography to obtain systolic myocardial velocity (Sm), longitudinal SS, and SSR from basal, mid, and apical segments of anterior and inferior walls in two-chamber apical view. Severity of LAD obstruction was measured by means of fractional flow reserve (FFR) during coronary catheterisation. Systolic velocities, strain, and strain rate measured in basal, middle, and apical segments of the anterior left ventricular (LV) wall were lower when compared to those obtained from the corresponding, i.e. unaffected, inferior LV wall. There was a significant correlation between FFR and the value of SS, SSR characterising the apical LV segment of the anterior wall (r = -0.583, p = 0.01; r = -0.598, p = 0.01, respectively). Moreover, we found significant correlation between FFR and Sm in the mid-segment of the LV anterior wall (r = 0.611, p = 0.009). We conclude that SS and SSR obtained from the apical segment of the anterior LV wall may be related to the severity of LAD stenosis.

  13. Functional assessment of sequential coronary artery fistula and coronary artery stenosis with fractional flow reserve and stress adenosine myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Kuan Leong Yew

    2015-10-01

    Full Text Available Coronary artery fistula is an abnormal connection between one coronary artery to another coronary artery or cardiac chambers. The coronary artery fistula may cause significant shunting of blood and cause “pseudo-stenosis” or “steal phenomenon”. This will also accentuate pre-existing mild-moderate de novo coronary lesions with resultant greater pressure gradient difference across the lesions. Thus, fractional flow reserve can be a useful tool to guide intervention decision on the coronary artery fistula. There are very few published reports regarding the use of FFR to assess coronary artery fistula. In fact, there is no outcome data regarding the deferment of coronary artery fistula intervention when the FFR is not physiologically significant. This case highlighted the use of FFR to evaluate the functional significance of coronary fistula in the setting of ischemia evaluation and it was proven to be safe to defer intervention with good 3 year clinical outcome. Stress adenosine myocardial perfusion imaging correlated with the FFR result.

  14. Diagnostic Performance of a Cadmium-Zinc-Telluride Single-Photon Emission Computed Tomography System With Low-Dose Technetium-99m as Assessed by Fractional Flow Reserve.

    Science.gov (United States)

    Chikamori, Taishiro; Hida, Satoshi; Tanaka, Nobuhiro; Igarashi, Yuko; Yamashita, Jun; Shiba, Chie; Murata, Naotaka; Hoshino, Kou; Hokama, Yohei; Yamashina, Akira

    2016-04-25

    Although stress single-photon emission computed tomography (SPECT) using a cadmium-zinc-telluride (CZT) camera facilitates radiation dose reduction, only a few studies have evaluated its diagnostic accuracy in Japanese patients by applying fractional flow reserve (FFR) measurements. We prospectively evaluated 102 consecutive patients with suspected or known coronary artery disease with a low-dose stress/rest protocol ((99m)Tc radiotracer 185/370 MBq) using CZT SPECT. Within 3 months, coronary angiography was performed and a significant stenosis was defined as ≥90% diameter narrowing on visual estimation, or as a lesion of <90% and ≥ 50% stenosis with FFR ≤0.80. To detect individual coronary stenosis, the respective sensitivity, specificity, and accuracy were 86%, 75%, and 82% for left anterior descending artery stenosis, 76%, 81%, and 79% for left circumflex artery stenosis, and 87%, 92%, and 90% for right coronary artery stenosis. When limited to 92 intermediate stenotic lesions in which FFR was measured, stress SPECT showed 77% sensitivity, 91% specificity, and 84% accuracy, whereas the diagnostic value decreased to 52% sensitivity, 68% specificity, and 58% accuracy based only on visual estimation of ≥75% diameter narrowing. CZT SPECT demonstrated a good diagnostic yield in detecting hemodynamically significant coronary stenoses as assessed by FFR, even when using a low-dose (99m)Tc protocol with an effective dose ≤5 mSv. (Circ J 2016; 80: 1217-1224).

  15. Resting multilayer 2D speckle-tracking TTE for detection of ischemic segments confirmed by invasive FFR part-2, using post-systolic-strain-index and time from aortic-valve-closure to regional peak longitudinal-strain.

    Science.gov (United States)

    Ozawa, Koya; Funabashi, Nobusada; Nishi, Takeshi; Takahara, Masayuki; Fujimoto, Yoshihide; Kamata, Tomoko; Kobayashi, Yoshio

    2016-08-15

    This study evaluated the post-systolic strain index (PSI), and the time interval between aortic valve closure (AVC) and regional peak longitudinal strain (PLS), measured by transthoracic echocardiography (TTE), for detection of left ventricular (LV) myocardial ischemic segments confirmed by invasive fractional flow reserve (FFR). 39 stable patients (32 males; 65.8±11.9years) with 46 coronary arteries at ≥50% stenosis on invasive coronary angiography underwent 2D speckle tracking TTE (Vivid E9, GE Healthcare) and invasive FFR measurements. PSI, AVC and regional PLS in each LV segment were calculated. FFR ≤0.80 was detected in 27 LV segments. There were no significant differences between segments supplied by FFR ≤0.80 and FFR >0.80 vessels in either PSI or the time interval between AVC and regional PLS. To identify LV segments±FFR ≤0.80, the receiver operator characteristic (ROC) curves for PSI, and the time interval between AVC and regional PLS had areas under the curve (AUC) values of 0.58 and 0.57, respectively, with best cut-off points of 12% (sensitivity 70.4%, specificity 57.9%) and 88ms (sensitivity 70.4%, specificity 52.6%), respectively, but the AUCs were not statistically significant. In stable coronary artery disease patients with ≥50% coronary artery stenosis, measurement of PSI, and the time interval between AVC and regional PLS, on resting TTE, enabled the identification of LV segments with FFR ≤0.80 using each appropriate threshold for PSI, and the time interval between AVC and regional PLS, with reasonable diagnostic accuracy. However, the AUC values were not statistically significant. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. 320-row CT coronary angiography predicts freedom from revascularisation and acts as a gatekeeper to defer invasive angiography in stable coronary artery disease: a fractional flow reserve-correlated study

    International Nuclear Information System (INIS)

    Ko, Brian S.; Wong, Dennis T.L.; Cameron, James D.; Leung, Michael; Meredith, Ian T.; Nerlekar, Nitesh; Antonis, Paul; Harper, Richard; Malaiapan, Yuvaraj; Seneviratne, Sujith K.; Leong, Darryl P.; Crossett, Marcus; Troupis, John

    2014-01-01

    To determine the accuracy of 320-row multidetector coronary computed tomography angiography (M320-CCTA) to detect functional stenoses using fractional flow reserve (FFR) as the reference standard and to predict revascularisation in stable coronary artery disease. One hundred and fifteen patients (230 vessels) underwent M320-CCTA and FFR assessment and were followed for 18 months. Diameter stenosis on invasive angiography (ICA) and M320-CCTA were assessed by consensus by two observers and significant stenosis was defined as ≥50 %. FFR ≤0.8 indicated functionally significant stenoses. M320-CCTA had 94 % sensitivity and 94 % negative predictive value (NPV) for FFR ≤0.8. Overall accuracy was 70 %, specificity 54 % and positive predictive value 65 %. On receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) for CCTA to predict FFR ≤0.8 was 0.74 which was comparable with ICA. The absence of a significant stenosis on M320-CCTA was associated with a 6 % revascularisation rate. M320-CCTA predicted revascularisation with an AUC of 0.71 which was comparable with ICA. M320-CCTA has excellent sensitivity and NPV for functional stenoses and therefore may act as an effective gatekeeper to defer ICA and revascularisation. Like ICA, M320-CCTA lacks specificity for functional stenoses and only has moderate accuracy to predict the need for revascularisation. (orig.)

  17. Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.

    Science.gov (United States)

    Siebert, Uwe; Arvandi, Marjan; Gothe, Raffaella M; Bornschein, Bernhard; Eccleston, David; Walters, Darren L; Rankin, James; De Bruyne, Bernard; Fearon, William F; Pijls, Nico H; Harper, Richard

    2014-06-01

    The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system. Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  18. Clinical and angiographic predictors of haemodynamically significant angiographic lesions: development and validation of a risk score to predict positive fractional flow reserve.

    Science.gov (United States)

    Sareen, Nishtha; Baber, Usman; Kezbor, Safwan; Sayseng, Sonny; Aquino, Melissa; Mehran, Roxana; Sweeny, Joseph; Barman, Nitin; Kini, Annapoorna; Sharma, Samin K

    2017-04-07

    Coronary revascularisation based upon physiological evaluation of lesions improves clinical outcomes. Angiographic or visual stenosis assessment alone is insufficient in predicting haemodynamic stenosis severity by fractional flow reserve (FFR) and therefore cannot be used to guide revascularisation, particularly in the lesion subset system formulated. Of 1,023 consecutive lesions (883 patients), 314 (31%) were haemodynamically significant. Characteristics associated with FFR ≤0.8 include male gender, higher SYNTAX score, lesions ≥20 mm, stenosis >50%, bifurcation, calcification, absence of tortuosity and smaller reference diameter. A user-friendly integer score was developed with the five variables demonstrating the strongest association. On prospective validation (in 279 distinct lesions), the increasing value of the score correlated well with increasing haemodynamic significance (C-statistic 0.85). We identified several clinical and angiographic characteristics and formulated a scoring system to guide the approach to intermediate lesions. This may translate into cost savings. Larger studies with prospective validation are required to confirm our results.

  19. First validation of myocardial flow reserve assessed by dynamic 99mTc-sestamibi CZT-SPECT camera: head to head comparison with 15O-water PET and fractional flow reserve in patients with suspected coronary artery disease. The WATERDAY study.

    Science.gov (United States)

    Agostini, Denis; Roule, Vincent; Nganoa, Catherine; Roth, Nathaniel; Baavour, Raphael; Parienti, Jean-Jacques; Beygui, Farzin; Manrique, Alain

    2018-07-01

    We assessed the feasibility of myocardial blood flow (MBF) and flow reserve (MFR) estimation using dynamic SPECT with a novel CZT camera in patients with stable CAD, in comparison with 15 O-water PET and fractional flow reserve (FFR). Thirty patients were prospectively included and underwent FFR measurements in the main coronary arteries (LAD, LCx, RCA). A stenosis ≥50% was considered obstructive and a FFR abnormal if ≤0.8. All patients underwent a dynamic rest/stress 99m Tc-sestamibi CZT-SPECT and 15 O-water PET for MBF and MFR calculation. Net retention kinetic modeling was applied to SPECT data to estimate global uptake values, and MBF was derived using Leppo correction. Ischemia by PET and CZT-SPECT was considered present if MFR was lower than 2 and 2.1, respectively. CZT-SPECT yielded higher stress and rest MBF compared to PET for global and LAD and LCx territories, but not in RCA territory. MFR was similar in global and each vessel territory for both modalities. The sensitivity, specificity, accuracy, positive and negative predictive value of CZT-SPECT were, respectively, 83.3, 95.8, 93.3, 100 and 85.7% for the detection of ischemia and 58.3, 84.6, 81.1, 36.8 and 93% for the detection of hemodynamically significant stenosis (FFR ≤ 0.8). Dynamic 99m Tc-sestamibi CZT-SPECT was technically feasible and provided similar MFR compared to 15 O-water PET and high diagnostic value for detecting impaired MFR and abnormal FFR in patients with stable CAD.

  20. The impact of coronary chronic total occlusion percutaneous coronary intervention upon donor vessel fractional flow reserve and instantaneous wave-free ratio: Implications for physiology-guided PCI in patients with CTO.

    Science.gov (United States)

    Mohdnazri, Shah R; Karamasis, Grigoris V; Al-Janabi, Firas; Cook, Christopher M; Hampton-Till, James; Zhang, Jufen; Al-Lamee, Rasha; Dungu, Jason N; Gedela, Swamy; Tang, Kare H; Kelly, Paul A; Davies, Justin E; Davies, John R; Keeble, Thomas R

    2018-03-22

    To investigate the immediate and short term impact of right coronary artery (RCA) chronic total coronary occlusion (CTO) percutaneous coronary intervention (PCI) upon collateral donor vessel fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). CTO PCI influences collateral donor vessel physiology, making the indication and/or timing of donor vessel revascularization difficult to determine. In patients with RCA CTO, FFR, iFR, and collateral function index (FFR coll ) were measured in LAD and LCx pre-CTO PCI, immediately post and at 4 month follow-up. 34 patients underwent successful PCI. In the predominant donor vessel immediately post PCI, FFR, and FFR coll did not change (0.76 ± 0.12 to 0.75 ± 0.13, P = 0.267 and 0.31 ± 0.10 vs. 0.34 ± 0.11, P = 0.078), but iFR increased significantly (0.86 ± 0.10 to 0.88 ± 0.10, P = 0.012). At follow-up, there was a significant increase in predominant donor FFR and iFR (0.76 ± 0.12 to 0.79 ± 0.11, P = 0.047 and 0.86 ± 0.10 to 0.90 ± 0.07, P = 0.003), accompanied by a significant reduction in FFR coll (0.31 ± 0.10 to 0.18 ± 0.07 P PCI in the case of iFR and at 4-month follow-up for FFR and iFR compared to pre-PCI with a concomitant reduction in collateral function. © 2018 Wiley Periodicals, Inc.

  1. Extremely tortuous coronary arteries - when optical coherence tomography and fractional flow reserve did not help us much

    Directory of Open Access Journals (Sweden)

    Miloradović Vladimir

    2018-01-01

    Full Text Available Introduction. Extreme coronary tortuosity may lead to flow alteration resulting in a reduction in coronary pressure distal to the tortuous segment, subsequently leading to ischemia. Therefore the detection of a true cause of ischemia, i.e. whether a fixed stenosis or tortuosity by itself is responsible for its creation, with non-invasive and invasive methods is a real challenge. Case report. We presented a case of a patient with a history of stable angina [Canadian Cardiovascular Society (CCS class II], an abnormal stress test and coronary tortuosity without hemodynamically significant stenosis. Due to suspected linear lesion between the two bends in proximal segment of Right coronary artery (RCA we performed optical coherence tomography (OCT, minimum lumen area (MLA-13.19 mm2 and fractional flow reserve (FFR RCA (0.94. We opted for conservative treatment for stable angina. Conclusion. When tortuosities are associated with atherosclerosis in coronary artery for determination of true cause of ischemia invasive methods can be used, such as OCT and FFR.

  2. TU-H-CAMPUS-IeP2-03: Development of 3D Printed Coronary Phantoms for In-Vitro CT-FFR Validation Using Data from 320- Detector Row Coronary CT Angiography

    International Nuclear Information System (INIS)

    Ionita, C; Rudin, S; Bednarek, D; Zaid, S; Wilson, M; Angel, E; Mitsouras, D; Rybicki, F

    2016-01-01

    Purpose: To validate Computed Tomography Fractional Flow Reserve (CT-FFR) measurements with accurate 3D printed coronary phantoms. Methods: DICOM data from four phases in two patients imaged with a standard 320 × 0.5mm coronary CT acquisition (70–80% cardiac cycle) underwent semi-automated segmentation using a research workstation. Both patients had a >50% stenosis from the clinical image interpretation. Each volume was saved as a Stereo Lithographic (STL) file with 250 micron resolution. The 3D geometries were qualitatively assessed; the best of the four phases was 3D printed using a Stratasys Eden260V printer in Tango+, a rubber-like material that roughly emulates mechanical properties of human vasculature. We connected the model to a programmable pump and measured the pressure drop using pressure sensors embedded proximal and distal to the arterial stenosis. Next, the STL files used for the 3D printed models were uploaded in the ANSYS meshing tool (ICEM CFD 16.1). A standard meshing process was applied and the meshed geometry was directly imported in the ANSYS Fluent for Computational Flow Dynamics simulations. The CFD simulations were used to calculate the CT-FFR and compared to the bench top FFR measured in the 3D printed phantoms. Results: FFR-CT measurements and phantoms were completed in within an hour after the segmentation. Patient 1 had a 60% stenosis that resulted in a CT-FFR of 0.68. The second case had a 50% stenosis and a CT-FFR of 0.75. The average bench top FFR measurements were 0.72 and 0.80, respectively. Conclusion: This pilot investigation demonstrated the use of a bench-top coronary model for CT-FFR validation. The measurements and the CFD simulations agreed within 6%. Project supported by Support: Toshiba America Medical Systems Corp.and NIH grant R01-EB002873. Project supported by Toshiba America Medical Systems Corp.and partial support from NIH grant R01-EB002873

  3. TU-H-CAMPUS-IeP2-03: Development of 3D Printed Coronary Phantoms for In-Vitro CT-FFR Validation Using Data from 320- Detector Row Coronary CT Angiography

    Energy Technology Data Exchange (ETDEWEB)

    Ionita, C; Rudin, S; Bednarek, D; Zaid, S; Wilson, M [University at Buffalo, Buffalo, NY (United States); Angel, E [Toshiba America Medical Systems, Inc, Tustin, CA (United States); Mitsouras, D [Brigham and Women’s Hospital, Boston, MA (United States); Rybicki, F [University of Ottawa, Ottawa, ON (Canada)

    2016-06-15

    Purpose: To validate Computed Tomography Fractional Flow Reserve (CT-FFR) measurements with accurate 3D printed coronary phantoms. Methods: DICOM data from four phases in two patients imaged with a standard 320 × 0.5mm coronary CT acquisition (70–80% cardiac cycle) underwent semi-automated segmentation using a research workstation. Both patients had a >50% stenosis from the clinical image interpretation. Each volume was saved as a Stereo Lithographic (STL) file with 250 micron resolution. The 3D geometries were qualitatively assessed; the best of the four phases was 3D printed using a Stratasys Eden260V printer in Tango+, a rubber-like material that roughly emulates mechanical properties of human vasculature. We connected the model to a programmable pump and measured the pressure drop using pressure sensors embedded proximal and distal to the arterial stenosis. Next, the STL files used for the 3D printed models were uploaded in the ANSYS meshing tool (ICEM CFD 16.1). A standard meshing process was applied and the meshed geometry was directly imported in the ANSYS Fluent for Computational Flow Dynamics simulations. The CFD simulations were used to calculate the CT-FFR and compared to the bench top FFR measured in the 3D printed phantoms. Results: FFR-CT measurements and phantoms were completed in within an hour after the segmentation. Patient 1 had a 60% stenosis that resulted in a CT-FFR of 0.68. The second case had a 50% stenosis and a CT-FFR of 0.75. The average bench top FFR measurements were 0.72 and 0.80, respectively. Conclusion: This pilot investigation demonstrated the use of a bench-top coronary model for CT-FFR validation. The measurements and the CFD simulations agreed within 6%. Project supported by Support: Toshiba America Medical Systems Corp.and NIH grant R01-EB002873. Project supported by Toshiba America Medical Systems Corp.and partial support from NIH grant R01-EB002873.

  4. Correlation between the tissue Doppler, strain rate, strain imaging during the dobutamine infusion and coronary fractional flow reserve during catheterization: a comparative study.

    Science.gov (United States)

    Dagdelen, Sinan; Yuce, Murat; Emiroglu, Yunus; Ergelen, Mehmet; Pala, Selcuk; Tanalp, Ali Cevat; Izgi, Akin; Kirma, Cevat

    2005-06-22

    Coronary fractional flow reserve (FFR) as an invasive, and dobutamine stress echocardiography (DSE) as a noninvasive technique were used to detect critical coronary stenosis. This study was undertaken to assess correlation between these two techniques by using tissue Doppler, strain rate (SR), and strain imaging (S). In 17 patients (aged 54.9+/-12.6, 4 F), a total of 22 vessels were studied. On dobutamine stress echocardiography, baseline and peak systolic (Sm), early (Em) and late (Am) diastolic myocardial velocities, SR and S were recorded from parasternal view (mid-posterior segment) for radial and apical view (mid-septum) for longitudinal deformation. Then coronary FFR was performed by using intracoronary adenosine infusion, and the value of system were analyzed for longitudinal SR and S values, it had a mild correlation with SR (r = 0.47, p = 0.044) and a good correlation with S (r = 0.66, p = 0.002). The quantification of regional myocardial deformation by using DSE rather than the motion would be more appropriate in detecting the ischemic dysfunctional segment supplied by the critical coronary stenosis. Strain measurement during the dobutamine infusion may provide an information on the FFR results of the culprit vessel.

  5. Coronary CT Angiography Derived Fractional Flow Reserve

    DEFF Research Database (Denmark)

    Nørgaard, Bjarne Linde; Jensen, Jesper Møller; Blanke, Philipp

    2017-01-01

    Purpose of Review: To summarize the scientific basis of CT derived fractional flow reserve (FFRCT) and present an updated review on the evidence from clinical trials and real-world observational data Recent Findings: In prospective multicenter studies of patients with stable coronary artery disea...... of patients with stable CAD. The optimal FFRCT testing interpretation strategy, as well as the relative cost-efficiency of FFRCT against standard noninvasive functional testing, need further investigation....

  6. Fractional flow reserve for the assessment of complex multivessel disease in a patient after hybrid coronary revascularization.

    Science.gov (United States)

    Corban, Michel T; Eshtehardi, Parham; Samady, Habib

    2013-06-01

    We present a case of a 43-year-old woman with history of hybrid coronary revascularization [endoscopic atraumatic coronary artery bypass (ACAB)] of left internal mammary artery (LIMA) to the left anterior descending artery (LAD) and stent implantation in right coronary artery (RCA), who presented 6 years later with recurrent atypical angina. Coronary angiography revealed patent LIMA to LAD and RCA stent, with a new lesion in an obtuse marginal artery and significant progression of disease in the proximal/mid LAD proximal to LIMA touchdown. To further evaluate the hemodynamic significance of these new disease segments, the patient underwent fractional flow reserve (FFR) assessment of the left coronary system with subsequent stent implantation in the proximal/mid LAD. This case illustrates (1) the critical value of FFR assessment in determining the ischemia provoking lesions in this post ACAB patient with complex multivessel coronary artery disease; and (2) the accelerated progression of atherosclerosis in bypassed segments as compared to segments proximal to stents. Copyright © 2012 Wiley Periodicals, Inc.

  7. Comparison of the intracoronary continuous infusion method using a microcatheter and the intravenous continuous adenosine infusion method for inducing maximal hyperemia for fractional flow reserve measurement.

    Science.gov (United States)

    Yoon, Myeong-Ho; Tahk, Seung-Jea; Yang, Hyoung-Mo; Park, Jin-Sun; Zheng, Mingri; Lim, Hong-Seok; Choi, Byoung-Joo; Choi, So-Yeon; Choi, Un-Jung; Hwang, Joung-Won; Kang, Soo-Jin; Hwang, Gyo-Seung; Shin, Joon-Han

    2009-06-01

    Inducing stable maximal coronary hyperemia is essential for measurement of fractional flow reserve (FFR). We evaluated the efficacy of the intracoronary (IC) continuous adenosine infusion method via a microcatheter for inducing maximal coronary hyperemia. In 43 patients with 44 intermediate coronary lesions, FFR was measured consecutively by IC bolus adenosine injection (48-80 microg in left coronary artery, 36-60 microg in the right coronary artery) and a standard intravenous (IV) adenosine infusion (140 microg x min(-1) x kg(-1)). After completion of the IV infusion method, the tip of an IC microcatheter (Progreat Microcatheter System, Terumo, Japan) was positioned at the coronary ostium, and FFR was measured with increasing IC continuous adenosine infusion rates from 60 to 360 microg/min via the microcatheter. Fractional flow reserve decreased with increasing IC adenosine infusion rates, and no further decrease was observed after 300 microg/min. All patients were well tolerated during the procedures. Fractional flow reserves measured by IC adenosine infusion with 180, 240, 300, and 360 microg/min were significantly lower than those by IV infusion (P < .05). Intracoronary infusion at 180, 240, 300, and 360 microg/min was able to shorten the times to induction of optimal and steady-stable hyperemia compared to IV infusion (P < .05). Functional significances were changed in 5 lesions by IC infusion at 240 to 360 microg/min but not by IV infusion. The results of this study suggest that an IC adenosine continuous infusion method via a microcatheter is safe and effective in inducing steady-state hyperemia and more potent and quicker in inducing optimal hyperemia than the standard IV infusion method.

  8. Digital radiographic assessment of coronary flow reserve

    International Nuclear Information System (INIS)

    Vogel, R.A.

    1985-01-01

    A method for measuring relative changes in regional blood flow using digital radiographic enhancement of selective coronary arteriography. Coronary flow reserve is measured in individual arterial distributions using the washin ratio of contrast appearance time under baseline and hyperemic conditions. Information is quantitatively presented in functional (parametric) image format. These images, termed contrast medium appearance pictures (CMAP), depict the transit of contrast through the arterial, myocardial and early venous stages. This process can be divided into three general phases: data acquisition, CMAP formation and CMAP analysis. The technique has evolved over its development period from a cine film-based technology which required substantial processing time to a real-time digital radiographic technique

  9. FFR-guided multivessel stenting reduces urgent revascularization compared with infarct-related artery only stenting in ST-elevation myocardial infarction: A meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Gupta, Ankur; Bajaj, Navkaranbir S; Arora, Pankaj; Arora, Garima; Qamar, Arman; Bhatt, Deepak L

    2018-02-01

    Randomized controlled trials (RCTs) have shown fractional flow reserve-guided (FFR) multivessel stenting to be superior to infarct-related artery (IRA) only stenting in patients with ST-elevation myocardial infarction (STEMI) and multivessel disease. This effect was mainly driven by a reduction in overall repeat revascularization. However, the ability to assess the effect of this strategy on urgent revascularization or reinfarction was underpowered in individual trials. We searched Pubmed, EMBASE, Cochrane CENTRAL, and Web of Science for RCTs of FFR-guided multivessel stenting versus IRA-only stenting in STEMI with multivessel disease. The outcomes of interest were death, reinfarction, urgent, and non-urgent repeat revascularization. Risk ratios (RR) were pooled using the DerSimonian and Laird random-effects model. After review of 786 citations, 2 RCTs were included. The pooled results demonstrated a significant reduction in the composite of death, reinfarction, or revascularization in the FFR-guided multivessel stenting group versus IRA-only stenting group (RR [95%, Confidence Interval]: 0.49 [0.33-0.72], p<0.001). This risk reduction was driven mainly by a reduction in repeat revascularization, both urgent (0.41 [0.24-0.71], p=0.002) and non-urgent revascularization (0.31 [0.19-0.50], p<0.001). Pooled RR for reinfarction was lower in the FFR-guided strategy, but was not statistically significant (0.71[0.39-1.31], p=0.28). This systematic review and meta-analysis suggests that a strategy of FFR-guided multivessel stenting in STEMI patients reduces not only overall repeat revascularization but also urgent revascularization. The effect on reinfarction needs to be evaluated in larger trials. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  10. Reserves and cash flows under stochastic retirement

    DEFF Research Database (Denmark)

    Gad, Kamille Sofie Tågholt; Nielsen, Jeppe Woetmann

    2016-01-01

    Uncertain time of retirement and uncertain structure of retirement benefits are risk factors for life insurance companies. Nevertheless, classical life insurance models assume these are deterministic. In this paper, we include the risk from stochastic time of retirement and stochastic benefit...... structure in a classical finite-state Markov model for a life insurance contract. We include discontinuities in the distribution of the retirement time. First, we derive formulas for appropriate scaling of the benefits according to the time of retirement and discuss the link between the scaling...... and the guarantees provided. Stochastic retirement creates a need to rethink the construction of disability products for high ages and ways to handle this are discussed. We show how to calculate market reserves and how to use modified transition probabilities to calculate expected cash flows without significantly...

  11. Coronary flow velocity reserve by echocardiography

    DEFF Research Database (Denmark)

    Olsen, Rasmus Huan; Pedersen, Lene Rørholm; Snoer, Martin

    2016-01-01

    BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography of the LAD is used to assess microvascular function but validation studies in clinical settings are lacking. We aimed to assess feasibility, reproducibility and agreement with myocardial flow...... performed within a week (1-week) and for all scans regardless of time gap (total) and to account for scar tissue for patients with and without previous myocardial infarction (MI). RESULTS: Eighty-six patients with median BMI 30.9 (IQR 29.4-32.9) kg × m(-2) and CFVR 2.29 (1.90-2.63) were included. CFVR...... was feasible in 83 (97 %) using a contrast agent in 14 %. For reproducibility overall (n = 21) limits of agreement (LOA) were (-0.75;0.71), within-subjects coefficient of variation (CV) 11 %, and reliability 0.84. For reproducibility within 1-week (n = 13) LOA were (-0.33;0.25), within-subjects CV 5...

  12. Instantaneous Wave-Free Ratio versus Fractional Flow Reserve guided intervention (iFR-SWEDEHEART): Rationale and design of a multicenter, prospective, registry-based randomized clinical trial.

    Science.gov (United States)

    Götberg, Matthias; Christiansen, Evald H; Gudmundsdottir, Ingibjörg; Sandhall, Lennart; Omerovic, Elmir; James, Stefan K; Erlinge, David; Fröbert, Ole

    2015-11-01

    Instantaneous wave-free ratio (iFR) is a new hemodynamic resting index for assessment of coronary artery stenosis severity. iFR uses high frequency sampling to calculate a gradient across a coronary lesion during a period of diastole. The index has been tested against fractional flow reserve (FFR) and found to have an overall classification agreement of 80% to 85%. Whether the level of disagreement is clinically relevant is unknown. Clinical outcome data on iFR are scarce. This study is a registry-based randomized clinical trial, which is a novel strategy using health quality registries as on-line platforms for randomization, case record forms, and follow-up. iFR-SWEDEHEART is a multicenter, prospective, randomized, controlled, clinical open-label clinical trial. Two thousand patients with stable angina or acute coronary syndrome and an indication for physiology-guided assessment of one or more coronary stenoses will be randomized 1:1 to either iFR- or FFR-guided intervention. The randomization will be conducted online in the Swedish web-based system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART) registry. The trial has a non-inferiority design, with a primary combined end point of all-cause death, non-fatal myocardial infarction, and unplanned revascularization at 12 months. End points will be identified through national registries and undergo central blind adjudication to ensure data quality. The iFR-SWEDEHEART trial is an registry-based randomized clinical trial evaluating the safety and efficacy of the diagnostic method iFR compared to FFR. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography

    DEFF Research Database (Denmark)

    Westra, Jelmer; Tu, Shengxian; Winther, Simon

    2018-01-01

    BACKGROUND: Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire...... patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv......, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50...

  14. Anatomical and Physiological Changes after Paclitaxel-Coated Balloon for Atherosclerotic De Novo Coronary Lesions: Serial IVUS-VH and FFR Study.

    Directory of Open Access Journals (Sweden)

    Soe Hee Ann

    Full Text Available To assess the serial changes of de novo coronary lesions treated with paclitaxel-coated balloon (PCB using intravascular ultrasound virtual histology (IVUS-VH and fractional flow reserve (FFR.This prospective observational study enrolled 27 patients with coronary artery disease treated with PCB who underwent coronary angiography, IVUS-VH and FFR before, immediately after intervention and at 9 months. 28 de novo lesions were successfully treated with PCB. Angiographic late luminal loss was 0.02 ± 0.27 mm. Mean vessel and lumen areas showed increase at 9 months (12.0 ± 3.5 mm(2 to 13.2 ± 3.9 mm(2, p <0.001; and 5.4 ± 1.2 mm(2 to 6.5 ± 1.8 mm(2, p <0.001, respectively. Although mean plaque area was unchanged (6.6 ± 2.6 mm2 to 6.6 ± 2.4 mm(2, p = 0.269, percent atheroma volume decreased significantly (53.4 ± 7.9% to 49.5 ± 6.4%, p = 0.002. The proportion of plaque compositions including fibrous, fibrofatty, dense calcium and necrotic core by IVUS-VH was unchanged at 9 months. The FFR of the treated lesion was 0.71 ± 0.13 pre-procedure, 0.87 ± 0.06 post-procedure and 0.84 ± 0.06 at follow-up.De novo coronary lesions treated with PCB showed persistent anatomical and physiological patency with plaque redistribution and vessel remodeling without chronic elastic recoil or plaque compositional change during follow-up.

  15. An intelligent FFR with a self-adjustable ventilation fan.

    Science.gov (United States)

    Zhou, Song; Li, Hui; Shen, Shengnan; Li, Siyu; Wang, Wei; Zhang, Xiaotie; Yang, James

    2017-11-01

    This article presents an intelligent Filtering Facepiece Respirator (FFR) with a self-adjustable ventilation fan for improved comfort. The ventilation fan with an intelligent control aims to reduce temperature, relative humidity, and CO 2 concentrations inside the facepiece. Compared with a previous version of the FFR, the advantage of this new FFR is the intelligent control of the fan's rotation speed based on the change in temperature and relative humidity in the FFR dead space. The design of the control system utilizes an 8-bit, ultra-low power STC15W404AS microcontroller (HongJin technology, Shenzhen, China), and adopts a high-precision AM2320 device (AoSong electronic, Guangzhou, China) as temperature and relative humidity sensor so that control of temperature and relative humidity is realized in real time within the FFR dead space. The ventilation fan is intelligently driven and runs on a rechargeable lithium battery with a power-save mode that provides a correspondingly longer operational time. Meanwhile, the design is simplistic. Two experiments were performed to determine the best location to place the fan.

  16. Integration of a capacitive pressure sensing system into the outer catheter wall for coronary artery FFR measurements

    Science.gov (United States)

    Stam, Frank; Kuisma, Heikki; Gao, Feng; Saarilahti, Jaakko; Gomes Martins, David; Kärkkäinen, Anu; Marrinan, Brendan; Pintal, Sebastian

    2017-05-01

    The deadliest disease in the world is coronary artery disease (CAD), which is related to a narrowing (stenosis) of blood vessels due to fatty deposits, plaque, on the arterial walls. The level of stenosis in the coronary arteries can be assessed by Fractional Flow Reserve (FFR) measurements. This involves determining the ratio between the maximum achievable blood flow in a diseased coronary artery and the theoretical maximum flow in a normal coronary artery. The blood flow is represented by a pressure drop, thus a pressure wire or pressure sensor integrated in a catheter can be used to calculate the ratio between the coronary pressure distal to the stenosis and the normal coronary pressure. A 2 Fr (0.67mm) outer diameter catheter was used, which required a high level of microelectronics miniaturisation to fit a pressure sensing system into the outer wall. The catheter has an eccentric guidewire lumen with a diameter of 0.43mm, which implies that the thickest catheter wall section provides less than 210 microns height for flex assembly integration consisting of two dies, a capacitive MEMS pressure sensor and an ASIC. In order to achieve this a very thin circuit flex was used, and the two chips were thinned down to 75 microns and flip chip mounted face down on the flex. Many challenges were involved in obtaining a flex layout that could wrap into a small tube without getting the dies damaged, while still maintaining enough flexibility for the catheter to navigate the arterial system.

  17. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve

    Directory of Open Access Journals (Sweden)

    Gianluca Pontone

    2015-01-01

    Full Text Available Coronary artery disease (CAD is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT, functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.

  18. Angiographic characteristics of intermediate stenosis of the left anterior descending artery for determination of lesion significance as identified by fractional flow reserve

    DEFF Research Database (Denmark)

    Biasco, Luigi; Pedersen, Frants; Lønborg, Jacob

    2015-01-01

    identification of flow-limiting stenoses. Coronary angiograms of 1,350 patients (1,883 lesions) were retrospectively analyzed for stenosis grade (eyeballing, %) and matched with FFR values. Angiography-derived optimal cut-off values and intervals delineating the [90% sensitivity-90% specificity] range were 50...

  19. Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Rui [Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260 (United States); Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing (China); Renker, Matthias [Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260 (United States); Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231 Bad Nauheim (Germany); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260 (United States); Wichmann, Julian L. [Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260 (United States); Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt (Germany); Fuller, Stephen R.; Rier, Jeremy D.; Bayer, Richard R.; Steinberg, Daniel H. [Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260 (United States); De Cecco, Carlo N. [Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260 (United States); Departments of Radiological Sciences, Oncology, and Pathology, University of Rome “Sapienza”-Polo Pontino, Latina, Viale Regina Elena, 324-00161 Roma (Italy); Baumann, Stefan [Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260 (United States); First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany)

    2015-08-15

    Highlights: • Evaluation of the diagnostic performance of CCTA predictors for coronary stenosis. • TAG was unable to detect hemodynamically significant coronary lesions. • CT-FFR, LL/MLD{sup 4} and CCO provide enhanced diagnostic performance over CCTA. • CT-FFR was the best parameter. - Abstract: Objective: To evaluate the diagnostic performance of CCTA-derived stenosis predictors including CT-FFR for the detection of ischemia-inducing stenosis compared to invasive FFR. Materials and methods: Stenosis parameters were assessed using dual-source CT (DSCT). All patients underwent both CCTA and invasive FFR within 3 months and were retrospectively analyzed. Observers visually assessed all CCTA studies and performed multiple lesion measurements. Lesion length/minimal luminal diameter{sup 4} (LL/MLD{sup 4}), transluminal attenuation gradient (TAG), corrected coronary attenuation (CCO) and CT-FFR were calculated. Results: The cohort included 32 patients (58 ± 12 years, 66%male). Among 32 coronary lesions, 8 (25%) were considered hemodynamically significant with an FFR <0.80. Compared to invasive FFR, the per-vessel sensitivity and specificity of CCTA, CT-FFR, LL/MLD{sup 4}, CCO and TAG for detecting hemodynamically significant lesions were 100% and 54%, 100% and 91%, 85% and 92%, 66% and 88%, 37% and 58%, respectively. Receiver operating characteristics analysis resulted in an area under the curve of 0.91 for CT-FFR (p = 0.0005), 0.88 for LL/MLD{sup 4} (p < 0.0001), 0.85 for CCO (p < 0.0001). TAG with an AUC of 0.67 (p = 0.152) was unable to discriminate between vessels with or without hemodynamically significant lesions. Conclusion: CT-FFR, LL/MLD{sup 4} and CCO provide enhanced diagnostic performance over CCTA analysis alone for discrimination of hemodynamically significant coronary stenosis.

  20. Dynamic CT myocardial perfusion imaging: detection of ischemia in a porcine model with FFR verification

    Science.gov (United States)

    Fahmi, Rachid; Eck, Brendan L.; Vembar, Mani; Bezerra, Hiram G.; Wilson, David L.

    2014-03-01

    Dynamic cardiac CT perfusion (CTP) is a high resolution, non-invasive technique for assessing myocardial blood ow (MBF), which in concert with coronary CT angiography enable CT to provide a unique, comprehensive, fast analysis of both coronary anatomy and functional ow. We assessed perfusion in a porcine model with and without coronary occlusion. To induce occlusion, each animal underwent left anterior descending (LAD) stent implantation and angioplasty balloon insertion. Normal ow condition was obtained with balloon completely de ated. Partial occlusion was induced by balloon in ation against the stent with FFR used to assess the extent of occlusion. Prospective ECG-triggered partial scan images were acquired at end systole (45% R-R) using a multi-detector CT (MDCT) scanner. Images were reconstructed using FBP and a hybrid iterative reconstruction (iDose4, Philips Healthcare). Processing included: beam hardening (BH) correction, registration of image volumes using 3D cubic B-spline normalized mutual-information, and spatio-temporal bilateral ltering to reduce partial scan artifacts and noise variation. Absolute blood ow was calculated with a deconvolutionbased approach using singular value decomposition (SVD). Arterial input function was estimated from the left ventricle (LV) cavity. Regions of interest (ROIs) were identi ed in healthy and ischemic myocardium and compared in normal and occluded conditions. Under-perfusion was detected in the correct LAD territory and ow reduction agreed well with FFR measurements. Flow was reduced, on average, in LAD territories by 54%.

  1. Concordance between myocardial perfusion scan assessed by SPECT and fractional flow reserve findings for detection of significant ischemia

    Directory of Open Access Journals (Sweden)

    Morteza Safi

    2016-09-01

    Conclusion: FFR and MPI with SPECT techniques showed significant concordance for detection of myocardial ischemia, regardless of the type of diseased coronary arteries. In this context, SPECT has high sensitivity and NPV for detection of ischemia compared with FFR.

  2. Fractional Flow Reserve: Intracoronary versus intravenous adenosine induced maximal coronary hyperemia

    Directory of Open Access Journals (Sweden)

    P.S. Sandhu

    2013-03-01

    Conclusions: This study suggests that IC adenosine is equivalent to IV infusion for the determination of FFR. The administration of IC adenosine is easy to use, cost effective, safe and associated with fewer systemic events.

  3. The deep hydrogeologic flow system underlying the Oak Ridge Reservation

    International Nuclear Information System (INIS)

    Nativ, R.; Hunley, A.E.

    1993-07-01

    The deep hydrogeologic system underlying the Oak Ridge Reservation contains some areas contaminated with radionuclides, heavy metals, nitrates, and organic compounds. The groundwater at that depth is saline and has previously been considered stagnant. On the basis of existing and newly collected data, the nature of flow of the saline groundwater and its potential discharge into shallow, freshwater systems was assessed. Data used for this purpose included (1) spatial and temporal pressures and hydraulic heads measured in the deep system, (2) hydraulic parameters of the formations in question, (3) spatial temperature variations, and (4) spatial and temporal chemical and isotopic composition of the saline groundwater. In addition, chemical analyses of brine in adjacent areas in Tennessee, Kentucky, Ohio, Pennsylvania, and West Virginia were compared with the deep water underlying the reservation to help assess the origin of the brine. Preliminary conclusions suggest that the saline water contained at depth is old but not isolated (in terms of recharge and discharge) from the overlying active and freshwater-bearing units. The confined water (along with dissolved solutes) moves along open fractures (or man-made shortcuts) at relatively high velocity into adjacent, more permeable units. Groundwater volumes involved in this flow probably are small

  4. Assessment of coronary fractional flow reserve using a monorail pressure catheter: the first-in-human ACCESS-NZ trial.

    Science.gov (United States)

    Menon, Madhav; Jaffe, Warwick; Watson, Tim; Webster, Mark

    2015-07-01

    FFR measurements have been limited by the handling characteristics of pressure wire (PW) systems, and by signal drift. This first-in-human study evaluated the safety and efficacy of a new monorail catheter (Navvus) to assess coronary FFR, compared to a PW system. Resting measurements were acquired with both systems. After initiating IV adenosine, FFR was measured with the PW alone, simultaneously using both systems, and again with PW alone. Any zero offset of PW or Navvus was then recorded. Navvus measured FFR in all patients in whom a PW recording was obtained (50 of 58 patients); there were no complications related to Navvus. Navvus FFR correlated well with PW FFR (r=0.87, slope 1.0, intercept -0.02). Within PW measurement accuracy, in no cases did Navvus FFR classify lesion significance differently from PW FFR. PW signal drift was significantly greater than Navvus (0.06±0.12 vs. 0.02±0.02, p=0.014). Navvus and PW FFR correlated well. Navvus had less sensor drift. This new catheter-based system offers an alternative method for measuring FFR, with some potential advantages over PW.

  5. Coronary flow reserve in patients with diabetes mellitus and prediabetes.

    Science.gov (United States)

    Atar, Asli I; Altuner, Tugba Kayhan; Bozbas, Huseyin; Korkmaz, Mehmet E

    2012-07-01

    Abnormalities of coronary microcirculation have been reported in patients with diabetes mellitus (DM) even in the presence of normal coronary arteries. It is unknown when the microvascular effects on coronary arteries begin to appear in the DM disease course. Coronary flow reserve (CFR), determined by pharmacological stress transthoracic Doppler echocardiography, is a reliable indicator of coronary microvascular function. We sought to determine the coronary microvascular function of prediabetic patients compared to DM patients and normal population. Seventy-four subjects with normal coronary arteries were enrolled. DM and prediabetes were diagnosed according to American Diabetes Association criteria. All subjects had Doppler recordings of the left anterior descending artery with adenosine infusion at a rate of 0.014 mg/kg per minute. The demographical characteristics and laboratory findings of the three groups were similar (DM group: n = 25, mean age 62 ± 7 years, 19 females; prediabetic group: n = 25, mean age 64 ± 12 years, 21 females; control group: n = 24, mean age 63 ± 7 years, 15 females) except fasting glucose levels. CFR values of the three groups were significantly different (DM group: CFR = 1.75 ± 0.50; prediabetic group: CFR = 2.24 ± 0.43; control group: CFR = 2.38 ± 0.32, P < 0.001). CFR values of DM group were lower than those of prediabetic and control groups (DM vs. prediabetic: P < 0.001, DM vs. control: P < 0.001). However, CFR levels of prediabetic group were not different from those of the control group (P = 0.481). DM was an independent factor predictive of CFR < 2 (OR, 22.69; 95% CI, 6.47-79.51; P < 0.001). Coronary microvascular function seems to be normal in the prediabetic state, but dysfunction appears after DM becomes overt. © 2012, Wiley Periodicals, Inc.

  6. Pressure Wire Compared to Microcatheter Sensing for Coronary Fractional Flow Reserve: The PERFORM Study.

    Science.gov (United States)

    Ali, Ziad A; Parviz, Yasir; Brinkman, Matthew; Matsumura, Mitsuaki; Redfors, Björn; Brogno, David A; Corral, Maria D; Fall, Khady N; Mintz, Gary S; Stone, Gregg W; Maehara, Akiko; Jeremias, Allen; Kirtane, Ajay J

    2018-05-15

    Among technologies used to assess FFR, a monorail, sensor-tipped micro pressure catheter (PC) may be advantageous for delivery and re-assessment. We sought to determine whether the larger cross-sectional area of the PC influences FFR measurements compared to the pressure wire. PERFORM was a single-center, prospective study designed to determine the precision and accuracy of the PC compared with the pressure wire (PW) for measurement of FFR. Eligible patients had native coronary artery target lesions with visually estimated diameter stenosis of 40-90%. The independently adjudicated primary endpoint was the difference in hyperemic PW-determined minimal FFR with and without the PC distal to the stenosis. Seventy-four patients (95 lesions) were prospectively analyzed between December 2015 and December 2016. Median hyperemic FFR was 0.84 [IQR 0.78, 0.89] with the PW and 0.79 [IQR 0.73, 0.85] with the PC distal to the stenosis (p0.80 to ≤0.80 in 17 of 95 measurements (19%). Median resting Pd/Pa was lower following introduction of the PC compared with the PW alone (0.93 [IQR 0.90, 0.97] versus 0.90 [IQR 0.86, 0.95], p<0.001). Median pressure drift was not different between the PW and the PC (0.01 [IQR -0.01, 0.05] versus 0.01 [IQR 0.00, 0.02], p=0.38). Introduction of the PC reduced device success and both hyperemic FFR and resting Pd/Pa compared with the PW alone, leading to re-classifying physiological significance to below ischemic threshold in one out of five assessments.

  7. Validation of the "smart" minimum FFR Algorithm in an unselected all comer population of patients with intermediate coronary stenoses.

    Science.gov (United States)

    Hennigan, Barry; Johnson, Nils; McClure, John; Corcoran, David; Watkins, Stuart; Berry, Colin; Oldroyd, Keith G

    2017-07-01

    Using data from a commercial pressure wire system (St. Jude Medical) we previously developed an automated "smart" algorithm to determine a reproducible value for minimum FFR (smFFR) and confirmed that it correlated very closely with measurements made off-line by experienced coronary physiology core laboratories. In this study we used the same "smart" minimum algorithm to analyze data derived from a different, commercial pressure wire system (Philips Volcano) and compared the values obtained to both operator-defined steady state FFR and the online automated minimum FFR reported by the pressure wire analyser. For this analysis, we used the data collected during the VERIFY 2 study (Hennigan et al. in Circ Cardiovasc Interv, doi: 10.1161/CIRCINTERVENTIONS.116.004016 ) in which we measured FFR in 257 intermediate coronary stenoses (mean DS 48%) in 197 patients. Maximal hyperaemia was induced using intravenous adenosine (140 mcg/kg/min). We recorded both the online minimum FFR generated by the analyser and the operator-reported steady state FFR. Subsequently, the raw pressure tracings were coded, anonymised and 256/257 were subjected to further off-line analysis using the smart minimum FFR (smFFR) algorithm. The operator-defined steady state FFR correlated well with smFFR: r = 0.988 (p 0.05 among methods were rare but in these cases the two automated algorithms almost always agreed with each other rather than with the operator-reported value. Within the VERIFY 2 dataset, experienced operators reported a similar FFR value to both an online automated minimum (Philips Volcano) and off-line "smart" minimum computer algorithm. Thus, treatment decisions and clinical studies using either method will produce nearly identical results.

  8. Deviance-Related Responses along the Auditory Hierarchy: Combined FFR, MLR and MMN Evidence

    Science.gov (United States)

    Shiga, Tetsuya; Althen, Heike; Cornella, Miriam; Zarnowiec, Katarzyna; Yabe, Hirooki; Escera, Carles

    2015-01-01

    The mismatch negativity (MMN) provides a correlate of automatic auditory discrimination in human auditory cortex that is elicited in response to violation of any acoustic regularity. Recently, deviance-related responses were found at much earlier cortical processing stages as reflected by the middle latency response (MLR) of the auditory evoked potential, and even at the level of the auditory brainstem as reflected by the frequency following response (FFR). However, no study has reported deviance-related responses in the FFR, MLR and long latency response (LLR) concurrently in a single recording protocol. Amplitude-modulated (AM) sounds were presented to healthy human participants in a frequency oddball paradigm to investigate deviance-related responses along the auditory hierarchy in the ranges of FFR, MLR and LLR. AM frequency deviants modulated the FFR, the Na and Nb components of the MLR, and the LLR eliciting the MMN. These findings demonstrate that it is possible to elicit deviance-related responses at three different levels (FFR, MLR and LLR) in one single recording protocol, highlight the involvement of the whole auditory hierarchy in deviance detection and have implications for cognitive and clinical auditory neuroscience. Moreover, the present protocol provides a new research tool into clinical neuroscience so that the functional integrity of the auditory novelty system can now be tested as a whole in a range of clinical populations where the MMN was previously shown to be defective. PMID:26348628

  9. Efficient Resource Allocation and Sectorization for Fractional Frequency Reuse (FFR in LTE Femtocell Systems

    Directory of Open Access Journals (Sweden)

    M. T. Kawser

    2015-12-01

    Full Text Available The Fractional Frequency Reuse (FFR is a resource allocation technique that can effectively mitigate inter-cell interference (ICI in LTE based HetNets and it is a promising solution. Various FFR schemes have been suggested to address the challenge of interference in femtocell systems. In this paper, we study the scopes of interference mitigation and capacity improvement. We propose a resource allocation scheme that gradually varies frequency resource share with distance from the eNodeB for both macrocells and femtocells in order to attain better utilization of the resources. This is performed effectively using three layers in the cell. The proposal also employs high number sectors in a cell, low interference and good frequency reuse. Monte-Carlo simulations are performed, which show that the proposed scheme achieves significantly better throughput compared to the existing FFR schemes.

  10. New possibilities in the diagnosis of ischemia. CT-FFR and CT-Perfusion; Neue Moeglichkeiten der Ischaemiediagnostik. CT-FFR und CT-Perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Lehmkuhl, Lukas [Herz- und Gefaessklinik, Bad Neustadt an der Saale (Germany). Abt. fuer Radiologie; Krieghoff, Christian [Herzzentrum Leipzig (Germany); Gutberlet, Matthias [Herzzentrum Leipzig (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Leipzig Univ. (Germany). Kardiologische Bildgebung

    2017-12-15

    Coronary CT-angiography (CCTA) plays an increasing role in the primary diagnostics of coronary artery disease (CAD) according to the present guidelines but also in clinical reality. The sensitivity and negative predictive value of CCTA is very high, but the specificity could still be improved. Newer techniques to assess myocardial ischemia like CT-FFR and CT-Perfusion may help to achieve that goal.

  11. Anatomical and functional assessment of Tryton bifurcation stent before and after final kissing balloon dilatation: Evaluations by three-dimensional coronary angiography, optical coherence tomography imaging and fractional flow reserve.

    Science.gov (United States)

    Pyxaras, Stylianos A; Toth, Gabor G; Di Gioia, Giuseppe; Ughi, Giovanni J; Tu, Shengxian; Rusinaru, Dan; Adriaenssens, Tom; Reiber, Johan H C; Leon, Martin B; Bax, Jeroen J; Wijns, William

    2017-07-01

    To assess the anatomical and functional impact of final kissing balloon inflation (FKBI) after implantation of a dedicated bifurcation stent system. Current evidence suggests clinical benefit of FKBI in patients undergoing bifurcation dilatation using the Tryton side branch stent (Tryton-SBS). We hypothesized that FKBI improves anatomical reconstruction and functional results of bifurcation treated by Tryton-SBS. An unselected group of patients with complex bifurcation coronary lesions undergoing percutaneous coronary intervention (PCI) with Tryton-SBS underwent paired anatomical assessment with two- and three-dimensional quantitative coronary analysis (2D- and 3D-QCA), and optical coherence tomography (OCT), including 3D reconstruction before and after FKBI. Functional assessment by fractional flow reserve (FFR) was performed in the main branch (MB) and side branch (SB) before and after FKBI. Paired pre- and post-FKBI data were obtained in 10 patients. By OCT imaging, FKBI increased both the SB ostial area (4.93 ± 2.81 vs. 7.43 ± 2.87 mm 2 , P system, FKBI is associated with improved anatomical and functional results at the SB level, without compromising the result at the MB. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  12. Net Capital Flows, Macroeconomic Shocks and Reserve Assets. The Case of Argentina (1994-2013

    Directory of Open Access Journals (Sweden)

    Luis N. Lanteri

    2014-06-01

    Full Text Available International reserves have been used as a source of protection against the vulnerability of the balance of payments, or alternatively, as an attempt to keep a competitive real exchange rate and to promote exports. This paper explores the correlation between the net capital flows and reserves. Similarly, the impact of some macroeconomic shocks on that variable is assessed. Estimates are carried out through both, the VEC (Vector Error Correction models and quarterly data of the Argentine economy for the period 1994-2013. Results show a negative correlation between international reserves and net capital flows (reserve accumulation through current account surpluses. At the same time, the expansionary fiscal policies and the continuing and widespread price increases would adversely affect the reserves.

  13. Effect of Varying Hemodynamic and Vascular Conditions on Fractional Flow Reserve: An In Vitro Study.

    Science.gov (United States)

    Kolli, Kranthi K; Min, James K; Ha, Seongmin; Soohoo, Hilary; Xiong, Guanglei

    2016-06-30

    The aim of this study was to investigate the impact of varying hemodynamic conditions on fractional flow reserve (ratio of pressure distal [Pd] and proximal [Pa] to stenosis under hyperemia) in an in vitro setting. Failure to achieve maximal hyperemia and the choice of hyperemic agents may have differential effects on coronary hemodynamics and, consequently, on the determination of fractional flow reserve. An in vitro flow system was developed to experimentally model the physiological coronary circulation as flow-dependent stenosis resistance in series with variable downstream resistance. Five idealized models with 30% to 70% diameter stenosis severity were fabricated using VeroClear rigid material in an Objet260 Connex printer. Mean aortic pressure was maintained at 7 levels (60-140 mm Hg) from hypotension to hypertension using a needle valve that mimicked adjustable microcirculatory resistance. A range of physiological flow rates was applied by a steady flow pump and titrated by a flow sensor. The pressure drop and the pressure ratio (Pd/Pa) were assessed for the 7 levels of aortic pressure and differing flow rates. The in vitro experimental data were coupled with pressure-flow relationships from clinical data for populations with and without myocardial infarction, respectively, to evaluate fractional flow reserve. The curve for pressure ratio and flow rate demonstrated a quadratic relationship with a decreasing slope. The absolute decrease in fractional flow reserve in the group without myocardial infarction (with myocardial infarction) was on the order of 0.03 (0.02), 0.05 (0.02), 0.07 (0.05), 0.17 (0.13) and 0.20 (0.24), respectively, for 30%, 40%, 50%, 60%, and 70% diameter stenosis, for an increase in aortic pressure from 60 to 140 mm Hg. The fractional flow reserve value, an index of physiological stenosis significance, was observed to decrease with increasing aortic pressure for a given stenosis in this idealized in vitro experiment for vascular

  14. Doppler Flow Wire Evaluation of Renal Blood Flow Reserve in Hypertensive Patients with Normal Renal Arteries

    International Nuclear Information System (INIS)

    Beregi, Jean-Paul; Mounier-Vehier, Claire; Devos, Patrick; Gautier, Corinne; Libersa, Christian; McFadden, Eugene P.; Carre, Alain

    2000-01-01

    Purpose: To study the vasomotor responses of the renal microcirculation in patients with essential hypertension.Methods: We studied the reactivity of the renal microcirculation to papaverine, with intraarterial Doppler and quantitative arteriography, in 34 renal arteries of 19 hypertensive patients without significant renal artery stenosis. Isosorbide dinitrate was given to maximally dilate proximal renal arteries. APV (average peak blood flow velocity) was used as an index of renal blood flow.Results: Kidneys could be divided into two distinct subgroups based on their response to papaverine. An increase in APV of up to 55% occurred in 21 kidneys, an increase > 55% in 13 kidneys. Within each group the values were normally distributed. Both baseline APV and the effect of papaverine on mean velocity differed significantly between groups.Conclusion: There seems to be a subgroup of patients with essential hypertension that has an impaired reactivity to papaverine, consistent with a functional impairment of the renal microcirculation. Further studies are required to determine whether this abnormality contributes to or results from elevated blood pressure

  15. Estimation of myocardial flow reserve utilizing an ultrafast cardiac SPECT: Comparison with coronary angiography, fractional flow reserve, and the SYNTAX score.

    Science.gov (United States)

    Miyagawa, Masao; Nishiyama, Yoshiko; Uetani, Teruyoshi; Ogimoto, Akiyoshi; Ikeda, Shuntaro; Ishimura, Hayato; Watanabe, Emiri; Tashiro, Rami; Tanabe, Yuki; Kido, Teruhito; Kurata, Akira; Mochizuki, Teruhito

    2017-10-01

    Quantitative assessment of myocardial flow reserve (MFR) by single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is challenging but may facilitate evaluation of multi-vessel coronary artery disease (CAD). We enrolled 153 patients with suspected or known CAD, referred for pharmacological stress MPI. They underwent a 99m Tc-perfusion stress/rest SPECT with an ultrafast cadmium-zinc-telluride (CZT) camera. Dynamic data were acquired and time-activity curves fitted to a 1-tissue compartment analysis with input function. K1 was assigned for stress and rest data. The MFR index (MFRi) was calculated as K1 stress/K1 at-rest. The findings were validated by invasive coronary angiography in 69 consecutive patients. The global MFRi was 1.46 (1.16-1.76), 1.33 (1.12-1.54), and 1.18 (1.01-1.35), for 1-vessel disease (VD), 2-VD, and 3-VD, respectively. In the 3-VD, global MFRi was lower than that in 0-VD (1.63 [1.22-2.04], Pfraction (OR: 61.6 [57.5-66.0]), and global MFRi (OR: 119.6 [111.5-127.7], P=0.002). A cut-off value of 1.3 yielded 93.3% sensitivity and 75.9% specificity for diagnosing 3-VD. Fractional flow reserve positively correlated with regional MFRi (r=0.62, P=0.008), and the SYNTAX score correlated negatively with global MFRi (r=0.567, P=0.0003). We developed and validated a clinically available method for MFR quantification by dynamic 99m Tc-perfusion SPECT utilizing a CZT camera, which improves the detectability of multi-vessel CAD. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Computed tomography derived fractional flow reserve testing in stable patients with typical angina pectoris

    DEFF Research Database (Denmark)

    Møller Jensen, Jesper; Erik Bøtker, Hans; Norling Mathiassen, Ole

    2017-01-01

    Aims: To assess the use of downstream coronary angiography (ICA) and short-term safety of frontline coronary CT angiography (CTA) with selective CT-derived fractional flow reserve (FFRCT) testing in stable patients with typical angina pectoris. Methods and results: Between 1 January 2016 and 30 J...... of safe cancellation of planned ICAs....

  17. A Network Flow-based Analysis of Cognitive Reserve in Normal Ageing and Alzheimer's Disease.

    Science.gov (United States)

    Wook Yoo, Sang; Han, Cheol E; Shin, Joseph S; Won Seo, Sang; Na, Duk L; Kaiser, Marcus; Jeong, Yong; Seong, Joon-Kyung

    2015-05-20

    Cognitive reserve is the ability to sustain cognitive function even with a certain amount of brain damages. Here we investigate the neural compensation mechanism of cognitive reserve from the perspective of structural brain connectivity. Our goal was to show that normal people with high education levels (i.e., cognitive reserve) maintain abundant pathways connecting any two brain regions, providing better compensation or resilience after brain damage. Accordingly, patients with high education levels show more deterioration in structural brain connectivity than those with low education levels before symptoms of Alzheimer's disease (AD) become apparent. To test this hypothesis, we use network flow measuring the number of alternative paths between two brain regions in the brain network. The experimental results show that for normal aging, education strengthens network reliability, as measured through flow values, in a subnetwork centered at the supramarginal gyrus. For AD, a subnetwork centered at the left middle frontal gyrus shows a negative correlation between flow and education, which implies more collapse in structural brain connectivity for highly educated patients. We conclude that cognitive reserve may come from the ability of network reorganization to secure the information flow within the brain network, therefore making it more resistant to disease progress.

  18. Coronary flow reserve index corrected by exercise load using Tl-201 SPECT

    International Nuclear Information System (INIS)

    Kubota, Yasushi; Sugihara, Hiroki; Azuma, Akihiro

    1990-01-01

    For simple, non-invasive evaluation of coronary flow reserve during exercise, we investigated the coronary flow reserve index using the ratio of change of fractional distribution in the regional myocardium to oxygen demand. The subjects included 24 patients with effort angina pectoris and 11 normal volunteers. PTCA was peformed for 11 patients. Using the biological properties of Tl-201 single photon emission computed tomography (SPECT) was performed at submaximal exercise and at rest by two successive injections of Tl-201 within a short time interval (double dose method). The correlation between the fractional distribution in the myocardium (Δ-Fract) and the oxygen demand during exercise and at rest were evaluated. Δ-Fract correlated well with the rate of change of the pressure rate product (Δ-PRP), and Δ-Fract/Δ-PRP (CRI) was a good indicator of the coronary flow reserve index. CRI in the ischemic region correlated well with the percent area stenosis of the supplying coronary artery and improved with resolution of percent area stenosis of the target coronary artery after PTCA, but in some cases they were not above the normal range. CRI as obtained by exercise SPECT using the double dose method is useful for non-invasively estimating the coronary flow reserve during exercise, and it can be used for evaluating the effect before and after PTCA. (author)

  19. Simulation of the regional groundwater-flow system of the Menominee Indian Reservation, Wisconsin

    Science.gov (United States)

    Juckem, Paul F.; Dunning, Charles P.

    2015-01-01

    A regional, two-dimensional, steady-state groundwater-flow model was developed to simulate the groundwater-flow system and groundwater/surface-water interactions within the Menominee Indian Reservation. The model was developed by the U.S. Geological Survey (USGS), in cooperation with the Menominee Indian Tribe of Wisconsin, to contribute to the fundamental understanding of the region’s hydrogeology. The objectives of the regional model were to improve understanding of the groundwater-flow system, including groundwater/surface-water interactions, and to develop a tool suitable for evaluating the effects of potential regional water-management programs. The computer code GFLOW was used because of the ease with which the model can simulate groundwater/surface-water interactions, provide a framework for simulating regional groundwater-flow systems, and be refined in a stepwise fashion to incorporate new data and simulate groundwater-flow patterns at multiple scales. Simulations made with the regional model reproduce groundwater levels and stream base flows representative of recent conditions (1970–2013) and illustrate groundwater-flow patterns with maps of (1) the simulated water table and groundwater-flow directions, (2) probabilistic areas contributing recharge to high-capacity pumped wells, and (3) estimation of the extent of infiltrated wastewater from treatment lagoons.

  20. Significant regional heterogeneity of coronary flow reserve in paediatric hypertrophic cardiomyopathy

    International Nuclear Information System (INIS)

    Tadamura, E.; Kudoh, T.; Kubo, S.; Konishi, J.; Motooka, M.; Nohara, R.; Matsumori, A.; Sasayama, S.; Matsuda, T.; Tamaki, N.

    2000-01-01

    Previous studies have indicated that cardiac events in young patients with hypertrophic cardiomyopathy (HCM) are related to ischaemia rather than to arrhythmia. We measured coronary flow reserve in paediatric HCM and compared the values with those in adult HCM. We studied 12 patients with HCM including six paediatric ( 20 years old: mean 62 years), and six healthy young adults (mean 29 years) as controls. Every patient underwent magnetic resonance imaging (MRI) for anatomical assessment. Myocardial blood flow at rest and after dipyridamole infusion was measured with dynamic nitrogen-13 ammonia positron emission tomography (PET). Partial volume effect was corrected for using the anatomical data obtained with MRI. In adult patients with HCM, coronary flow reserve in the hypertrophied septal region was not significantly different from that in the non-hypertrophied lateral wall (1.38±0.29 vs 1.77±0.39, respectively). In the paediatric patients, coronary flow reserve in the hypertrophied septal region was significantly lower than in the non-hypertrophied lateral wall (0.84±0.33 vs 2.74±0.90, respectively, P<0.01). In addition, coronary flow reserve in adult patients was lower than in control subjects both in the septal wall (1.38±0.29 vs 2.94±0.35, respectively, P<0.0001) and in the lateral wall (1.77±0.39 vs 2.85±0.69, respectively, P<0.05). In contrast, coronary flow reserve in paediatric patients was not significantly different from that in control subjects in the lateral wall (2.74±0.90 vs 2.85±0.69, respectively), while absolute reduction of myocardial blood flow was noted after pharmacological vasodilatation in the hypertrophied septal region. In conclusion, significant regional differences of coronary flow reserve were present in the paediatric patients with HCM. These results suggest that paediatric patients with HCM intrinsically have the potential to experience significant regional ischaemia even in the absence of coronary stenosis. (orig.)

  1. Reduced coronary flow and resistance reserve in primary scleroderma myocardial disease

    International Nuclear Information System (INIS)

    Nitenberg, A.; Foult, J.M.; Kahan, A.; Perennec, J.; Devaux, J.Y.; Menkes, C.J.; Amor, B.

    1986-01-01

    The maximum coronary vasodilator capacity after intravenous dipyridamole (0.14 mg X kg-1 X min-1 X 4 minutes) was studied in seven patients with primary scleroderma myocardial disease and compared to that of seven control subjects. Hemodynamic data and left ventricular angiographic data were not different in the two groups. The coronary flow reserve was evaluated by the dipyridamole/basal coronary sinus blood flow ratio (D/B CSBF) and the coronary resistance reserve by the dipyridamole/basal coronary resistance ratio (D/B CR). Coronary reserve was greatly impaired in the group with primary scleroderma myocardial disease: D/B CSBF was lower than in the control group (2.54 +/- 1.37 vs 4.01 +/- 0.56, respectively; p less than 0.05) and D/B CR was higher than in the control group (0.47 +/- 0.25 vs 0.23 +/- 0.04, respectively; p less than 0.05). Such a decreased coronary flow and resistance reserve in patients with primary scleroderma myocardial disease was not explained by an alteration of left ventricular function. It may be an important contributing factor in the pathogenesis of primary scleroderma myocardial disease

  2. Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Mady Charles

    2007-09-01

    Full Text Available Abstract Background In patients with advanced non-ischemic cardiomyopathy (NIC, right-sided cardiac disturbances has prognostic implications. Right coronary artery (RCA flow pattern and flow reserve (CFR are not well known in this setting. The purpose of this study was to assess, in human advanced NIC, the RCA phasic flow pattern and CFR, also under right-sided cardiac disturbances, and compare with left coronary circulation. As well as to investigate any correlation between the cardiac structural, mechanical and hemodynamic parameters with RCA phasic flow pattern or CFR. Methods Twenty four patients with dilated severe NIC were evaluated non-invasively, even by echocardiography, and also by cardiac catheterization, inclusive with Swan-Ganz catheter. Intracoronary Doppler (Flowire data was obtained in RCA and left anterior descendent coronary artery (LAD before and after adenosine. Resting RCA phasic pattern (diastolic/systolic was compared between subgroups with and without pulmonary hypertension, and with and without right ventricular (RV dysfunction; and also with LAD. RCA-CFR was compared with LAD, as well as in those subgroups. Pearson's correlation analysis was accomplished among echocardiographic (including LV fractional shortening, mass index, end systolic wall stress more hemodynamic parameters with RCA phasic flow pattern or RCA-CFR. Results LV fractional shortening and end diastolic diameter were 15.3 ± 3.5 % and 69.4 ± 12.2 mm. Resting RCA phasic pattern had no difference comparing subgroups with vs. without pulmonary hypertension (1.45 vs. 1.29, p = NS either with vs. without RV dysfunction (1.47 vs. 1.23, p = NS; RCA vs. LAD was 1.35 vs. 2.85 (p Conclusion In patients with chronic advanced NIC, RCA phasic flow pattern has a mild diastolic predominance, less marked than in LAD, with no effects from pulmonary artery hypertension or RV dysfunction. There is no significant correlation between any cardiac mechanical-structural or

  3. Adenosine-induced coronary flow reserve in Watanabe heritable hyperlipidemic rabbits

    Energy Technology Data Exchange (ETDEWEB)

    Shimada, Kazuhiro; Yoshida, Katsuya [Chiba Univ. (Japan). School of Medicine; Tadokoro, Hiroyuki [and others

    2000-12-01

    The Watanabe heritable hyperlipidemic (WHHL) rabbit develops coronary atherosclerosis and hypercholesterolemia because of a genetic deficiency of low-density lipoprotein receptors and is therefore a good animal model for studying the relationships of coronary atherosclerosis, hypercholesterolemia and coronary flow reserve. The aim of the present study was to assess myocardial perfusion at baseline and during adenosine infusion (0.2 mg{center_dot}kg{sup -1}{center_dot}min{sup -1}) in 8 WHHL rabbits (13.8{+-}0.5 months) with {sup 13}N-ammonia, small-animal positron emission tomography (PET) and colored microspheres. Results were compared with those from 6 age-matched Japanese white rabbits. Plaque distribution was also examined in the extramural coronary arteries. All 8 WHHL rabbits had coronary plaques, with 6 showing multiple plaques. Mean global myocardial blood flow (ml{center_dot}min{sup -1}{center_dot}g{sup -1}) did not differ significantly between control and WHHL groups both at baseline (3.67{+-}0.72 vs 4.26{+-}1.12 ml{center_dot}min{sup -1}{center_dot}g{sup -1}, p=NS) and with adenosine (7.92{+-}2.00 vs 9.27{+-}2.91 ml{center_dot}min{sup -1}{center_dot}g{sup -1}, p=NS), nor did coronary flow reserve (2.16{+-}0.37 vs 2.18{+-}0.41, p=NS). None showed evidence of regional perfusion abnormalities by visual and semiquantitative analyses of PET images. It was concluded that WHHL rabbits preserve adenosine-induced coronary flow reserve despite coronary atherosclerosis and hypercholesterolemia, suggesting that a compensatory mechanism develops in this animal model. (author)

  4. Adenosine-induced coronary flow reserve in Watanabe heritable hyperlipidemic rabbits

    International Nuclear Information System (INIS)

    Shimada, Kazuhiro; Yoshida, Katsuya; Tadokoro, Hiroyuki

    2000-01-01

    The Watanabe heritable hyperlipidemic (WHHL) rabbit develops coronary atherosclerosis and hypercholesterolemia because of a genetic deficiency of low-density lipoprotein receptors and is therefore a good animal model for studying the relationships of coronary atherosclerosis, hypercholesterolemia and coronary flow reserve. The aim of the present study was to assess myocardial perfusion at baseline and during adenosine infusion (0.2 mg·kg -1 ·min -1 ) in 8 WHHL rabbits (13.8±0.5 months) with 13 N-ammonia, small-animal positron emission tomography (PET) and colored microspheres. Results were compared with those from 6 age-matched Japanese white rabbits. Plaque distribution was also examined in the extramural coronary arteries. All 8 WHHL rabbits had coronary plaques, with 6 showing multiple plaques. Mean global myocardial blood flow (ml·min -1 ·g -1 ) did not differ significantly between control and WHHL groups both at baseline (3.67±0.72 vs 4.26±1.12 ml·min -1 ·g -1 , p=NS) and with adenosine (7.92±2.00 vs 9.27±2.91 ml·min -1 ·g -1 , p=NS), nor did coronary flow reserve (2.16±0.37 vs 2.18±0.41, p=NS). None showed evidence of regional perfusion abnormalities by visual and semiquantitative analyses of PET images. It was concluded that WHHL rabbits preserve adenosine-induced coronary flow reserve despite coronary atherosclerosis and hypercholesterolemia, suggesting that a compensatory mechanism develops in this animal model. (author)

  5. An Outflow Boundary Condition Model for Noninvasive Prediction of Fractional Flow Reserve in Diseased Coronary Arteries.

    Science.gov (United States)

    Fayssal, Iyad A; Moukalled, Fadl; Alam, Samir; Isma'eel, Hussain

    2018-04-01

    This paper reports on a new boundary condition formulation to model the total coronary myocardial flow and resistance characteristics of the myocardial vascular bed for any specific patient when considered for noninvasive diagnosis of ischemia. The developed boundary condition model gives an implicit representation of the downstream truncated coronary bed. Further, it is based on incorporating patient-specific physiological parameters that can be noninvasively extracted to account for blood flow demand to the myocardium at rest and hyperemic conditions. The model is coupled to a steady three-dimensional (3D) collocated pressure-based finite volume flow solver and used to characterize the "functional significance" of a patient diseased coronary artery segment without the need for predicting the hemodynamics of the entire arterial system. Predictions generated with this boundary condition provide a deep understanding of the inherent challenges behind noninvasive image-based diagnostic techniques when applied to human diseased coronary arteries. The overall numerical method and formulated boundary condition model are validated via two computational-based procedures and benchmarked with available measured data. The newly developed boundary condition is used via a designed computational methodology to (a) confirm the need for incorporating patient-specific physiological parameters when modeling the downstream coronary resistance, (b) explain the discrepancies presented in the literature between measured and computed fractional flow reserve (FFRCT), and (c) discuss the current limitations and future challenges in shifting to noninvasive assessment of ischemia.

  6. Clinical Outcomes of patients with coronary artery disease who underwent FFR evaluation of intermediate coronary lesionS– COFFRS study

    Directory of Open Access Journals (Sweden)

    Srinivasa Prasad

    2017-07-01

    Conclusion: In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73. Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03. FFR based revascularization decision appears to be a safe strategy in Indian patients.

  7. Flow sheet development for the remediation of tank SY-102 at the Hanford Nuclear Reservation

    International Nuclear Information System (INIS)

    Yarbro, S.L.; Punjak, W.A.; Schreiber, S.B.; Ortiz, E.M.; Jarvinen, G.D.

    1994-01-01

    The U.S. Department of Energy established the Tank Waste Remediation System (TWRS) to safely manage and dispose of radioactive waste stored in underground tanks at the Hanford Nuclear Reservation. A major task of TWRS is to separate tank wastes into high-level and low-level fractions. This separation is important because of the enormous costs associated with handling high-level waste and the limited repository space that is available. Due to their high activity, segregating the actinides and fission products from the bulk of the waste is required to achieve this goal. As a part of this program, personnel at the Los Alamos National Laboratory have developed and demonstrated a flow sheet to remediate tank SY-102 at the Hanford Site. This presentation documents the results of the flow sheet demonstrations performed with simulated, but radioactive, wastes using an existing glovebox line at the Los Alamos Plutonium Facility. Removal of the actinides from a high-salt, low-acid feed by ion exchange is the key unit operation. The flow sheet produces relatively low waste volumes, can be accomplished with conventional chemical processing equipment, and takes advantage of the components of the waste to increase the efficiency of the TRU elements recovery

  8. Acetazolamide assisted Tc-99m MAG3 renography to assess renal blood flow reserve

    International Nuclear Information System (INIS)

    Horita, Yoshio; Hayashida, Kohei; Fukuchi, Kazuki

    2003-01-01

    The present study examines whether or not baseline and acetazolamide (ACZ) Tc-99m MAG3 renography can assess renal blood flow reserve. Renography proceeded for 50 min after sequential injections of 370 MBq Tc-99m MAG3 for baseline renography and 10 min after a 1,000 mg injection of ACZ for ACZ renography. Effective renal plasma flow of renal cortex (cERPF) in each kidney and the percentage change in cERPF of those parameters (ΔERPF) were obtained before and after the administration of ACZ in 10 subjects without hypertension or diabetes (normal group), in 10 with essential hypertension (hypertensive group) and in 10 who had Type 2 diabetes with hypertension (diabetic group). A placebo test was performed in the 10 without hypertension or diabetes using distilled water instead of ACZ (placebo group). The placebo test performed in the 10 without hypertension or diabetes using distilled water instead of ACZ indicated that the parameter variance between the two types of renogram was below 3.2%. The cERPF of baseline and ACZ Tc-99m MAG3 renography and ΔERPF in the normal, hypertensive and diabetic groups were 89±10 and 110±10 ml/min, 89±14 and 117±22 ml/min, 100±23 and 112±23 ml/min, respectively, and 24.5±13.5%, 26.0±9.7% and 12.3±11.1%, respectively. The difference in the cERPF value was significant in the normal and hypertensive groups whereas this did not change in the diabetic group before or after ACZ administration. We suggested that the ΔERPF determined by baseline and ACZ Tc-99m MAG3 renography is a useful parameter for assessing renal blood flow reserve. (author)

  9. Transthoracic Doppler echocardiography – noninvasive diagnostic window for coronary flow reserve assessment

    Directory of Open Access Journals (Sweden)

    Dimitrow Paweł

    2003-04-01

    Full Text Available Abstract This review focuses on transthoracic Doppler echocardiography as noninvasive method used to assess coronary flow reserve (CFR in a wide spectrum of clinical settings. Transthoracic Doppler echocardiography is rapidly gaining appreciation as popular tool to measure CFR both in stenosed and normal epicardial coronary arteries (predominantly in left anterior descending coronary artery. Post-stenotic CFR measurement is helpful in: functional assessment of moderate stenosis, detection of significant or critical stenosis, monitoring of restenosis after revascularization. In the absence of stenosis in the epicardial coronary artery, decreased CFR enable to detect impaired microvascular vasodilatation in: reperfused myocardial infarct, arterial hypertension with or without left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, syndrome X, hypertrophic cardiomyopathy. In these diseases, noninvasive transthoracic Doppler echocardiography allows for serial CFR evaluations to explore the effect of various pharmacological therapies.

  10. Coronary flow reserve/diastolic function relationship in angina-suffering patients with normal coronary angiography.

    Science.gov (United States)

    Anchisi, Chiara; Marti, Giuliano; Bellacosa, Ilaria; Mary, David; Vacca, Giovanni; Marino, Paolo; Grossini, Elena

    2017-05-01

    Coronary blood flow and diastolic function are well known to interfere with each other through mechanical and metabolic mechanisms. We aimed to assess the relationship between coronary flow reserve (CFR) and diastolic dysfunction in patients suffering from angina but with normal coronary angiography. In 16 patients with chest pain and angiographically normal coronary arteries, CFR was measured using transthoracic echo-Doppler by inducing hyperemia through dipyridamole infusion. Diastolic function (E/A, deceleration time, isovolumetric relaxation time [IVRT], propagation velocity [Vp]) and left ventricular mass were evaluated by means of two-dimensional transthoracic echocardiography. The patients were initially divided into two groups on the grounds of CFR only (ACFR: altered CFR, n = 9; NACFR: unaltered CFR, n = 7). Thereafter they were divided into four groups on the grounds of CFR and diastolic function (NN: normal; AA: altered CFR/diastole; AN: altered CFR/normal diastole; NA: normal CFR/altered diastole). Most of the subjects were scheduled in AA (n = 8) or NA (n = 5) groups, which were taken into consideration for further analysis. Patients were not different regarding various risk factors. ACFR and AA patients were older with normal body weight in comparison with NACFR and NA patients (P relationship between altered CFR and diastole.

  11. Analysis of digital subtraction coronary angiography for estimation of flow reserve in critical coronary stenosis

    International Nuclear Information System (INIS)

    Kohtoku, Shinya

    1988-01-01

    To examine the accuracy of digital subtraction angiographic assessment of coronary flow reserve in critical coronary stenosis, time-density curve was obtained from digital subtraction coronary angiograms for myocardial region of interest. Time to peak contrast(TPC) and time constant of the washout exponential curve(T) were measured in 14 patients with stable effort angina pectoris and critical one vessel lesion before and after percutaneous transluminal coronary angioplasty(PTCA). All patients had normal left ventricular ejection fraction (59 ± 7 %) and Tl 201 myocardial image at rest. The values of TPC and T were significantly shortened from 5.4 ± 1.3 to 4.5 ± 1.0 sec (p < 0.02) and from 10.9 ± 3.8 to 5.3 ± 1.3 sec(p < 0.001) after PTCA, respectively. However, in 9 of all patients TPC after PTCA showed approximately the same valued as those before PTCA. In 5 experimental dogs with critical circumflex stenosis, coronary flow(CF;Doppler flow meter) and systolic thickning of the posterior wall(by sonomicrometry) at rest were not different from control, however, contrast media-induced reactive hyperemia was markedly attenuated, accompanied with a significant of T (7.7 ± 4.5 vs 15.8 ± 10.9 sec, p < 0.01) and completely unchanged TPC (both 6.8 sec). With simultaneous tracing of CF and time-density curve, TPC and washout phase corresponded with contrast-induced transient CF reduction and hyperemic phase, respectively. We conclude that T might be more sensitive for estimation of CF is maintained almost normal, such as patients with stable effort angina pectoris having normal left ventricular wall motion at rest. (author)

  12. Blood flow, flow reserve, and glucose utilization in viable and nonviable myocardium in patients with ischemic cardiomyopathy.

    Science.gov (United States)

    Zhang, Xiaoli; Schindler, Thomas H; Prior, John O; Sayre, James; Dahlbom, Magnus; Huang, Sung-Cheng; Schelbert, Heinrich R

    2013-04-01

    The aim of the study was to determine whether glucose uptake in viable myocardium of ischemic cardiomyopathy patients depends on rest myocardial blood flow (MBF) and the residual myocardial flow reserve (MFR). Thirty-six patients with ischemic cardiomyopathy (left ventricular ejection fraction 25 ± 10 %) were studied with (13)N-ammonia and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Twenty age-matched normals served as controls. Regional MBF was determined at rest and during dipyridamole hyperemia and regional FDG extraction was estimated from regional FDG to (13)N-ammonia activity ratios. Rest MBF was reduced in viable (0.42 ± 0.18 ml/min per g) and nonviable regions (0.32 ± 0.09 ml/min per g) relative to remote regions (0.68 ± 0.23 ml/min per g, p MFRs did not differ significantly (p > 0.05). Compared to MFR in remote myocardium, MFRs in viable regions were similar (1.39 ± 0.56 vs 1.70 ± 0.45, p > 0.05) but were significantly lower in nonviable regions (1.23 ± 0.43, p MFRs (r =-0.424, p MFRs in viable myocardium are associated with increasing glucose extraction that likely reflects a metabolic adaptation of remodeling hibernating myocytes.

  13. Environmental flow calculation for the maintenance of the water reserve of the Piaxtla River, Sinaloa, Mexico

    Directory of Open Access Journals (Sweden)

    Guadalupe de la Lanza Espino

    2014-03-01

    status to be achieved within the watershed to maintain the integrity of existing ecosystems or when they believe that they are degraded, contributing to the recovery or rehabilitation; and annual percentage rate recommended for environmental protection. Based on this, the purpose of this study was to quantify the river flow of the Piaxtla river, in the state of Sinaloa. The river runoff data bases for 36 and nine years were compared, showed differences mainly between the frequency of maximum runoff and its origin, and indicated that it is advisable to use a data base of more than 20 years. However, results were similar in the final calculation of the environmental or ecological river flows; that is to say, total runoff volume was 62.1% considering 36 years and 57.7% for nine years of information. We conclude that the ecological importance of Piaxtla river was very high and the use of water pressure was low (considering that database runoff only included until 1999 and did not take into account population growth and activities. To determine the final volume reserved for the environment or ecological flow, could be estimated not only with a database of 36 years, but for nine years also confirming that those rivers that have databases of 10 years can the methodology used hydrological indicated by the NMX said. Particularly in this study it was determined that for parameters more detailed as the volume of the base rate of the annual volume, according to the frequency of occurrence, both very dry years, dry, average and wet, and influence of meteorological events that determine periods separate return, it is advisable to use minimum data bases as brand NMX 20 years.

  14. Analysis of digital subtraction angiography for estimating flow reserve in critical coronary artery stenosis

    International Nuclear Information System (INIS)

    Kotoku, Shinya; Matsuzaki, Masunori; Otani, Nozomi

    1988-01-01

    To assess the accuracy of digital subtraction angiography in evaluating coronary flow reserve in cases with critical coronary artery stenosis, time-density curves were obtained from digital subtraction coronary angiograms in the myocardial region of interest. Time to peak contrast (TPC) and time constant of the washout exponential curve (T) were measured in 14 patients with stable effort angina pectoris and critical one vessel lesion before and after percutaneous transluminal coronary angioplasty (PTCA). All patients had normal left ventricular ejection fraction (59±7%) and 201 Tl myocardial images at rest. The values of TPC and T were significantly shortened from 5.4±1.3 to 4.5±1.0 sec (p<0.02) and from 10.9±3.8 to 5.3±1.3 sec (p<0.001) after PTCA, respectively. However, in 9 patients TPC values were approximately the same before and after PTCA. In five experimental dogs with critical circumflex coronary artery stenosis, coronary flow (CF; Doppler flowmeter) and systolic thickening of the posterior wall (by sonomicrometry) at rest did not differ from those of the controls. However, contrast media-induced reactive hyperemia was markedly attenuated, accompanied by a significant increase in T (7.7±4.5 vs 15.8±10.9 sec, p<0.01) and totally unchanged TPC (both 6.8 sec). With simultaneous tracings of CF and time-density curves, TPC and washout phases corresponded with contrast-induced transient CF reduction and hyperemic phases, respectively. We concluded that T may be more sensitive for estimating CF maintained nearly normal, e.g., in patients with stable effort angina pectoris having normal left ventricular wall motion at rest. (author)

  15. Estimation of the flow resistances exerted in coronary arteries using a vessel length-based method.

    Science.gov (United States)

    Lee, Kyung Eun; Kwon, Soon-Sung; Ji, Yoon Cheol; Shin, Eun-Seok; Choi, Jin-Ho; Kim, Sung Joon; Shim, Eun Bo

    2016-08-01

    Flow resistances exerted in the coronary arteries are the key parameters for the image-based computer simulation of coronary hemodynamics. The resistances depend on the anatomical characteristics of the coronary system. A simple and reliable estimation of the resistances is a compulsory procedure to compute the fractional flow reserve (FFR) of stenosed coronary arteries, an important clinical index of coronary artery disease. The cardiac muscle volume reconstructed from computed tomography (CT) images has been used to assess the resistance of the feeding coronary artery (muscle volume-based method). In this study, we estimate the flow resistances exerted in coronary arteries by using a novel method. Based on a physiological observation that longer coronary arteries have more daughter branches feeding a larger mass of cardiac muscle, the method measures the vessel lengths from coronary angiogram or CT images (vessel length-based method) and predicts the coronary flow resistances. The underlying equations are derived from the physiological relation among flow rate, resistance, and vessel length. To validate the present estimation method, we calculate the coronary flow division over coronary major arteries for 50 patients using the vessel length-based method as well as the muscle volume-based one. These results are compared with the direct measurements in a clinical study. Further proving the usefulness of the present method, we compute the coronary FFR from the images of optical coherence tomography.

  16. Changes in ovarian reserve and ovarian blood flow in patients with polycystic ovary syndrome following laparoscopic ovarian drilling.

    Science.gov (United States)

    Kamal, Nasser; Sanad, Zakaria; Elkelani, Osama; Rezk, Mohamed; Shawky, Mohamed; Sharaf, Abd-Elbar

    2018-04-10

    This prospective cohort study was conducted on 80 patients with clomiphene citrate (CC)-resistant polycystic ovary syndrome undergoing laparoscopic ovarian drilling (LOD). Pre- and post-LOD ovarian reserve parameters (anti-Mullerian hormone: AMH, ovarian volume: OV, and antral follicle count: AFC) and ovarian stromal blood flow indices (Vascularization index: VI, flow index: FI, and vascularization flow index: VFI) were measured to explore the effect of LOD and to find out the correlation between serum AMH and different clinical, hormonal, and ultrasonic variables. There was a highly significant reduction of the serum AMH (p ovarian reserve parameters (AMH, OV and AFC) and ovarian stromal blood flow indices (VI, FI and VFI) with no observed correlation between AMH levels and Doppler indices.

  17. Vascular flow reserve as a link between long-term blood pressure level and physical performance capacity in mammals

    DEFF Research Database (Denmark)

    Poulsen, Christian B; Damkjær, Mads; Hald, Bjørn O

    2016-01-01

    Mean arterial pressure (MAP) is surprisingly similar across different species of mammals, and it is, in general, not known which factors determine the arterial pressure level. Mammals often have a pronounced capacity for sustained physical performance. This capacity depends on the vasculature...... having a flow reserve that comes into play as tissue metabolism increases. We hypothesize that microvascular properties allowing for a large vascular flow reserve is linked to the level of the arterial pressure.To study the interaction between network properties and network inlet pressure, we developed...

  18. Quantitative assessment of blood flow reserve using {sup 99m}Tc-HMPAO in carotid stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Garai, I.; Varga, J.; Galuska, L. [Department of Nuclear Medicine, University of Debrecen Medical and Health Centre, Debrecen (Hungary); Szomjak, E. [3. Department of Internal Medicine, University of Debrecen Medical and Health Centre, Debrecen (Hungary); Toth, C.; Olvaszto, S. [1. Department of Surgery, University of Debrecen Medical and Health Centre, Debrecen (Hungary); Bank, J. [Department of Neurology, Kenezy Hospital (Hungary); Ficzere, A. [Department of Neurology, University of Debrecen Medical and Health Centre, Debrecen (Hungary)

    2002-02-01

    Dynamic imaging of the inflow of technetium-99m hexamethylpropylene amine oxime (HMPAO) to the brain has been proved to allow estimation of the hemispherical cerebral blood flow (CBF) using the Patlak plot. In this study, we compared the hemispherical CBF (in ml/min/100 g) of different patient groups. A total of 25 patients (comprising 13 with migraine and 12 scheduled for endarterectomy owing to angiographically confirmed severe stenosis of the internal carotid artery on at least one side) underwent baseline and acetazolamide {sup 99m}Tc-HMPAO brain perfusion studies. In addition, acetazolamide {sup 99m}Tc-HMPAO studies were performed in 12 healthy subjects (no baseline study was performed for ethical reasons.) Dynamic studies were acquired by means of a dual-detector gamma camera with a large field of view (HELIX, Elscint). Special difference images were created to make definition of the aortic arch and hemispherical brain regions easier and more reproducible. A semi-automatic method was developed to determine the transit time from the aorta to the brain, making the generation of the Patlak plot even more robust. The baseline CBF values did not significantly depend on the disease (P>0.1), whereas the CBF values obtained after acetazolamide provocation did do so (ANOVA, P<0.001). Patients suffering from migraine showed a significant increase in global CBF values after acetazolamide provocation (paired t test, P<0.05), but we could not find any effect of the provocation in patients awaiting carotid endarterectomy, indicating a lack of cerebrovascular reserve capacity. Comparison of the results of the acetazolamide study in patients and the control group revealed the CBF values to be significantly lower in patients with carotid stenosis (two-sample t-test, P<0.001), but not in those with migraine (P>0.1). In summary, using quantitative analysis of {sup 99m}Tc-HMPAO brain studies we could objectively compare the CBF of patients suffering from different diseases

  19. Effect of streptozotocin-induced diabetes on myocardial blood flow reserve assessed by myocardial contrast echocardiography in rats

    Directory of Open Access Journals (Sweden)

    Weytjens Caroline

    2008-09-01

    Full Text Available Abstract The role of structural and functional abnormalities of small vessels in diabetes cardiomyopathy remains unclear. Myocardial contrast echocardiography allows the quantification of myocardial blood flow at rest and during dipyridamole infusion. The aim of the study was to determine the myocardial blood flow reserve in normal rats compared with Streptozotocin-induced diabetic rats using contrast echocardiography. Methods We prospectively studied 40 Wistar rats. Diabetes was induced by intravenous streptozotocin in 20 rats. All rats underwent baseline and stress (dipyridamole: 20 mg/kg high power intermittent imaging in short axis view under anaesthesia baseline and after six months. Myocardial blood flow was determined and compared at rest and after dipyridamole in both populations. The myocardial blood flow reserve was calculated and compared in the 2 groups. Parameters of left ventricular function were determined from the M-mode tracings and histological examination was performed in all rats at the end of the study. Results At six months, myocardial blood flow reserve was significantly lower in diabetic rats compared to controls (3.09 ± 0.98 vs. 1.28 ± 0.67 ml min-1 g-1; p Conclusion In this animal study, diabetes induced a functional alteration of the coronary microcirculation, as demonstrated by contrast echocardiography, a decrease in capillary density and of the cardiac systolic function. These findings may offer new insights into the underlying mechanisms of diabetes cardiomyopathy.

  20. Coronary flow reserve as a link between diastolic and systolic function and exercise capacity in heart failure

    DEFF Research Database (Denmark)

    Snoer, Martin; Monk-Hansen, Tea; Olsen, Rasmus Huan

    2012-01-01

    AIMS: In heart failure, a reduced exercise capacity is the prevailing symptom and an important prognostic marker of future outcome. The purpose of the study was to assess the relation of coronary flow reserve (CFR) to diastolic and systolic function in heart failure and to determine which...

  1. Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Lassen, Jens Flensted

    2007-01-01

    AIMS: Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis...... in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment. METHODS AND RESULTS: In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure.......02-1.12, P = 0.016). CONCLUSION: Recruitable collateral blood flow measured during balloon inflation predicts angiographic instent restenosis in PCI patients treated with bare metal stents. Udgivelsesdato: 2007-Aug...

  2. Coronary Flow Reserve Predicts Cardiopulmonary Fitness in Patients with Coronary Artery Disease Independently of Systolic and Diastolic Function

    DEFF Research Database (Denmark)

    Snoer, Martin; Olsen, Rasmus Huan; Monk-Hansen, Tea

    2014-01-01

    Aims Despite revascularization and optimal medical treatment, patients with coronary artery disease (CAD) have reduced exercise capacity. In the absence of coronary artery stenosis, coronary flow reserve (CFR) is a measure of coronary microvascular function, and a marker of future poor outcome...... in CAD patients. The aim of this study was to examine the relationship among CFR, systolic and diastolic function, peripheral vascular function, and cardiopulmonary fitness in CAD patients. Methods and Results Forty patients with median left ventricular ejection fraction (LVEF) 49 (interquartile 46....... Conclusions Coronary flow reserve measured noninvasively predicts cardiopulmonary fitness independently of resting systolic and diastolic function in CAD patients, indicating that cardiac output during maximal exercise is dependent on the ability of the coronary circulation to adapt to the higher metabolic...

  3. Normal Myocardial Flow Reserve in HIV-Infected Patients on Stable Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Knudsen, Andreas; Christensen, Thomas E; Ghotbi, Adam Ali

    2015-01-01

    . The HIV-infected patients had a mean age of 53 years (range 37-68 years) with 23% active smokers. The controls had a mean age of 52 years (range 36-68 years) and 26% active smokers. In the HIV-infected group 73% had a normal MFR, 17% borderline, and 10% low values of MFR. Among controls these values were...... 71%, 19%, and 10%, respectively (P = 0.99). However, the HIV-infected group had lower values of stress myocardial blood flow (MBF) (2.63 ± 0.09 mL/g/min vs 2.99 ± 0.14 mL/g/min; P = 0.03). We found no evidence of decreased MFR as assessed by 82Rb PET among HIV-infected patients on stable ART...

  4. Simulation of groundwater flow and interaction of groundwater and surface water on the Lac du Flambeau Reservation, Wisconsin

    Science.gov (United States)

    Juckem, Paul F.; Fienen, Michael N.; Hunt, Randall J.

    2014-01-01

    The Lac du Flambeau Band of Lake Superior Chippewa and Indian Health Service are interested in improving the understanding of groundwater flow and groundwater/surface-water interaction on the Lac du Flambeau Reservation (Reservation) in southwest Vilas County and southeast Iron County, Wisconsin, with particular interest in an understanding of the potential for contamination of groundwater supply wells and the fate of wastewater that is infiltrated from treatment lagoons on the Reservation. This report describes the construction, calibration, and application of a regional groundwater flow model used to simulate the shallow groundwater flow system of the Reservation and water-quality results for groundwater and surface-water samples collected near a system of waste-water-treatment lagoons. Groundwater flows through a permeable glacial aquifer that ranges in thickness from 60 to more than 200 feet (ft). Seepage and drainage lakes are common in the area and influence groundwater flow patterns on the Reservation. A two-dimensional, steady-state analytic element groundwater flow model was constructed using the program GFLOW. The model was calibrated by matching target water levels and stream base flows through the use of the parameter-estimation program, PEST. Simulated results illustrate that groundwater flow within most of the Reservation is toward the Bear River and the chain of lakes that feed the Bear River. Results of analyses of groundwater and surface-water samples collected downgradient from the wastewater infiltration lagoons show elevated levels of ammonia and dissolved phosphorus. In addition, wastewater indicator chemicals detected in three downgradient wells and a small downgradient stream indicate that infiltrated wastewater is moving southwest of the lagoons toward Moss Lake. Potential effects of extended wet and dry periods (within historical ranges) were evaluated by adjusting precipitation and groundwater recharge in the model and comparing the

  5. Magnetic Resonance Imaging Measurement of Left Ventricular Blood Flow and Coronary Flow Reserve in Patients with Chronic Heart Failure due to Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Aras, A.; Anik, Y.; Demirci, A.; Balci, N.C.; Kozdag, G.; Ural, D.; Komsuoglu, B. (Radiology Dept. and Cardiology Dept., Kocaeli Univ. School of Medicine, Kocaeli (Turkey))

    2007-11-15

    Background: Coronary sinus flow reflects global cardiac perfusion and has been used for the assessment of myocardial flow reserve, which is reduced in chronic heart failure (CHF). Coronary flow reserve (CFR) can be measured by using phase-contrast (PC) velocity-encoded cine (VEC) magnetic resonance imaging (MRI). Purpose: To quantify and compare global left ventricular (LV) perfusion and CFR in patients with CHF and in a healthy control group by measuring coronary sinus flow with PC VEC MRI, and to correlate this with global LV perfusion, segmental first-pass perfusion, and viability in the same patients. Material and Methods: Cardiac MRI was performed in 20 patients with CHF of ischemic origin and in a control group of healthy subjects (n 11) at rest and after pharmacological stress induced by i.v. dipyridamole. The MRI protocol included cine MRI, VEC MRI, first-pass perfusion, and delayed contrast-enhanced MRI for viability. Global LV perfusion was quantified by measuring coronary sinus flow on VEC MRI at rest in all subjects. CFR was determined as the ratio of global LV perfusion before and after pharmacologic stress. Results: At rest, global LV perfusion was not significantly different in patients with CHF and the control group. After administration of dipyridamole, global LV perfusion and CFR were significantly lower in patients with CHF compared to the control group (P<0.001). An inverse correlation was observed between CFR and the number of infarcted and/or ischemic segments (P = 0.083, P = 0.037). Conclusion: A combined cardiac MRI protocol including function and perfusion techniques together with VEC MRI can be used to evaluate global LV perfusion and CFR in patients with CHF. Global LV perfusion and CFR measurements may have potential in the monitoring of CHF. Impaired CFR may contribute to progressive decline in LV function in patients with CHF

  6. Magnetic Resonance Imaging Measurement of Left Ventricular Blood Flow and Coronary Flow Reserve in Patients with Chronic Heart Failure due to Coronary Artery Disease

    International Nuclear Information System (INIS)

    Aras, A.; Anik, Y.; Demirci, A.; Balci, N.C.; Kozdag, G.; Ural, D.; Komsuogl u, B.

    2007-01-01

    Background: Coronary sinus flow reflects global cardiac perfusion and has been used for the assessment of myocardial flow reserve, which is reduced in chronic heart failure (CHF). Coronary flow reserve (CFR) can be measured by using phase-contrast (PC) velocity-encoded cine (VEC) magnetic resonance imaging (MRI). Purpose: To quantify and compare global left ventricular (LV) perfusion and CFR in patients with CHF and in a healthy control group by measuring coronary sinus flow with PC VEC MRI, and to correlate this with global LV perfusion, segmental first-pass perfusion, and viability in the same patients. Material and Methods: Cardiac MRI was performed in 20 patients with CHF of ischemic origin and in a control group of healthy subjects (n 11) at rest and after pharmacological stress induced by i.v. dipyridamole. The MRI protocol included cine MRI, VEC MRI, first-pass perfusion, and delayed contrast-enhanced MRI for viability. Global LV perfusion was quantified by measuring coronary sinus flow on VEC MRI at rest in all subjects. CFR was determined as the ratio of global LV perfusion before and after pharmacologic stress. Results: At rest, global LV perfusion was not significantly different in patients with CHF and the control group. After administration of dipyridamole, global LV perfusion and CFR were significantly lower in patients with CHF compared to the control group (P<0.001). An inverse correlation was observed between CFR and the number of infarcted and/or ischemic segments (P = 0.083, P 0.037). Conclusion: A combined cardiac MRI protocol including function and perfusion techniques together with VEC MRI can be used to evaluate global LV perfusion and CFR in patients with CHF. Global LV perfusion and CFR measurements may have potential in the monitoring of CHF. Impaired CFR may contribute to progressive decline in LV function in patients with CHF

  7. Relationship between coronary flow reserve evaluated by phase-contrast cine cardiovascular magnetic resonance and serum eicosapentaenoic acid

    Science.gov (United States)

    2013-01-01

    Background Long-term intake of long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs), especially eicosapentaenoic acid (EPA) is associated with a low risk for cardiovascular disease. Phase-contrast cine cardiovascular magnetic resonance (PC cine CMR) can assess coronary flow reserve (CFR). The present study investigates the relationship between CFR evaluated by PC cine CMR and the serum EPA. Methods We studied 127 patients (male, 116 (91%); mean age, 72.2 ± 7.4 years) with known or suspected coronary artery disease (CAD). X-ray coronary angiography revealed no significant coronary arterial stenoses (defined as luminal diameter reduction ≥50% on quantitative coronary angiogram (QCA) analysis) in all study participants. Breath-hold PC cine CMR images of the coronary sinus (CS) were acquired to assess blood flow of the CS both at rest and during adenosine triphosphate (ATP) infusion. We calculated CFR as CS blood flow during ATP infusion divided by that at rest. Patients were allocated to groups according to whether they had high (n = 64, EPA ≥ 75.8 μg/mL) or low (n = 63, EPA  2.5, which is the previously reported lower limit of normal flow reserve without obstructive CAD. Multivariate analysis revealed that EPA is an independent predictor of CFR > 2.5 (odds ratio, 1.01; 95% confidence interval, 1.00 – 1.02, p = 0.008). Conclusions The serum EPA is significantly correlated with CFR in CAD patients without significant coronary artery stenosis. PMID:24359564

  8. Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes.

    Science.gov (United States)

    Majmudar, Maulik D; Murthy, Venkatesh L; Shah, Ravi V; Kolli, Swathy; Mousavi, Negareh; Foster, Courtney R; Hainer, Jon; Blankstein, Ron; Dorbala, Sharmila; Sitek, Arkadiusz; Stevenson, Lynne W; Mehra, Mandeep R; Di Carli, Marcelo F

    2015-08-01

    Patients with left ventricular systolic dysfunction frequently show abnormal coronary vascular function, even in the absence of overt coronary artery disease. Moreover, the severity of vascular dysfunction might be related to the aetiology of cardiomyopathy.We sought to determine the incremental value of assessing coronary vascular dysfunction among patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy at risk for adverse cardiovascular outcomes. Coronary flow reserve (CFR, stress/rest myocardial blood flow) was quantified in 510 consecutive patients with rest left ventricular ejection fraction (LVEF) ≤45% referred for rest/stress myocardial perfusion PET imaging. The primary end point was a composite of major adverse cardiovascular events (MACE) including cardiac death, heart failure hospitalization, late revascularization, and aborted sudden cardiac death.Median follow-up was 8.2 months. Cox proportional hazards model was used to adjust for clinical variables. The annualized MACE rate was 26.3%. Patients in the lowest two tertiles of CFR (CFR ≤ 1.65) experienced higher MACE rates than those in the highest tertile (32.6 vs. 15.5% per year, respectively, P = 0.004), irrespective of aetiology of cardiomyopathy. Impaired coronary vascular function, as assessed by reduced CFR by PET imaging, is common in patients with both ischaemic and non-ischaemic cardiomyopathy and is associated with MACE. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  9. Correlations between quantitative cineangiography, coronary flow reserve measured with digital subtraction cineangiography and exercise thallium perfusion scintigraphy

    International Nuclear Information System (INIS)

    Zijlstra, F.; Fioretti, P.; Reiber, J.H.; Serruys, P.W.

    1988-01-01

    The goal of this investigation was to establish which anatomical parameters of stenotic lesions correlate best with its functional severity. Therefore, thirty-eight patients with single vessel disease underwent coronary cineangiography and exercise/redistribution thallium-201 scintigraphy. Cross-sectional area at the site of obstruction (OA), percentage diameter stenosis (DS), the calculated pressuredrop over the stenosis (PD), as well as coronary flow reserve (CFR) derived from myocardial contrast appearance time and density were determined. The relations between CFR and the 3 anatomical parameters were described by the following equations: CFR = 4.6 - 0.053 DS, r = 0.82, SEE: 0.79, p less than 0.001 CFR = 0.5 + 0.75 OA, r = 0.87, SEE: 0.68, p less than 0.001 CFR = 3.6 - 1.5 log PD, r = 0.90, SEE: 0.62, p less than 0.001 The calculated pressuredrop was highly predictive of the thallium scintigraphic results with a sensitivity of 94% and a specificity of 90%. Therefore, the calculated pressuredrop is a better anatomical parameter for assessing the functional importance of a stenosis than percentage diameter stenosis or obstruction area. However, the 95% confidence limits of the relation between pressuredrop and coronary flow reserve are wide, making measurement of CFR a valuable addition to quantitative angiography, especially when determining the functional importance of moderately severe coronary artery lesions

  10. Comparison of fractional flow reserve of composite Y-grafts with saphenous vein or right internal thoracic arteries.

    Science.gov (United States)

    Glineur, David; Boodhwani, Munir; Poncelet, Alain; De Kerchove, Laurent; Etienne, Pierre Yves; Noirhomme, Philippe; Deceuninck, Paul; Michel, Xavier; El Khoury, Gebrine; Hanet, Claude

    2010-09-01

    Composite Y-grafts, using the left internal thoracic artery as the inflow, allow a more efficient use of conduits without the need to touch a diseased ascending aorta. Among other conduits, the saphenous vein graft may be an alternative to the radial artery in elderly patients. We evaluated the hemodynamic characteristics of 17 composite Y-grafts made with the left internal thoracic artery anastomosed to the left anterior descending coronary artery in all cases and with either the free right internal thoracic artery (RITA group, n = 10) or a saphenous vein graft (SVG group, n = 7) implanted proximally to the left internal thoracic artery and distally to the circumflex territory 6 months after the operation. At baseline, the pressure gradient measured with a 0.014-inch pressure wire was minimal between the aorta and the internal thoracic artery stem (2 +/- 1 mm Hg), the internal thoracic artery and left anterior descending (4 +/- 2 mm Hg), the internal thoracic artery and left circumflex (3 +/- 1 mm Hg), and the saphenous vein graft and left circumflex (2 +/- 2 mm Hg). During hyperemia induced by adenosine, the pressure gradient increased significantly to 6 +/- 2 mm Hg in the internal thoracic artery stem, 9 +/- 4 mm Hg in the internal thoracic artery and left anterior descending artery, 9 +/- 3 mm Hg in the internal thoracic artery and left circumflex, and 7 +/- 4 mm Hg in the saphenous vein graft and left circumflex. Fractional flow reserve was 0.94 +/- 0.02 in internal thoracic artery stem, 0.90 +/- 0.04 mm Hg in the internal thoracic artery and left anterior descending, 0.91 +/- 0.03 mm Hg in the internal thoracic artery and left circumflex, and 0.92 +/- 0.06 mm Hg in the saphenous vein graft and left circumflex. No difference between the two types of composite Y-grafts was observed for pressure gradients or fractional flow reserve measured in internal thoracic artery stem or in distal branches. Composite Y-grafts with saphenous vein or right internal thoracic

  11. Relationship between coronary contrast-flow quantitative flow ratio and myocardial ischemia assessed by SPECT MPI

    Energy Technology Data Exchange (ETDEWEB)

    Smit, Jeff M.; Rosendael, Alexander R. van; Jukema, J.W.; Delgado, Victoria; Bax, Jeroen J.; Scholte, Arthur J. [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Koning, Gerhard [Medis Medical Imaging Systems B.V., Leiden (Netherlands); Dibbets-Schneider, Petra [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands); Mertens, Bart J. [Leiden University Medical Center, Department of Medical Statistics, Leiden (Netherlands); Reiber, Johan H.C. [Medis Medical Imaging Systems B.V., Leiden (Netherlands); Leiden University Medical Center, Department of Radiology, Leiden (Netherlands)

    2017-10-15

    A new method has been developed to calculate fractional flow reserve (FFR) from invasive coronary angiography, the so-called ''contrast-flow quantitative flow ratio (cQFR)''. Recently, cQFR was compared to invasive FFR in intermediate coronary lesions showing an overall diagnostic accuracy of 85%. The purpose of this study was to investigate the relationship between cQFR and myocardial ischemia assessed by single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). Patients who underwent SPECT MPI and coronary angiography within 3 months were included. The cQFR computation was performed offline, using dedicated software. The cQFR computation was based on 3-dimensional quantitative coronary angiography (QCA) and computational fluid dynamics. The standard 17-segment model was used to determine the vascular territories. Myocardial ischemia was defined as a summed difference score ≥2 in a vascular territory. A cQFR of ≤0.80 was considered abnormal. Two hundred and twenty-four coronary arteries were analysed in 85 patients. Overall accuracy of cQFR to detect ischemia on SPECT MPI was 90%. In multivariable analysis, cQFR was independently associated with ischemia on SPECT MPI (OR per 0.01 decrease of cQFR: 1.10; 95% CI 1.04-1.18, p = 0.002), whereas clinical and QCA parameters were not. Furthermore, cQFR showed incremental value for the detection of ischemia compared to clinical and QCA parameters (global chi square 48.7 to 62.6; p <0.001). A good relationship between cQFR and SPECT MPI was found. cQFR was independently associated with ischemia on SPECT MPI and showed incremental value to detect ischemia compared to clinical and QCA parameters. (orig.)

  12. Relationship Between Coronary Contrast-Flow Quantitative Flow Ratio and Myocardial Ischemia Assessed by SPECT MPI.

    Science.gov (United States)

    Smit, Jeff M; Koning, Gerhard; van Rosendael, Alexander R; Dibbets-Schneider, Petra; Mertens, Bart J; Jukema, J Wouter; Delgado, Victoria; Reiber, Johan H C; Bax, Jeroen J; Scholte, Arthur J

    2017-10-01

    A new method has been developed to calculate fractional flow reserve (FFR) from invasive coronary angiography, the so-called "contrast-flow quantitative flow ratio (cQFR)". Recently, cQFR was compared to invasive FFR in intermediate coronary lesions showing an overall diagnostic accuracy of 85%. The purpose of this study was to investigate the relationship between cQFR and myocardial ischemia assessed by single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). Patients who underwent SPECT MPI and coronary angiography within 3 months were included. The cQFR computation was performed offline, using dedicated software. The cQFR computation was based on 3-dimensional quantitative coronary angiography (QCA) and computational fluid dynamics. The standard 17-segment model was used to determine the vascular territories. Myocardial ischemia was defined as a summed difference score ≥2 in a vascular territory. A cQFR of ≤0.80 was considered abnormal. Two hundred and twenty-four coronary arteries were analysed in 85 patients. Overall accuracy of cQFR to detect ischemia on SPECT MPI was 90%. In multivariable analysis, cQFR was independently associated with ischemia on SPECT MPI (OR per 0.01 decrease of cQFR: 1.10; 95% CI 1.04-1.18, p = 0.002), whereas clinical and QCA parameters were not. Furthermore, cQFR showed incremental value for the detection of ischemia compared to clinical and QCA parameters (global chi square 48.7 to 62.6; p relationship between cQFR and SPECT MPI was found. cQFR was independently associated with ischemia on SPECT MPI and showed incremental value to detect ischemia compared to clinical and QCA parameters.

  13. Quantitation of myocardial blood flow and myocardial flow reserve with {sup 99m}Tc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Hsu, Bailing [University of Missouri-Columbia, Nuclear Science and Engineering Institute, Columbia, MO (United States); Chen, Fu-Chung; Chen, Chien-Cheng [Show Chwan Memorial Hospital, Section of Cardiology, Department of Internal Medicine, Changhua (China); Wu, Tao-Cheng [Taipei Veterans General Hospital, Section of Cardiology, Department of Internal Medicine, Taipei (China); Huang, Wen-Sheng [Changhua Christian Hospital, Department of Medical Research and Department of Nuclear Medicine, Changhua (China); Hou, Po-Nien [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Lukong Town, Changhua Shien (China); Hung, Guang-Uei [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Lukong Town, Changhua Shien (China); Central Taiwan University of Science and Technology, Department of Medical Imaging and Radiological Science, Taichung (China); China Medical University, Department of Biomedical Imaging and Radiological Science, Taichung (China)

    2014-12-15

    Conventional dual-head single photon emission computed tomography (SPECT)/CT systems capable of fast dynamic SPECT (DySPECT) imaging have a potential for flow quantitation. This study introduced a new method to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) with DySPECT scan and evaluated the diagnostic performance of detecting coronary artery disease (CAD) compared with perfusion using invasive coronary angiography (CAG) as the reference standard. This study included 21 patients with suspected or known CAD who had received DySPECT, ECG-gated SPECT (GSPECT), and CAG (13 with ≥50 % stenosis in any vessel; non-CAD group: 8 with patent arteries or <50 % stenosis). DySPECT and GSPECT scans were performed on a widely used dual-head SPECT/CT scanner. The DySPECT imaging protocol utilized 12-min multiple back-and-forth gantry rotations during injections of {sup 99m}Tc-sestamibi (MIBI) tracer at rest or dipyridamole-stress stages. DySPECT images were reconstructed with full physical corrections and converted to the physical unit of becquerels per milliliter. Stress MBF (SMBF), rest MBF (RMBF), and MFR were quantified by a one-tissue compartment flow model using time-activity curves derived from DySPECT images. Perfusion images were processed for GSPECT scan and interpreted to obtain summed stress score (SSS) and summed difference score (SDS). Receiver-operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of flow and perfusion. Using the criteria of ≥50 % stenosis as positive CAD, areas under the ROC curve (AUCs) of flow assessment were overall significantly greater than those of perfusion. For patient-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.91 ± 0.07, 0.86 ± 0.09, 0.64 ± 0.12, and 0.59 ± 0.13. For vessel-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.81 ± 0.05, 0.76 ± 0.06, 0.62 ± 0.07, and 0.56 ± 0.08, respectively. The preliminary data suggest that MBF quantitation with a

  14. Quantitation of myocardial blood flow and myocardial flow reserve with 99mTc-sestamibi dynamic SPECT/CT to enhance detection of coronary artery disease

    International Nuclear Information System (INIS)

    Hsu, Bailing; Chen, Fu-Chung; Chen, Chien-Cheng; Wu, Tao-Cheng; Huang, Wen-Sheng; Hou, Po-Nien; Hung, Guang-Uei

    2014-01-01

    Conventional dual-head single photon emission computed tomography (SPECT)/CT systems capable of fast dynamic SPECT (DySPECT) imaging have a potential for flow quantitation. This study introduced a new method to quantify myocardial blood flow (MBF) and myocardial flow reserve (MFR) with DySPECT scan and evaluated the diagnostic performance of detecting coronary artery disease (CAD) compared with perfusion using invasive coronary angiography (CAG) as the reference standard. This study included 21 patients with suspected or known CAD who had received DySPECT, ECG-gated SPECT (GSPECT), and CAG (13 with ≥50 % stenosis in any vessel; non-CAD group: 8 with patent arteries or 99m Tc-sestamibi (MIBI) tracer at rest or dipyridamole-stress stages. DySPECT images were reconstructed with full physical corrections and converted to the physical unit of becquerels per milliliter. Stress MBF (SMBF), rest MBF (RMBF), and MFR were quantified by a one-tissue compartment flow model using time-activity curves derived from DySPECT images. Perfusion images were processed for GSPECT scan and interpreted to obtain summed stress score (SSS) and summed difference score (SDS). Receiver-operating characteristic (ROC) analyses were conducted to evaluate the diagnostic performance of flow and perfusion. Using the criteria of ≥50 % stenosis as positive CAD, areas under the ROC curve (AUCs) of flow assessment were overall significantly greater than those of perfusion. For patient-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.91 ± 0.07, 0.86 ± 0.09, 0.64 ± 0.12, and 0.59 ± 0.13. For vessel-based analysis, AUCs for MFR, SMBF, SSS, and SDS were 0.81 ± 0.05, 0.76 ± 0.06, 0.62 ± 0.07, and 0.56 ± 0.08, respectively. The preliminary data suggest that MBF quantitation with a conventional SPECT/CT system and the flow quantitation method is a clinically effective approach to enhance CAD detection. (orig.)

  15. Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Cecilia [CNR Institute of Bioimages and Molecular Physiology, Milan, Section of Genoa (Italy); Bezante, GianPaolo; Modonesi, Elisa; Rollando, Daniela; Balbi, Manrico; Brunelli, Claudio [University of Genoa, Department of Internal Medicine, Cardiology, Genoa (Italy); Gandolfo, Patrizia; Morbelli, Silvia D.; Armonino, Riccardo [University of Genoa, Department of Internal Medicine, Nuclear Medicine, Genoa (Italy); DePascale, Angelo; Maggi, Davide; Albertelli, Manuela; Cordera, Renzo [University of Genoa, Department of Endocrinological Metabolic Sciences, Diabetology, Genoa (Italy); Sambuceti, Gianmario [University of Genoa, Department of Internal Medicine, Nuclear Medicine, Genoa (Italy); Advanced Biotechnology Center, Genoa (Italy)

    2010-02-15

    The aim of this study was to validate a new method to measure regional myocardial perfusion reserve (MPR) with technetium-labelled tracers in patients with type 2 diabetes mellitus (DM2). A total of 40 consecutive DM2 patients without history of coronary artery disease (CAD) and 7 control subjects were recruited. Dipyridamole myocardial blood flow index (MBF) was assessed by measuring first transit counts in the pulmonary artery and myocardial count rate from gated SPECT images using {sup 99m}Tc-labelled tracers. The corresponding MBF index was estimated 2 h later according to the same procedure. Regional myocardial perfusion reserve (MPR) was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular (LV) model. Coronary flow reserve (CFR) was estimated by transthoracic contrast echo Doppler monitoring of flow velocity in the left anterior descending coronary artery (LAD) during the same session. Estimated MPR was higher in control subjects than in patients (3.36 {+-} 0.66 vs 1.91 {+-} 0.61, respectively, p < 0.01). In patients, LAD CFR and LAD MPR were 2.01 {+-} 0.78 vs 1.93 {+-} 0.63, respectively (p = ns). The agreement between the two techniques was documented by their close correlation (r = 0.92, p < 0.001) and confirmed by the Bland-Altman analysis. Reversible perfusion defects occurred in 13 patients (32%) who showed similar MPR values as the remaining 27 (2.10 {+-} 0.71 vs 1.83 {+-} 0.71, respectively, p = ns). Finally, MPR was closely correlated with age (r = -0.50, p < 0.01) and time elapsed from the diagnosis of DM2 (r = -0.51, p < 0.01). LV regional MPR can be accurately estimated with the broadly available single photon technology. Application of this method to DM2 patients documents the presence of a microvascular dysfunction homogeneously distributed throughout the LV walls and most frequently not associated with reversible perfusion defects. (orig.)

  16. Feasibility and diagnostic power of transthoracic coronary Doppler for coronary flow velocity reserve in patients referred for myocardial perfusion imaging

    Directory of Open Access Journals (Sweden)

    Nylander Eva

    2008-03-01

    Full Text Available Abstract Background Myocardial perfusion imaging (MPI, using single photon emission computed tomography (SPECT is a validated method for detecting coronary artery disease. Transthoracic Doppler echocardiography (TTDE of flow at rest and during adenosine provocation has previously been evaluated in selected patient groups. We therefore wanted to compare the diagnostic ability of TTDE in the left anterior descending coronary artery (LAD to that of MPI in an unselected population of patients with chest pain referred for MPI. Our hypothesis was that TTDE with high accuracy would identify healthy individuals and exclude them from the need for further studies, enabling invasive investigations to be reserved for patients with a high probability of disease. Methods Sixty-nine patients, 44 men and 25 women, age 61 ± 10 years (range 35–82, with a clinical suspicion of stress induced myocardial ischemia, were investigated. TTDE was performed at rest and during adenosine stress for myocardial scintigraphy. Results We found that coronary flow velocity reserve (CFVR determined from diastolic measurements separated normal from abnormal MPI findings with statistical significance. TTDE identified coronary artery disease, defined from MPI, as reversible ischemia and/or permanent defect, with a sensitivity of 60% and a specificity of 79%. The positive predictive value was 43% and the negative predictive value was 88%. There was an overlap between groups which could be due to abnormal endothelial function in patients with normal myocardial perfusion having either hypertension or diabetes. Conclusion TTDE is an attractive non-invasive method to evaluate chest pain without the use of isotopes, but the diagnostic power is strongly dependent on the population investigated. Even in our heterogeneous clinical cardiac population, we found that CFVR>2 in the LAD excluded significant coronary artery disease detected by MPI.

  17. Estimation of coronary flow reserve by sestamibi imaging in patients with mild hypertension and normal coronary arteries

    International Nuclear Information System (INIS)

    Storto, G.; Gallicchio, R.; Maddalena, F.; Pellegrino, T.; Petretta, M.; Fiumara, G.; Cuocolo, A.

    2015-01-01

    Patients with hypertension may exhibit abnormal vasodilator capacity during pharmacological vasodilatation. We assessed coronary flow reserve (CFR) by sestamibi imaging in hypertensive patients with normal coronary vessels. Twenty-five patients with untreated mild essential hypertension and normal coronary vessels and 10 control subjects underwent dipyridamole-rest Tc-99m sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in pulmonary artery and myocardial counts from tomograhic images. CFR was expressed as the ratio of stress to rest MBF. Coronary vascular resistances (CVR) were computed as the ratio between mean arterial pressure and MBF. Estimated MBF at rest was not different in patients and controls (1.11±0.59 vs. 1.14±0.28 counts/pixel/s; P=0.87). Conversely, stress MBF was lower in patients than in controls (1.55±0.47 vs. 2.68±0.53 counts/pixel/s; P<0.001). Thus, CFR was reduced in patients compared to controls (1.61±0.58 vs. 2.43±0.62; P<0.001). Rest and stress CVR values were higher in patients (P<0.001), while stress-induced changes in CVR were not different (P=0.08) between patients (-51%) and controls (-62%). In the overall study population, a significant relation between CFR and stress-induced changes in CVR was observed (r=-0.86; P<0.001). Sestamibi imaging may detect impaired coronary vascular function in response to dipyridamole in patients with untreated mild essential hypertension and normal coronary arteries. A mild increase in arterial blood pressure does not affect baseline MBF, but impairs coronary reserve due to the amplified resting coronary resistances.

  18. Impaired myocardial blood flow reserve in subjects with metabolic syndrome analyzed using positron emission tomography and N-13 labeled ammonia

    Energy Technology Data Exchange (ETDEWEB)

    Teragawa, Hiroki; Kihara, Yasuki [Hiroshima University Graduate School of Biomedical Sciences, Department of Cardiovascular Medicine, Hiroshima (Japan); Morita, Koichi; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Shishido, Hiroki; Otsuka, Nobuaki; Hirokawa, Yutaka [Hiroshima Heiwa Clinic, Hiroshima (Japan); Chayama, Kazuaki [Hiroshima University Graduate School of Biomedical Sciences, Department of Molecular Science and Medicine, Hiroshima (Japan)

    2010-02-15

    Coronary vasomotor response might be impaired in metabolic syndrome (MS); however, the precise abnormality has not been elucidated. The aim of this study was to assess coronary-vasomotor response in MS subjects using N-13 labeled ammonia and positron emission tomography. Myocardial blood flow (MBF) was measured at rest and during adenosine infusion in MS subjects (n = 13, MS group) with no definite evidence of heart disease and in subjects without MS (n = 14, non-MS group). Coronary vascular resistance (CVR) was calculated by dividing the mean aortic blood pressure by MBF. Myocardial blood flow reserve (MFR) was calculated as the ratio of the MBF during adenosine infusion to that during rest. Blood chemical parameters were measured to evaluate their relationship with MFR. During adenosine infusion, MBF was lower (p = 0.0085) and CVR higher (p = 0.0128) in the MS group than in the non-MS group and MFR was significantly lower in the MS group than in the non-MS group (2.13 {+-} 0.99 vs. 3.38 {+-} 0.95, p = 0.0027). Multivariate analysis demonstrated that the homeostasis model assessment-insulin resistance (p < 0.05) and the presence of hypertension (p < 0.05) were independent determinants of MFR. The results indicate that MFR was impaired in MS subjects, suggesting that an abnormal coronary microvascular response occurred in these subjects. This abnormality may have been partially due to insulin resistance and hypertension. (orig.)

  19. Quantitative relationship between coronary calcium content and coronary flow reserve as assessed by integrated PET/CT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Curillova, Zelmira [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); VA Boston Healthcare System, Division of Cardiology, Department of Medicine, West Roxbury, MA (United States); Yaman, Bettina F.; Sitek, Arkadius; El Fakhri, Georges [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Dorbala, Sharmila [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Kwong, Raymond Y. [Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women' s Hospital, Boston, MA (United States); Brigham and Women' s Hospital, Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Anagnostopoulos, Constantinos [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Royal Brompton Hospital, Department of Nuclear Medicine, London (United Kingdom); Di Carli, Marcelo F. [Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston, MA (United States); Harvard Medical School, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women' s Hospital, Boston, MA (United States); Brigham and Women' s Hospital, Noninvasive Cardiovascular Imaging Program, Departments of Medicine (Cardiology) and Radiology, Boston, MA (United States); Brigham and Women' s Hospital, Division of Nuclear Medicine and Molecular Imaging, Boston, MA (United States)

    2009-10-15

    To evaluate the relationship between coronary artery calcium (CAC) and coronary vasodilator function. We evaluated 136 patients without known coronary artery disease (CAD) undergoing vasodilator stress {sup 82}Rb PET/CT and CAC scoring who showed normal myocardial perfusion. The CAC score, resting and hyperemic myocardial blood flow (MBF), coronary flow reserve (CFR) and coronary vascular resistance were analyzed. Global and regional CAC scores showed significant but weak inverse correlations with hyperemic MBF (r=-0.31 and r=-0.26, p{<=}0.0002 respectively) and CFR (r=-0.28 and r=-0.2, p{<=}0.001 respectively). With increasing CAC score, there was a modest stepwise decline in CFR on a per-patient basis (1.8{+-}0.5 vs 1.7{+-}0.5 vs 1.5{+-}0.4, p=0.048, with total CAC=0, 1-400 and >400, respectively) and on a per-vessel basis. In multivariable modeling only body mass index and CAC score were predictive of CFR. In patients with an intermediate likelihood of, but without overt, CAD, there is a statistically significant but weak inverse correlation between CAC content and coronary vasodilator function. The strength of this association weakens after adjusting CAC scores for age, gender and coronary risk factors. This suggests that CAC and coronary vasodilator function provide biologically different information regarding atherosclerosis. (orig.)

  20. Assessment of endothelial function and myocardial flow reserve using {sup 15}O-water PET without attenuation correction

    Energy Technology Data Exchange (ETDEWEB)

    Tuffier, Stephane; Joubert, Michael; Bailliez, Alban [EA 4650, Normandie Universite, Caen (France); Legallois, Damien [EA 4650, Normandie Universite, Caen (France); Caen University Hospital, Department of Cardiology, Caen (France); Belin, Annette [Caen University Hospital, Department of Cardiac Surgery, Caen (France); Redonnet, Michel [Rouen University Hospital, Department of Cardiac Surgery, Rouen (France); Agostini, Denis [EA 4650, Normandie Universite, Caen (France); Caen University Hospital, Department of Nuclear Medicine, Caen (France); Manrique, Alain [EA 4650, Normandie Universite, Caen (France); Caen University Hospital, Department of Nuclear Medicine, Caen (France); Cyceron PET Centre, Caen (France)

    2016-02-15

    Myocardial blood flow (MBF) measurement using positron emission tomography (PET) from the washout rate of {sup 15}O-water is theoretically independent of tissue attenuation. The aim of this study was to evaluate the impact of not using attenuation correction in the assessment of coronary endothelial function and myocardial flow reserve (MFR) using {sup 15}O-water PET. We retrospectively processed 70 consecutive {sup 15}O-water PET examinations obtained at rest and during cold pressor testing (CPT) in patients with dilated cardiomyopathy (n = 58), or at rest and during adenosine infusion in heart transplant recipients (n = 12). Data were reconstructed with attenuation correction (AC) and without attenuation correction (NAC) using filtered backprojection, and MBF was quantified using a single compartmental model. The agreement between AC and NAC data was assessed using Lin's concordance correlation coefficient followed by Bland-Altman plot analysis. Regarding endothelial function, NAC PET showed poor reproducibility and poor agreement with AC PET data. Conversely, NAC PET demonstrated high reproducibility and a strong agreement with AC PET for the assessment of MFR. Non-attenuation-corrected {sup 15}O-water PET provided an accurate measurement of MFR compared to attenuation-corrected PET. However, non-attenuation-corrected PET data were less effective for the assessment of endothelial function using CPT in this population. (orig.)

  1. Impaired myocardial blood flow reserve in subjects with metabolic syndrome analyzed using positron emission tomography and N-13 labeled ammonia

    International Nuclear Information System (INIS)

    Teragawa, Hiroki; Kihara, Yasuki; Morita, Koichi; Tamaki, Nagara; Shishido, Hiroki; Otsuka, Nobuaki; Hirokawa, Yutaka; Chayama, Kazuaki

    2010-01-01

    Coronary vasomotor response might be impaired in metabolic syndrome (MS); however, the precise abnormality has not been elucidated. The aim of this study was to assess coronary-vasomotor response in MS subjects using N-13 labeled ammonia and positron emission tomography. Myocardial blood flow (MBF) was measured at rest and during adenosine infusion in MS subjects (n = 13, MS group) with no definite evidence of heart disease and in subjects without MS (n = 14, non-MS group). Coronary vascular resistance (CVR) was calculated by dividing the mean aortic blood pressure by MBF. Myocardial blood flow reserve (MFR) was calculated as the ratio of the MBF during adenosine infusion to that during rest. Blood chemical parameters were measured to evaluate their relationship with MFR. During adenosine infusion, MBF was lower (p = 0.0085) and CVR higher (p = 0.0128) in the MS group than in the non-MS group and MFR was significantly lower in the MS group than in the non-MS group (2.13 ± 0.99 vs. 3.38 ± 0.95, p = 0.0027). Multivariate analysis demonstrated that the homeostasis model assessment-insulin resistance (p < 0.05) and the presence of hypertension (p < 0.05) were independent determinants of MFR. The results indicate that MFR was impaired in MS subjects, suggesting that an abnormal coronary microvascular response occurred in these subjects. This abnormality may have been partially due to insulin resistance and hypertension. (orig.)

  2. Assessment of endothelial function and myocardial flow reserve using 15O-water PET without attenuation correction

    International Nuclear Information System (INIS)

    Tuffier, Stephane; Joubert, Michael; Bailliez, Alban; Legallois, Damien; Belin, Annette; Redonnet, Michel; Agostini, Denis; Manrique, Alain

    2016-01-01

    Myocardial blood flow (MBF) measurement using positron emission tomography (PET) from the washout rate of 15 O-water is theoretically independent of tissue attenuation. The aim of this study was to evaluate the impact of not using attenuation correction in the assessment of coronary endothelial function and myocardial flow reserve (MFR) using 15 O-water PET. We retrospectively processed 70 consecutive 15 O-water PET examinations obtained at rest and during cold pressor testing (CPT) in patients with dilated cardiomyopathy (n = 58), or at rest and during adenosine infusion in heart transplant recipients (n = 12). Data were reconstructed with attenuation correction (AC) and without attenuation correction (NAC) using filtered backprojection, and MBF was quantified using a single compartmental model. The agreement between AC and NAC data was assessed using Lin's concordance correlation coefficient followed by Bland-Altman plot analysis. Regarding endothelial function, NAC PET showed poor reproducibility and poor agreement with AC PET data. Conversely, NAC PET demonstrated high reproducibility and a strong agreement with AC PET for the assessment of MFR. Non-attenuation-corrected 15 O-water PET provided an accurate measurement of MFR compared to attenuation-corrected PET. However, non-attenuation-corrected PET data were less effective for the assessment of endothelial function using CPT in this population. (orig.)

  3. Quantitative relationship between coronary calcium content and coronary flow reserve as assessed by integrated PET/CT imaging

    International Nuclear Information System (INIS)

    Curillova, Zelmira; Yaman, Bettina F.; Sitek, Arkadius; El Fakhri, Georges; Dorbala, Sharmila; Kwong, Raymond Y.; Anagnostopoulos, Constantinos; Di Carli, Marcelo F.

    2009-01-01

    To evaluate the relationship between coronary artery calcium (CAC) and coronary vasodilator function. We evaluated 136 patients without known coronary artery disease (CAD) undergoing vasodilator stress 82 Rb PET/CT and CAC scoring who showed normal myocardial perfusion. The CAC score, resting and hyperemic myocardial blood flow (MBF), coronary flow reserve (CFR) and coronary vascular resistance were analyzed. Global and regional CAC scores showed significant but weak inverse correlations with hyperemic MBF (r=-0.31 and r=-0.26, p≤0.0002 respectively) and CFR (r=-0.28 and r=-0.2, p≤0.001 respectively). With increasing CAC score, there was a modest stepwise decline in CFR on a per-patient basis (1.8±0.5 vs 1.7±0.5 vs 1.5±0.4, p=0.048, with total CAC=0, 1-400 and >400, respectively) and on a per-vessel basis. In multivariable modeling only body mass index and CAC score were predictive of CFR. In patients with an intermediate likelihood of, but without overt, CAD, there is a statistically significant but weak inverse correlation between CAC content and coronary vasodilator function. The strength of this association weakens after adjusting CAC scores for age, gender and coronary risk factors. This suggests that CAC and coronary vasodilator function provide biologically different information regarding atherosclerosis. (orig.)

  4. PET measurements of myocardial blood flow post myocardial infarction: Relationship to invasive and cardiac magnetic resonance studies and potential clinical applications.

    Science.gov (United States)

    Gewirtz, Henry

    2017-12-01

    This review focuses on clinical studies concerning assessment of coronary microvascular and conduit vessel function primarily in the context of acute and sub acute myocardial infarction (MI). The ability of quantitative PET measurements of myocardial blood flow (MBF) to delineate underlying pathophysiology and assist in clinical decision making in this setting is discussed. Likewise, considered are physiological metrics fractional flow reserve, coronary flow reserve, index of microvascular resistance (FFR, CFR, IMR) obtained from invasive studies performed in the cardiac catheterization laboratory, typically at the time of PCI for MI. The role both of invasive studies and cardiac magnetic resonance (CMR) imaging in assessing microvascular function, a key determinant of prognosis, is reviewed. The interface between quantitative PET MBF measurements and underlying pathophysiology, as demonstrated both by invasive and CMR methodology, is discussed in the context of optimal interpretation of the quantitative PET MBF exam and its potential clinical applications.

  5. Stress Perfusion Coronary Flow Reserve Versus Cardiac Magnetic Resonance for Known or Suspected CAD.

    Science.gov (United States)

    Kato, Shingo; Saito, Naka; Nakachi, Tatsuya; Fukui, Kazuki; Iwasawa, Tae; Taguri, Masataka; Kosuge, Masami; Kimura, Kazuo

    2017-08-15

    Phase-contrast (PC) cine magnetic resonance imaging (MRI) of the coronary sinus is a noninvasive method to quantify coronary flow reserve (CFR). This study sought to compare the prognostic value of CFR by cardiac magnetic resonance (CMR) and stress perfusion CMR to predict major adverse cardiac events (MACE). Participants included 276 patients with known coronary artery disease (CAD) and 400 with suspected CAD. CFR was calculated as myocardial blood flow during adenosine triphosphate infusion divided by myocardial blood flow at rest using PC cine MRI of the coronary sinus. During a median follow-up of 2.3 years, 47 patients (7%) experienced MACE. Impaired CFR (10% ischemia on stress perfusion CMR were significantly associated with MACE in patients with known CAD (hazard ratio [HR]: 5.17 and HR: 5.10, respectively) and suspected CAD (HR: 14.16 and HR: 6.50, respectively). The area under the curve for predicting MACE was 0.773 for CFR and 0.731 for stress perfusion CMR (p = 0.58) for patients with known CAD, and 0.885 for CFR and 0.776 for stress perfusion CMR (p = 0.059) in the group with suspected CAD. In patients with known CAD, sensitivity, specificity, and positive and negative predictive values to predict MACE were 64%, 91%, 38%, and 97%, respectively, for CFR, and 82%, 59%, 15%, and 97%, respectively, for stress perfusion CMR. In the suspected CAD group, these values were 65%, 99%, 80%, and 97%, respectively, for CFR, and 72%, 83%, 22%, and 98%, respectively, for stress perfusion CMR. The predictive values of CFR and stress perfusion CMR for MACE were comparable in patients with known CAD. In patients with suspected CAD, CFR showed higher HRs and areas under the curve than stress perfusion CMR, suggesting that CFR assessment by PC cine MRI might provide better risk stratification for patients with suspected CAD. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Myocardial blood flow reserve is impaired in patients with aortic valve calcification and unobstructed epicardial coronary arteries.

    Science.gov (United States)

    Nel, Karen; Nam, Michael C Y; Anstey, Chris; Boos, Christopher J; Carlton, Edward; Senior, Roxy; Kaski, Juan Carlos; Khattab, Ahmed; Shamley, Delva; Byrne, Christopher D; Stanton, Tony; Greaves, Kim

    2017-12-01

    Although calcific aortic valve disease (CAVD) is associated with coronary atherosclerosis, it is not known whether early CAVD is associated with coronary microcirculatory dysfunction (CMD). We sought to investigate the relationship between myocardial blood flow reserve (MBFR) - a measure of CMD, and early CAVD in the absence of obstructive epicardial coronary artery disease. We also determined whether this relationship was independent of coronary artery disease (CAD) and hs-CRP, a marker of systemic inflammation. 183 patients with chest pain and unobstructed coronary arteries were studied. Aortic valve calcification score (AVCS), coronary total plaque length (TPL), and coronary calcium score were quantified from multislice CT. MBFR was assessed using vasodilator myocardial contrast echocardiography. Hs-CRP was measured from venous blood using a particle-enhanced immunoassay. Mean (±SD) participant age was 59.8 (9.6) years. Mean AVCS was 68 (258) AU, TPL was 15.6 (22.2) mm, and median coronary calcification score was 43.5AU. Mean MBFR was 2.20 (0.52). Mean hs-CRP was 2.52 (3.86) mg/l. Multivariable linear regression modelling incorporating demographics, coronary plaque characteristics, MBFR, and inflammatory markers, demonstrated that age (β=0.05, 95% CI: 0.02, 0.08, P=0.007), hs-CRP (β=0.09, CI: 0.02, 0.16, P=0.010) and diabetes (β=1.03, CI: 0.08, 1.98, P=0.033), were positively associated with AVCS. MBFR (β=-0.87, CI: -1.44, -0.30, P=0.003), BMI (β=-0.11, CI: -0.21, -0.01, P=0.033), and LDL (β=-0.32, CI: -0.61, -0.03, P=0.029) were negatively associated with AVCS. TPL and coronary calcium score were not independently associated with AVCS when included in the regression model. Coronary microvascular function as determined by measurement of myocardial blood flow reserve is independently associated with early CAVD. This effect is independent of the presence of coronary artery disease and also systemic inflammation. Copyright © 2017 Elsevier B.V. All rights

  7. No relationship between cerebral blood flow velocity and cerebrovascular reserve capacity and contemporaneously measured glucose and insulin concentrations in diabetes mellitus

    NARCIS (Netherlands)

    Fülesdi, B.; Limburg, M.; Bereczki, D.; Molnár, C.; Michels, R. P.; Leányvári, Z.; Csiba, L.

    1999-01-01

    Blood glucose and insulin concentrations have been reported to influence cerebral hemodynamics. We studied the relationship between actual blood glucose and insulin concentrations and resting cerebral blood flow velocity in the middle cerebral artery and cerebrovascular reserve capacity after

  8. The deep hydrogeologic flow system underlying the Oak Ridge Reservation - Assessing the potential for active groundwater flow and origin of the brine

    International Nuclear Information System (INIS)

    Nativ, R.; Halleran, A.; Hunley, A.

    1997-08-01

    The deep hydrogeologic system underlying the Oak Ridge Reservation (ORR) contains contaminants such as radionuclides, heavy metals, nitrates, and organic compounds. The groundwater in the deep system is saline and has been considered to be stagnant in previous studies. This study was designed to address the following questions: is groundwater in the deep system stagnant; is contaminant migration controlled by diffusion only or is advection a viable mechanism; where are the potential outlet points? On the basis of existing and newly collected data, the nature of saline groundwater flow and potential discharge into shallow, freshwater systems was assessed. Data used for this purpose included (1) spatial and temporal pressures and hydraulic heads measured in the deep system, (2) hydraulic parameters of the formations in question, (3) spatial and temporal temperature variations at depth, and (4) spatial and temporal chemical and isotopic composition of the saline groundwater. The observations suggest that the saline water contained at depth is old but not isolated (in terms of recharge and discharge) from the overlying active, freshwater-bearing units. Influx of recent water does occur. Groundwater volumes involved in this flow are likely to be small. The origin of the saline groundwater was assessed by using existing and newly acquired chemical and isotopic data. The proposed model that best fits the data is modification of residual brine from which halite has been precipitated. Other models, such as ultrafiltration and halite dissolution, were also evaluated

  9. Assessment of myocardial blood flow and coronary flow reserve with positron emission tomography in ischemic heart disease: current state and future directions.

    Science.gov (United States)

    Al Badarin, Firas; Aljizeeri, Ahmed; Almasoudi, Fatimah; Al-Mallah, Mouaz H

    2017-07-01

    Positron emission tomography (PET) is a versatile imaging technology that allows assessment of myocardial perfusion, both at a spatially relative scale and also in absolute terms, thereby enabling noninvasive evaluation of myocardial blood flow (MBF) and coronary flow reserve (CFR). Assessment of MBF using FDA-approved PET isotopes, such as 82 Rb and 13 N-ammonia, has been well validated, and several software packages are currently available, thereby allowing for MBF evaluation to be incorporated into routine workflow in contemporary nuclear laboratories. Incremental diagnostic and prognostic information provided with the knowledge of MBF has the potential for widespread applications. Improving the ability to identify the true burden of obstructive epicardial coronary stenoses and allowing for noninvasive assessment of coronary micro circulatory function can be achieved with MBF assessment. On the other hand, attenuated CFR has been shown to predict adverse cardiovascular prognosis in a variety of clinical settings and patient subgroups. With expanding applications of MBF, this tool promises to provide unique insight into the integrity of the entire coronary vascular bed beyond what is currently available with relative perfusion assessment. This review intends to provide an in-depth discussion of technical and clinical aspects of MBF assessment with PET as it relates to patients with ischemic heart disease.

  10. Assessment of coronary flow reserve by sestamibi imaging in patients with typical chest pain and normal coronary arteries

    International Nuclear Information System (INIS)

    Storto, Giovanni; Sorrentino, Anna R.; Pellegrino, Teresa; Liuzzi, Raffaele; Cuocolo, Alberto; Petretta, Mario

    2007-01-01

    We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels. Thirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest 99m Tc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate-pressure product (RPP) and expressed as normalised MBF (MBF n ) and normalised CFR (CFR n ). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF. At rest, estimated MBF and MBF n were lower in controls than in patients (0.98 ± 0.4 vs 1.30 ± 0.3 counts/pixel/s and 1.14 ± 0.5 vs 1.64 ± 0.6 counts/pixel/s, respectively, both p n was still higher in controls than in patients (2.1 ± 0.5 vs 1.29 ± 0.5, p < 0.0001). At baseline, CVR values were lower (p < 0.01) in patients than in controls. Dipyridamole-induced changes in CVR were greater (p < 0.0001) in controls (-63%) than in patients (-35%). In the overall study population, a significant correlation between dipyridamole-induced changes in CVR and CFR was observed (r = -0.88, p < 0.0001). SPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram. (orig.)

  11. The Bolivar Channel Ecosystem of the Galapagos Marine Reserve: Energy flow structure and role of keystone groups

    Science.gov (United States)

    Ruiz, Diego J.; Wolff, Matthias

    2011-08-01

    The Bolivar Channel Ecosystem (BCE) is among the most productive zones in the Galapagos Marine Reserve (GMR). It is exposed to relatively cool, nutrient-rich waters of the Cromwell current, which are brought to the photic zone through topographic upwelling. The BCE is characterized by a heterogeneous rocky reef habitat covered by dense algae beds and inhabited by numerous invertebrate and fish species, which represent the food for higher predators including seals and sharks and exploited fish species. In addition, plankton and detritus based food chains channel large amounts of energy through the complex food web. Important emblematic species of the Galapagos archipelagos reside in this area such as the flightless cormorant, the Galapagos penguin and the marine iguanas. A trophic model of BCE was constructed for the habitats < 30 m depth that fringe the west coast of Isabela and east coast of Fernandina islands covering 14% of the total BCE area (44 km 2). The model integrates data sets from sub tidal ecological monitoring and marine vertebrate population monitoring (2004 to 2008) programs of the Charles Darwin Foundation and consists of 30 compartments, which are trophically linked through a diet matrix. Results reveal that the BCE is a large system in terms of flows (38 695 t km - 2 yr - 1 ) comparable to Peruvian Bay Systems of the Humboldt upwelling system. A very large proportion of energy flows from the primary producers (phytoplankton and macro-algae) to the second level and to the detritus pool. Catches are high (54.3 t km - 2 yr - 1 ) and are mainly derived from the second and third trophic levels (mean TL of catch = 2.45) making the fisheries gross efficiency high (0.3%). The system's degree of development seems rather low as indicated by a P/R ratio of 4.19, a low ascendency (37.4%) and a very low Finn's cycling index (1.29%). This is explained by the system's exposure to irregular changes in oceanographic conditions as related to the EL Niño Southern

  12. Recovery of distal coronary flow reserve in LAD and LCx after Y-Graft intervention assessed by transthoracic echocardiography

    Science.gov (United States)

    2010-01-01

    Background Y- graft (Y-G) is a graft formed by the Left Internal Mammary Artery (LIMA) connected to the Left Anterior Descending Artery (LAD) and by a free Right Internal Mammary Artery (RIMA) connected to LIMA and to a Marginal artery of Left Circumflex Artery (LCx). Aim of the work was to study the flow of this graft during a six months follow-up to assess whether the graft was able to meet the request of all the left coronary circulation, and to assess whether it could be done by evaluation of coronary flow reserve (CFR). Methods In 13 consecutive patients submitted to Y-G (13 men), CFR was measured in distal LAD and in distal LCx from 1 week after , every two months, up to six months after operation (a total of 8 tests for each patient) by means of transthoracic echocardiography (TTE) and Adenosine infusion (140 mcg/kg/min for 3-6 min). A Sequoia 256, Acuson-Siemens, was used. Contrast was used when necessary (Levovist 300 mg/ml solution at a rate of 0,5-1 ml/min). Max coronary flow diastolic velocity post-/pre-test ≥2 was considered normal CFR. Results Coronary arteriography revealed patency of both branches of Y-G after six months. Accuracy of TTE was 100% for LAD and 85% for LCx. Feasibility was 100% for LAD and 85% for LCx. CFR improved from baseline in LAD (2.21 ± 0.5 to 2.6 ± 0.5, p = 0.03) and in LCx (1.7 ± 1 to 2.12 ± 1, p = 0.05). CFR was under normal at baseline in 30% of patients vs 8% after six months in LAD (p = 0.027), and in 69% of patients vs 30% after six months in LCx (p = 0.066). Conclusion CFR in Y-G is sometimes reduced in both left territories postoperatively but it improves at six months follow-up. A follow-up can be done non-invasively by TTE and CFR evaluation. PMID:20716357

  13. Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease

    International Nuclear Information System (INIS)

    Houghton, J.L.; Frank, M.J.; Carr, A.A.; von Dohlen, T.W.; Prisant, L.M.

    1990-01-01

    Invasive Doppler catheter-derived coronary flow reserve, echocardiographic measurements of left ventricular hypertrophy and intravenous dipyridamole-limited stress thallium-201 scintigraphy were compared in 48 patients (40 were hypertensive or diabetic) with clinical ischemic heart disease and no or minor coronary artery disease. Abnormal vasodilator reserve (ratio less than 3:1) occurred in 50% of the study group and markedly abnormal reserve (less than or equal to 2:1) occurred in 27%. Coronary vasodilator reserve was significantly lower (2.2 +/- 0.8 versus 3.5 +/- 1.3, p = 0.003) and indexed left ventricular mass significantly higher (152.6 +/- 42.2 versus 113.6 +/- 24.0 g, p = 0.0007) in patients with a positive (n = 11) versus a negative (n = 32) thallium perfusion scan. Coronary flow reserve was linearly related in coronary basal flow velocity as follows: y = -0.17x + 4.59; r = -0.57; p = 0.00002. The decrement in flow reserve was not linearly related to the degree of left ventricular hypertrophy. Abnormal vasodilator reserve subsets found in hypertensive patients were defined on the basis of basal flow velocity, indexed left ventricular mass and clinical factors. In this series, diabetes did not cause a detectable additional decrement in flow reserve above that found with hypertension alone. These findings demonstrate that thallium perfusion defects are associated with depressed coronary vasodilator reserve in hypertensive patients without obstructive coronary artery disease. Left ventricular hypertrophy by indexed mass criteria is predictive of which hypertensive patients are likely to have thallium defects

  14. Alterations of cerebral blood flow and cerebrovascular reserve in patients with chronic traumatic brain injury accompanying deteriorated intelligence

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ho Chun; Bom, Hee Seung [Chonnam National Univ. Hospital, Kwangju (Korea, Republic of)

    2000-06-01

    The purpose of this study was to evaluate alterations of regional cerbral blood flow (CBF) and cerebrovascular reserve (CVR), and correlation between these alternations and cognitive dysfunctin in patients with chronic traumatic brain injury (TBI) and normal brain MRI findings. Thirty TBI patients and 19 healthy volunteers underwent rest/acetazolaminde brain SPECT using Tc-99m HMPAO. Korean-Wechsler Adult Intelligence scale test was also performed in the patient group. Statistical analysis was performed with statistical parametric mapping software (SPM '97). CBF was diminished in the left hemisphere including Wernicke's area in all patients with lower verbal scale scores. In addition, a reduction in CBF in the right frontal, temporal and parietal cortices was related with depressed scores in information, digital span, arithmetic and similarities. In patients with lower performance scale scores, CBF was mainly diminished in the right hemisphere including superior temporal and supramarginal gyri, premotor, primary somatomotor and a part of prefrontal cortices, left frontal lobe and supramarginal gyrus. CVR was diminished in sixty-four Brodmann's areas compared to control. A reduction in CVR was demonstrated bilaterally in the frontal and temporal lobes in patients with lower scores in both verbal and performance tests, and in addition, both inferior parietal and occipital lobes in information subset. Alterations of CBF and CVR were demonstrated in the symptomatic TBI patients with normal MRI finding. These alterations were correlated with the change of intelligence, of which the complex functions are subserved by multiple interconnected cortical structures.

  15. Alterations of cerebral blood flow and cerebrovascular reserve in patients with chronic traumatic brain injury accompanying deteriorated intelligence

    International Nuclear Information System (INIS)

    Song, Ho Chun; Bom, Hee Seung

    2000-01-01

    The purpose of this study was to evaluate alterations of regional cerbral blood flow (CBF) and cerebrovascular reserve (CVR), and correlation between these alternations and cognitive dysfunctin in patients with chronic traumatic brain injury (TBI) and normal brain MRI findings. Thirty TBI patients and 19 healthy volunteers underwent rest/acetazolaminde brain SPECT using Tc-99m HMPAO. Korean-Wechsler Adult Intelligence scale test was also performed in the patient group. Statistical analysis was performed with statistical parametric mapping software (SPM '97). CBF was diminished in the left hemisphere including Wernicke's area in all patients with lower verbal scale scores. In addition, a reduction in CBF in the right frontal, temporal and parietal cortices was related with depressed scores in information, digital span, arithmetic and similarities. In patients with lower performance scale scores, CBF was mainly diminished in the right hemisphere including superior temporal and supramarginal gyri, premotor, primary somatomotor and a part of prefrontal cortices, left frontal lobe and supramarginal gyrus. CVR was diminished in sixty-four Brodmann's areas compared to control. A reduction in CVR was demonstrated bilaterally in the frontal and temporal lobes in patients with lower scores in both verbal and performance tests, and in addition, both inferior parietal and occipital lobes in information subset. Alterations of CBF and CVR were demonstrated in the symptomatic TBI patients with normal MRI finding. These alterations were correlated with the change of intelligence, of which the complex functions are subserved by multiple interconnected cortical structures.=20

  16. Cerebral blood flow and cerebrovascular reserve capacity in patients with occlusion or severe stenosis of cerebral arterial trunk

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Shinya; Tanaka, Akira; Nakayama, Yoshiya; Tomonaga, Masamichi [Fukuoka Univ., Chikushino (Japan). Chikushi Hospital

    1997-12-01

    The cerebral blood flow (CBF) and the cerebrovascular reserve capacity (CVRC) were sequentially measured using a xenon enhanced CT scan in patients with transient ischemic attack or minor stroke due to an occlusion or a severe stenosis of the cerebral arterial trunk. The patients consisted of twelve males and one female ranging from 37 to 71 years of age (53 years on average). The vascular lesion was located in the internal carotid artery (7 patients) and in the middle cerebral artery (6 patients). Eleven patients received antiplatelet drug therapy, while two other patients underwent STA-MCA anastomosis. The CBF measurements were initially done within one month after the attack and then from 6 to 24 months (12 months on average) after the first study. Only one of 13 patients demonstrated a reattack during the period of observation and the CVRC decreased to 0% from the 14% level observed prior to the reattack, although the CBF was preserved. In the other twelve patients without a reattack, the CVRC was found to improve to 29.4% from 9.9% with statistical significance, even though the CBF remained the same in the first study. This study suggests hemodynamic insult to be closely related to the decreased in the CVRC, while STA-MCA anastomosis does not for prevent hemodynamic reattack based on a decrease in the CVRC in the early stage. (author)

  17. Estimation of myocardial blood flow and myocardial flow reserve by 99mTc-sestamibi imaging: comparison with the results of [15O]H2O PET

    International Nuclear Information System (INIS)

    Ito, Yoshinori; Noriyasu, Kazuyuki; Kohya, Tetsuro; Kitabatake, Akira; Katoh, Chietsugu; Kuge, Yuji; Furuyama, Hideto; Morita, Koichi; Tamaki, Nagara

    2003-01-01

    We developed a noninvasive method to quantitatively estimate the myocardial blood flow (MBF) index and flow reserve (MFR) using dynamic and static data obtained with technetium-99m sestamibi, and compared the results with MBF and MFR measured by oxygen-15-labeled water ([ 15 O]H 2 O) PET. Twenty patients with coronary artery disease (CAD) and nine normal subjects underwent both 99m Tc-sestamibi and PET studies within 2 weeks. From the anterior view, dynamic data were acquired for 2 min immediately after the injection of 99m Tc-sestamibi, and planar static images were also obtained after 5 min at rest and during ATP stress (0.16 mg kg -1 min -1 for 5 min) on another day. The area under the time-activity curve on the aortic arch (Aorta ACU), myocardial weight with the SPET image (M), and the myocardial count on the planar image for 1 min (C m ) were obtained. The MBF index (MBFI) was calculated as follows: MBFI=C m /Aorta ACU x 100/M. MFR was measured by dividing the MBFI at ATP stress by MBFI at rest. The MBFI measured by 99m Tc-sestamibi was significantly correlated with MBF obtained using [ 15 O]H 2 O PET (MBFI=13.174+11.732 x MBF, r=0.821, P 99m Tc-sestamibi was well correlated with that obtained using [ 15 O]H 2 O PET, with some underestimation (r=0.845, P 99m Tc-sestamibi in patients with CAD was significantly lower than that in normal subjects (CAD: 1.484±0.256 vs normal: 2.127±0.308, P 99m Tc-sestamibi. This may be useful for the quantitative assessment of CAD, especially in those patients with diffuse coronary disease. (orig.)

  18. Myocardial Blood Flow and Flow Reserve in Proximal and Mid-to-Distal Lesions of Left Anterior Descending Artery Measured By N-13 Ammonia PET/CT

    International Nuclear Information System (INIS)

    Cho, Sanggeon; Kim, Ju Han; Cho, Jae Young; Kim, Hyeon Sik; Bom, Heeseung

    2013-01-01

    The purpose of this study is to compare the myocardial blood flow (MBF) and flow reserve (MFR) between proximal and mid-to-distal lesions of the left anterior descending artery (pLAD and mdLAD, respectively) using N-13 ammonia positron emission tomography/computed tomography (PET/CT). Subjects were 11 patients (six men and five women, mean age 64.5 years) with known coronary artery disease (CAD) involving LAD studied by N-13 ammonia PET/CT. They were divided into two groups by the location of stenotic lesions, i.e. pLAD versus mdLAD. Global and regional MBF and MFR were measured and compared. Characteristics of perfusion defects including the number of involved segments, basal area involvement, location, size, and shape were also compared between the two groups. The regional MFR in mid-anterior segment was significantly lower in pLAD group (1.80±0.35 vs 2.76±1.13 for pLAD and mdLAD groups, respectively, p=0.034), while global MFR was not different (2.10±1.10 vs 2.34±0.84). Both stress and rest MBF in LAD territories were not different in both groups. The size of the perfusion defects were significantly larger in pLAD group (44.0±11.5 % vs 21-1±15.8 %, p=0.041). Other characteristics such as location, basal area involvement, and shape were not significantly different between two groups. Conclusions The proximal lesion makes lower MFR in the mid-anterior segment and larger perfusion defect in the LAD territory but comparable MBF compared with mdLAD lesion

  19. Assessment of coronary flow reserve by sestamibi imaging in patients with typical chest pain and normal coronary arteries

    Energy Technology Data Exchange (ETDEWEB)

    Storto, Giovanni; Sorrentino, Anna R.; Pellegrino, Teresa; Liuzzi, Raffaele; Cuocolo, Alberto [University Federico II, Department of Biomorphological and Functional Sciences, Institute of Biostructures and Bioimages of the National Council of Research, Naples (Italy); Petretta, Mario [University Federico II, Department of Internal Medicine, Cardiovascular and Immunological Sciences, Naples (Italy)

    2007-08-15

    We assessed coronary flow reserve (CFR) by sestamibi imaging in patients with typical chest pain, positive exercise stress test and normal coronary vessels. Thirty-five patients with typical chest pain and normal angiogram and 12 control subjects with atypical chest pain underwent dipyridamole/rest {sup 99m}Tc-sestamibi imaging. Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Estimated CFR was expressed as the ratio of stress to rest MBF. Rest MBF and CFR were corrected for rate-pressure product (RPP) and expressed as normalised MBF (MBF{sub n}) and normalised CFR (CFR{sub n}). Coronary vascular resistances (CVR) were calculated as the ratio between mean arterial pressure and estimated MBF. At rest, estimated MBF and MBF{sub n} were lower in controls than in patients (0.98 {+-} 0.4 vs 1.30 {+-} 0.3 counts/pixel/s and 1.14 {+-} 0.5 vs 1.64 {+-} 0.6 counts/pixel/s, respectively, both p < 0.02). Stress MBF was not different between controls and patients (2.34 {+-} 0.8 vs 2.01 {+-} 0.7 counts/pixel/s, p=NS). Estimated CFR was 2.40 {+-} 0.3 in controls and 1.54 {+-} 0.3 in patients (p < 0.0001). After correction for the RPP, CFR{sub n} was still higher in controls than in patients (2.1 {+-} 0.5 vs 1.29 {+-} 0.5, p < 0.0001). At baseline, CVR values were lower (p < 0.01) in patients than in controls. Dipyridamole-induced changes in CVR were greater (p < 0.0001) in controls (-63%) than in patients (-35%). In the overall study population, a significant correlation between dipyridamole-induced changes in CVR and CFR was observed (r = -0.88, p < 0.0001). SPECT might represent a useful non-invasive method for assessing coronary vascular function in patients with angina and a normal coronary angiogram. (orig.)

  20. Reduced {sup 123}I-BMIPP uptake implies decreased myocardial flow reserve in patients with chronic stable angina

    Energy Technology Data Exchange (ETDEWEB)

    Kageyama, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Mabuchi, Megumi; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Tsukamoto, Takahiro; Noriyasu, Kazuyuki; Naya, Masanao [Hokkaido University, Department of Cardiovascular Medicine, Sapporo (Japan); Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Kawai, Yuko [Hokko Memorial Hospital, Department of Cardiovascular Medicine, Sapporo (Japan)

    2006-01-01

    Long-chain fatty acid (LCFA) is the main energy source for normal myocardium at rest, but in ischemic myocardium, the main energy substrate shifts from LCFA to glucose. {sup 123}I-BMIPP is a radiolabeled LCFA analog. In chronic stable angina without previous infarction, we suppose that reduced {sup 123}I-BMIPP uptake is related to the substrate shift in myocardium with decreased myocardial flow reserve (MFR). The purpose of this study was to relate {sup 123}I-BMIPP uptake to rest myocardial blood flow (MBF), hyperemic MBF, and MFR assessed with {sup 15}O-water positron emission tomography (PET). We enrolled 21 patients with chronic stable angina without previous infarction, all of whom underwent {sup 123}I-BMIPP single-photon emission computed tomography (SPECT) and {sup 15}O-water PET. The left ventricle was divided into 13 segments. In each segment, rest MBF and hyperemic MBF were measured by PET. {sup 123}I-BMIPP uptake was evaluated as follows: score 0=normal, 1=slightly decreased uptake, 2=moderately decreased uptake, 3=severely decreased uptake, and 4=complete defect. {sup 123}I-BMIPP uptake was compared with rest MBF, hyperemic MBF, and MFR. The numbers of segments with {sup 123}I-BMIPP scores 0, 1, 2, 3, and 4 were 178, 40, 25, 24, and 0, respectively. The rest MBFs for scores 0, 1, 2, and 3 were 0.93{+-}0.25, 0.86{+-}0.21, 0.97{+-}0.30, and 0.99{+-}0.37 ml/min/g, respectively. The hyperemic MBFs for scores 0, 1, 2, and 3 were 2.76{+-}1.29, 1.84{+-}0.74, 1.37{+-}0.39, and 1.08{+-}0.40 ml/min/g, respectively. The MFRs for scores 0, 1, 2, and 3 were 3.01{+-}1.38, 2.20{+-}0.95, 1.44{+-}0.22, and 1.10{+-}0.26, respectively. As {sup 123}I-BMIPP uptake declined, hyperemic MBF and MFR decreased. In chronic stable angina without previous infarction, reduced {sup 123}I-BMIPP uptake implies decreased MFR. (orig.)

  1. Reduced 123I-BMIPP uptake implies decreased myocardial flow reserve in patients with chronic stable angina.

    Science.gov (United States)

    Kageyama, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Tsukamoto, Takahiro; Noriyasu, Kazuyuki; Mabuchi, Megumi; Naya, Masanao; Kawai, Yuko; Tamaki, Nagara

    2006-01-01

    Long-chain fatty acid (LCFA) is the main energy source for normal myocardium at rest, but in ischemic myocardium, the main energy substrate shifts from LCFA to glucose. 123I-BMIPP is a radiolabeled LCFA analog. In chronic stable angina without previous infarction, we suppose that reduced 123I-BMIPP uptake is related to the substrate shift in myocardium with decreased myocardial flow reserve (MFR). The purpose of this study was to relate 123I-BMIPP uptake to rest myocardial blood flow (MBF), hyperemic MBF, and MFR assessed with 15O-water positron emission tomography (PET). We enrolled 21 patients with chronic stable angina without previous infarction, all of whom underwent 123I-BMIPP single-photon emission computed tomography (SPECT) and 15O-water PET. The left ventricle was divided into 13 segments. In each segment, rest MBF and hyperemic MBF were measured by PET. 123I-BMIPP uptake was evaluated as follows: score 0=normal, 1=slightly decreased uptake, 2=moderately decreased uptake, 3=severely decreased uptake, and 4=complete defect. 123I-BMIPP uptake was compared with rest MBF, hyperemic MBF, and MFR. The numbers of segments with 123I-BMIPP scores 0, 1, 2, 3, and 4 were 178, 40, 25, 24, and 0, respectively. The rest MBFs for scores 0, 1, 2, and 3 were 0.93+/-0.25, 0.86+/-0.21, 0.97+/-0.30, and 0.99+/-0.37 ml/min/g, respectively. The hyperemic MBFs for scores 0, 1, 2, and 3 were 2.76+/-1.29, 1.84+/-0.74, 1.37+/-0.39, and 1.08+/-0.40 ml/min/g, respectively. The MFRs for scores 0, 1, 2, and 3 were 3.01+/-1.38, 2.20+/-0.95, 1.44+/-0.22, and 1.10+/-0.26, respectively. As 123I-BMIPP uptake declined, hyperemic MBF and MFR decreased. In chronic stable angina without previous infarction, reduced 123I-BMIPP uptake implies decreased MFR.

  2. Reduced 123I-BMIPP uptake implies decreased myocardial flow reserve in patients with chronic stable angina

    International Nuclear Information System (INIS)

    Kageyama, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Mabuchi, Megumi; Tamaki, Nagara; Tsukamoto, Takahiro; Noriyasu, Kazuyuki; Naya, Masanao; Kawai, Yuko

    2006-01-01

    Long-chain fatty acid (LCFA) is the main energy source for normal myocardium at rest, but in ischemic myocardium, the main energy substrate shifts from LCFA to glucose. 123 I-BMIPP is a radiolabeled LCFA analog. In chronic stable angina without previous infarction, we suppose that reduced 123 I-BMIPP uptake is related to the substrate shift in myocardium with decreased myocardial flow reserve (MFR). The purpose of this study was to relate 123 I-BMIPP uptake to rest myocardial blood flow (MBF), hyperemic MBF, and MFR assessed with 15 O-water positron emission tomography (PET). We enrolled 21 patients with chronic stable angina without previous infarction, all of whom underwent 123 I-BMIPP single-photon emission computed tomography (SPECT) and 15 O-water PET. The left ventricle was divided into 13 segments. In each segment, rest MBF and hyperemic MBF were measured by PET. 123 I-BMIPP uptake was evaluated as follows: score 0=normal, 1=slightly decreased uptake, 2=moderately decreased uptake, 3=severely decreased uptake, and 4=complete defect. 123 I-BMIPP uptake was compared with rest MBF, hyperemic MBF, and MFR. The numbers of segments with 123 I-BMIPP scores 0, 1, 2, 3, and 4 were 178, 40, 25, 24, and 0, respectively. The rest MBFs for scores 0, 1, 2, and 3 were 0.93±0.25, 0.86±0.21, 0.97±0.30, and 0.99±0.37 ml/min/g, respectively. The hyperemic MBFs for scores 0, 1, 2, and 3 were 2.76±1.29, 1.84±0.74, 1.37±0.39, and 1.08±0.40 ml/min/g, respectively. The MFRs for scores 0, 1, 2, and 3 were 3.01±1.38, 2.20±0.95, 1.44±0.22, and 1.10±0.26, respectively. As 123 I-BMIPP uptake declined, hyperemic MBF and MFR decreased. In chronic stable angina without previous infarction, reduced 123 I-BMIPP uptake implies decreased MFR. (orig.)

  3. Relationship between myocardial flow reserve by oxygen-15 water positron emission tomography in the subacute phase of myocardial infarction and left ventricular remodeling in the chronic phase

    International Nuclear Information System (INIS)

    Ohara, Minako; Yukiiri, Kazushi; Masugata, Hisashi

    2008-01-01

    The purposes of this study were to examine the effects of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) on myocardial flow reserve in patients with acute myocardial infarction (AMI) in the subacute phase using oxygen-15 positron emission tomography (PET) and to elucidate the relationship between the myocardial flow reserve and remodeling in the chronic phase. Sixty patients who had been treated with coronary angioplasty within 12 h after the onset of AMI were enrolled. Patients were divided into an enalapril (ACEI) group and a candesartan (ARB) group. The myocardial flow reserve was measured by oxygen-15 water PET in the subacute phase from the 20th to the 30th day after the onset of AMI. Left ventriculography was performed to measure the left ventricular ejection fraction in the chronic phase about 6 months after the onset. Ten patients (33%) in the enalapril group and 4 patients (13%) in the candesartan group stopped taking their respective medications within a few days of starting, because of side effects such as cough or hypotension. Thus, the prevalence of medication intolerance was higher in the enalapril group. The myocardial flow reserve in the subacute phase and the left ventricular ejection fraction in the chronic phase were lower in the enalapril group (2.08±0.30 and 42±6%) than in the candesartan group (2.25±0.20 and 49±5%) (p<0.05). The myocardial flow reserve significantly correlated with the left ventricular ejection fraction in all patients (r=0.45, p<0.01). The myocardial flow reserve assessed by PET in the subacute phase after AMI was found to be related to left ventricular remodeling in the chronic phase. (author)

  4. The relationship between fractional flow reserve, platelet reactivity and platelet leukocyte complexes in stable coronary artery disease

    NARCIS (Netherlands)

    Sels, J.W.E.M.; Rutten, B.; Holten, van T.C.; Hillaert, M.A.K.; Waltenberger, J.; Pijls, N.H.J.; Pasterkamp, G.; Groot, de P.G.; Roest, M.

    2013-01-01

    Background: The presence of stenoses that significantly impair blood flow and cause myocardial ischemia negatively affects prognosis of patients with stable coronary artery disease. Altered platelet reactivity has been associated with impaired prognosis of stable coronary artery disease. Platelets

  5. Fractional Flow Reserve-Guided Complete Revascularization Improves the Prognosis in Patients With ST-Segment-Elevation Myocardial Infarction and Severe Nonculprit Disease

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Engstrøm, Thomas; Kelbæk, Henning

    2017-01-01

    , and severity of the noninfarct-related stenosis on the effect of fractional flow reserve-guided complete revascularization. METHODS AND RESULTS: In the DANAMI-3-PRIMULTI study (Primary PCI in Patients With ST-Elevation Myocardial Infarction and Multivessel Disease: Treatment of Culprit Lesion Only or Complete...

  6. Comparison of quantitative myocardial perfusion imaging CT to fluorescent microsphere-based flow from high-resolution cryo-images

    Science.gov (United States)

    Eck, Brendan L.; Fahmi, Rachid; Levi, Jacob; Fares, Anas; Wu, Hao; Li, Yuemeng; Vembar, Mani; Dhanantwari, Amar; Bezerra, Hiram G.; Wilson, David L.

    2016-03-01

    Myocardial perfusion imaging using CT (MPI-CT) has the potential to provide quantitative measures of myocardial blood flow (MBF) which can aid the diagnosis of coronary artery disease. We evaluated the quantitative accuracy of MPI-CT in a porcine model of balloon-induced LAD coronary artery ischemia guided by fractional flow reserve (FFR). We quantified MBF at baseline (FFR=1.0) and under moderate ischemia (FFR=0.7) using MPI-CT and compared to fluorescent microsphere-based MBF from high-resolution cryo-images. Dynamic, contrast-enhanced CT images were obtained using a spectral detector CT (Philips Healthcare). Projection-based mono-energetic images were reconstructed and processed to obtain MBF. Three MBF quantification approaches were evaluated: singular value decomposition (SVD) with fixed Tikhonov regularization (ThSVD), SVD with regularization determined by the L-Curve criterion (LSVD), and Johnson-Wilson parameter estimation (JW). The three approaches over-estimated MBF compared to cryo-images. JW produced the most accurate MBF, with average error 33.3+/-19.2mL/min/100g, whereas LSVD and ThSVD had greater over-estimation, 59.5+/-28.3mL/min/100g and 78.3+/-25.6 mL/min/100g, respectively. Relative blood flow as assessed by a flow ratio of LAD-to-remote myocardium was strongly correlated between JW and cryo-imaging, with R2=0.97, compared to R2=0.88 and 0.78 for LSVD and ThSVD, respectively. We assessed tissue impulse response functions (IRFs) from each approach for sources of error. While JW was constrained to physiologic solutions, both LSVD and ThSVD produced IRFs with non-physiologic properties due to noise. The L-curve provided noise-adaptive regularization but did not eliminate non-physiologic IRF properties or optimize for MBF accuracy. These findings suggest that model-based MPI-CT approaches may be more appropriate for quantitative MBF estimation and that cryo-imaging can support the development of MPI-CT by providing spatial distributions of MBF.

  7. Use of integrity control and automatic start of reserve in a multi-channel temperature and flow rate control device

    International Nuclear Information System (INIS)

    Strzalkowski, L.

    1975-01-01

    A way to increase reliability of process quantity control is control of the integrity of the control plants themselves. The possibilities of integrity control on control devices having simply duplicated control channels or working on the basis of the ''two-from-three'' principle are valued. A highly reliable integrity control is possible by use of test signals. For an appropriate control device, structure and function of the assemblies are described. The integrity control device may be used in the water coolant temperature and flow rate control system for all technological channels of the research reactor ''Maria''

  8. Relationship Between Endothelial Wall Shear Stress and High-Risk Atherosclerotic Plaque Characteristics for Identification of Coronary Lesions That Cause Ischemia: A Direct Comparison With Fractional Flow Reserve.

    Science.gov (United States)

    Han, Donghee; Starikov, Anna; Ó Hartaigh, Bríain; Gransar, Heidi; Kolli, Kranthi K; Lee, Ji Hyun; Rizvi, Asim; Baskaran, Lohendran; Schulman-Marcus, Joshua; Lin, Fay Y; Min, James K

    2016-12-19

    Wall shear stress (WSS) is an established predictor of coronary atherosclerosis progression. Prior studies have reported that high WSS has been associated with high-risk atherosclerotic plaque characteristics (APCs). WSS and APCs are quantifiable by coronary computed tomography angiography, but the relationship of coronary lesion ischemia-evaluated by fractional flow reserve-to WSS and APCs has not been examined. WSS measures were obtained from 100 evaluable patients who underwent coronary computed tomography angiography and invasive coronary angiography with fractional flow reserve. Patients were categorized according to tertiles of mean WSS values defined as low, intermediate, and high. Coronary ischemia was defined as fractional flow reserve ≤0.80. Stenosis severity was determined by minimal luminal diameter. APCs were defined as positive remodeling, low attenuation plaque, and spotty calcification. The likelihood of having positive remodeling and low-attenuation plaque was greater in the high WSS group compared with the low WSS group after adjusting for minimal luminal diameter (odds ratio for positive remodeling: 2.54, 95% CI 1.12-5.77; odds ratio for low-attenuation plaque: 2.68, 95% CI 1.02-7.06; both Prelationship was observed between WSS and fractional flow reserve when adjusting for either minimal luminal diameter or APCs. WSS displayed no incremental benefit above stenosis severity and APCs for detecting lesions that caused ischemia (area under the curve for stenosis and APCs: 0.87, 95% CI 0.81-0.93; area under the curve for stenosis, APCs, and WSS: 0.88, 95% CI 0.82-0.93; P=0.30 for difference). High WSS is associated with APCs independent of stenosis severity. WSS provided no added value beyond stenosis severity and APCs for detecting lesions with significant ischemia. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  9. Study of Coronary Flow Reserve with Intravenous Use of Microbubbles (Contrast Echocardiography and Adenosine: Protocol for Clinical Application in Patients Suspected of Having Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Morcerf Fernando

    2002-01-01

    Full Text Available OBJECTIVE: To test the feasibility, safety and accuracy of the adenosine protocol in the study of myocardial perfusion with microbubbles contrast echocardiography. METHODS: 81 pts (64 male, 60+11 years were submitted to contrast echocardiography with PESDA (sonicated solution of albumin 20%-1ml, dextrose 5%-12ml and deca-fluorobutane gas-8ml to study the myocardial perfusion at rest and after bolus injection of adenosine (6 to 18mg and to coronary angiography within 1 month each other. For each patient 3 left ventricle perfusion beds were considered (total of 243 territories. 208 territories were analyzed and 35 territories were excluded. PESDA was continuously infused (1-2ml/min, titrated for best myocardial contrast. Triggered (1:1 second harmonic imaging was used. RESULTS: Coronary angiography showed 70 flow limiting (> 75% lesions and 138 no flow limiting lesions. At rest an obvious myocardium contrast enhancement was seen in at least 1 segment of a territory in all patients. After adenosine injection an unquestionable further increase in myocardial contrast was observed in 136 territories (99% related to no flow limiting lesions, lasting < 10 s, and a myocardial perfusion defect was detected in 68 territories (97% related to flow limiting lesions. It was observed only 4 false results. There were no serious complications. CONCLUSION: Myocardial perfusion study with PESDA and adenosine protocol is a practical, safe and accurate method to analyze the coronary flow reserve.

  10. Simulations of fusion chamber dynamics and first wall response in a Z-pinch driven fusion–fission hybrid power reactor (Z-FFR)

    Energy Technology Data Exchange (ETDEWEB)

    Qi, J.M., E-mail: qjm06@sina.com [Laboratory of Advanced Nuclear Energy (LANE), Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang 621999 (China); Center for Fusion Energy Science and Technology (CFEST), China Academy of Engineering Physics, Mianyang 621999 (China); Wang, Z., E-mail: wangz_es@caep.cn [Laboratory of Advanced Nuclear Energy (LANE), Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang 621999 (China); Center for Fusion Energy Science and Technology (CFEST), China Academy of Engineering Physics, Mianyang 621999 (China); Chu, Y.Y., E-mail: chuyanyun@caep.cn [Laboratory of Advanced Nuclear Energy (LANE), Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang 621999 (China); Center for Fusion Energy Science and Technology (CFEST), China Academy of Engineering Physics, Mianyang 621999 (China); Li, Z.H., E-mail: lee_march@sina.com [Laboratory of Advanced Nuclear Energy (LANE), Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang 621999 (China)

    2016-03-15

    Highlights: • Z-FFR utilizes DT neutrons to drive a sub-critical fission blanket to produce energy. • A metal shell and Ar gas are employed in the fusion chamber for shock mitigation. • Massive materials can effectively mitigate the thermal heats on the chamber wall. • The W-coated Zr-alloy first wall exhibits good viability as a long-lived component. - Abstract: In a Z-pinch driven fusion–fission hybrid power reactor (Z-FFR), the fusion target will produce enormous energy of ∼1.5 GJ per pulse at a frequency of 0.1 Hz. Almost 20% of the fusion energy yield, approximately 300 MJ, is released in forms of pulsed X-rays. To prevent the first wall from fatal damages by the intense X-rays, a thin spherical metal shell and rare Ar buffer gas are introduced to mitigate the transient X-ray bursts. Radiation hydrodynamics in the fusion chamber were investigated by MULTI-1D simulations, and the corresponding thermal and mechanical loads on the first wall were also obtained. The simulations indicated that by optimizing the design parameters of the metal shell and Ar buffer gas, peak power flux of the thermal heats on the first wall could be mitigated to less than 10{sup 4} W/cm{sup 2} within a time scale of several milliseconds, while peak overpressures of the mechanical loads varying from 0.6 to 0.7 MPa. In addition, the thermomechanical response in a W–coated Zr-alloy first wall was performed by FWDR1D calculations using the derived thermal and mechanical loads as inputs. The temperature and stress fields were analyzed, and the corresponding elastic strains were conducted for primary lifetime estimations by using the Coffin–Manson relationships of both W and Zr-alloy. It was shown that the maximum temperature rises and stresses in the first wall were less than 50 K and 130 MPa respectively, and lifetime of the first wall would be in excess of 10{sup 9} cycles. The chamber exhibits good viability as a long-lived component to sustain the Z-FFR conceptual

  11. The renal blood flow reserve in healthy humans and patients with atherosclerotic renovascular disease measured by positron emission tomography using [15O]H2O.

    Science.gov (United States)

    Päivärinta, Johanna; Koivuviita, Niina; Oikonen, Vesa; Iida, Hidehiro; Liukko, Kaisa; Manner, Ilkka; Löyttyniemi, Eliisa; Nuutila, Pirjo; Metsärinne, Kaj

    2018-06-11

    Microvascular function plays an important role in ARVD (atherosclerotic renovascular disease). RFR (renal flow reserve), the capacity of renal vasculature to dilate, is known to reflect renal microvascular function. In this pilot study, we assessed PET (positron emission tomography)-based RFR values of healthy persons and renal artery stenosis patients. Seventeen patients with ARVD and eight healthy subjects were included in the study. Intravenous enalapril 1 mg was used as a vasodilatant, and the maximum response (blood pressure and RFR) to it was measured at 40 min. Renal perfusion was measured by means of oxygen-15-labeled water PET. RFR was calculated as a difference of stress flow and basal flow and was expressed as percent [(stress blood flow - basal blood flow)/basal blood flow] × 100%. RFR of the healthy was 22%. RFR of the stenosed kidneys of bilateral stenosis patients (27%) was higher than that of the stenosed kidneys of unilateral stenosis patients (15%). RFR of the contralateral kidneys of unilateral stenosis patients was 21%. There was no difference of statistical significance between RFR values of ARVD subgroups or between ARVD subgroups and the healthy. In the stenosed kidneys of unilateral ARVD patients, stenosis grade of the renal artery correlated negatively with basal (p = 0.04) and stress flow (p = 0.02). Dispersion of RFR values was high. This study is the first to report [ 15 O]H 2 O PET-based RFR values of healthy subjects and ARVD patients in humans. The difference between RFR values of ARVD patients and the healthy did not reach statistical significance perhaps because of high dispersion of RFR values. [ 15 O]H 2 O PET is a valuable non-invasive and quantitative method to evaluate renal blood flow though high dispersion makes imaging challenging. Larger studies are needed to get more information about [ 15 O]H 2 O PET method in evaluation of renal blood flow.

  12. Doença aterosclerótica difusa desmascarada pela avaliação fisiológica invasiva da circulação coronária Diffuse atherosclerotic disease unmasked by invasive physiologic assessment of coronary flow

    Directory of Open Access Journals (Sweden)

    Fernando Mendes Sant'Anna

    2005-08-01

    Full Text Available Sabe-se que a aterosclerose coronária é um processo difuso, pouco visível à angiografia. Este artigo descreve um paciente com angina estável, três meses após infarto agudo do miocárdio (IAM, e uma lesão severa na artéria descendente anterior (ADA, evidenciada pela cinecoronariografia. A reserva de fluxo fracionada do miocárdio (FFR, obtida através de medidas pressóricas intracoronárias, foi 0,37 durante a hiperemia máxima, demonstrando claramente a existência de isquemia. Um stent foi implantado na ADA e, a despeito do excelente resultado angiográfico, a FFR pós-stent foi apenas 0,75, o limite mínimo abaixo do qual existe isquemia. Quando a corda guia pressórica (pressure wire - PW foi lentamente recuada da porção distal da ADA para sua porção proximal, notou-se um aumento contínuo e gradativo na pressão intracoronária, o que indica claramente aterosclerose difusa e não estenose focal. Não se notava gradiente no local do stent. O paciente foi mantido em tratamento médico e permanece assintomático até o momento.It is known that coronary atherosclerosis is a diffuse process, very little visible at angiography. This article describes a stable angina patient, three months after acute myocardial infarction (AMI, and a severe lesion in anterior descending artery (ADA, evinced by coronariography. Myocardial fractional flow reserve (FFR, obtained through intracoronary pressure measurements, was 0.37 during maximum hyperemia, clearly showing the presence of ischemia. A stent was implanted in ADA and, despite the excellent angiographic result, post-stent FFR was only 0.75, the minimum limit, below which there is ischemia. When the pressure wire (PW was slowly drawn back from the distal portion of ADA to its proximal portion, a continuous and gradual increase in intracoronary pressure was noted, which clearly indicates diffuse atherosclerosis and not focal stenosis. A gradient was not observed at the stent place. The patient

  13. Reduction of myocardial blood flow reserve in idiopathic dilated cardiomyopathy without overt heart failure and its relation with functional indices: an echo-Doppler and positron emission tomography study.

    Science.gov (United States)

    Morales, Maria-Aurora; Neglia, Danilo; L'Abbate, Antonio

    2008-08-01

    Myocardial blood flow during pharmacological vasodilatation is depressed in patients with idiopathic dilated cardiomyopathy even the in absence of overt heart failure; the extent of myocardial blood flow abnormalities is not predictable by left ventricular ejection fraction (LVEF) and diastolic dimensions. To assess whether myocardial blood flow impairment in idiopathic dilated cardiomyopathy without overt heart failure can be related to Doppler-derived dP/dt and to echocardiographically determined left ventricular end systolic stress - which is linked to myocardial blood flow reserve in advanced disease. Twenty-six patients, New York Heart Association Class I-II, (LVEF 37.4 +/- 1.4%, left ventricular diastolic dimensions 62.6 +/- 0.9 mm) underwent resting/dipyridamole [13N]NH3 flow positron emission tomography and an ultrasonic study. Regional myocardial blood flow values (ml/min per g) were computed from positron emission tomography data in 13 left ventricular (LV) myocardial regions and averaged to provide mean myocardial blood flow and myocardial blood flow reserve, defined as dipyridamole/resting mean myocardial blood flow ratio. Resting myocardial blood flow was 0.686 +/- 0.045, dipyridamole myocardial blood flow 1.39 +/- 0.15 and myocardial blood flow reserve 2.12 +/- 0.2, lower than in controls (P < 0.01). The ratio dP/dt was directly related to dipyridamole myocardial blood flow and myocardial blood flow reserve (r = 0.552 and 0.703, P < 0.005 and P < 0.0001); no relation was found between myocardial blood flow and LVEF left ventricular diastolic dimensions, and left ventricular end systolic stress. In idiopathic dilated cardiomyopathy patients without overt heart failure, the extent of myocardial blood flow reserve impairment is related to dP/dt but not to more classical indices of left ventricular function.

  14. Relationship between HgbA1c and myocardial blood flow reserve in patients with type 2 diabetes mellitus: noninvasive assessment using real-time myocardial perfusion echocardiography.

    Science.gov (United States)

    Huang, Runqing; Abdelmoneim, Sahar S; Nhola, Lara F; Mulvagh, Sharon L

    2014-01-01

    To study the relationship between glycosylated hemoglobin (HgbA1c) and myocardial perfusion in type 2 diabetes mellitus (T2DM) patients, we prospectively enrolled 24 patients with known or suspected coronary artery disease (CAD) who underwent adenosine stress by real-time myocardial perfusion echocardiography (RTMPE). HgbA1c was measured at time of RTMPE. Microbubble velocity (β min(-1)), myocardial blood flow (MBF, mL/min/g), and myocardial blood flow reserve (MBFR) were quantified. Quantitative MCE analysis was feasible in all patients (272/384 segments, 71%). Those with HgbA1c > 7.1% had significantly lower βreserve and MBFR than those with HgbA1c ≤ 7.1% (P relationship was not significant (r = -0.117, P = 0.129). Using a MBFR cutoff value > 2 as normal, HgbA1c > 7.1% significantly increased the risk for abnormal MBFR, (adjusted odds ratio: 1.92, 95% CI: 1.12-3.35, P = 0.02). Optimal glycemic control is associated with preservation of MBFR as determined by RTMPE, in T2DM patients at risk for CAD.

  15. Quantitative assessment of regional myocardial flow reserve using Tc-99m-sestamibi imaging. Comparison with results of O-15 water PET

    International Nuclear Information System (INIS)

    Tsukamoto, Takahiro; Ito, Yoshinori; Noriyasu, Kazuyuki; Morita, Koichi; Katoh, Chietsugu; Okamoto, Hiroshi; Tamaki, Nagara

    2005-01-01

    The aims of this study were to develop a method for quantitative estimation of the myocardial blood flow index (MBFI) and myocardial flow reserve (MFR) of the whole left ventricle using 99m technetium (Tc-99m)-sestamibi imaging. Twenty-two patients with suspected coronary artery disease and 7 controls underwent both Tc-99m-sestamibi imaging and O-15 water positron emission tomography (PET). The global MBFI was calculated on the basis of the microsphere model from the ratio of the myocardial count to the area under the time-activity curve on the aortic arch. The regional MBFI was calculated from the relative distributions of Tc-99m-sestamibi uptake values. The regional MBFI and MFR (Tc-MFR) obtained using single-photon emission computed tomography were compared with the myocardial blood flow (MBF) and MFR (PET-MFR) obtained using PET as the gold standard. Regional MBFI significantly correlated with the MBF obtained using PET. Regional Tc-MFR also correlated with the regional PET-MER, with some underestimation. These results indicate that regional MBF and MFR may be estimated by dynamic Tc-99m-sestamibi imaging and can be used for the early detection and estimation of the functional severity of coronary lesions without the need for a PET camera. (author)

  16. Prognostic Value of Transthoracic Doppler Echocardiography Coronary Flow Velocity Reserve in Patients with Nonculprit Stenosis of Intermediate Severity Early after Primary Percutaneous Coronary Intervention.

    Science.gov (United States)

    Tesic, Milorad; Djordjevic-Dikic, Ana; Giga, Vojislav; Stepanovic, Jelena; Dobric, Milan; Jovanovic, Ivana; Petrovic, Marija; Mehmedbegovic, Zlatko; Milasinovic, Dejan; Dedovic, Vladimir; Zivkovic, Milorad; Juricic, Stefan; Orlic, Dejan; Stojkovic, Sinisa; Vukcevic, Vladan; Stankovic, Goran; Nedeljkovic, Milan; Ostojic, Miodrag; Beleslin, Branko

    2018-04-03

    Treatment of nonculprit coronary stenosis during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction may be beneficial, but the mode and timing of the intervention are still controversial. The aim of this study was to examine the significance and prognostic value of preserved coronary flow velocity reserve (CFVR) in patients with nonculprit intermediate stenosis early after primary percutaneous coronary intervention. Two hundred thirty patients with remaining intermediate (50%-70%) stenosis of non-infarct-related arteries, in whom CFVR was performed within 7 days after primary percutaneous coronary intervention, were prospectively enrolled. Twenty patients with reduced CFVR and positive results on stress echocardiography or impaired fractional flow reserve underwent revascularization and were not included in further analysis. The final study population of 210 patients (mean age, 58 ± 10 years; 162 men) was divided into two groups on the basis of CFVR: group 1, CFVR > 2 (n = 174), and group 2, CFVR ≤ 2 (n = 36). Cardiac death, nonfatal myocardial infarction, and revascularization of the evaluated vessel were considered adverse events. Mean follow-up duration was 47 ± 16 months. Mean CFVR for the whole group was 2.36 ± 0.40. There were six adverse events (3.4%) related to the nonculprit coronary artery in group 1, including one cardiac death, one ST-segment elevation myocardial infarction, and four revascularizations. In group 2, there were 30 adverse events (83.3%, P  2 of the intermediate nonculprit coronary lesion, deferral of revascularization is safe and associated with excellent long-term clinical outcomes. Copyright © 2018 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  17. A novel flow-based parameter of collateral function assessed by intracoronary thermodilution.

    Science.gov (United States)

    Lindner, Markus; Felix, Stephan B; Empen, Klaus; Reffelmann, Thorsten

    2014-04-01

    Currently, many methods for quantitation of coronary collateral function are based on intracoronary pressure measurements distal of an occluded balloon, which do not fully account for the dynamic nature of collateral flow. Therefore, a flow-based parameter of coronary collateral function based upon principles of thermodilution was evaluated. In 26 patients with a high-grade coronary artery stenosis, intracoronary hemodynamics were analyzed by the RadiAnalyzer system (St Jude Medical), including fractional flow reserve (FFR), index of microcirculatory resistance (IMR), and the pressure-based collateral flow index (CFI) during balloon occlusion and hyperemia (intravenous adenosine). Moreover, immediately after an intracoronary bolus of room-temperature saline, the balloon was occluded and the intracoronary temperature distal to the balloon was analyzed over time. The slope of the temperature-time curve was calculated after logarithmic transformation as an index of collateral blood flow (CBFI). The coefficient of variation between two measurements of CBFI amounted to 11 ± 2%. In patients with CFI ≥0.25, CBFI amounted to 0.55 ± 0.09, whereas in those with CFI function, and should be evaluated in further studies.

  18. Myocardial blood flow and left ventricular functional reserve in hypertrophic cardiomyopathy: a {sup 13}NH{sub 3} gated PET study

    Energy Technology Data Exchange (ETDEWEB)

    Sciagra, Roberto; Calabretta, Raffaella; Passeri, Alessandro; Castello, Angelo; Pupi, Alberto [University of Florence, Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences ' ' Mario Serio' ' , Florence (Italy); Cipollini, Fabrizio [University of Florence, Department of Statistics, Florence (Italy); Cecchi, Franco; Olivotto, Iacopo [Careggi University Hospital, Referral Centre for Myocardial Diseases, Florence (Italy)

    2017-05-15

    Ischemia in hypertrophic cardiomyopathy (HCM) is caused by coronary microvascular dysfunction (CMD), which is detected by measuring myocardial blood flow (MBF) with PET. Whether CMD may be associated with ischemic left ventricular (LV) dysfunction is unclear. We therefore assessed LV ejection fraction (EF) reserve in HCM patients undergoing dipyridamole (Dip) PET. Resting and stress {sup 13}NH{sub 3} dynamic as well as gated PET were performed in 34 HCM patients. Segmental MBF and transmural perfusion gradient (TPG = subendocardial / subepicardial MBF) were assessed. LVEF reserve was considered abnormal if Dip LVEF decreased more than 5 units as compared to rest. Eighteen patients had preserved (group A) and 16 abnormal LVEF reserve (group B; range -7 to -32). Group B patients had greater wall thickness than group A, but resting volumes, LVEF, resting and Dip MBF, and myocardial flow reserve were similar. Group B had slightly higher summed stress score and summed difference score in visual analysis than group A, and a significantly higher summed stress wall motion score. In group B, resting TPG was slightly lower (1.31 ± 0.29 vs. 1.37 ± 0.34, p <0.05), and further decreased after Dip, whilst in group A it increased (B = 1.20 ± 0.39, p < 0.0001 vs. rest and vs. A = 1.40 ± 0.43). The number of segments per patient with TPG <1 was higher than in group A (p < 0.001) and was a significant predictor of impaired LVEF reserve (OR 1.86, p < 0.02), together with wall thickness (OR 1.3, p < 0.02). Abnormal LVEF response is common in HCM patients following Dip, and is related to abnormal TPG, suggesting that subendocardial ischemia might occur under Dip and cause transient LV dysfunction. Although in vivo this effect may be hindered by the adrenergic drive associated with effort, these findings may have relevance in understanding exercise limitation and heart failure symptoms in HCM. (orig.)

  19. Assessment of cerebral blood flow reserve using blood oxygen level-dependent echo planar imaging after acetazolamide administration in patients post-STA-MCA anastomosis surgery

    International Nuclear Information System (INIS)

    Zenke, Kiichiro; Kusunoki, Katsusuke; Saito, Masahiro; Sadamoto, Kazuhiko; Ohta, Shinsuke; Kumon, Yoshiaki; Sakaki, Saburo; Nagasawa, Kiyoshi

    1998-01-01

    Recently, blood oxygen level-dependent (BOLD) echo planar imaging (EPI) has been used to estimate blood flow changes. Theoretically, a relative decrement of deoxyhemoglobin in cerebral blood supply induces a MR signal change after neuronal stimulation. In the present study, we have attempted to evaluate CBF reserve capacity by the BOLD EPI in patients who had undergone STA-MCA anastomosis surgery. Then, we compared with the signal intensity changes obtained by this procedure with the CBF changes by Xe-SPECT after acetazolamide administration. Six patients, post-STA-MCA anastomosis surgery, were studied. Pre-operatively, MR signal intensity and CBF, by Xe-SPECT, were increased in the intact side after acetazolamide administration in all patients, and MR signal intensities were decreased in low flow regions after acetazolamide administration in all four patients in whom so-called steal phenomenon was demonstrated by Xe-SPECT study. Post-operatively, poor response was shown after acetazolamide administration with both Xe-SPECT and BOLD EPI in the two patients who had unsuccessful anastomoses. In the successfully anastomosed patients, improved vascular reactivity was demonstrated on BOLD EPI after acetazolamide administration in 3 of 4 patients in whom an improvement of vascular reactivity was demonstrated on Xe-SPECT. In one patient, MRI studies were considered to have technical artifacts, because the MR signal intensity did not increase, even in the intact side after acetazolamide administration. In conclusion, BOLD EPI after acetazolamide administration is an useful procedure for the pre- and post-operative of vascular reserve in patients with ischemic stroke. (author)

  20. Difference in myocardial flow reserve between patients with dilated cardiomyopathy and those with dilated phase of hypertrophic cardiomyopathy. Evaluation by 15O-water PET

    International Nuclear Information System (INIS)

    Ohba, Muneo; Kambara, Naoshige; Hosokawa, Ryohei

    2007-01-01

    The clinical features of patients with the dilated phase of hypertrophic cardiomyopathy (DHCM) may resemble those of patients with dilated cardiomyopathy (DCM); that is, systolic dysfunction and left ventricular dilatation. Myocardial flow reserve (MFR) is impaired in patients with nonischemic cardiomyopathy, and the reduced MFR may be related to poor prognosis. Several studies report that the mortality rate for patients with DHCM is higher than for DCM, but the difference between these 2 cardiomyopathies is still unclear. The purpose of this study was to assess the MFR of these 2 cardiomyopathies, using 15 O-water positron emission tomography (PET) to elucidate their differences. In total 30 patients were investigated: 23 with DCM (Group A) and 7 with DHCM (Group B). All those who were in a stable condition underwent cardiac catheterization. Myocardial blood flow (MBF) at rest and under adenosine 5'-triphosphate (ATP) infusion was measured by 15 O-water PET, and the MFR was calculated. There were no significant differences in the hemodynamics of the 2 groups. The mean MFR in DHCM was significantly lower than that in DCM (1.49±0.31 vs 2.62±1.08; p=0.042), whereas MBF at rest did not differ (DCM vs DHCM: 0.66±0.20 vs 0.49±0.05 ml·min -1 ·g -1 ; no significance (NS)). The MFR in both Group A and B was significantly decreased compared with the normal controls (MFR in normal controls: 5.15±1.64, p=0.00015, 0.00013, respectively). These results suggest that impaired vasodilatation (ie, dysfunction of the microcirculation) is more severe in patients with DHCM than in patients with DCM, even though patients' characteristics and hemodynamics do not differ. (author)

  1. Myocardial flow reserve is influenced by both coronary artery stenosis severity and coronary risk factors in patients with suspected coronary artery disease

    International Nuclear Information System (INIS)

    Tsukamoto, Takahiro; Naya, Masanao; Tsutsui, Hiroyuki; Morita, Koichi; Katoh, Chietsugu; Inubushi, Masayuki; Kuge, Yuji; Tamaki, Nagara

    2006-01-01

    Myocardial flow reserve (MFR) measurement has an important role in assessing the functional severity of coronary artery stenosis. However, a discrepancy between the anatomical severity of coronary artery stenosis and MFR is often observed. Such a discrepancy may be explained by coronary risk factors. In this study, we aimed to investigate the influence of coronary artery stenosis severity and risk factors on MFR. Seventy-four patients suspected to have coronary artery disease and seven age-matched healthy volunteers were enrolled. Myocardial blood flow (MBF) and MFR were measured using 15 O-labelled water PET. Regional MFR was calculated in regions with significant coronary artery stenosis (stenotic regions) and in regions without significant stenosis (remote regions). The contributions of coronary artery stenosis severity and coronary risk factors were assessed using univariate and multivariate analyses. In stenotic regions, MFR correlated inversely with coronary artery stenosis severity (r=-0.50, p<0.01). Univariate analysis did not show any significant difference in MFR between the patients with and the patients without each risk factor. In remote regions, however, MFR was significantly decreased in the diabetes and smoking groups (each p<0.05). By multivariate analysis, diabetes and smoking were independent predictors of MFR (each p<0.05). In the group with more than one risk factor, MFR was significantly lower (2.78±0.79) than in the other group (3.40±1.22, p<0.05). MFR is influenced not only by coronary stenosis severity but also by coronary risk factors. In particular, the influence of risk factors should be considered in regions without severe coronary stenosis. (orig.)

  2. Evaluation of coronary blood flow reserve by 13N-NH3 positron emission computed tomography (PET) with dipyridamole in the treatment of hypertension with the ACE inhibitor (Cilazapril)

    International Nuclear Information System (INIS)

    Masuda, Daisuke; Nohara, Ryuji; Tamaki, Nagara

    2000-01-01

    The purpose of this study was to evaluate the effect of treatment with an angiotensin-converting enzyme (ACE) inhibitor (Cilazapril) for early hypertensive patients in terms of coronary blood flow reserve evaluated by 13 NH 3 -positron emission tomography (PET). Before and after 12 weeks of ACE inhibitor treatment, 13 NH 3 -PET with dipyridamole provocation test was performed, and definite myocardial perfusion and coronary flow reserve (CFR) were calculated. Compared to our normal subjects previously reported (2.61±0.74), average coronary flow reserve was decreased (1.70±0.64 in hypertensive patients), and improved after treatment (1.77±0.52), but not significantly. Of 12 patients, five (42%) showed improved coronary flow reserve from 1.34 to 1.99 without a significant change in the resting flow. Only one patient (8%) showed deterioration after the ACE inhibitor treatment. The coronary vascular resistance (CVR) after ACE inhibitor treatment of the patients with CFR <2.0 decreased significantly compared with those with CFR ≥2.0 (p<0.03). These results indicate that hypertensive patients at the early stage show decreased coronary flow reserve despite having normal resting flow. Treatment with an ACE inhibitor (Cilazapril) for 12 weeks improved coronary flow reserve in 42% of our patients. The CVR of the patients with CFR <2.0 showed improvement compared to those with CFR ≥2.0. This result indicates that an ACE inhibitor (e.g., Cilazapril) should be one of the choices for improving CFR if hypertensive patients in early stage show signs of ischemia or diastolic dysfunction, which may be one of the sequels of reserve restriction. (author)

  3. Simulated groundwater flow in the Ogallala and Arikaree aquifers, Rosebud Indian Reservation area, South Dakota - Revisions with data through water year 2008 and simulations of potential future scenarios

    Science.gov (United States)

    Long, Andrew J.; Putnam, Larry D.

    2010-01-01

    The Ogallala and Arikaree aquifers are important water resources in the Rosebud Indian Reservation area and are used extensively for irrigation, municipal, and domestic water supplies. Drought or increased withdrawals from the Ogallala and Arikaree aquifers in the Rosebud Indian Reservation area have the potential to affect water levels in these aquifers. This report documents revisions and recalibration of a previously published three-dimensional, numerical groundwater-flow model for this area. Data for a 30-year period (water years 1979 through 2008) were used in steady-state and transient numerical simulations of groundwater flow. In the revised model, revisions include (1) extension of the transient calibration period by 10 years, (2) the use of inverse modeling for steady-state calibration, (3) model calibration to base flow for an additional four surface-water drainage basins, (4) improved estimation of transient aquifer recharge, (5) improved delineation of vegetation types, and (6) reduced cell size near large capacity water-supply wells. In addition, potential future scenarios were simulated to assess the potential effects of drought and increased groundwater withdrawals.The model comprised two layers: the upper layer represented the Ogallala aquifer and the lower layer represented the Arikaree aquifer. The model’s grid had 168 rows and 202 columns, most of which were 1,640 feet (500 meters) wide, with narrower rows and columns near large water-supply wells. Recharge to the Ogallala and Arikaree aquifers occurs from precipitation on the outcrop areas. The average recharge rates used for the steady-state simulation were 2.91 and 1.45 inches per year for the Ogallala aquifer and Arikaree aquifer, respectively, for a total rate of 255.4 cubic feet per second (ft3/s). Discharge from the aquifers occurs through evapotranspiration, discharge to streams as base flow and spring flow, and well withdrawals. Discharge rates for the steady-state simulation were 171

  4. Combined diagnostic performance of coronary computed tomography angiography and computed tomography derived fractional flow reserve for the evaluation of myocardial ischemia: A meta-analysis.

    Science.gov (United States)

    Tan, Xiao Wei; Zheng, Qishi; Shi, Luming; Gao, Fei; Allen, John Carson; Coenen, Adriaan; Baumann, Stefan; Schoepf, U Joseph; Kassab, Ghassan S; Lim, Soo Teik; Wong, Aaron Sung Lung; Tan, Jack Wei Chieh; Yeo, Khung Keong; Chin, Chee Tang; Ho, Kay Woon; Tan, Swee Yaw; Chua, Terrance Siang Jin; Chan, Edwin Shih Yen; Tan, Ru San; Zhong, Liang

    2017-06-01

    To evaluate the combined diagnostic accuracy of coronary computed tomography angiography (CCTA) and computed tomography derived fractional flow reserve (FFRct) in patients with suspected or known coronary artery disease (CAD). PubMed, The Cochrane library, Embase and OpenGray were searched to identify studies comparing diagnostic accuracy of CCTA and FFRct. Diagnostic test measurements of FFRct were either extracted directly from the published papers or calculated from provided information. Bivariate models were conducted to synthesize the diagnostic performance of combined CCTA and FFRct at both "per-vessel" and "per-patient" levels. 7 articles were included for analysis. The combined diagnostic outcomes from "both positive" strategy, i.e. a subject was considered as "positive" only when both CCTA and FFRct were "positive", demonstrated relative high specificity (per-vessel: 0.91; per-patient: 0.81), high positive likelihood ratio (LR+, per-vessel: 7.93; per-patient: 4.26), high negative likelihood ratio (LR-, per-vessel: 0.30; per patient: 0.24) and high accuracy (per-vessel: 0.91; per-patient: 0.81) while "either positive" strategy, i.e. a subject was considered as "positive" when either CCTA or FFRct was "positive", demonstrated relative high sensitivity (per-vessel: 0.97; per-patient: 0.98), low LR+ (per-vessel: 1.50; per-patient: 1.17), low LR- (per-vessel: 0.07; per-patient: 0.09) and low accuracy (per-vessel: 0.57; per-patient: 0.54). "Both positive" strategy showed better diagnostic performance to rule in patients with non-significant stenosis compared to "either positive" strategy, as it efficiently reduces the proportion of testing false positive subjects. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Hyperemic stenosis resistance index for evaluation of functional coronary lesion severity

    NARCIS (Netherlands)

    Meuwissen, Martijn; Siebes, Maria; Chamuleau, Steven A. J.; van Eck-Smit, Berthe L. F.; Koch, Karel T.; de Winter, Robbert J.; Tijssen, Jan G. P.; Spaan, Jos A. E.; Piek, Jan J.

    2002-01-01

    Background-Both coronary blood flow velocity reserve (CFVR) and myocardial fractional flow reserve (FFR) are used to evaluate the hemodynamic severity of coronary lesions. However, discordant results between CFVR and FFR have been observed in 25%, to 30% of intermediate coronary lesions. An index of

  6. The effect of EC-IC bypass surgery on resting cerebral blood flow and cerebrovascular reserve capacity studied with stable Xe-CT and acetazolamide test

    Energy Technology Data Exchange (ETDEWEB)

    Yamashita, T.; Kashiwagi, S.; Nakano, S.; Takasago, T.; Abiko, S.; Shiroyama, Y.; Hayashi, M.; Ito, H. (Yamaguchi Univ. School of Medicine (Japan). Dept. of Neurosurgery)

    1991-06-01

    Cerebral blood flow (CBF) and cerebrovascular reserve capacity (CRC) were measured by stable xenon computerized tomography (Xe-CT) and acetazolamide test in 15 patients with cerebrovascular disease before and after extracranial-intracranial (EC-IC) bypass surgery for minor stroke, reversible ischemic neurological deficit or transient ischemic attack. All had angiographically shown occlusive lesions of the major arterial trunk. In the present series, global analysis showed that the bypass did not increase the resting rCBF, but did increase the rCRC. We divided the patients into four groups according to the preoperative resting rCBF and rCRC. All 3 patients with normal resting rCBF and reduced rCRC showed postoperative improvement of rCRC. Of 6 patients with reduced CBF and reduced CRC, three had postoperative increase in resting CBF and four had increased CRC. One of two patients with reduced CBF and normal CRC showed only an increase in CRC. We propose that reduced CRC or reduced CBF with reduced CRC are criteria for selection of candidates for bypass surgery. We conclude that Xe-CT with the Diamox test is a useful and simple method for evaluating cerebral hemodynamics. Preoperative grouping with a combination of preoperative resting rCBF and preoperative rCRC is useful for predicting the effect of EC-IC bypass surgery. (orig.).

  7. New noninvasive diagnosis of myocardial ischemia of the left circumflex coronary artery using coronary flow reserve measurement by transthoracic Doppler echocardiography. Comparison with thallium-201 single photon emission computed tomography

    International Nuclear Information System (INIS)

    Fujimoto, Kohei; Watanabe, Hiroyuki; Hozumi, Takeshi; Otsuka, Ryo; Hirata, Kumiko; Yamagishi, Hiroyuki; Yoshiyama, Minoru; Yoshikawa, Junichi

    2004-01-01

    The usefulness of coronary flow reserve measurement in the left circumflex coronary artery by transthoracic Doppler echocardiography to detect myocardial ischemia was compared with exercise thallium-201 single photon emission computed tomography (SPECT). Transthoracic Doppler echocardiography was performed in 110 patients with suspected coronary artery disease. Color Doppler signals of the left circumflex coronary artery flow in the apical four-chamber view were identified, and the velocities at rest and during hyperemia recorded for calculation of coronary flow reserve by the pulsed Doppler method. All patients underwent SPECT within 1 week of the transthoracic Doppler echocardiographic study. Coronary flow reserve in the left circumflex coronary artery was measured in 79 (72%) of 110 patients. SPECT revealed reversible perfusion defect in the left circumflex coronary artery territories in 12 of 69 patients excluding those with multivessel disease. Coronary flow reserve <2.0 had a sensitivity of 92% and specificity of 96% for reversible perfusion defect detected by SPECT. Noninvasive coronary flow reserve measurement in the left circumflex coronary artery by transthoracic Doppler echocardiography can estimate myocardial ischemia in the left ventricular lateral regions. (author)

  8. Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

    Directory of Open Access Journals (Sweden)

    Morteza Safi

    2017-07-01

    Full Text Available Introduction: The present study aimed at assessing the role of lesion length in predicting Fractional Flow Reserve (FFR value for physiological evaluation of intermediate coronary lesions.Methods: In the current study, 68 patients with 83 coronary lesions were enrolled. All of the patients in this study underwent routine coronary angiography, according to appropriate indications. To evaluate physiologically significant intermediate coronary stenosis (defined between 40% and 70% on visual estimation, the Fractional Flow Reserve (FFR study was performed and the Quantitative Coronary Angiography (QCA data were also assessed for measurement of lesion length. The correlation between QCA data and FFR values was also examined.Results: Eighty-three lesions were evaluated from 68 patients. Stenosis was considered physiologically significant when FFR was lower than 0.75. The FFR was significant in twelve lesions (14.5%. There was a negative correlation between FFR value and lesion length (r = -0.294 and P = 0.013. Moreover, lesion length in physiologically significant FFR group (21.07  ± 6.9 was greater than that of the non-significant FFR group (15.23 ± 6.5 (P value < 0.05. Furthermore, the correlation between QCA data and FFR values was also investigated, yet, there was only a positive correlation between FFR and Minimum Luminal Diameter (MLD values (r = 0.248 and P value = 0.04. The Receiver Operating Characteristic (ROC curve analysis for predicting the significant FFR value demonstrated that a lesion length greater than 17.5 mm was the best cut-off point for prediction of the significant FFR value with acceptable sensitivity and specificity of 83.3% and 68.8%, respectively.Conclusions: There is a negative correlation between lesion length and FFR value in intermediate coronary lesions. In addition, a lesion length greater than 17.5 mm is the best cut- off point for prediction of significant FFR values.

  9. Relationship Between Quantitative Adverse Plaque Features From Coronary Computed Tomography Angiography and Downstream Impaired Myocardial Flow Reserve by 13N-Ammonia Positron Emission Tomography: A Pilot Study.

    Science.gov (United States)

    Dey, Damini; Diaz Zamudio, Mariana; Schuhbaeck, Annika; Juarez Orozco, Luis Eduardo; Otaki, Yuka; Gransar, Heidi; Li, Debiao; Germano, Guido; Achenbach, Stephan; Berman, Daniel S; Meave, Aloha; Alexanderson, Erick; Slomka, Piotr J

    2015-10-01

    We investigated the relationship of quantitative plaque features from coronary computed tomography (CT) angiography and coronary vascular dysfunction by impaired myocardial flow reserve (MFR) by (13)N-Ammonia positron emission tomography (PET). Fifty-one patients (32 men, 62.4±9.5 years) underwent combined rest-stress (13)N-ammonia PET and CT angiography scans by hybrid PET/CT. Regional MFR was measured from PET. From CT angiography, 153 arteries were evaluated by semiautomated software, computing arterial noncalcified plaque (NCP), low-density NCP (NCP<30 HU), calcified and total plaque volumes, and corresponding plaque burden (plaque volumex100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum difference in luminal attenuation per unit area in the lesion), and plaque length. Quantitative stenosis, plaque burden, and myocardial mass were combined by boosted ensemble machine-learning algorithm into a composite risk score to predict impaired MFR (MFR≤2.0) by PET in each artery. Nineteen patients had impaired regional MFR in at least 1 territory (41/153 vessels). Patients with impaired regional MFR had higher arterial NCP (32.4% versus 17.2%), low-density NCP (7% versus 4%), and total plaque burden (37% versus 19.3%, P<0.02). In multivariable analysis with 10-fold cross-validation, NCP burden was the most significant predictor of impaired MFR (odds ratio, 1.35; P=0.021 for all). For prediction of impaired MFR with 10-fold cross-validation, receiver operating characteristics area under the curve for the composite score was 0.83 (95% confidence interval, 0.79-0.91) greater than for quantitative stenosis (0.66, 95% confidence interval, 0.57-0.76, P=0.005). Compared with stenosis, arterial NCP burden and a composite score combining quantitative stenosis and plaque burden from CT angiography significantly improves identification of downstream regional vascular dysfunction. © 2015 American Heart Association, Inc.

  10. Change of cerebral blood flow distribution and vascular reserver according to age in Koreans measured by Tc-99m HMPAO brain SPECT

    International Nuclear Information System (INIS)

    Song, Ho Cheon; Bom, Hee Seung; Sohn, Hye Kyung; Jeong, Hwan Jeong; Min, Jung Jun; Kim, Ji Yeol; Lee Jae Tae; Moon, Dae Hyuk; Lee, Hee Kyung

    1999-01-01

    The aim of this study was to evaluate the normal values of regional cerebral blood flow (rCBF) and cerebrovascular reserve (CVR) in normal children to aged volunteers using Tc-99m HMPAO. Thirty four right-handed normal volunteers (20 males, 14 females, mean age 40.3±24.9 years, range 4 to 82 years) were underwent rest/acetazolamide (ACZ) brain SPECT using Tc-99m HMPAO and the sequential injection and subtraction method. rCBF was estimated on the basis of a semiquantitative approach by means of right/left ratio, region/cerebellum and region to whole brain ratios in frontal, parietal, temporal, and occipital lobes, basal ganglia, thalami, and cerebellum. CVR was measured by means of % perfusion increase calculated as % mean count change compared to rest rCBF in each regions. Mean values of right to left ratios range from 1.004 to 1.018. rCBF was highest in cerebellum and lowest in basal ganglia and thalami. Frontal and temporal rCBF decreased while occipital and thalamic rCBF increased according to age. No sexual difference of rCBF was noted. Mean CVR was 29.9±12.9%. Mean CVR significantly increased to late teens, and declined thereafter. After 6th decade, CVR in both frontal lobes, left parietal lobe and right basal ganglia decreased significantly with advancing age. There was no sexual difference of CVR. Quantitative assessment of CVR was possible by ACZ Tc-99m MHPAO brain SPECT. It revealed that rCBF and CVR changed according to age in normal Korean volunteers. There was no sexual difference

  11. Computer-model analysis of ground-water flow and simulated effects of contaminant remediation at Naval Weapons Industrial Reserve Plant, Dallas, Texas

    Science.gov (United States)

    Barker, Rene A.; Braun, Christopher L.

    2000-01-01

    In June 1993, the Department of the Navy, Southern Division Naval Facilities Engineering Command (SOUTHDIV), began a Resource Conservation and Recovery Act (RCRA) Facility Investigation (RFI) of the Naval Weapons Industrial Reserve Plant (NWIRP) in north-central Texas. The RFI has found trichloroethene, dichloroethene, vinyl chloride, as well as chromium, lead, and other metallic residuum in the shallow alluvial aquifer underlying NWIRP. These findings and the possibility of on-site or off-site migration of contaminants prompted the need for a ground-water-flow model of the NWIRP area. The resulting U.S. Geological Survey (USGS) model: (1) defines aquifer properties, (2) computes water budgets, (3) delineates major flowpaths, and (4) simulates hydrologic effects of remediation activity. In addition to assisting with particle-tracking analyses, the calibrated model could support solute-transport modeling as well as help evaluate the effects of potential corrective action. The USGS model simulates steadystate and transient conditions of ground-water flow within a single model layer.The alluvial aquifer is within fluvial terrace deposits of Pleistocene age, which unconformably overlie the relatively impermeable Eagle Ford Shale of Late Cretaceous age. Over small distances and short periods, finer grained parts of the aquifer are separated hydraulically; however, most of the aquifer is connected circuitously through randomly distributed coarser grained sediments. The top of the underlying Eagle Ford Shale, a regional confining unit, is assumed to be the effective lower limit of ground-water circulation and chemical contamination.The calibrated steady-state model reproduces long-term average water levels within +5.1 or –3.5 feet of those observed; the standard error of the estimate is 1.07 feet with a mean residual of 0.02 foot. Hydraulic conductivity values range from 0.75 to 7.5 feet per day, and average about 4 feet per day. Specific yield values range from 0

  12. Recent changes (1973-2014 versus 1903-1972) in the flow regime of the Lower Paraná River and current fluvial pollution warnings in its Delta Biosphere Reserve.

    Science.gov (United States)

    Puig, Alba; Olguín Salinas, Héctor F; Borús, Juan A

    2016-06-01

    Alterations in flow regimes of large rivers may originate or increase risks to ecosystems and humans. The Paraná River basin (South America) undergoes human pressures (e.g., heavy damming in the upper basin, deforestation, and mixed pollution) that may affect the water quantity and quality of its terminal Delta (Argentina). In this study, after applying univariate and multivariate change-point detection and trend analyses to the daily data series of flows incoming to the Delta (Paraná-Santa Fe section), flow characteristics were compared by Indicators of Hydrologic Alteration (IHA) and Environmental Flow Components (EFC). Some flood characteristics were also compared from hydrometric levels in the middle Delta (San Pedro station). Chemical and microbiological water variables in the main rivers of the "Paraná Delta" Biosphere Reserve were examined during two extreme hydrologic years (October 2008 to July 2010) to detect potential risk factors in association with hydrologic conditions. In the Lower Paraná River, a historical period (1903-1972) and two more altered periods (1973-1999 wet period and 2000-2014 dry period) were identified. Flow duration curves evidenced different changes in both altered periods, reflecting the joint effect of climatic variability and human influence. The most evident alterations in the flow regime were the lack of record of the extreme-low-flow component, the attenuation of monthly flow seasonality, and the increase in the number of reversals (dry period) and in the variability of maximum and minimum flow dates. These alterations are consistent with the monthly and daily flow regulation by upstream dams evidenced by available data from the current dry period. In the middle Delta, the marked monthly seasonality in flood days decreased only in the wet period. The proportion between the number of flood days exceeding the evacuation level and that of those exceeding the warning level doubled in the wet period but decreased only

  13. Peripheral Endothelial Function and Coronary Flow Velocity Reserve Are Not Associated in Women with Angina and No Obstructive Coronary Artery Disease

    DEFF Research Database (Denmark)

    Flintholm Raft, Kristoffer; Frestad, Daria; Michelsen, Marie Mide

    2017-01-01

    PURPOSE: We investigated whether impaired flow-mediated dilation (FMD) and plasma biomarkers reflecting endothelial dysfunction are associated with coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease (CAD). METHODS: Patients (n = 194) were rand...

  14. Clinical implication and prognosis of normal baseline cerebral blood flow with impaired vascular reserve in patients with major cerebral artery occlusive disease

    International Nuclear Information System (INIS)

    Isozaki, Makoto; Arai, Yoshikazu; Kubota, Toshihiko; Kikuta, Ken-ichiro; Kudo, Takashi; Kiyono, Yasushi; Kobayashi, Masato; Okazawa, Hidehiko

    2010-01-01

    To investigate the prognosis of patients with cerebrovascular steno-occlusive disease who have preserved baseline cerebral blood flow (CBF) and reduced cerebral vasoreactivity (CVR), they were followed up after scans of positron emission tomography (PET). Fifty-seven patients with symptomatic unilateral major cerebral arterial occlusion or severe stenosis underwent O-15 gas and water PET scans to measure cerebral blood volume, metabolic rate of oxygen, oxygen extraction fraction (OEF), and CBF at the baseline and after acetazolamide administration. Thirty of them (mean age 60±10 years) had normal ipsilateral CBF, and were followed prospectively at least 30 months from the last ischemic event. They were medically treated for cerebral circulation and underlying diseases during follow-up periods. The primary endpoint was determined as stroke recurrence during the follow-up. Thirty patients were divided into two groups of reduced CVR (N=16, 63±8 years) and normal CVR (N=14, 56±10 years) on the basis of CVR values from healthy volunteers. None of them showed significant laterality in baseline CBF and OEF between the hemispheres although patients with reduced CVR showed a tendency of ipsilateral increases in OEF and CBV. Patients were followed up for 50.5±19.0 and 48.1±12.4 months in the reduced and normal CVR groups, respectively. Although one patient with reduced CVR died of heart disease, there was no incidence of ischemic events during follow-up periods for either group. In the present prospective study, patients with sufficient baseline CBF showed good prognosis and no difference in recurrent stroke risks even though they had poor CVR in the affected hemisphere, indicating that these patients can be treated by medication for cerebral circulation and baseline diseases if they have high risk factors for neurosurgical treatment. (author)

  15. Bioremediation of arsenic (As from mine effluent by a horizontal flow constructed wetland: A case study in largest borax reserve area in over the world, Kırka, Eskişehir

    Directory of Open Access Journals (Sweden)

    Onur Can Türker

    2016-12-01

    Full Text Available In this study, a horizontal flow constructed wetland (HFCW planted with Typha angustifolia, was tested to bioremediation potential for arsenic from mine effluent under the natural climatic conditions in largest boron mine reserve area over the world, Kırka (Eskişehir. Briefly, the objective of the present experiment was to investigate arsenic bioremediation capability of wetland system and asses the phytoremediation efficiency of T. angustifolia, selected as a donor plant in this study, with different initial arsenic concentrations. Our results indicated that HFCW has capability to decreased arsenic in mine effluent from 49 µg L-1 to 21.8 µg L-1 in a period of 84 days, suggesting that HFCW could be a reasonable bio-filter option to control arsenic pollution directly from mining effluent in largest borax reserve over the world. Furthermore, we found that arsenic concentration in outflow samples was stably below 10 µg L-1 (drinking water safety limit with an inflow range from 42.3 to 42.1 arsenic µg L-1 during the first 28 days. Our results also indicated that belowground parts of T.angustifolia accumulate more arsenic from mine effluent compared to aboveground parts during experiment period. Therefore, we suggested that belowground parts of the plants in HFCW play an important role for arsenic bioremediation from mine effluent which origin of Kırka Borax reserve area. In this respect, bioconcentration factor (BCF for the plants which grown in HFCW was found higher than those of control group. Moreover, results of the present experiment also showed that relatively high level of arsenic retained in the filtration media of HFCW during the experiment period, indicating that filtration media which was used in HFCW has potential to filter arsenic from mine effluent. Consequently, the scientific insight of the present study is to present an innovative, cost effective, and easy operating method for arsenic remediation from mine effluent.

  16. Replacing reserve requirements

    OpenAIRE

    Edward J. Stevens

    1993-01-01

    An examination of the fading significance of the Federal Reserve System's reserve requirements and the recent flowering of required clearing balances, a rapidly growing feature of Reserve Bank operations.

  17. Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve: A PRISMA-compliant meta-analysis of randomized studies.

    Science.gov (United States)

    Man, Wanrong; Hu, Jianqiang; Zhao, Zhijing; Zhang, Mingming; Wang, Tingting; Lin, Jie; Duan, Yu; Wang, Ling; Wang, Haichang; Sun, Dongdong; Li, Yan

    2016-09-01

    The instantaneous wave-free ratio (iFR) is a new vasodilator-free index of coronary stenosis severity. The aim of this meta-analysis is to assess the diagnostic performance of iFR for the evaluation of coronary stenosis severity with fractional flow reserve as standard reference. We searched PubMed, EMBASE, CENTRAL, ProQuest, Web of Science, and International Clinical Trials Registry Platform (ICTRP) for publications concerning the diagnostic value of iFR. We used a random-effects covariate to synthesize the available data of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). Overall test performance was summarized by the summary receiver operating characteristic curve (sROC) and the area under the curve (AUC). Eight studies with 1611 subjects were included in the meta-analysis. The pooled sensitivity, specificity, LR+, LR-, and DOR for iFR were respectively 73.3% (70.1-76.2%), 86.4% (84.3-88.3%), 5.71 (4.43-7.37), 0.29 (0.22-0.38), and 20.54 (16.11-26.20). The area under the summary receiver operating characteristic curves for iFR was 0.8786. No publication bias was identified. The available evidence suggests that iFR may be a new, simple, and promising technology for coronary stenosis physiological assessment.

  18. Impaired coronary flow reserve is the most important marker of viable myocardium in the myocardial segment-based analysis of dual-isotope gated myocardial perfusion single-photon emission computed tomography

    International Nuclear Information System (INIS)

    Lee, Won Woo; So, Young; Kim, Ki Bong; Lee, Dong Soo

    2014-01-01

    The aim of this study was to investigate the most robust predictor of myocardial viability among stress/rest reversibility (coronary flow reserve [CFR] impairment), 201 Tl perfusion status at rest, 201 Tl 24 hours redistribution and systolic wall thickening of 99m Tc-methoxyisobutylisonitrile using a dual isotope gated myocardial perfusion single-photon emission computed tomography (SPECT) in patients with coronary artery disease (CAD) who were re-vascularized with a coronary artery bypass graft (CABG) surgery. A total of 39 patients with CAD was enrolled (34 men and 5 women), aged between 36 and 72 years (mean 58 ± 8 standard in years) who underwent both pre- and 3 months post-CABG myocardial SPECT. We analyzed 17 myocardial segments per patient. Perfusion status and wall motion were semi-quantitatively evaluated using a 4-point grading system. Viable myocardium was defined as dysfunctional myocardium which showed wall motion improvement after CABG. The left ventricular ejection fraction (LVEF) significantly increased from 37.8 ± 9.0% to 45.5 ± 12.3% (p 201 Tl rest perfusion status (p = 0.024) were significant predictors of wall motion improvement. However, in multiple logistic regression analysis, stress/rest reversibility alone was a significant predictor for post-CABG wall motion improvement (p < 0.001). Stress/rest reversibility (impaired CFR) during dual-isotope gated myocardial perfusion SPECT was the single most important predictor of wall motion improvement after CABG.

  19. Shell trips over its reserves

    International Nuclear Information System (INIS)

    Jemain, A.

    2004-01-01

    Some mistakes in the evaluation of the proven reserves of Royal Dutch Shell group, the second world petroleum leader, will oblige the other oil and gas companies to be more transparent and vigilant in the future. The proven reserves ('P90' in petroleum professionals' language) are the most important indicators of the mining patrimony of companies. These strategic data are reported each year in the annual reports of the companies and are examined by the security exchange commission. The evaluation of reserves is perfectly codified by the US energy policy and conservation act and its accountable translation using the FAS 69 standard allows to establish long-term cash-flow forecasts. The revision announced by Shell on January 9 leads to a 20% reduction of its proven reserves. Short paper. (J.S.)

  20. Micro-level stochastic loss reserving

    NARCIS (Netherlands)

    Antonio, K.; Plat, R.

    2010-01-01

    To meet future liabilities general insurance companies will set-up reserves. Predicting future cash-flows is essential in this process. Actuarial loss reserving methods will help them to do this in a sound way. The last decennium a vast literature about stochastic loss reserving for the general

  1. Assessment of the functional significance of coronary lesions using a monorail catheter.

    Science.gov (United States)

    Briguori, C; Nishida, T; Adamian, M; Anzuini, A; Corvaja, N; Carlino, M; Colombo, A

    2001-04-01

    Myocardial fractional flow reserve (FFR) monorail catheter, can be used to accurately measure intracoronary pressure and FFR. In 35 lesions (35 patients; learning group), we calculated FFR by both PW (FFRPW) and MFP (FFRMFP). Using ROC analysis, the FFRMFP value of 0.65 had the highest sensitivity with the FFRPW 0.75) by PW. In all these cases, minimal lumen cross-sectional area was 0.65, FFRPW is always > 0.75. These data demonstrate that even with larger cross-sectional area than a pressure wire, the MFP catheter can easily and reliably be used to assess the functional severity of coronary stenosis.

  2. HYDROCARBONS RESERVES IN VENEZUELA

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez Cruz, D.J.

    2007-07-01

    Venezuela is an important player in the energy world, because of its hydrocarbons reserves. The process for calculating oil and associated gas reserves is described bearing in mind that 90% of the gas reserves of Venezuela are associated to oil. Likewise, an analysis is made of the oil reserves figures from 1975 to 2003. Reference is also made to inconsistencies found by international experts and the explanations offered in this respect by the Ministry of Energy and Petroleum (MENPET) and Petroleos de Venezuela (PDVSA) regarding the changes that took place in the 1980s. In turn, Hubbert's Law is explained to determine peak production of conventional oil that a reservoir or field will reach, as well as its relationship with remaining reserves. Emphasis is placed on the interest of the United Nations on this topic. The reserves of associated gas are presented along with their relationship with the different crude oils that are produced and with injected gas, as well as with respect to the possible changes that would take place in the latter if oil reserves are revised. Some recommendations are submitted so that the MENPET starts preparing the pertinent policies ruling reserves. (auth)

  3. Skyline Reservation System

    Data.gov (United States)

    US Agency for International Development — Flight reservation application used for in-country flights by USAID and DoS staff in Afghanistan. The application is managed and maintained by the vendor and USAID...

  4. US uranium reserves

    International Nuclear Information System (INIS)

    Hansen, M.V.

    1981-01-01

    The current low level of demand, compounded by rapidly rising costs and low prices, has caused a significant reduction in drilling for uranium in the United States, and the trend is likely to continue for a few more years. The effect on uranium reserves will be fewer additions to reserves because less exploration is being done. Further reductions will occur, especially in low-cost reserves, because of increasing costs, continuing depletion through production, and erosion through the high grading of deposits to fulfill previous contractual commitments. During the past several years, it has been necessary to increase the upper reserve cost level twice to compensate for rising costs. Rising costs are reducing the $15 reserves, the cost category corresponding most closely to the present market price, to an insignificant level. An encouraging factor related to US uranium reserves is that the US position internationally, as far as quantity is concerned, is not bad for the longer term. Also, there is a general opinion that US consumers would rather contract for domestic uranium than for foreign because of greater assurance of supply. Still another factor, nearly impossible to assess, is what effect rising costs in other countries will have on their uranium reserves. The annual conferences between the Grand Junction Area Office staff and major uranium companies provide a broad overview of the industry's perception of the future. It is not optimistic for the short term. Many companies are reducing their exploration and mining programs; some are switching to other more marketable mineral commodities, and a few are investing more heavily in foreign ventures. However, there is general optimism for the long term, and many predict a growth in demand in the mid-1980s. If the industry can survive the few lean years ahead, rising prices may restore its viability to former levels

  5. Handbook on loss reserving

    CERN Document Server

    Schmidt, Klaus; Schnaus, Anja

    2016-01-01

    This handbook presents the basic aspects of actuarial loss reserving. Besides the traditional methods, it also includes a description of more recent ones and a discussion of certain problems occurring in actuarial practice, like inflation, scarce data, large claims, slow loss development, the use of market statistics, the need for simulation techniques and the task of calculating best estimates and ranges of future losses. In property and casualty insurance the provisions for payment obligations from losses that have occurred but have not yet been settled usually constitute the largest item on the liabilities side of an insurer's balance sheet. For this reason, the determination and evaluation of these loss reserves is of considerable economic importance for every property and casualty insurer. Actuarial students, academics as well as practicing actuaries will benefit from this overview of the most important actuarial methods of loss reserving by developing an understanding of the underlying stochastic models...

  6. Lithium reserves and resources

    International Nuclear Information System (INIS)

    Evans, R.K.

    1978-01-01

    As a result of accelerating research efforts in the fields of secondary batteries and thermonuclear power generation, concern has been expressed in certain quarters regarding the availability, in sufficient quantities, of lithium. As part of a recent study by the National Research Council on behalf of the Energy Research and Development Administration, a subpanel was formed to consider the outlook for lithium. Principal areas of concern were reserves, resources and the 'surplus' available for energy applications after allowing for the growth in current lithium applications. Reserves and resources were categorized into four classes ranging from fully proved reserves to resources which are probably dependent upon the marketing of co-products to become economically attractive. Because of the proprietary nature of data on beneficiation and processing recoveries, the tonnages of available lithium are expressed in terms of plant feed. However, highly conservative assumptions have been made concerning mining recoveries and these go a considerable way to accounting for total losses. Western World reserves and resources of all classes are estimated at 10.6 million tonnes Li of which 3.5 million tonnes Li are located in the United States. Current United States capacity, virtually equivalent to Western World capacity, is 4700 tonnes Li and production in 1976 approximated to 3500 tonnes Li. Production for current applications is expected to grow to approx. 10,000 tonnes in year 2000 and 13,000 tonnes a decade later. The massive excess of reserves and resources over that necessary to support conventional requirements has limited the amount of justifiable exploration expenditures; on the last occasion, there was a a major increase in demand (by the USAEA) reserves and capacity were increased rapidly. There are no foreseeable reasons why this shouldn't happen again when the need is clear. (author)

  7. Brazilian uranium reserves

    International Nuclear Information System (INIS)

    Marques, J.P.M.

    1981-01-01

    Due to a growing demand of electric power to support Brasil's development, the use of nuclear energy will be indispensable. The nuclear fuel cycle for the production of energy, starts with the uranium exploration. The work performed in this field led to the discovery of several deposits in the country, which to-date totalize a reserve of 236,300t of U 308 , ranking Brazil in the 6th place among the nations of the western world holding uranium reserves. (Author) [pt

  8. Session 7: Reserve

    International Nuclear Information System (INIS)

    Bailey, R.; Crockford, G.

    2001-01-01

    The reserve session was devoted to some issues that came up through the workshop, which were grouped into three main areas: The Global Accelerator Network, Problems of stress and how to get organized to minimize them, What should an operations group be responsible for? This paper summarizes the discussions that took place. (author)

  9. SUIKERBOSRAND NATURE RESERVE

    African Journals Online (AJOL)

    reserve, the total length being 66 km with six overnight huts. There are also the BokmakiePie. Nature Troil. and the Cheetah Interpretive Troil. which can be used by day visitors. The former has two loops, one of 10 km and another of 17 km. The. Cheetah Troil. is much shorter and various points of interest are interpreted en ...

  10. School Shootings Stun Reservation

    Science.gov (United States)

    Borja, Rhea R.; Cavanagh, Sean

    2005-01-01

    This article deals with the impact brought by the school shootings at Red Lake Indian Reservation in Minnesota to the school community. A deeply troubled 16-year-old student shot and killed seven other people and himself at a high school. The nation's deadliest school attack since the 1999 slayings at Colorado's suburban Columbine High School took…

  11. Uranium reserves fall: AAEC

    International Nuclear Information System (INIS)

    Anon.

    1982-01-01

    Figures released by the AAEC show that Australia's reasonably assured resources of uranium recoverable at US$80 a kg fell by 5,000 tonnes during 1980-81. Reserves at 30 June 1981 totalled 294,000 tonnes. This represented 17 per cent of the Western World's low cost reasonably assured resources

  12. Fractional Reserve Banking

    OpenAIRE

    Andreasen, Niels; Bjerregaard, Mads; Lund, Jonas; Olsen, Ove Bitsch; Rasmussen, Andreas Dalgas

    2012-01-01

    Projektet er bygget op omkring kritisk realisme, som er det gennemgående videnskabelige fundament til undersøgelsen af hvilke strukturelle grunde der er til finansiel ustabilitet i Danmark. Projektet går i dybden med Fractional Reserve Banking og incitamentsstrukturen i banksystemet. Vi bevæger os både på det makro- og mikroøkonomiske niveau i analysen. På makro niveau bruger vi den østrigske skole om konjunktur teori (The Positive Theory of the Cycle). På mikro niveau arbejder vi med princip...

  13. Naval Petroleum and Oil Shale Reserves

    International Nuclear Information System (INIS)

    1992-01-01

    During fiscal year 1992, the reserves generated $473 million in revenues, a $181 million decrease from the fiscal year 1991 revenues, primarily due to significant decreases in oil and natural gas prices. Total costs were $200 million, resulting in net cash flow of $273 million, compared with $454 million in fiscal year 1991. From 1976 through fiscal year 1992, the Naval Petroleum and Oil Shale Reserves generated more than $15 billion in revenues and a net operating income after costs of $12.5 billion. In fiscal year 1992, production at the Naval Petroleum Reserves at maximum efficient rates yielded 26 million barrels of crude oil, 119 billion cubic feet of natural gas, and 164 million gallons of natural gas liquids. From April to November 1992, senior managers from the Naval Petroleum and Oil Shale Reserves held a series of three workshops in Boulder, Colorado, in order to build a comprehensive Strategic Plan as required by Secretary of Energy Notice 25A-91. Other highlights are presented for the following: Naval Petroleum Reserve No. 1--production achievements, crude oil shipments to the strategic petroleum reserve, horizontal drilling, shallow oil zone gas injection project, environment and safety, and vanpool program; Naval Petroleum Reserve No. 2--new management and operating contractor and exploration drilling; Naval Petroleum Reserve No. 3--steamflood; Naval Oil Shale Reserves--protection program; and Tiger Team environmental assessment of the Naval Petroleum and Oil Shale Reserves in Colorado, Utah, and Wyoming

  14. Are uranium reserves adequate?

    International Nuclear Information System (INIS)

    Anon.

    2006-01-01

    Against a backdrop of growing concerns about global warming and geopolitical pressures on fossil energies, especially natural gas and oil, interest in nuclear power has revived considerably. Conscious of its addiction to oil and reeling from a series of gigantic blackouts, the United States, in the words of its president, must 'aggressively move forward with the construction of nuclear power plants'. Some European countries have approved new power plant construction (Finland and France), while the more reserved ones (Belgium, Germany and Sweden) have begun to show a change in attitude. Asia, meanwhile, is host to the planet's largest number of potential nuclear construction projects in this first half of the 21. century. All these signs point to a sharp rise in uranium consumption, the basic fuel for these plants. But are there enough resources to support a nuclear revival on a planetary scale? The publication of the Red Book on uranium in late May 2006 was an opportunity for Thierry Dujardin, Deputy Director of Science and Development at the OECD's Nuclear Energy Agency, to take stock of resources. He gives his opinion in this paper

  15. Qual o erro da angiografia na definição de isquemia miocárdica durante intervenções coronarianas percutâneas? What is the angiography error when defining myocardial ischemia during percutaneous coronary interventions?

    Directory of Open Access Journals (Sweden)

    Fernando Mendes Sant'Anna

    2008-09-01

    Full Text Available FUNDAMENTO: A angiografia vem sendo utilizada como padrão de referência para definição de doença arterial coronariana (DAC, embora suas limitações sejam conhecidas. O valor da medida do fluxo fracionado de reserva do miocárdio (FFR na avaliação da DAC está bem estabelecido. OBJETIVO: O objetivo deste estudo é avaliar a acurácia da angiografia em definir as lesões isquêmicas e sua correlação com o FFR. MÉTODOS: Duzentos e cinqüenta pacientes foram incluídos no estudo (471 vasos. Todas as estenoses > 50% pela estimativa visual da angiografia (EVA foram avaliadas medindo-se o FFR. Se o FFR 0,75 a lesão não foi tratada. As lesões foram divididas em moderadas (BACKGROUND: The angiography has been used as a reference standard to define coronary artery disease (CAD, although its limitations are well-known. The significance of the myocardial fractional flow reserve (FFR in the assessment of CAD is well established. OBJECTIVE: The aim of this study was to evaluate the accuracy of angiography when defining ischemic lesions and its correlation with FFR. METHODS: Two hundred and fifty consecutive patients (471 arteries were included in this study. All stenoses > 50% at the angiography visual estimate (AVE were assessed by FFR measurements. When FFR was 0.75, no interventional treatment was carried out. Offline quantitative coronary angiography (QCA was performed in all stenoses, which were divided in intermediate (< 70% - 327 and severe (125. The correlation coefficients between the diameter of the stenosis (%DS and FFR and the accuracy of VA of the angiography when assessing ischemia were determined. RESULTS: FFR could be obtained in 452 lesions (96%. Mean %DS and FFR were 56 ± 8% and 0.74 and 76 ± 6% and 0.48 for moderate and severe stenoses, respectively. Concordance between QCA and FFR was poor, especially in intermediate stenoses (Spearman's rho = - 0.33, p<0.0001. Visual assessment resulted in an accuracy of 57% and 96% in

  16. A new CFD based non-invasive method for functional diagnosis of coronary stenosis.

    Science.gov (United States)

    Xie, Xinzhou; Zheng, Minwen; Wen, Didi; Li, Yabing; Xie, Songyun

    2018-03-22

    Accurate functional diagnosis of coronary stenosis is vital for decision making in coronary revascularization. With recent advances in computational fluid dynamics (CFD), fractional flow reserve (FFR) can be derived non-invasively from coronary computed tomography angiography images (FFR CT ) for functional measurement of stenosis. However, the accuracy of FFR CT is limited due to the approximate modeling approach of maximal hyperemia conditions. To overcome this problem, a new CFD based non-invasive method is proposed. Instead of modeling maximal hyperemia condition, a series of boundary conditions are specified and those simulated results are combined to provide a pressure-flow curve for a stenosis. Then, functional diagnosis of stenosis is assessed based on parameters derived from the obtained pressure-flow curve. The proposed method is applied to both idealized and patient-specific models, and validated with invasive FFR in six patients. Results show that additional hemodynamic information about the flow resistances of a stenosis is provided, which cannot be directly obtained from anatomy information. Parameters derived from the simulated pressure-flow curve show a linear and significant correlations with invasive FFR (r > 0.95, P < 0.05). The proposed method can assess flow resistances by the pressure-flow curve derived parameters without modeling of maximal hyperemia condition, which is a new promising approach for non-invasive functional assessment of coronary stenosis.

  17. 77 FR 21846 - Reserve Requirements of Depository Institutions: Reserves Simplification

    Science.gov (United States)

    2012-04-12

    ... Requirements of Depository Institutions: Reserves Simplification AGENCY: Board of Governors of the Federal Reserve System. ACTION: Final rule. SUMMARY: The Board is amending Regulation D, Reserve Requirements of Depository Institutions, to simplify the administration of reserve requirements. The final rule creates a...

  18. Risk assessment of atherosclerotic plaques based on global biomechanics.

    Science.gov (United States)

    Melchionna, Simone; Amati, Giorgio; Bernaschi, Massimo; Bisson, Mauro; Succi, Sauro; Mitsouras, Dimitrios; Rybicki, Frank J

    2013-09-01

    We present the results of a computational study of the entire left coronary system simulated both at Newtonian level and at red blood cell resolution for a sizeable number of physiological conditions. We analyze the cardiovascular implications of stenotic plaques and show that the standard clinical criterion for surgical or percutaneous intervention, based on the fractional flow reserve (FFR), is significantly affected by system-dependent, local hemodynamic factors. A refined version, based on the new notion of local FFR response to stenotic growth, and accounting for statistical uncertainties due to flow heterogeneity, is suggested and illustrated. Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

  19. Status of fossil fuel reserves

    International Nuclear Information System (INIS)

    Laherrere, J.

    2005-01-01

    Reserves represent the sum of past and future productions up to the end of production. In most countries the reserve data of fields are confidential. Therefore, fossil fuel reserves are badly known because the published data are more political than technical and many countries make a confusion between resources and reserves. The cumulated production of fossil fuels represents only between a third and a fifth of the ultimate reserves. The production peak will take place between 2020 and 2050. In the ultimate reserves, which extrapolate the past, the fossil fuels represent three thirds of the overall energy. This document analyses the uncertainties linked with fossil fuel reserves: reliability of published data, modeling of future production, comparison with other energy sources, energy consumption forecasts, reserves/production ratio, exploitation of non-conventional hydrocarbons (tar sands, extra-heavy oils, bituminous shales, coal gas, gas shales, methane in overpressure aquifers, methane hydrates), technology impacts, prices impact, and reserves growth. (J.S.)

  20. 77 FR 66361 - Reserve Requirements of Depository Institutions: Reserves Simplification

    Science.gov (United States)

    2012-11-05

    ... Requirements of Depository Institutions: Reserves Simplification AGENCY: Board of Governors of the Federal... (Reserve Requirements of Depository Institutions) published in the Federal Register on April 12, 2012. The... simplifications related to the administration of reserve requirements: 1. Create a common two-week maintenance...

  1. Flow chemistry vs. flow analysis.

    Science.gov (United States)

    Trojanowicz, Marek

    2016-01-01

    The flow mode of conducting chemical syntheses facilitates chemical processes through the use of on-line analytical monitoring of occurring reactions, the application of solid-supported reagents to minimize downstream processing and computerized control systems to perform multi-step sequences. They are exactly the same attributes as those of flow analysis, which has solid place in modern analytical chemistry in several last decades. The following review paper, based on 131 references to original papers as well as pre-selected reviews, presents basic aspects, selected instrumental achievements and developmental directions of a rapidly growing field of continuous flow chemical synthesis. Interestingly, many of them might be potentially employed in the development of new methods in flow analysis too. In this paper, examples of application of flow analytical measurements for on-line monitoring of flow syntheses have been indicated and perspectives for a wider application of real-time analytical measurements have been discussed. Copyright © 2015 Elsevier B.V. All rights reserved.

  2. Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler

    DEFF Research Database (Denmark)

    Michelsen, Marie M; Peña, Adam; Mygind, Naja D

    2016-01-01

    the feasibility and factors associated with the quality of CFVR obtained in a large prospective study of women suspected of having microvascular disease. METHODS: Women with angina-like chest pain and no obstructive coronary artery disease on coronary angiography (

  3. Marine Forces Reserve: Accelerating Knowledge Flow through Asynchronous Learning Technologies

    Science.gov (United States)

    2014-12-19

    pedagogic techniques that are infeasible in the classroom, and they suggest that in some respects technologically intermediated learning can be even better...appropriate for this research (Yin, 1994). We employ multiple techniques for data collection in the field. Foremost, through a unique relationship between...initial interpretations are both grounded firmly in the data and meaningful to organization participants. The Researchers’ relationship with the focal

  4. Fractional Flow Reserve Assessment of a Coronary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Joseph Petit

    2015-01-01

    Full Text Available A 63 y/o male with a past medical history of hypertension, chronic obstructive pulmonary disease, and obesity was admitted to an outside hospital for an abdominal incisional hernia repair and cholecystectomy. Post-operatively he developed shortness of breath (SOB and multiple runs of paroxysmal atrial fibrillation. A CT scan was negative for pulmonary embolism, but showed a left anterior descending (LAD coronary artery to main pulmonary artery (MPA fistula. He was transferred to our facility for further management.

  5. Fractional Reserve in Banking System

    OpenAIRE

    Valkonen, Maria

    2016-01-01

    This thesis is aimed to provide understanding of the role of the fractional reserve in the mod-ern banking system worldwide and particularly in Finland. The fractional reserve banking is used worldwide, but the benefits of this system are very disputable. On the one hand, experts say that the fractional reserve is a necessary instrument for the normal business and profit making. On the other hand, sceptics openly criticize the fractional reserve system and blame it for fiat money (money n...

  6. Biosphere reserves: Attributes for success.

    Science.gov (United States)

    Van Cuong, Chu; Dart, Peter; Hockings, Marc

    2017-03-01

    Biosphere reserves established under the UNESCO Man and the Biosphere Program aim to harmonise biodiversity conservation and sustainable development. Concerns over the extent to which the reserve network was living up to this ideal led to the development of a new strategy in 1995 (the Seville Strategy) to enhance the operation of the network of reserves. An evaluation of effectiveness of management of the biosphere reserve network was called for as part of this strategy. Expert opinion was assembled through a Delphi Process to identify successful and less successful reserves and investigate common factors influencing success or failure. Ninety biosphere reserves including sixty successful and thirty less successful reserves in 42 countries across all five Man and the Biosphere Program regions were identified. Most successful sites are the post-Seville generation while the majority of unsuccessful sites are pre-Seville that are managed as national parks and have not been amended to conform to the characteristics that are meant to define a biosphere reserve. Stakeholder participation and collaboration, governance, finance and resources, management, and awareness and communication are the most influential factors in the success or failure of the biosphere reserves. For success, the biosphere reserve concept needs to be clearly understood and applied through landscape zoning. Designated reserves then need a management system with inclusive good governance, strong participation and collaboration, adequate finance and human resource allocation and stable and responsible management and implementation. All rather obvious but it is difficult to achieve without commitment to the biosphere reserve concept by the governance authorities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Effect of porous media of the stenosed artery wall to the coronary physiological diagnostic parameter: a computational fluid dynamic analysis.

    Science.gov (United States)

    Govindaraju, Kalimuthu; Kamangar, Sarfaraz; Badruddin, Irfan Anjum; Viswanathan, Girish N; Badarudin, A; Salman Ahmed, N J

    2014-04-01

    Functional assessment of a coronary artery stenosis severity is generally assessed by fractional flow reserve (FFR), which is calculated from pressure measurements across the stenosis. The purpose of this study is to investigate the effect of porous media of the stenosed arterial wall on this diagnostic parameter. To understand the role of porous media on the diagnostic parameter FFR, a 3D computational simulations of the blood flow in rigid and porous stenotic artery wall models are carried out under steady state and transient conditions for three different percentage area stenoses (AS) corresponding to 70% (moderate), 80% (intermediate), and 90% (severe). Blood was modeled as a non Newtonian fluid. The variations of pressure drop across the stenosis and diagnostic parameter were studied in both models. The FFR decreased in proportion to the increase in the severity of the stenosis. The relationship between the percentage AS and the FFR was non linear and inversely related in both the models. The cut-off value of 0.75 for FFR was observed at 81.89% AS for the rigid artery model whereas 83.61% AS for the porous artery wall model. This study demonstrates that the porous media consideration on the stenotic arterial wall plays a substantial role in defining the cut-off value of FFR. We conclude that the effect of porous media on FFR, could lead to misinterpretation of the functional severity of the stenosis in the region of 81.89 %-83.61% AS. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  8. Reserves Represented by Random Walks

    International Nuclear Information System (INIS)

    Filipe, J A; Ferreira, M A M; Andrade, M

    2012-01-01

    The reserves problem is studied through models based on Random Walks. Random walks are a classical particular case in the analysis of stochastic processes. They do not appear only to study reserves evolution models. They are also used to build more complex systems and as analysis instruments, in a theoretical feature, of other kind of systems. In this work by studying the reserves, the main objective is to see and guarantee that pensions funds get sustainable. Being the use of these models considering this goal a classical approach in the study of pensions funds, this work concluded about the problematic of reserves. A concrete example is presented.

  9. OPINIONS ON INTERNATIONAL RESERVES MANAGEMENT - POST CRISIS

    Directory of Open Access Journals (Sweden)

    MERCEA (HANDRO PATRICIA AMALIA

    2017-11-01

    Full Text Available The recent crisis demonstrated once again the importance of maintaining an adequate level of the international reserves as part of the defense of a country against the shocks internationally transmitted. Liquidity buffers aided the good functioning of financial systems, and allowed countries to cope with sudden foreign capital stops or to manage massive outflows without facing a costly crisis. This logic has been strengthened in the context of the crisis from 2008, when countries with lots of reserves, such as China or Brazil, came through better than those with lower liquid assets. Economists have argued that developing countries need reserves mainly to cover urgent imports and short-term debts. The current level of global reserves far exceeds this traditional postulate. In this context, it is necessary to rethink the adequacy of the level of constituting the reserves portfolio. The dominance of the dollar as a reserve currency, another important feature of the current reserves portfolio, makes the holders become vulnerable to the monetary policy of FED. A greater flexibility of the currency will also be needed. The often called the “trilemma” of international economics dictates: when capital is mobile, countries must choose between fixing their currencies and controlling their domestic monetary conditions. They cannot do both. The domestic currency inflexibility will ultimately lead to asset bubbles and inflation. The pressure of capital flows will depend on the prospects of rich economies, especially America’s. The increment of emerging economies availability to allow the exchange rate to move will depend on what China does - and China may remain forever linked to the dollar. The emergence of a global currency that constitute a genuine means of exchange or the use of cross-border multifaceted cash pools common to IMF members would reduce systemic risks. International regulations for countries with persistent trade surpluses could be a

  10. Reservation wages and starting wages

    NARCIS (Netherlands)

    van Ophem, H.; Hartog, J.; Berkhout, P.

    2011-01-01

    We analyse a unique data set that combines reservation wage and actually paid wage for a large sample of Dutch recent higher education graduates. On average, accepted wages are almost 8% higher than reservation wages, but there is no fixed proportionality. We find that the difference between

  11. Can Creativity Predict Cognitive Reserve?

    Science.gov (United States)

    Palmiero, Massimiliano; Di Giacomo, Dina; Passafiume, Domenico

    2016-01-01

    Cognitive reserve relies on the ability to effectively cope with aging and brain damage by using alternate processes to approach tasks when standard approaches are no longer available. In this study, the issue if creativity can predict cognitive reserve has been explored. Forty participants (mean age: 61 years) filled out: the Cognitive Reserve…

  12. Disaggregating reserve-to-production ratios: An algorithm for United States oil and gas reserve development

    Science.gov (United States)

    Williams, Charles William

    Reserve-to-production ratios for oil and gas development are utilized by oil and gas producing states to monitor oil and gas reserve and production dynamics. These ratios are used to determine production levels for the manipulation of oil and gas prices while maintaining adequate reserves for future development. These aggregate reserve-to-production ratios do not provide information concerning development cost and the best time necessary to develop newly discovered reserves. Oil and gas reserves are a semi-finished inventory because development of the reserves must take place in order to implement production. These reserves are considered semi-finished in that they are not counted unless it is economically profitable to produce them. The development of these reserves is encouraged by profit maximization economic variables which must consider the legal, political, and geological aspects of a project. This development is comprised of a myriad of incremental operational decisions, each of which influences profit maximization. The primary purpose of this study was to provide a model for characterizing a single product multi-period inventory/production optimization problem from an unconstrained quantity of raw material which was produced and stored as inventory reserve. This optimization was determined by evaluating dynamic changes in new additions to reserves and the subsequent depletion of these reserves with the maximization of production. A secondary purpose was to determine an equation for exponential depletion of proved reserves which presented a more comprehensive representation of reserve-to-production ratio values than an inadequate and frequently used aggregate historical method. The final purpose of this study was to determine the most accurate delay time for a proved reserve to achieve maximum production. This calculated time provided a measure of the discounted cost and calculation of net present value for developing new reserves. This study concluded that

  13. Securities issues in reserves reporting

    International Nuclear Information System (INIS)

    Legg, M.B.

    1997-01-01

    Securities issues in oil and gas reserves reporting were discussed. Alberta requires specific information regarding important oil and gas properties, plants, facilities and installations. When preparing the reserves report, the following elements are important to consider: (1) the author of the report must be a registered professional engineer or registered professional geologist, (2) the report itself must be an engineering document, (3) the content of the report must be extensive, (4) it should be prepared in accordance with petroleum engineering and evaluation practices, and must include a summary of estimated net reserves

  14. Estimating Foreign Exchange Reserve Adequacy

    Directory of Open Access Journals (Sweden)

    Abdul Hakim

    2013-04-01

    Full Text Available Accumulating foreign exchange reserves, despite their cost and their impacts on other macroeconomics variables, provides some benefits. This paper models such foreign exchange reserves. To measure the adequacy of foreign exchange reserves for import, it uses total reserves-to-import ratio (TRM. The chosen independent variables are gross domestic product growth, exchange rates, opportunity cost, and a dummy variable separating the pre and post 1997 Asian financial crisis. To estimate the risky TRM value, this paper uses conditional Value-at-Risk (VaR, with the help of Glosten-Jagannathan-Runkle (GJR model to estimate the conditional volatility. The results suggest that all independent variables significantly influence TRM. They also suggest that the short and long run volatilities are evident, with the additional evidence of asymmetric effects of negative and positive past shocks. The VaR, which are calculated assuming both normal and t distributions, provide similar results, namely violations in 2005 and 2008.

  15. Cognitive Reserve Scale and ageing

    Directory of Open Access Journals (Sweden)

    Irene León

    2016-01-01

    Full Text Available The construct of cognitive reserve attempts to explain why some individuals with brain impairment, and some people during normal ageing, can solve cognitive tasks better than expected. This study aimed to estimate cognitive reserve in a healthy sample of people aged 65 years and over, with special attention to its influence on cognitive performance. For this purpose, it used the Cognitive Reserve Scale (CRS and a neuropsychological battery that included tests of attention and memory. The results revealed that women obtained higher total CRS raw scores than men. Moreover, the CRS predicted the learning curve, short-term and long-term memory, but not attentional and working memory performance. Thus, the CRS offers a new proxy of cognitive reserve based on cognitively stimulating activities performed by healthy elderly people. Following an active lifestyle throughout life was associated with better intellectual performance and positive effects on relevant aspects of quality of life.

  16. Professionalizing the Estonian Reserve Component

    National Research Council Canada - National Science Library

    Everett, William

    1998-01-01

    .... In particular, citizen-soldier reserves can allow nations that do not face immediate external threats, such as Estonia, to meet their security requirements for less money than required by standing forces...

  17. Fractional Reserve Banking: Some Quibbles

    OpenAIRE

    Bagus, Philipp; Howden, David

    2010-01-01

    We explore several unaddressed issues in George Selgin’s (1988) claim that the best monetary system to maintain monetary equilibrium is a fractional reserve free banking one. The claim that adverse clearing balances would limit credit expansion in a fractional reserve free banking system is more troublesome than previously reckoned. Both lengthened clearing periods and interbank agreements render credit expansion unrestrained. “The theory of free banking” confuses increases in money held with...

  18. Demand as frequency controlled reserve

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Z.; Togeby, M.; OEstergaard, J.

    2008-09-15

    Using demand as frequency controlled reserve (DFR) is an emerging technology which allow demand to participate actively in maintaining the system operation without reducing the energy service delivered to the customer and without need of user interaction. The basic premise is that traditional frequency controlled reserves from power plants and interconnections with neighbouring systems can be costly, slow and not fulfil the need for future power grids with a high share of wind power and fewer central power plants, and an intention to perform flexible operation such as is landing. Electricity demands, on the other hand, have advantages as frequency reserve including fast activation speed, smooth linear activation, low expected costs, and well-dispersed in the distribution grid. The main challenge of DFR is new methods for monitoring the available capacity. This project has investigated the technology of using electricity demands for providing frequency reserve to power systems. Within the project the potential and economy of DFR compatible loads in Denmark has been investigated, control logic has been designed, power system impact has been investigated, potential business models has been evaluated and an implementation strategy has been suggested. The tasks and goals of the project have been successfully accomplished based on which the conclusion and future recommendation are made. This project has developed the DFR technology that enables electricity demands to autonomously disconnect or reconnect to the grid in response to system frequency variations. The developed DFR technology is proved to be a promising technology from several perspectives. Technically, using DFR is feasible to provide reserves and enhance power system frequency control, while fulfilling technical requirements such as linear activation (or reconnection) according to frequency (or time). Environmentally, the DFR technology is pollution free in contrast to traditional reserves from generation

  19. Improved Effectiveness of Reserve Forces During Reserve Duty Training.

    Science.gov (United States)

    Treadaway, Harry H.

    The problem areas of motivation, job enrichment, recruiting, and retention are addressed from the viewpoint of the behavioral scientist. Special attention is given to relating job enrichment and motivation techniques, as successfully demonstrated in industry, to the United State Army Reserve. Research method utilized was a literature review…

  20. Do we need invasive confirmation of cardiac magnetic resonance results?

    Science.gov (United States)

    Siastała, Paweł; Kądziela, Jacek; Małek, Łukasz A; Śpiewak, Mateusz; Lech, Katarzyna; Witkowski, Adam

    2017-01-01

    Coronary artery revascularization is indicated in patients with documented significant obstruction of coronary blood flow associated with a large area of myocardial ischemia and/or untreatable symptoms. There are a few invasive or noninvasive methods that can provide information about the functional results of coronary artery narrowing. The application of more than one method of ischemia detection in one patient to reevaluate the indications for revascularization is used in case of atypical or no symptoms and/or borderline stenosis. To evaluate whether the results of cardiac magnetic resonance need to be reconfirmed by the invasive functional method. The hospital database revealed 25 consecutive patients with 29 stenoses who underwent cardiac magnetic resonance (CMR) and fractional flow reserve (FFR) between the end of 2010 and the end of 2014. The maximal time interval between CMR and FFR was 6 months. None of the patients experienced any clinical events or underwent procedures on coronary arteries between the studies. According to the analysis, the agreement of CMR perfusion with the FFR method was at the level of 89.7%. Assuming that FFR is the gold standard in assessing the severity of stenoses, the sensitivity of CMR perfusion was 90.9%. The percentage of non-severe lesions which were correctly identified in CMR was 88.9%. The study shows that CMR perfusion is a highly sensitive method to detect hemodynamically significant CAD and exclude nonsevere lesions. With FFR as the reference standard, the diagnostic accuracy of MR perfusion to detect ischemic CAD is high.

  1. Extractive reserves in Brazilian Amazonia

    Energy Technology Data Exchange (ETDEWEB)

    Fearnside, P.M (National Institute for Research in the Amazon, Manaus-Amazonas (Brazil))

    1989-06-01

    In 1985 an opportunity arose for maintaining tracts of Amazonian forest under sustainable use. Brazil's National Council of Rubber Tappers and the Rural Worker's Union proposed the creation of a set of reserves of a new type, called extractive reserves. The first six are being established in one of the Brazilian states most threatened by deforestatation. The creation of extractive reserves grants legal protection to forest land traditionally used by rubber tappers, Brazil-nut gatherers, and other extractivists. The term extrativismo (extractivism) in Brazil refers to removing nontimber forest products, such as latex, resins, and nuts, without felling the trees. Approximately 30 products are collected for commercial sale. Many more types of forest materials are gathered, for example as food and medicines, for the extractivists' own use. The reserve proposal is attractive for several reasons related to social problems. It allows the rubber tappers to continue their livelihood rather than be expelled by deforestation. However, it is unlikely that sufficient land will be set aside as extractive reserves to employ all the tappers. Displaced rubber tappers already swell the ranks of urban slum dwellers in Brazil's Amazonian cities, and they have become refugees to continue their profession in the forests of neighboring countries, such as Bolivia.

  2. Hydrocarbon Reserves: Abundance or Scarcity

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    IFP and the OAPEC jointly organize a regular international seminar dealing with world oil-related problems appearing in the news. For the first time, this seminar has been opened to oil and gas company specialists, service companies, research centers and independents. This year's theme concerns oil and gas reserves: are they abundant or are we headed towards the shortages announced by some experts? This theme is especially topical in that: oil and gas currently meet two thirds of world energy needs and almost completely dominate the transport sector; the reserves declared by the OAPEC countries account for nearly half of world reserves; the price of a barrel of oil went through the roof in 2004; world energy demand is growing fast and alternative sources of energy are far from ready to take over from oil and gas in the next few decades. Since the reserves correspond to the volume it is technically and economically viable to produce, the seminar has, of course, dealt with the technical and economic questions that arise in connection with exploration and production, but it has also considered changes in the geopolitical context. Presentations by the leading companies of the OAPEC countries and by the IFP group were completed by presentation from the International Energy Agency (IEA), the United States Geological Survey (USGS), the IHS Energy Group, Total and Gaz de France. This document gathers the transparencies of the following presentations: Hydrocarbon reserves in OAPEC members countries: current and future (M. Al-Lababidi); Non OAPEC liquid reserves and production forecasts (Y. Mathieu); World oil and gas resources and production outlook (K. Chew); Global investments in the upstream (F. Birol); Total's policy in the oil and gas sector (C. de Margerie); Gaz de France's policy in the oil and gas sector (J. Abiteboul); NOC/IOC's opportunities in OPEC countries (I. Sandrea); Relationships between companies, countries and investors: How they may impact on the growth

  3. Hydrocarbon Reserves: Abundance or Scarcity

    International Nuclear Information System (INIS)

    2005-01-01

    IFP and the OAPEC jointly organize a regular international seminar dealing with world oil-related problems appearing in the news. For the first time, this seminar has been opened to oil and gas company specialists, service companies, research centers and independents. This year's theme concerns oil and gas reserves: are they abundant or are we headed towards the shortages announced by some experts? This theme is especially topical in that: oil and gas currently meet two thirds of world energy needs and almost completely dominate the transport sector; the reserves declared by the OAPEC countries account for nearly half of world reserves; the price of a barrel of oil went through the roof in 2004; world energy demand is growing fast and alternative sources of energy are far from ready to take over from oil and gas in the next few decades. Since the reserves correspond to the volume it is technically and economically viable to produce, the seminar has, of course, dealt with the technical and economic questions that arise in connection with exploration and production, but it has also considered changes in the geopolitical context. Presentations by the leading companies of the OAPEC countries and by the IFP group were completed by presentation from the International Energy Agency (IEA), the United States Geological Survey (USGS), the IHS Energy Group, Total and Gaz de France. This document gathers the transparencies of the following presentations: Hydrocarbon reserves in OAPEC members countries: current and future (M. Al-Lababidi); Non OAPEC liquid reserves and production forecasts (Y. Mathieu); World oil and gas resources and production outlook (K. Chew); Global investments in the upstream (F. Birol); Total's policy in the oil and gas sector (C. de Margerie); Gaz de France's policy in the oil and gas sector (J. Abiteboul); NOC/IOC's opportunities in OPEC countries (I. Sandrea); Relationships between companies, countries and investors: How they may impact on the growth

  4. Hydrocarbon Reserves: Abundance or Scarcity

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    IFP and the OAPEC jointly organize a regular international seminar dealing with world oil-related problems appearing in the news. For the first time, this seminar has been opened to oil and gas company specialists, service companies, research centers and independents. This year's theme concerns oil and gas reserves: are they abundant or are we headed towards the shortages announced by some experts? This theme is especially topical in that: oil and gas currently meet two thirds of world energy needs and almost completely dominate the transport sector; the reserves declared by the OAPEC countries account for nearly half of world reserves; the price of a barrel of oil went through the roof in 2004; world energy demand is growing fast and alternative sources of energy are far from ready to take over from oil and gas in the next few decades. Since the reserves correspond to the volume it is technically and economically viable to produce, the seminar has, of course, dealt with the technical and economic questions that arise in connection with exploration and production, but it has also considered changes in the geopolitical context. Presentations by the leading companies of the OAPEC countries and by the IFP group were completed by presentation from the International Energy Agency (IEA), the United States Geological Survey (USGS), the IHS Energy Group, Total and Gaz de France. This document gathers the transparencies of the following presentations: Hydrocarbon reserves in OAPEC members countries: current and future (M. Al-Lababidi); Non OAPEC liquid reserves and production forecasts (Y. Mathieu); World oil and gas resources and production outlook (K. Chew); Global investments in the upstream (F. Birol); Total's policy in the oil and gas sector (C. de Margerie); Gaz de France's policy in the oil and gas sector (J. Abiteboul); NOC/IOC's opportunities in OPEC countries (I. Sandrea); Relationships between companies, countries and investors: How they may

  5. Demand as Frequency Controlled Reserve

    DEFF Research Database (Denmark)

    Xu, Zhao; Østergaard, Jacob; Togeby, Mikael

    2011-01-01

    Relying on generation side alone is deemed insufficient to fulfill the system balancing needs for future Danish power system, where a 50% wind penetration is outlined by the government for year 2025. This paper investigates using the electricity demand as frequency controlled reserve (DFR) as a new...... balancing measure, which has a high potential and can provide many advantages. Firstly, the background of the research is reviewed, including conventional power system reserves and the electricity demand side potentials. Subsequently, the control logics and corresponding design considerations for the DFR...

  6. Demand as Frequency Controlled Reserve

    DEFF Research Database (Denmark)

    Xu, Zhao; Togeby, Mikael; Østergaard, Jacob

    This report summaries the research outcomes of the project ‘Demand as Frequency Controlled Reserve (DFR)’, which has received the support from Energinet.dk’s PSO program, Grant no. 2005-2-6380. The objective of this project is to investigate the technology of using electricity demands for providing...

  7. Demand Response Spinning Reserve Demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Eto, Joseph H.; Nelson-Hoffman, Janine; Torres, Carlos; Hirth,Scott; Yinger, Bob; Kueck, John; Kirby, Brendan; Bernier, Clark; Wright,Roger; Barat, A.; Watson, David S.

    2007-05-01

    The Demand Response Spinning Reserve project is a pioneeringdemonstration of how existing utility load-management assets can providean important electricity system reliability resource known as spinningreserve. Using aggregated demand-side resources to provide spinningreserve will give grid operators at the California Independent SystemOperator (CAISO) and Southern California Edison (SCE) a powerful, newtool to improve system reliability, prevent rolling blackouts, and lowersystem operating costs.

  8. Gas reserves, discoveries and production

    International Nuclear Information System (INIS)

    Saniere, A.

    2006-01-01

    Between 2000 and 2004, new discoveries, located mostly in the Asia/Pacific region, permitted a 71% produced reserve replacement rate. The Middle East and the offshore sector represent a growing proportion of world gas production Non-conventional gas resources are substantial but are not exploited to any significant extent, except in the United States, where they account for 30% of U.S. gas production. (author)

  9. Uranium reserves and exploration activity

    International Nuclear Information System (INIS)

    Meehan, R.J.

    1975-01-01

    The strategy that ERDA plans to employ regarding resource appraisal is outlined. All types of uranium occurrences will be evaluated as sources of domestic ore reserves. Industry's exploration efforts will be compiled. These data will include information on land acquisition and costs, footage drilled and costs, estimates of exploration activities and expenditures, exploration for non-sandstone deposits, exploration in non-established areas, and foreign exploration plans and costs. Typical data in each of these areas are given

  10. Federal reservation of geothermal resources

    Energy Technology Data Exchange (ETDEWEB)

    Silver, R.M.

    1978-01-01

    Union Oil had developed or was seeking to develop wells on the land in Sonoma County, California in order to produce geothermal steam for generating electricity. The US Attorney General brought a quiet title action pursuant to 21(b) of the Geothermal Steam Act of 1970 to determine whether geothermal resources are included in the mineral reservation under the Homestead Act. The US District Court granted Union Oil's motion to dismiss for failure to state a claim upon which relief may be granted. On appeal, the Ninth Circuit reversed and remanded. In summary, the court concluded on the basis of the legislative history of the Stock-Raising Homestead Act that sources of energy are intended to remain in the government's possession, and the purposes of the Act will be best served by including geothermal resources in the reservation of mineral interests. Noting the strictly agricultural purpose of the Act, the subsurface estate reservation was broadly interpreted, even though title passed to all rights that were not expressly reserved. The court left open on remand the question of estoppel of the government from interfering with private lessees by developing subsurface resources compensation.This is a unique and intriguing decision, as it opens wide the definition of ''mineral interest,'' construing it in the timely terms of a valuable natural resource that may be in great demand for future energy needs. The decision is being appealed to the United States Supreme Court, and it will be interesting to observe whether this liberal interpretation of mineral interests will be upheld.

  11. Ultrasound in evaluating ovarian reserve

    Directory of Open Access Journals (Sweden)

    Eman Ahmaed Shawky Sabek

    2015-12-01

    Full Text Available The objective of this study was to compare the diagnostic accuracy of transvaginal ultrasound (TVS, as a less invasive technique instead of hormonal assay to evaluate the ovarian reserve. This study included fifty-five females with breast cancer and we compared the ovarian reserve for these patients by hormonal assay through measuring the serum AntiMullerian Hormone (AMH level and follicular stimulating hormone (FSH level before and after chemotherapy, and by transvaginal ultrasound through the ovarian volume (OV calculation and counting the Antral follicles (AFC before and after chemotherapy treatment. There was decline in the AntiMullerian Hormone level after chemotherapy by 27 ± 11.19% and decrease in the Antral follicle counts by 21 ± 13.43%. In conclusion there was strong relation between AMH level and AFC which makes the use of transvaginal ultrasound is a reliable alternative method to the hormonal assay to detect the ovarian reserve.

  12. Invasive FFR — Current Applications and New Developments

    Directory of Open Access Journals (Sweden)

    Chiţu Monica

    2016-12-01

    Full Text Available Myocardial ischemia caused by coronary atherosclerosis is the main cause of cardiovascular mortality, which is the first cause of death in developed countries. Inducible myocardial ischemia is a negative prognostic factor for coronary artery disease patients, and it represents a major risk stratification marker for predicting mortality. The evolution of these patients depends largely on the extension of the ischemic myocardial mass and the severity of the inducible ischemia. Most patients do not show angiographically significant coronary stenosis. Therefore, such patients do not undergo coronary revascularization therapies, even though they present functional stenoses that trigger myocardial ischemia under stress conditions, which subsequently lead to a high risk for major adverse cardiovascular events. We performed a review that aims to pinpoint invasive techniques used for evaluating the functional impact of a coronary lesion that is considered non-significant upon angiographic examination, but which triggers episodes of myocardial ischemia under stress conditions, and to describe the functional markers that show the highest specificity for predicting ischemic risk, in order to recommend invasive coronary revascularization.

  13. Foreign Exchange Reserves: Bangladesh Perspective

    Directory of Open Access Journals (Sweden)

    Md Zahangir Alam

    2013-10-01

    Full Text Available This study is about foreign exchangereserves of Bangladesh. The mainpurpose of this study is to the influence of exchange rates on foreign exchangereserves to the Bangladesh context.  Both the primary and secondary data has been used inthis study. The primary data has been collected through a structuredquestionnaire from 50 respondents. The secondary data, namely Bangladeshforeign exchange reserves (FER, Bangladesh current account balance (CAB,Bangladesh capital andfinancial account balance (CFAB, and BDT/USD exchange rates (ER.  This study covers yearly data from July 01,1996 to June 30, 2005 and quarterly data from July 01, 2005 to June 30, 2012. Findingsof this study shows that out of the selected 16 factors affecting foreignexchange reserves, exchange rates occupy the first position, weighted averagescore (WAS being 4.56. Foreign exchange reserves (FER and current accountbalance (CAB have increased by 502.9087% and 1451.218%,whereas capital and financial account (CFAB has decreased by -649.024% on June30, 2012 compared to June 30, 1997. The influence of other factors heldconstant, as ER changes by 285.6894 units due to one unit change in FER, onaverage in the same direction which represents that ER has positive effect on theFER and this relationship is statistically significant.  62.1526 percentof the variation in FER is explained by ER. The outcomes of Breusch-Godfrey test (LM test, ARCHtest, and the Normality test are that there is a serial correlation among residuals, the variance of residuals is notconstant, and the residuals are not normally distributed.

  14. Naval Reserve Annual Operating Costs

    Science.gov (United States)

    1975-10-29

    C. c ) CPi i 0 0 00 0 le C C.C~r In 1]1 In 00 It .- I to C-38 ’U2 WIX ’W~ - m u. -C-LC m4 C v , v ul FA ?w % -D 1 o r cl jc j, II t %c oK W)i Ir of... platform programs, while Program 11 contains 26 sub-programs each having a separate Reserve program sponsor. The distribution of Program 11 resources is...a mix of specific skills required to bring an active Navy oper-Iating platform to organizational manning. Each SRU is tailored to a specific ship

  15. Individual loss reserving with the Multivariate Skew Normal distribution

    NARCIS (Netherlands)

    Pigeon, M.; Antonio, K.; Denuit, M.

    2012-01-01

    The evaluation of future cash flows and solvency capital recently gained importance in general insurance. To assist in this process, our paper proposes a novel loss reserving model, designed for individual claims in discrete time. We model the occurrence of claims, as well as their reporting delay,

  16. Individual loss reserving with the multivariate skew normal framework

    NARCIS (Netherlands)

    Pigeon, M.; Antonio, K.; Denuit, M.

    2013-01-01

    The evaluation of future cash flows and solvency capital recently gained importance in general insurance. To assist in this process, our paper proposes a novel loss reserving model, designed for individual claims developing in discrete time. We model the occurrence of claims, as well as their

  17. A Century in Reserve and Beyond

    National Research Council Canada - National Science Library

    Monagle, James P

    2008-01-01

    ... Reserve, this Strategy Research Project (SRP) describes the role of the Army Reserve from its beginning as a reserve corps of medical doctors to that of a strategic reserve force, and then to its current operational role...

  18. Dynamics of International Reserve Accumulation in Turkish Economy

    Directory of Open Access Journals (Sweden)

    Duygu Ayhan

    2015-05-01

    Full Text Available Many of the emerging market economies embody macroeconomic and structural vulnerabilities due to large deficits, high inflation, slowing growth and heavy reliance on short-term capital inflows. Therefore, accumulation of international reserve holdings has been frequently used by authorities to serve as an insurance against the volatility of the capital flows and strengthen the fragile nature of these economies. Turkish economy, classified as one of the most fragile of the emerging economies, has been experiencing a similar process of international reserve accumulation. The chronically high current account deficit and low savings rate boost the importance of international reserves. Thus, the aim of this paper is to investigate the determinants of international reserves in Turkey. The dataset covers the 2000-2013 period. Consequently, we find that the international reserve accumulation is mainly explained by current account balance, per capita income and past crisis experience.

  19. FEATURES OF PERFECT AND IMPERFECT RESERVES AND RESERVE FUNDS WITHIN THE FEDERAL BUDGET OF THE RUSSIAN FEDERATION

    Directory of Open Access Journals (Sweden)

    Tatyana P. Lomakina

    2018-03-01

    Full Text Available During the past two years (2016–2017, the mass media was engaged in tense discussion about the status and flow of funds within the two reserves – the Reserve Fund of the Russian Federation and the National Welfare Fund. The Reserve Fund of the Russian Federation aroused especial worries among the experts. Its funds rapidly declined and by December 2017 they were fully used to cover the deficit of the domestic budget. In accordance with the law “On Amendments to the Budget Code of the Russian Federation in the Use of Oil and Gas Revenues of the Federal Budget,” from February 1, 2018, the Reserve Fund of the Russian Federation will cease to exist. For financial theory, this fact can serve as an illustration of the process of forming the foundations of budgetary financial security, their change over time, circumstances and options the government can take to modify them. At the same time, there are other types of financial resources within the federal budget. Their diversity necessitates their classification in order to identify groups and types with similar characteristics. However, in financial theory, many types of reserves are not described in detail, and some are not described at all. This article introduces the concepts of “perfect” and “imperfect” reserves, for their characterization as part of the federal budget. The Russian Reserve Fund and the National Welfare Fund (Sovereign Funds are the examples of perfect financial reserves. Imperfect reserves comprise a large group of reserve funds that are included in the federal budget, for example, the Reserve Fund of the President of the Russian Federation and the Reserve Fund of the Government of the Russian Federation, the Reserve Fund of the Government of the Russian Federation for the prevention and control of emergencies and impact of natural disasters. The introduction of new typological features largely clarifies the situation with increased attention to one type of reserves

  20. Reserve growth during financial volatility in a technologically challenging world

    Science.gov (United States)

    Klett, Timothy R.; Gautier, Donald L.

    2010-01-01

    Reserve growth (growth-to-known) is the addition of oil and gas quantities to reported proved or proved-plus-probable reserves in discovered fields. The amount of reserve growth fluctuates through time with prevailing economic and technological conditions. Most reserve additions are the result of investment in field operations and in development technology. These investments can be justified by higher prices of oil and gas, the desire to maintain cash flow, and by greater recovery efficiency in well established fields. The price/cost ratio affects decisions for field abandonment and (or) implementation of improved recovery methods. Although small- to medium-size fields might show higher percentages of reserve growth, a relatively few giant fields contribute most volumetric reserve growth, indicating that companies may prefer to invest in existing fields with low geologic and production risk and an established infrastructure in order to increase their price/cost relationship. Whereas many previous estimates of reserve growth were based on past trends of reported reserves, future reserve growth is expected to be greatly affected by financial volatility and fluctuating economic and technological conditions.

  1. Contaminant transport model validation: The Oak Ridge Reservation

    International Nuclear Information System (INIS)

    Lee, R.R.; Ketelle, R.H.

    1988-09-01

    In the complex geologic setting on the Oak Ridge Reservation, hydraulic conductivity is anisotropic and flow is strongly influenced by an extensive and largely discontinuous fracture network. Difficulties in describing and modeling the aquifer system prompted a study to obtain aquifer property data to be used in a groundwater flow model validation experiment. Characterization studies included the performance of an extensive suite of aquifer test within a 600-square-meter area to obtain aquifer property values to describe the flow field in detail. Following aquifer test, a groundwater tracer test was performed under ambient conditions to verify the aquifer analysis. Tracer migration data in the near-field were used in model calibration to predict tracer arrival time and concentration in the far-field. Despite the extensive aquifer testing, initial modeling inaccurately predicted tracer migration direction. Initial tracer migration rates were consistent with those predicted by the model; however, changing environmental conditions resulted in an unanticipated decay in tracer movement. Evaluation of the predictive accuracy of groundwater flow and contaminant transport models on the Oak Ridge Reservation depends on defining the resolution required, followed by field testing and model grid definition at compatible scales. The use of tracer tests, both as a characterization method and to verify model results, provides the highest level of resolution of groundwater flow characteristics. 3 refs., 4 figs

  2. Rotating flow

    CERN Document Server

    Childs, Peter R N

    2010-01-01

    Rotating flow is critically important across a wide range of scientific, engineering and product applications, providing design and modeling capability for diverse products such as jet engines, pumps and vacuum cleaners, as well as geophysical flows. Developed over the course of 20 years' research into rotating fluids and associated heat transfer at the University of Sussex Thermo-Fluid Mechanics Research Centre (TFMRC), Rotating Flow is an indispensable reference and resource for all those working within the gas turbine and rotating machinery industries. Traditional fluid and flow dynamics titles offer the essential background but generally include very sparse coverage of rotating flows-which is where this book comes in. Beginning with an accessible introduction to rotating flow, recognized expert Peter Childs takes you through fundamental equations, vorticity and vortices, rotating disc flow, flow around rotating cylinders and flow in rotating cavities, with an introduction to atmospheric and oceanic circul...

  3. Flow visualization

    CERN Document Server

    Merzkirch, Wolfgang

    1974-01-01

    Flow Visualization describes the most widely used methods for visualizing flows. Flow visualization evaluates certain properties of a flow field directly accessible to visual perception. Organized into five chapters, this book first presents the methods that create a visible flow pattern that could be investigated by visual inspection, such as simple dye and density-sensitive visualization methods. It then deals with the application of electron beams and streaming birefringence. Optical methods for compressible flows, hydraulic analogy, and high-speed photography are discussed in other cha

  4. 24 CFR 891.605 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.605... 8 Assistance § 891.605 Replacement reserve. (a) Establishment of reserve. The Borrower shall establish and maintain a replacement reserve to aid in funding extraordinary maintenance, and repair and...

  5. 24 CFR 891.405 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.405....405 Replacement reserve. (a) Establishment of reserve. The Owner shall establish and maintain a replacement reserve to aid in funding extraordinary maintenance and repair and replacement of capital items...

  6. Veterinary Science Students, Center Changing a Reservation

    Science.gov (United States)

    Blackwater, Jasmine

    2011-01-01

    Kayenta is a rural community located in northeastern Arizona on a Navajo reservation. On the reservation, many families rely on their livestock for income, and as a result, many reservation high school students show a great interest in agricultural education. Having livestock on the reservation is not just a source of income, but also part of a…

  7. Calculation program development for spinning reserve

    International Nuclear Information System (INIS)

    1979-01-01

    This study is about optimal holding of spinning reserve and optimal operation for it. It deals with the purpose and contents of the study, introduction of the spinning reserve electricity, speciality of the spinning reserve power, the result of calculation, analysis for limited method of optimum load, calculation of requirement for spinning reserve, analysis on measurement of system stability with summary, purpose of the analysis, cause of impact of the accident, basics on measurement of spinning reserve and conclusion. It has the reference on explanation for design of spinning reserve power program and using and trend about spinning reserve power in Korea.

  8. Flow regimes

    International Nuclear Information System (INIS)

    Kh'yuitt, G.

    1980-01-01

    An introduction into the problem of two-phase flows is presented. Flow regimes arizing in two-phase flows are described, and classification of these regimes is given. Structures of vertical and horizontal two-phase flows and a method of their identification using regime maps are considered. The limits of this method application are discussed. The flooding phenomena and phenomena of direction change (flow reversal) of the flow and interrelation of these phenomena as well as transitions from slug regime to churn one and from churn one to annular one in vertical flows are described. Problems of phase transitions and equilibrium are discussed. Flow regimes in tubes where evaporating liquid is running, are described [ru

  9. Commercial helium reserves, continental rifting and volcanism

    Science.gov (United States)

    Ballentine, C. J.; Barry, P. H.; Hillegonds, D.; Fontijn, K.; Bluett, J.; Abraham-James, T.; Danabalan, D.; Gluyas, J.; Brennwald, M. S.; Pluess, B.; Seneshens, D.; Sherwood Lollar, B.

    2017-12-01

    Helium has many industrial applications, but notably provides the unique cooling medium for superconducting magnets in medical MRI scanners and high energy beam lines. In 2013 the global supply chainfailed to meet demand causing significant concern - the `Liquid Helium Crisis' [1]. The 2017 closure of Quatar borders, a major helium supplier, is likely to further disrupt helium supply, and accentuates the urgent need to diversify supply. Helium is found in very few natural gas reservoirs that have focused 4He produced by the dispersed decay (a-particle) of U and Th in the crust. We show here, using the example of the Rukwa section of the Tanzanian East African Rift, how continental rifting and local volcanism provides the combination of processes required to generate helium reserves. The ancient continental crust provides the source of 4He. Rifting and associated magmatism provides the tectonic and thermal mechanism to mobilise deep fluid circulation, focusing flow to the near surface along major basement faults. Helium-rich springs in the Tanzanian Great Rift Valley were first identified in the 1950's[2]. The isotopic compositions and major element chemistry of the gases from springs and seeps are consistent with their release from the crystalline basement during rifting [3]. Within the Rukwa Rift Valley, helium seeps occur in the vicinity of trapping structures that have the potential to store significant reserves of helium [3]. Soil gas surveys over 6 prospective trapping structures (1m depth, n=1486) show helium anomalies in 5 out of the 6 at levels similar to those observed over a known helium-rich gas reservoir at 1200m depth (7% He - Harley Dome, Utah). Detailed macroseep gas compositions collected over two days (n=17) at one site allows us to distinguish shallow gas contributions and shows the deep gas to contain between 8-10% helium, significantly increasing resource estimates based on uncorrected values (1.8-4.2%)[2,3]. The remainder of the deep gas is

  10. Introducing optional reserve ratios in Hungary

    OpenAIRE

    Lóránt Varga

    2010-01-01

    As of the reserve maintenance period commencing in November 2010, Hungarian credit institutions will be free to decide whether to apply the previously valid 2% reserve ratio, or to apply a higher mandatory reserve ratio. Credit institutions required to hold reserves may select from reserve ratios of 2, 3, 4 and 5%, and may change their decision on a semi-annual basis. In line with the international best practice, the purpose of the MNB’s reserve requirement system is to support credit institu...

  11. Advance reservation access control using software-defined networking and tokens

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Joaquin; Jung, Eun-Sung; Kettimuthu, Rajkumar; Rao, Nageswara S. V.; Foster, Ian T.; Clark, Russ; Owen, Henry

    2018-02-01

    Advance reservation systems allow users to reserve dedicated bandwidth connection resources from advanced high-speed networks. A common use case for such systems is data transfers in distributed science environments in which a user wants exclusive access to the reservation. However, current advance network reservation methods cannot ensure exclusive access of a network reservation to the specific flow for which the user made the reservation. We present here a novel network architecture that addresses this limitation and ensures that a reservation is used only by the intended flow. We achieve this by leveraging software-defined networking (SDN) and token-based authorization. We use SDN to orchestrate and automate the reservation of networking resources, end-to-end and across multiple administrative domains, and tokens to create a strong binding between the user or application that requested the reservation and the flows provisioned by SDN. We conducted experiments on the ESNet 100G SDN testbed, and demonstrated that our system effectively protects authorized flows from competing traffic in the network. (C) 2017 Elsevier B.V. All rights reserved.

  12. Reservation wages, expected wages and unemployment

    OpenAIRE

    Brown, S; Taylor, K

    2013-01-01

    We model unemployment duration, reservation and expected wages simultaneously for individuals not in work, where wage expectations are identified via an exogenous policy shock. The policy shock increased expected wages, which were found to be positively associated with reservation wages.

  13. Transforming the Reserve Component: Four Essays

    National Research Council Canada - National Science Library

    Binnendijk, Hans; Baranick, Michael J; Bell, Raymond E., Jr; Cordero, Gina; Duncan, Stephen M; Holshek, Christopher; Wentz, Larry

    2005-01-01

    This volume contains four essays on various aspects of the Reserve Component. We publish it at a time when Reserves are serving overseas at historically high rates and when new missions like homeland security demand their attention...

  14. 47 CFR 25.219 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false [Reserved] 25.219 Section 25.219 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS Technical Standards § 25.219 [Reserved] ...

  15. 47 CFR 25.402 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false [Reserved] 25.402 Section 25.402 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES SATELLITE COMMUNICATIONS Competitive Bidding Procedures for DARS § 25.402 [Reserved] ...

  16. Reservation system with graphical user interface

    KAUST Repository

    Mohamed, Mahmoud A. Abdelhamid; Jamjoom, Hani T.; Podlaseck, Mark E.; Qu, Huiming; Shae, Zon-Yin; Sheopuri, Anshul

    2012-01-01

    Techniques for providing a reservation system are provided. The techniques include displaying a scalable visualization object, wherein the scalable visualization object comprises an expanded view element of the reservation system depicting

  17. 47 CFR 80.146 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... MARITIME SERVICES Operating Requirements and Procedures Shipboard General Purpose Watches § 80.146 [Reserved] ... 47 Telecommunication 5 2010-10-01 2010-10-01 false [Reserved] 80.146 Section 80.146...

  18. 47 CFR 80.145 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... MARITIME SERVICES Operating Requirements and Procedures Special Procedures-Ship Stations § 80.145 [Reserved] Shipboard General Purpose Watches ... 47 Telecommunication 5 2010-10-01 2010-10-01 false [Reserved] 80.145 Section 80.145...

  19. 5 CFR 330.610 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false [Reserved] 330.610 Section 330.610 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS RECRUITMENT, SELECTION, AND... Employees § 330.610 [Reserved] ...

  20. 5 CFR 330.603 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false [Reserved] 330.603 Section 330.603 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS RECRUITMENT, SELECTION, AND... Employees § 330.603 [Reserved] ...

  1. 40 CFR 405.73 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 405.73 Section 405.73 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS DAIRY... § 405.73 [Reserved] ...

  2. 40 CFR 408.73 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 408.73 Section 408.73 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS... Processing Subcategory § 408.73 [Reserved] ...

  3. 40 CFR 407.73 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.73 Section 407.73 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS... Vegetables Subcategory § 407.73 [Reserved] ...

  4. Reserving by detailed conditioning on individual claim

    Science.gov (United States)

    Kartikasari, Mujiati Dwi; Effendie, Adhitya Ronnie; Wilandari, Yuciana

    2017-03-01

    The estimation of claim reserves is an important activity in insurance companies to fulfill their liabilities. Recently, reserving method of individual claim have attracted a lot of interest in the actuarial science, which overcome some deficiency of aggregated claim method. This paper explores the Reserving by Detailed Conditioning (RDC) method using all of claim information for reserving with individual claim of liability insurance from an Indonesian general insurance company. Furthermore, we compare it to Chain Ladder and Bornhuetter-Ferguson method.

  5. Time-averaged currents in the Northeast Corridor Reserve during November 2013.

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — A 2D numerical model, CMS-Flow, was implemented for the Northeast Corridor Reserve (NECR) using a telescoping grid. Tide and wind forcing was provided to the model...

  6. Reserve evaluation of minerals at NUCLEBRAS

    International Nuclear Information System (INIS)

    Marques, J.P.M.; Guerra, P.A.G.; Vinha, C.A.G. da

    1980-10-01

    The method used for the reserve evaluation of minerals, particularly of uranium, as used worldwide, and specially at NUCLEBRAS is described. This is done through a series of procedures envolving basic definitions, reserve evaluation methods (conventional, statistical and geoestatistical), data management, use of computer systems, classification and evaluation of reserves. (Author) [pt

  7. 24 CFR 880.602 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 880.602... Replacement reserve. (a) A replacement reserve must be established and maintained in an interest-bearing account to aid in funding extraordinary maintenance and repair and replacement of capital items. (1) Part...

  8. 24 CFR 891.745 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.745... and Individuals-Section 162 Assistance § 891.745 Replacement reserve. The general requirements for the replacement reserve are provided in § 891.605. For projects funded under §§ 891.655 through 891.790, the...

  9. Poverty and corruption compromise tropical forest reserves.

    Science.gov (United States)

    Wright, S Joseph; Sanchez-Azofeifa, G Arturo; Portillo-Quintero, Carlos; Davies, Diane

    2007-07-01

    We used the global fire detection record provided by the satellite-based Moderate Resolution Imaging Spectroradiometer (MODIS) to determine the number of fires detected inside 823 tropical and subtropical moist forest reserves and for contiguous buffer areas 5, 10, and 15 km wide. The ratio of fire detection densities (detections per square kilometer) inside reserves to their contiguous buffer areas provided an index of reserve effectiveness. Fire detection density was significantly lower inside reserves than in paired, contiguous buffer areas but varied by five orders of magnitude among reserves. The buffer: reserve detection ratio varied by up to four orders of magnitude among reserves within a single country, and median values varied by three orders of magnitude among countries. Reserves tended to be least effective at reducing fire frequency in many poorer countries and in countries beset by corruption. Countries with the most successful reserves include Costa Rica, Jamaica, Malaysia, and Taiwan and the Indonesian island of Java. Countries with the most problematic reserves include Cambodia, Guatemala, Paraguay, and Sierra Leone and the Indonesian portion of Borneo. We provide fire detection density for 3964 tropical and subtropical reserves and their buffer areas in the hope that these data will expedite further analyses that might lead to improved management of tropical reserves.

  10. Assessment of secondary aluminum reserves of nations

    DEFF Research Database (Denmark)

    Maung, Kyaw Nyunt; Yoshida, Tomoharu; Liu, Gang

    2017-01-01

    aluminum resources are accumulated in landfill sites. Understanding the sizes of primary and secondary aluminum reserves enables us to extend knowledge of efficient raw material sourcing from a narrow perspective of primary reserves alone to a broader perspective of both primary and secondary reserves...

  11. 24 CFR 572.125 - Replacement reserves.

    Science.gov (United States)

    2010-04-01

    ...) Homeownership Program Requirements-Implementation Grants § 572.125 Replacement reserves. (a) Purpose. A single replacement reserve may be established for the homeownership program only if HUD determines it is necessary to... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Replacement reserves. 572.125...

  12. Evaluation system of minerals reserve at Nuclebras

    International Nuclear Information System (INIS)

    Marques, J.P.M.; Guerra, P.A.G.; Vinha, C.A.G. da.

    1980-01-01

    The paper describes the methodology used for the reserve evaluation of minerals, particularly of uranium, as used world wide, and specially at Nuclebras. The paper discusses a series of procedures envolving basic definitions, reserve evaluation methods (Conventional, Statistical and Geoestatistical), data management, use of computer systems, classification of reserves as well as the results achieved [pt

  13. Reserve Requirements and Monetary Management; An Introduction

    OpenAIRE

    International Monetary Fund

    1993-01-01

    Reserve requirements are widely used by central banks as a means to improve monetary control, an instrument for policy implementation, a source of revenue, and a safeguard of bank liquidity. The effectiveness of reserve requirements in fulfilling these functions is reviewed, and the detailed modalities of their use are examined. Reserve requirements in a sample of developing countries are described.

  14. 42 CFR 417.934 - Reserve requirement.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Reserve requirement. 417.934 Section 417.934 Public... PLANS Administration of Outstanding Loans and Loan Guarantees § 417.934 Reserve requirement. (a) Timing... section 1305 of the PHS Act was required to establish a restricted reserve account on the earlier of the...

  15. Numerical investigation of the effect of stenosis geometry on the coronary diagnostic parameters.

    Science.gov (United States)

    Kamangar, Sarfaraz; Kalimuthu, Govindaraju; Badruddin, Irfan Anjum; Badarudin, A; Ahmed, N J Salman; Khan, T M Yunus

    2014-01-01

    The present study deals with the functional severity of a coronary artery stenosis assessed by the fractional flow reserve (FFR). The effects of different geometrical shapes of lesion on the diagnostic parameters are unknown. In this study, 3D computational simulation of blood flow in three different geometrical shapes of stenosis (triangular, elliptical, and trapezium) is considered in steady and transient conditions for 70% (moderate), 80% (intermediate), and 90% (severe) area stenosis (AS). For a given percentage AS, the variation of diagnostic parameters which are derived from pressure drop across the stenosis was found in three different geometrical shapes of stenosis and it was observed that FFR is higher in triangular shape and lower in trapezium shape. The pressure drop coefficient (CDP) was higher in trapezium shape and lower in triangular model whereas the LFC shows opposite trend. From the clinical perspective, the relationship between percentage AS and FFR is linear and inversely related in all the three models. A cut-off value of 0.75 for FFR was observed at 76.5% AS in trapezium model, 79.5% in elliptical model, and 82.7% AS for the triangular shaped model. The misinterpretation of the functional severity of the stenosis is in the region of 76.5%-82.7 % AS from different shapes of stenosis models.

  16. Numerical Investigation of the Effect of Stenosis Geometry on the Coronary Diagnostic Parameters

    Directory of Open Access Journals (Sweden)

    Sarfaraz Kamangar

    2014-01-01

    Full Text Available The present study deals with the functional severity of a coronary artery stenosis assessed by the fractional flow reserve (FFR. The effects of different geometrical shapes of lesion on the diagnostic parameters are unknown. In this study, 3D computational simulation of blood flow in three different geometrical shapes of stenosis (triangular, elliptical, and trapezium is considered in steady and transient conditions for 70% (moderate, 80% (intermediate, and 90% (severe area stenosis (AS. For a given percentage AS, the variation of diagnostic parameters which are derived from pressure drop across the stenosis was found in three different geometrical shapes of stenosis and it was observed that FFR is higher in triangular shape and lower in trapezium shape. The pressure drop coefficient (CDP was higher in trapezium shape and lower in triangular model whereas the LFC shows opposite trend. From the clinical perspective, the relationship between percentage AS and FFR is linear and inversely related in all the three models. A cut-off value of 0.75 for FFR was observed at 76.5% AS in trapezium model, 79.5% in elliptical model, and 82.7% AS for the triangular shaped model. The misinterpretation of the functional severity of the stenosis is in the region of 76.5%-82.7 % AS from different shapes of stenosis models.

  17. Flow visualization

    International Nuclear Information System (INIS)

    Weinstein, L.M.

    1991-01-01

    Flow visualization techniques are reviewed, with particular attention given to those applicable to liquid helium flows. Three techniques capable of obtaining qualitative and quantitative measurements of complex 3D flow fields are discussed including focusing schlieren, particle image volocimetry, and holocinematography (HCV). It is concluded that the HCV appears to be uniquely capable of obtaining full time-varying, 3D velocity field data, but is limited to the low speeds typical of liquid helium facilities. 8 refs

  18. Flow regimes

    International Nuclear Information System (INIS)

    Liles, D.R.

    1982-01-01

    Internal boundaries in multiphase flow greatly complicate fluid-dynamic and heat-transfer descriptions. Different flow regimes or topological configurations can have radically dissimilar interfacial and wall mass, momentum, and energy exchanges. To model the flow dynamics properly requires estimates of these rates. In this paper the common flow regimes for gas-liquid systems are defined and the techniques used to estimate the extent of a particular regime are described. Also, the current computer-code procedures are delineated and introduce a potentially better method is introduced

  19. Reserve selection with land market feedbacks.

    Science.gov (United States)

    Butsic, Van; Lewis, David J; Radeloff, Volker C

    2013-01-15

    How to best site reserves is a leading question for conservation biologists. Recently, reserve selection has emphasized efficient conservation: maximizing conservation goals given the reality of limited conservation budgets, and this work indicates that land market can potentially undermine the conservation benefits of reserves by increasing property values and development probabilities near reserves. Here we propose a reserve selection methodology which optimizes conservation given both a budget constraint and land market feedbacks by using a combination of econometric models along with stochastic dynamic programming. We show that amenity based feedbacks can be accounted for in optimal reserve selection by choosing property price and land development models which exogenously estimate the effects of reserve establishment. In our empirical example, we use previously estimated models of land development and property prices to select parcels to maximize coarse woody debris along 16 lakes in Vilas County, WI, USA. Using each lake as an independent experiment, we find that including land market feedbacks in the reserve selection algorithm has only small effects on conservation efficacy. Likewise, we find that in our setting heuristic (minloss and maxgain) algorithms perform nearly as well as the optimal selection strategy. We emphasize that land market feedbacks can be included in optimal reserve selection; the extent to which this improves reserve placement will likely vary across landscapes. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. Relationship of the duke jeopardy score combined with minimal lumen diameter as assessed by computed tomography angiography to the hemodynamic relevance of coronary artery stenosis.

    Science.gov (United States)

    Yu, Mengmeng; Zhao, Yonghong; Li, Wenbin; Lu, Zhigang; Wei, Meng; Zhou, Wenxiao; Zhang, Jiayin

    2018-03-02

    To study the diagnostic performance of the ratio between the Duke jeopardy score (DJS) and the minimal lumen diameter (MLD) (DJS/MLD CT ratio) as assessed by coronary computed tomographic angiography (CTA) for differentiating functionally significant from non-significant coronary artery stenoses, with reference to invasive fractional flow reserve (FFR). Patients who underwent both coronary CTA and FFR measurement during invasive coronary angiography (ICA) within 2 weeks were retrospectively included in the study. Invasive FFR measurement was performed in patients with intermediate to severe coronary stenoseis. DJS/MLD CT ratio and anatomical parameters were recorded. Lesions with FFR ≤0.80 were considered to be functionally significant. One hundred and sixty-one patients with 175 lesions were included into the analysis. Diameter stenosis in CT, area stenosis, plaque burden, lesion length (LL), ICA-based stenosis degree, DJS, LL/MLD 4 ratio, DJS/MLA ratio as well as DJS/MLD ratio were all significantly different between hemodynamically significant and non-significant lesions (pvalue for DJS/MLD CT ratio to be 1.96 (area under curve = 0.863, 95 % confidence interval = 0.803-0.910), yielding a high diagnostic accuracy (86.9%, 152/175). In coronary artery stenoses detected by coronary CTA, the DJS/MLD ratio is able to predict hemodynamic relevance. Copyright © 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  1. Dollar as the world's reserve currency: Challenges and prospects

    Directory of Open Access Journals (Sweden)

    Kovačević Radovan

    2014-01-01

    Full Text Available The US dollar gained the status of the world's reserve currency in the Bretton Woods system and has preserved it until the present day. Such position in international finance entails both advantages and disadvantages to the USA as the issuer of this currency, and to the rest of the world using it in trading, as store of value, and for the purpose of various financial operations and transactions. After the collapse of the Bretton Woods system, the regime of fixed FX rates was replaced by floating FX rates. Yet, regardless of this change, the dollar kept its role of the world's reserve currency. Numerous banking and currency crises following the transfer to the floating FX rates regime, along with the shifts in international capital flows, forced the developing countries and countries in transition to increase their FX reserves. In the tendency to store their value, central banks usually invest them into US Treasury securities, as liquid and reliable assets. However, due to the risk incurred by the reliance on a single national currency in the role of the world's reserve currency, there have been many proposals to reform the international monetary system. According to the current global tendencies, the most serious candidates for acquiring the status of the world's reserve currency in the future are the dollar, the euro, and the Chinese yuan.

  2. A General Business Model for Marine Reserves

    Science.gov (United States)

    Sala, Enric; Costello, Christopher; Dougherty, Dawn; Heal, Geoffrey; Kelleher, Kieran; Murray, Jason H.; Rosenberg, Andrew A.; Sumaila, Rashid

    2013-01-01

    Marine reserves are an effective tool for protecting biodiversity locally, with potential economic benefits including enhancement of local fisheries, increased tourism, and maintenance of ecosystem services. However, fishing communities often fear short-term income losses associated with closures, and thus may oppose marine reserves. Here we review empirical data and develop bioeconomic models to show that the value of marine reserves (enhanced adjacent fishing + tourism) may often exceed the pre-reserve value, and that economic benefits can offset the costs in as little as five years. These results suggest the need for a new business model for creating and managing reserves, which could pay for themselves and turn a profit for stakeholder groups. Our model could be expanded to include ecosystem services and other benefits, and it provides a general framework to estimate costs and benefits of reserves and to develop such business models. PMID:23573192

  3. Substantiating the Incurred but not Reported Reserve

    Directory of Open Access Journals (Sweden)

    Georgeta Vintilã

    2009-12-01

    Full Text Available In order to handle past and future liability taken by insurance contracts concluded, any insurance company must constitute and maintain technical reserves. Substantiating technical reserves is done through actuarial methods and its over-evaluation or under-evaluation influence solvency and financial performance of the insurance companies, in the sense of reducing solvency through over-evaluating reserves and, respectively, influencing profit (hence of outstanding tax through under-evaluating reserves. An important reserve for insurance companies is represented by the incurred but not reported reserve, as it allows the estimation of the liability the company may confront in the future, generated by events occurred in the past, which are not currently known in the present but will be reported in the future.

  4. Reserve valuation in electric power systems

    Science.gov (United States)

    Ruiz, Pablo Ariel

    Operational reliability is provided in part by scheduling capacity in excess of the load forecast. This reserve capacity balances the uncertain power demand with the supply in real time and provides for equipment outages. Traditionally, reserve scheduling has been ensured by enforcing reserve requirements in the operations planning. An alternate approach is to employ a stochastic formulation, which allows the explicit modeling of the sources of uncertainty. This thesis compares stochastic and reserve methods and evaluates the benefits of a combined approach for the efficient management of uncertainty in the unit commitment problem. Numerical studies show that the unit commitment solutions obtained for the combined approach are robust and superior with respect to the traditional approach. These robust solutions are especially valuable in areas with a high proportion of wind power, as their built-in flexibility allows the dispatch of practically all the available wind power while minimizing the costs of operation. The scheduled reserve has an economic value since it reduces the outage costs. In several electricity markets, reserve demand functions have been implemented to take into account the value of reserve in the market clearing process. These often take the form of a step-down function at the reserve requirement level, and as such they may not appropriately represent the reserve value. The value of reserve is impacted by the reliability, dynamic and stochastic characteristics of system components, the system operation policies, and the economic aspects such as the risk preferences of the demand. In this thesis, these aspects are taken into account to approximate the reserve value and construct reserve demand functions. Illustrative examples show that the demand functions constructed have similarities with those implemented in some markets.

  5. The energy reserves of our planet

    International Nuclear Information System (INIS)

    Bischoff, G.

    1977-01-01

    Starting from a prognosis for the development of the world energy consumption, the situation of special primary energy sources (reserves, potential) is briefly described. According to the amount and location of the reserves - 90% of the fossil energy reserves are in industrialized countries -, coal will play a leading role in meeting the energy demands of the future. Without breeder reactors, the role of nuclear energy will be limited in time. (UA) [de

  6. Reserve reporting from a banker's perspective

    International Nuclear Information System (INIS)

    Larson, B.O.

    1996-01-01

    A banker's perspective of oil and gas reserve reporting was presented. Topics chosen for discussion emphasized oil and gas lending, and the type of capital which is most relevant to the oil and gas industry. The concept of capital differentiation, potential worst case, and least specialization, were explained. An explanation of the reasons for the lender's different perspective on reserves was given. Methods that banks use to limit risk, and the role that reserve reports play in loan approvals were also reviewed

  7. IGT calculates world reserves of fossil fuels

    International Nuclear Information System (INIS)

    Anon.

    1986-01-01

    The Institute of Gas Technology has published the IGT World Reserves Survey, giving their latest tabulation of world reserves of fossil fuels and uranium. The report contains 120 Tables and 41 Figures. Estimates are provided for proved reserves, resources, current production, and life indexes of the non-renewable energy sources of the US and of the world as a whole. World regional data are also provided in many cases. The data are summarized here. 2 figures, 5 tables

  8. Reserve requirement systems in OECD countries

    OpenAIRE

    Yueh-Yun C. O’Brien

    2007-01-01

    This paper compares the reserve requirements of OECD countries. Reserve requirements are the minimum percentages or amounts of liabilities that depository institutions are required to keep in cash or as deposits with their central banks. To facilitate monetary policy implementation, twenty-four of the thirty OECD countries impose reserve requirements to influence their banking systems’ demand for liquidity. These include twelve OECD countries that are also members of the European Economic and...

  9. When will fossil fuel reserves be diminished?

    International Nuclear Information System (INIS)

    Shafiee, Shahriar; Topal, Erkan

    2009-01-01

    Crude oil, coal and gas are the main resources for world energy supply. The size of fossil fuel reserves and the dilemma that 'when non-renewable energy will be diminished' is a fundamental and doubtful question that needs to be answered. This paper presents a new formula for calculating when fossil fuel reserves are likely to be depleted and develops an econometrics model to demonstrate the relationship between fossil fuel reserves and some main variables. The new formula is modified from the Klass model and thus assumes a continuous compound rate and computes fossil fuel reserve depletion times for oil, coal and gas of approximately 35, 107 and 37 years, respectively. This means that coal reserves are available up to 2112, and will be the only fossil fuel remaining after 2042. In the Econometrics model, the main exogenous variables affecting oil, coal and gas reserve trends are their consumption and respective prices between 1980 and 2006. The models for oil and gas reserves unexpectedly show a positive and significant relationship with consumption, while presenting a negative and significant relationship with price. The econometrics model for coal reserves, however, expectedly illustrates a negative and significant relationship with consumption and a positive and significant relationship with price. Consequently, huge reserves of coal and low-level coal prices in comparison to oil and gas make coal one of the main energy substitutions for oil and gas in the future, under the assumption of coal as a clean energy source

  10. Reservation system with graphical user interface

    KAUST Repository

    Mohamed, Mahmoud A. Abdelhamid

    2012-01-05

    Techniques for providing a reservation system are provided. The techniques include displaying a scalable visualization object, wherein the scalable visualization object comprises an expanded view element of the reservation system depicting information in connection with a selected interval of time and a compressed view element of the reservation system depicting information in connection with one or more additional intervals of time, maintaining a visual context between the expanded view and the compressed view within the visualization object, and enabling a user to switch between the expanded view and the compressed view to facilitate use of the reservation system.

  11. Design and rationale of the MR-INFORM study: stress perfusion cardiovascular magnetic resonance imaging to guide the management of patients with stable coronary artery disease

    Directory of Open Access Journals (Sweden)

    Hussain Shazia T

    2012-09-01

    Full Text Available Abstract Background In patients with stable coronary artery disease (CAD, decisions regarding revascularisation are primarily driven by the severity and extent of coronary luminal stenoses as determined by invasive coronary angiography. More recently, revascularisation decisions based on invasive fractional flow reserve (FFR have shown improved event free survival. Cardiovascular magnetic resonance (CMR perfusion imaging has been shown to be non-inferior to nuclear perfusion imaging in a multi-centre setting and superior in a single centre trial. In addition, it is similar to invasively determined FFR and therefore has the potential to become the non-invasive test of choice to determine need for revascularisation. Trial design The MR-INFORM study is a prospective, multi-centre, randomised controlled non-inferiority, outcome trial. The objective is to compare the efficacy of two investigative strategies for the management of patients with suspected CAD. Patients presenting with stable angina are randomised into two groups: 1 The FFR-INFORMED group has subsequent management decisions guided by coronary angiography and fractional flow reserve measurements. 2 The MR-INFORMED group has decisions guided by stress perfusion CMR. The primary end-point will be the occurrence of major adverse cardiac events (death, myocardial infarction and repeat revascularisation at one year. Clinical trials.gov identifier NCT01236807. Conclusion MR INFORM will assess whether an initial strategy of CMR perfusion is non-inferior to invasive angiography supplemented by FFR measurements to guide the management of patients with stable coronary artery disease. Non-inferiority of CMR perfusion imaging to the current invasive reference standard (FFR would establish CMR perfusion imaging as an attractive non-invasive alternative to current diagnostic pathways.

  12. 7 CFR 1221.114 - Operating reserve.

    Science.gov (United States)

    2010-01-01

    ... Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING... INFORMATION ORDER Sorghum Promotion, Research, and Information Order Sorghum Promotion, Research, and Information Board § 1221.114 Operating reserve. The Board may establish an operating monetary reserve and may...

  13. 24 CFR 891.855 - Replacement reserves.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserves. 891.855... § 891.855 Replacement reserves. (a) The mixed-finance owner shall establish and maintain a replacement... the funds will be used to pay for capital replacement costs for the Section 202 or 811 supportive...

  14. 40 CFR 406.43 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 406.43 Section 406.43 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GRAIN MILLS POINT SOURCE CATEGORY Bulgur Wheat Flour Milling Subcategory § 406.43 [Reserved] ...

  15. 40 CFR 406.23 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 406.23 Section 406.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GRAIN MILLS POINT SOURCE CATEGORY Corn Dry Milling Subcategory § 406.23 [Reserved] ...

  16. 40 CFR 406.13 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 406.13 Section 406.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GRAIN MILLS POINT SOURCE CATEGORY Corn Wet Milling Subcategory § 406.13 [Reserved] ...

  17. 41 CFR 101-39.205 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... FEDERAL PROPERTY MANAGEMENT REGULATIONS AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.2-GSA Interagency Fleet Management System Services § 101-39.205 [Reserved] ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true [Reserved] 101-39.205...

  18. 22 CFR 99.3 - [Reserved

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false [Reserved] 99.3 Section 99.3 Foreign Relations DEPARTMENT OF STATE LEGAL AND RELATED SERVICES REPORTING ON CONVENTION AND NON-CONVENTION ADOPTIONS OF EMIGRATING CHILDREN § 99.3 [Reserved] ...

  19. 14 CFR 99.12 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false [Reserved] 99.12 Section 99.12 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES SECURITY CONTROL OF AIR TRAFFIC General § 99.12 [Reserved] ...

  20. 26 CFR 1.46-10 - [Reserved

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 1 2010-04-01 2010-04-01 true [Reserved] 1.46-10 Section 1.46-10 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Rules for Computing Credit for Investment in Certain Depreciable Property § 1.46-10 [Reserved] ...

  1. 26 CFR 48.4161(b) - [Reserved

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 16 2010-04-01 2010-04-01 true [Reserved] 48.4161(b) Section 48.4161(b) Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) MISCELLANEOUS EXCISE TAXES MANUFACTURERS AND RETAILERS EXCISE TAXES Sporting Goods § 48.4161(b) [Reserved] ...

  2. 26 CFR 48.4161(a) - [Reserved

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 16 2010-04-01 2010-04-01 true [Reserved] 48.4161(a) Section 48.4161(a) Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) MISCELLANEOUS EXCISE TAXES MANUFACTURERS AND RETAILERS EXCISE TAXES Sporting Goods § 48.4161(a) [Reserved] ...

  3. 20 CFR 410.394 - [Reserved

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false [Reserved] 410.394 Section 410.394 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Relationship and Dependency § 410.394 [Reserved] ...

  4. 7 CFR 1900.57 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1900.57 Section 1900.57 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE... GENERAL Adverse Decisions and Administrative Appeals § 1900.57 [Reserved] ...

  5. 39 CFR 111.5 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false [Reserved] 111.5 Section 111.5 Postal Service UNITED STATES POSTAL SERVICE POST OFFICE SERVICES [DOMESTIC MAIL] GENERAL INFORMATION ON POSTAL SERVICE § 111.5 [Reserved] ...

  6. 29 CFR 579.4 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false [Reserved] 579.4 Section 579.4 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS CHILD LABOR VIOLATIONS-CIVIL MONEY PENALTIES § 579.4 [Reserved] ...

  7. 19 CFR 210.22 - [Reserved

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 3 2010-04-01 2010-04-01 false [Reserved] 210.22 Section 210.22 Customs Duties UNITED STATES INTERNATIONAL TRADE COMMISSION INVESTIGATIONS OF UNFAIR PRACTICES IN IMPORT TRADE ADJUDICATION AND ENFORCEMENT Motions § 210.22 [Reserved] ...

  8. 12 CFR 614.4710 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false [Reserved] 614.4710 Section 614.4710 Banks and Banking FARM CREDIT ADMINISTRATION FARM CREDIT SYSTEM LOAN POLICIES AND OPERATIONS Banks for Cooperatives and Agricultural Credit Banks Financing International Trade § 614.4710 [Reserved] ...

  9. 12 CFR 996.1 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false [Reserved] 996.1 Section 996.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD NON-BANK SYSTEM ENTITIES AUTHORITY FOR BANK ASSISTANCE OF THE RESOLUTION FUNDING CORPORATION § 996.1 [Reserved] ...

  10. 29 CFR 4.106 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true [Reserved] 4.106 Section 4.106 Labor Office of the Secretary of Labor LABOR STANDARDS FOR FEDERAL SERVICE CONTRACTS Application of the McNamara-O'Hara Service Contract Act Introductory § 4.106 [Reserved] Agencies Whose Contracts May Be Covered ...

  11. 46 CFR 308.301 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false [Reserved] 308.301 Section 308.301 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.301 [Reserved] ...

  12. 46 CFR 308.305 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 8 2010-10-01 2010-10-01 false [Reserved] 308.305 Section 308.305 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION EMERGENCY OPERATIONS WAR RISK INSURANCE Second Seamen's War Risk Insurance § 308.305 [Reserved] ...

  13. 7 CFR 1709.2 Policy. - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false [Reserved] 1709.2 Policy. Section 1709.2 Policy. Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES General Requirements § 1709.2 Policy. [Reserved] ...

  14. 7 CFR 1709.202 Policy. - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 11 2010-01-01 2010-01-01 false [Reserved] 1709.202 Policy. Section 1709.202 Policy... AGRICULTURE ASSISTANCE TO HIGH ENERGY COST COMMUNITIES Bulk Fuel Revolving Fund Grant Program § 1709.202 Policy. [Reserved] ...

  15. 15 CFR 2003.3 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false [Reserved] 2003.3 Section 2003.3 Commerce and Foreign Trade Regulations Relating to Foreign Trade Agreements OFFICE OF THE UNITED STATES TRADE REPRESENTATIVE REGULATIONS OF TRADE POLICY STAFF COMMITTEE § 2003.3 [Reserved] ...

  16. Price, technology, and ore reserves, ch. 2

    International Nuclear Information System (INIS)

    McAllister, A.L.

    1976-01-01

    Factors determining ore reserves in view of future uses are investigated: existing mining technologies, new techniques, price-technology relationship, effects of the use of different energy sources, exploration techniques, and price change are discussed. The effect of price and technology on reserves of specific commodities is dealth with. A section is also devoted to uranium

  17. 21 CFR 211.170 - Reserve samples.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 4 2010-04-01 2010-04-01 false Reserve samples. 211.170 Section 211.170 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS: GENERAL... of deterioration unless visual examination would affect the integrity of the reserve sample. Any...

  18. 48 CFR 4.501 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false [Reserved] 4.501 Section 4.501 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL ADMINISTRATIVE MATTERS Electronic Commerce in Contracting 4.501 [Reserved] ...

  19. 5 CFR 9901.513 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false [Reserved] 9901.513 Section 9901.513 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT... (NSPS) Staffing and Employment External Recruitment and Internal Placement § 9901.513 [Reserved] ...

  20. 31 CFR 281.2 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false [Reserved] 281.2 Section 281.2 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE FOREIGN EXCHANGE OPERATIONS § 281.2 [Reserved] ...

  1. 7 CFR 1776.4 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 12 2010-01-01 2010-01-01 false [Reserved] 1776.4 Section 1776.4 Agriculture Regulations of the Department of Agriculture (Continued) RURAL UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE (CONTINUED) HOUSEHOLD WATER WELL SYSTEM GRANT PROGRAM General § 1776.4 [Reserved] ...

  2. 49 CFR 17.4 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false [Reserved] 17.4 Section 17.4 Transportation Office of the Secretary of Transportation INTERGOVERNMENTAL REVIEW OF DEPARTMENT OF TRANSPORTATION PROGRAMS AND ACTIVITIES § 17.4 [Reserved] ...

  3. 7 CFR 1962.5 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 14 2010-01-01 2009-01-01 true [Reserved] 1962.5 Section 1962.5 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE... REGULATIONS (CONTINUED) PERSONAL PROPERTY Servicing and Liquidation of Chattel Security § 1962.5 [Reserved] ...

  4. 18 CFR 284.125 - [Reserved

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false [Reserved] 284.125 Section 284.125 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT... Certain Transportation by Intrastate Pipelines § 284.125 [Reserved] ...

  5. 40 CFR 73.32 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false [Reserved] 73.32 Section 73.32 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) SULFUR DIOXIDE ALLOWANCE SYSTEM Allowance Tracking System § 73.32 [Reserved] ...

  6. 40 CFR 73.51 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false [Reserved] 73.51 Section 73.51 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) SULFUR DIOXIDE ALLOWANCE SYSTEM Allowance Transfers § 73.51 [Reserved] ...

  7. 40 CFR 73.11 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false [Reserved] 73.11 Section 73.11 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) SULFUR DIOXIDE ALLOWANCE SYSTEM Allowance Allocations § 73.11 [Reserved] ...

  8. 7 CFR 801.10 - [Reserved

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 7 2010-01-01 2010-01-01 false [Reserved] 801.10 Section 801.10 Agriculture Regulations of the Department of Agriculture (Continued) GRAIN INSPECTION, PACKERS AND STOCKYARD... FOR GRAIN INSPECTION EQUIPMENT § 801.10 [Reserved] ...

  9. 40 CFR 26.1124 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 1 2010-07-01 2010-07-01 false [Reserved] 26.1124 Section 26.1124 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL PROTECTION OF HUMAN SUBJECTS Basic Ethical...-nursing Adults § 26.1124 [Reserved] ...

  10. The Economics of NASA Mission Cost Reserves

    Science.gov (United States)

    Whitley, Sally; Shinn, Stephen

    2012-01-01

    Increases in NASA mission costs are well-noted but not well-understood, and there is little evidence that they are decreasing in frequency or amount over time. The need to control spending has led to analysis of the causes and magnitude of historical mission overruns, and many program control efforts are being implemented to attempt to prevent or mitigate the problem (NPR 7120). However, cost overruns have not abated, and while some direct causes of increased spending may be obvious (requirements creep, launch delays, directed changes, etc.), the underlying impetus to spend past the original budget may be more subtle. Gaining better insight into the causes of cost overruns will help NASA and its contracting organizations to avoid .them. This paper hypothesizes that one cause of NASA mission cost overruns is that the availability of reserves gives project team members an incentive to make decisions and behave in ways that increase costs. We theorize that the presence of reserves is a contributing factor to cost overruns because it causes organizations to use their funds less efficiently or to control spending less effectively. We draw a comparison to the insurance industry concept of moral hazard, the phenomenon that the presence of insurance causes insureds to have more frequent and higher insurance losses, and we attempt to apply actuarial techniques to quantifY the increase in the expected cost of a mission due to the availability of reserves. We create a theoretical model of reserve spending motivation by defining a variable ReserveSpending as a function of total reserves. This function has a positive slope; for every dollar of reserves available, there is a positive probability of spending it. Finally, the function should be concave down; the probability of spending each incremental dollar of reserves decreases progressively. We test the model against available NASA CADRe data by examining missions with reserve dollars initially available and testing whether

  11. Disclosure of oil and gas reserve information

    International Nuclear Information System (INIS)

    Emsile, B.H.

    1998-01-01

    The current regulations regarding disclosure of oil and gas reserve information in Canada are described. These regulations have been in place since the early 1980s and have generally worked well, but there are some issues that need to be updated. The Alberta Securities Commission Oil and Gas Securities Task Force was established to review the regulations and the major issues that need to be addressed. The issues under consideration are: (1) reserve definitions and price assumptions, (2) use of deterministic or probabilistic reserve calculation methods, (3) use of audits in reserve reporting, (4) abandonment costs, (5) calculation of barrels of oil equivalents, and (6) the calculation of various performance indicators such as finding and development costs and reserve replacement ratios

  12. Influence of Microcirculatory Dysfunction on Angiography-Based Functional Assessment of Coronary Stenoses.

    Science.gov (United States)

    Mejía-Rentería, Hernán; Lee, Joo Myung; Lauri, Francesco; van der Hoeven, Nina W; de Waard, Guus A; Macaya, Fernando; Pérez-Vizcayno, María José; Gonzalo, Nieves; Jiménez-Quevedo, Pilar; Nombela-Franco, Luis; Salinas, Pablo; Núñez-Gil, Iván; Del Trigo, María; Goto, Sonoka; Lee, Hyun Jong; Liontou, Catherine; Fernández-Ortiz, Antonio; Macaya, Carlos; van Royen, Niels; Koo, Bon-Kwon; Escaned, Javier

    2018-04-23

    The authors sought to evaluate the influence of coronary microcirculatory dysfunction (CMD) on the diagnostic performance of the quantitative flow ratio (QFR). Functional angiographic assessment of coronary stenoses based on fluid dynamics, such as QFR, constitutes an attractive alternative to fractional flow reserve (FFR). However, it is unknown whether CMD affects the reliability of angiography-based functional indices. FFR and the index of microcirculatory resistance (IMR) were measured in 300 vessels (248 patients) as part of a multicenter international registry. QFR was calculated at a blinded core laboratory. Vessels were classified into 2 groups according to microcirculatory status: low IMR (<23 U), and high IMR (≥23 U, CMD). The impact of CMD on the diagnostic performance of QFR, as well as on incremental value of QFR over quantitative angiography, was assessed using FFR as reference. Percent diameter stenosis (%DS) and FFR were similar in low- and high-IMR groups (%DS 51 ± 12% vs. 53 ± 11%; p = 0.16; FFR 0.80 ± 0.11 vs. 0.81 ± 0.11; p = 0.23, respectively). In the overall cohort, classification agreement (CA) between QFR and FFR and diagnostic efficiency of QFR (area under the receiver-operating characteristics curve [AUC]) were high (CA: 88%; AUC: 0.93 [95% confidence interval (CI): 0.90 to 0.96]). However, when assessed according to microcirculatory status, a significantly lower CA and AUC of QFR were found in the high-IMR group as compared with the low-IMR group (CA: 76% vs. 92%; p < 0.001; AUC: 0.88 [95% CI: 0.79 to 0.94] vs. 0.96 [95% CI: 0.92 to 0.98]; p < 0.05). Compared with angiographic assessment, QFR increased by 0.20 (p < 0.001) and by 0.16 (p < 0.001) the AUC of %DS in low- and high-IMR groups, respectively. Independent predictors of misclassification between QFR and FFR were high IMR and acute coronary syndrome. CMD decreases the diagnostic performance of QFR. However, even in the presence of CMD, QFR remains superior to

  13. CURRENT APPROACHES TO EVALUATION OF THE MULTIVESSEL CORONARY ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    D. N. Perutsky

    2011-01-01

    Full Text Available Aim. To determine the validity of stress echocardiography by fractional reserve blood flow (FFR as the reference method in detection of coronary arteries requiring revascularization, as well as to optimize the determination of the functional significance of coronary artery lesions in patients with multivessel coronary atherosclerosis. Material and methods. Patients (n=36 with stable angina class 2-3 with multivessel coronary atherosclerosis were included into the study. Stress echocardiography with dobutamine or exercise test (treadmill was performed in all patients. Selective coronary angiography with subsequent evaluation of FFR was carried out in patients with a positive result of stress echocardiography. Totally 108 arteries (87 with stenosing atherosclerosis were assessed.  Results. According to coronary angiography bi-vessel and three-vessel damages were revealed in 21 (58% and 15 (42% patients, respectively. Method of stress echocardiography as compared with FFR shown sensitivity — 58%, specificity — 95%, positive predictive value — 87%, positive predictive value of a negative result — 17%. Method of coronary angiography (as a method to detect significant stenosis by visual assessment of coronary artery as compared with FFR demonstrated sensitivity 100%, specificity — 30%, positive predictive value — 42%. Conclusion. Stress echocardiography for noninvasive patient examination improves the accuracy of determination for the need and extent of revascularization.

  14. Reserves and Trade Jointly Determine Exposure to Food Supply Shocks

    Science.gov (United States)

    Marchand, Philippe; Carr, Joel A.; Dell'Angelo, Jampel; Fader, Marianela; Gephart, Jessica A.; Kummu, Matti; Magliocca, Nicholas; Porkka, Miina; Puma, Michael J.; Zak, Ratajczak

    2016-01-01

    While a growing proportion of global food consumption is obtained through international trade, there is an ongoing debate on whether this increased reliance on trade benefits or hinders food security, and specifically, the ability of global food systems to absorb shocks due to local or regional losses of production. This paper introduces a model that simulates the short-term response to a food supply shock originating in a single country, which is partly absorbed through decreases in domestic reserves and consumption, and partly transmitted through the adjustment of trade flows. By applying the model to publicly-available data for the cereals commodity group over a 17 year period, we find that differential outcomes of supply shocks simulated through this time period are driven not only by the intensification of trade, but as importantly by changes in the distribution of reserves. Our analysis also identifies countries where trade dependency may accentuate the risk of food shortages from foreign production shocks; such risk could be reduced by increasing domestic reserves or importing food from a diversity of suppliers that possess their own reserves. This simulation-based model provides a framework to study the short-term, nonlinear and out-of-equilibrium response of trade networks to supply shocks, and could be applied to specific scenarios of environmental or economic perturbations.

  15. High flow ceramic pot filters.

    Science.gov (United States)

    van Halem, D; van der Laan, H; Soppe, A I A; Heijman, S G J

    2017-11-01

    Ceramic pot filters are considered safe, robust and appropriate technologies, but there is a general consensus that water revenues are limited due to clogging of the ceramic element. The objective of this study was to investigate the potential of high flow ceramic pot filters to produce more water without sacrificing their microbial removal efficacy. High flow pot filters, produced by increasing the rice husk content, had a higher initial flow rate (6-19 L h -1 ), but initial LRVs for E. coli of high flow filters was slightly lower than for regular ceramic pot filters. This disadvantage was, however, only temporarily as the clogging in high flow filters had a positive effect on the LRV for E. coli (from below 1 to 2-3 after clogging). Therefore, it can be carefully concluded that regular ceramic pot filters perform better initially, but after clogging, the high flow filters have a higher flow rate as well as a higher LRV for E. coli. To improve the initial performance of new high flow filters, it is recommended to further utilize residence time of the water in the receptacle, since additional E. coli inactivation was observed during overnight storage. Although a relationship was observed between flow rate and LRV of MS2 bacteriophages, both regular and high flow filters were unable to reach over 2 LRV. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. The impact of tissue Doppler index E/e' ratio on instantaneous wave-free ratio.

    Science.gov (United States)

    Arashi, Hiroyuki; Yamaguchi, Junichi; Ri, Tonre; Otsuki, Hisao; Nakao, Masashi; Kamishima, Kazuho; Jujo, Kentaro; Minami, Yuichiro; Ogawa, Hiroshi; Hagiwara, Nobuhisa

    2018-03-01

    The instantaneous wave-free ratio (iFR) is a vasodilator-free, invasive pressure wire index of the functional severity of coronary stenosis and is calculated under resting conditions. In a recent study, iFR was found to be more closely linked to coronary flow reserve (CFR) than fractional flow reserve (FFR). E/e' is a surrogate marker of left ventricular (LV) filling pressure and LV diastolic dysfunction. Coronary resting flow was found to be increased in patients with elevated E/e', and higher coronary resting flow was associated with lower CFR. Higher baseline coronary flow induces a greater loss of translesional pressure and may affect iFR. However, no reports have examined the impact of E/e' on iFR. The purpose of this study was to assess the relationship between iFR and E/e' compared with FFR. We retrospectively examined 103 consecutive patients (142 with stenosis) whose iFR, FFR, and E/e' were measured simultaneously. The mean age, LV mass index, and systolic blood pressure of patients with elevated E/e' were higher than those of patients with normal E/e'. Although no significant differences were observed in mean FFR values and % diameter stenosis, the mean iFR value in patients with elevated E/e' was significantly lower than that in patients with normal E/e'. The iFR was negatively correlated with E/e', while there was no correlation between FFR and E/e'. Multivariate analysis showed that E/e' and % diameter stenosis were independent determinants of iFR. E/e' ratio affects iFR values. Our results suggest that FFR mainly reflects the functional severity of the epicardial stenosis whereas iFR could potentially be influenced by not only epicardial stenosis but also other factors related to LV filling pressure or LV diastolic dysfunction. Further research is needed to understand the underlying mechanisms that influence the evaluation of iFR in patients with elevated E/e'. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights

  17. The Economics of NASA Mission Cost Reserves

    Science.gov (United States)

    Whitley, Sally; Shinn, Stephen

    2012-01-01

    Increases in NASA mission costs have led to analysis of the causes and magnitude of historical mission overruns as well as mitigation and prevention attempts. This paper hypothesizes that one cause is that the availability of reserves may reduce incentives to control costs. We draw a comparison to the insurance concept of moral hazard, and we use actuarial techniques to better understand the increase in mission costs due to the availability of reserves. NASA's CADRe database provided the data against which we tested our hypothesis and discovered that there is correlation between the amount of available reserves and project overruns, particularly for mission hardware cost increases. We address the question of how to prevent reserves from increasing mission spending without increasing cost risk to projects.

  18. Transforming the Reserve Component: Four Essays

    National Research Council Canada - National Science Library

    Binnendijk, Hans; Baranick, Michael J; Bell, Raymond E., Jr; Cordero, Gina; Duncan, Stephen M; Holshek, Christopher; Wentz, Larry

    2005-01-01

    .... The first essay calls for a fundamental restructuring of the Reserve Component in light of the largest mobilization since the Korean War, which has been fraught with problems in terms of combat...

  19. Phytosociological classification of the Nylsvley nature reserve

    CSIR Research Space (South Africa)

    Coetzee, BJ

    1977-12-01

    Full Text Available The vegetation of the Nylsvley Nature Reserve in the Transvaal Mixed Bushveld is classified hierarchically by the Braun-Blanquet method of vegetation survey. The vegetation is seasonal grassland and deciduous savanna with four floristically distinct...

  20. 24 CFR 266.110 - Reserve requirements.

    Science.gov (United States)

    2010-04-01

    ... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Housing Finance Agency Requirements § 266.110 Reserve requirements. (a) HFAs with top-tier designation or overall...

  1. 49 CFR 392.15 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS DRIVING OF COMMERCIAL MOTOR VEHICLES Driving of Commercial Motor Vehicles § 392.15 [Reserved] ...

  2. 49 CFR 392.18 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS DRIVING OF COMMERCIAL MOTOR VEHICLES Driving of Commercial Motor Vehicles § 392.18 [Reserved] ...

  3. 45 CFR 400.6 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Grants to States for Refugee Resettlement The State Plan § 400.6 [Reserved] ...

  4. 49 CFR 192.57 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Materials § 192.57 [Reserved] ...

  5. 49 CFR 192.61 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Other Regulations Relating to Transportation (Continued) PIPELINE AND HAZARDOUS MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY TRANSPORTATION OF NATURAL AND OTHER GAS BY PIPELINE: MINIMUM FEDERAL SAFETY STANDARDS Materials § 192.61 [Reserved] ...

  6. Uniform Reserve Training and Retirement Category Administration

    National Research Council Canada - National Science Library

    Kohner, D

    1997-01-01

    This Instruction implement policy as provided in DoD Directive 1215.6, assigns responsibilities and prescribes procedures that pertain to the designation and use of uniform Reserve component (RC) categories (RCCs...

  7. U.S. Federal Reserve Systems

    Data.gov (United States)

    Department of Homeland Security — This dataset is comprised of forty-five entities that are part of the United States Federal Reserve System according to the United States Department of Treasury. The...

  8. 48 CFR 9904.405-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.405-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.405-10 [Reserved] ...

  9. 48 CFR 9904.402-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.402-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.402-10 [Reserved] ...

  10. 48 CFR 9904.409-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.409-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.409-10 [Reserved] ...

  11. 48 CFR 9904.408-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.408-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.408-10 [Reserved] ...

  12. 48 CFR 9904.401-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.401-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.401-10 [Reserved] ...

  13. 48 CFR 9904.403-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.403-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.403-10 [Reserved] ...

  14. 48 CFR 9904.406-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.406-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.406-10 [Reserved] ...

  15. 48 CFR 9904.404-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.404-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.404-10 [Reserved] ...

  16. 48 CFR 9904.400 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.400 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.400 [Reserved] ...

  17. 48 CFR 9904.410-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.410-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.410-10 [Reserved] ...

  18. 48 CFR 9904.407-10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Section 9904.407-10 Federal Acquisition Regulations System COST ACCOUNTING STANDARDS BOARD, OFFICE OF FEDERAL PROCUREMENT POLICY, OFFICE OF MANAGEMENT AND BUDGET PROCUREMENT PRACTICES AND COST ACCOUNTING STANDARDS COST ACCOUNTING STANDARDS 9904.407-10 [Reserved] ...

  19. Communicating marine reserve science to diverse audiences

    Science.gov (United States)

    Grorud-Colvert, Kirsten; Lester, Sarah E.; Airamé, Satie; Neeley, Elizabeth; Gaines, Steven D.

    2010-01-01

    As human impacts cause ecosystem-wide changes in the oceans, the need to protect and restore marine resources has led to increasing calls for and establishment of marine reserves. Scientific information about marine reserves has multiplied over the last decade, providing useful knowledge about this tool for resource users, managers, policy makers, and the general public. This information must be conveyed to nonscientists in a nontechnical, credible, and neutral format, but most scientists are not trained to communicate in this style or to develop effective strategies for sharing their scientific knowledge. Here, we present a case study from California, in which communicating scientific information during the process to establish marine reserves in the Channel Islands and along the California mainland coast expanded into an international communication effort. We discuss how to develop a strategy for communicating marine reserve science to diverse audiences and highlight the influence that effective science communication can have in discussions about marine management. PMID:20427745

  20. 24 CFR 206.115 - [Reserved

    Science.gov (United States)

    2010-04-01

    ... MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES HOME EQUITY CONVERSION MORTGAGE INSURANCE Contract Rights and Obligations Mortgage Insurance Premiums § 206.115 [Reserved] ...

  1. Army Reserve Military Intelligence: Time for Change

    Science.gov (United States)

    2010-04-20

    Miramax Books, 2002. Goleman , Daniel . Emotional Intelligence . New York: Bantam Books, 1997. Goleman , Daniel , Richard Boyatzis, and Annie McKee...or position of the Department of the Army, Department of Defense, or the U.S. Government. ARMY RESERVE MILITARY INTELLIGENCE : TIME FOR CHANGE...Research Project 3. DATES COVERED 00-00-2009 to 00-00-2010 4. TITLE AND SUBTITLE Army Reserve Military Intelligence : Time for Change 5a

  2. Leadership Stability in Army Reserve Component Units

    Science.gov (United States)

    2013-01-01

    OMB control number. 1. REPORT DATE 2013 2. REPORT TYPE 3. DATES COVERED 00-00-2013 to 00-00-2013 4. TITLE AND SUBTITLE Leadership Stability in...standards for research quality and objectivity. Leadership Stability in Army Reserve Component Units Thomas F. Lippiatt, J. Michael Polich NATIONAL SECURITY...RESEARCH DIVISION Leadership Stability in Army Reserve Component Units Thomas F. Lippiatt, J. Michael Polich Prepared for the Office of the

  3. Exploration report in mining reserve XIV

    International Nuclear Information System (INIS)

    Spoturno Pioppo, J.; Lara Vigil, P.

    1991-01-01

    This report has been referred to the antecedents and works developed in the mining Reservation XIV. This Reservation, covered a 1900 km2 surface, involving the aerial photography Valentines Cerro Chato, Chileno, Rossel y Rius, Sarandi del Yi and Cuchilla del Pescado. It has been reduced this area to western part of the aerial phothograpy Pavas, releasing other areas such as Chileno, Rossel y Rius, Cuchilla del Pescado y Cerro Chato. Finally, gold, sulphures, pirite and carbonates iron oxides findings have been found.

  4. Unanswered Quibbles with Fractional Reserve Free Banking

    OpenAIRE

    Bagus, Philipp; Howden, David

    2011-01-01

    In this article we reply to George Selgin’s counterarguments to our article “Fractional Reserve Free Banking: Some Quibbles”. Selgin regards holding cash as saving while we focus on the real savings necessary to maintain investment projects. Real savings are unconsumed real income. Variations in real savings are not necessarily equal to variations in cash holdings. We show that a coordinated credit expansion in a fractional reserve free banking (FRFB) system is possible and that precautionary...

  5. Required reserves as a credit policy tool

    OpenAIRE

    Mimir, Yasin; Sunel, Enes; Taskin, Temel

    2012-01-01

    This paper conducts a quantitative investigation of the role of reserve requirements as a macroprudential policy tool. We build a monetary DSGE model with a banking sector in which (i) an agency problem between households and banks leads to endogenous capital constraints for banks in obtaining funds from households, (ii) banks are subject to time-varying reserve requirements that countercyclically respond to expected credit growth, (iii) households face cash-in-advance constraints, requiring ...

  6. Status of fossil fuel reserves; Etat des reserves des combustibles fossiles

    Energy Technology Data Exchange (ETDEWEB)

    Laherrere, J

    2005-07-01

    Reserves represent the sum of past and future productions up to the end of production. In most countries the reserve data of fields are confidential. Therefore, fossil fuel reserves are badly known because the published data are more political than technical and many countries make a confusion between resources and reserves. The cumulated production of fossil fuels represents only between a third and a fifth of the ultimate reserves. The production peak will take place between 2020 and 2050. In the ultimate reserves, which extrapolate the past, the fossil fuels represent three thirds of the overall energy. This document analyses the uncertainties linked with fossil fuel reserves: reliability of published data, modeling of future production, comparison with other energy sources, energy consumption forecasts, reserves/production ratio, exploitation of non-conventional hydrocarbons (tar sands, extra-heavy oils, bituminous shales, coal gas, gas shales, methane in overpressure aquifers, methane hydrates), technology impacts, prices impact, and reserves growth. (J.S.)

  7. Selling the SPR [Strategic Petroleum Reserve

    International Nuclear Information System (INIS)

    Gurney, J.

    1997-01-01

    The Strategic Petroleum Reserve (SPR) in the USA was created in 1975, in conjunction with the wider reserve programme of the International Energy Agency, following the 1973/74 Arab oil embargo. The only source of funding for the SPR has been annual appropriations bills from Congress. In 1994, however, Congress, seeking ways to balance the nation's budget and given the perception by many free market economists that the danger of serious oils supply disruption has passed, refused to allocate funds for SPR oil purchases. No crude oil stocks have been added to the reserve since then. In 1996, congress took the further step of requiring sales of oil from the reserve in order to pay for the programme's running costs and to meet the costs of maintaining the reserve's storage facilities. The reserve oil is stored in caverns under salt domes in the coastal regions of the Gulf of Mexico and some of these are beginning to fracture to the extent that they are having to be decommissioned. The SPR has been investigating ways of raising money in order to lessen its dependence on Congress. These include leasing pipelines and a marine terminal, and allowing the storage of foreign owned oil in underused caverns. (author)

  8. Do we need invasive confirmation of cardiac magnetic resonance results?

    Directory of Open Access Journals (Sweden)

    Paweł Siastała

    2017-03-01

    Full Text Available Introduction : Coronary artery revascularization is indicated in patients with documented significant obstruction of coronary blood flow associated with a large area of myocardial ischemia and/or untreatable symptoms. There are a few invasive or noninvasive methods that can provide information about the functional results of coronary artery narrowing. The application of more than one method of ischemia detection in one patient to reevaluate the indications for revascularization is used in case of atypical or no symptoms and/or borderline stenosis. Aim : To evaluate whether the results of cardiac magnetic resonance need to be reconfirmed by the invasive functional method. Material and methods : The hospital database revealed 25 consecutive patients with 29 stenoses who underwent cardiac magnetic resonance (CMR and fractional flow reserve (FFR between the end of 2010 and the end of 2014. The maximal time interval between CMR and FFR was 6 months. None of the patients experienced any clinical events or underwent procedures on coronary arteries between the studies. Results: According to the analysis, the agreement of CMR perfusion with the FFR method was at the level of 89.7%. Assuming that FFR is the gold standard in assessing the severity of stenoses, the sensitivity of CMR perfusion was 90.9%. The percentage of non-severe lesions which were correctly identified in CMR was 88.9%. Conclusions : The study shows that CMR perfusion is a highly sensitive method to detect hemodynamically significant CAD and exclude nonsevere lesions. With FFR as the reference standard, the diagnostic accuracy of MR perfusion to detect ischemic CAD is high.

  9. Vortical flows

    International Nuclear Information System (INIS)

    Wu, Jie-Zhi; Ma, Hui-Yang; Zhou, Ming-De

    2015-01-01

    This book is a comprehensive and intensive book for graduate students in fluid dynamics as well as scientists, engineers and applied mathematicians. Offering a systematic introduction to the physical theory of vortical flows at graduate level, it considers the theory of vortical flows as a branch of fluid dynamics focusing on shearing process in fluid motion, measured by vorticity. It studies vortical flows according to their natural evolution stages,from being generated to dissipated. As preparation, the first three chapters of the book provide background knowledge for entering vortical flows. The rest of the book deals with vortices and vortical flows, following their natural evolution stages. Of various vortices the primary form is layer-like vortices or shear layers, and secondary but stronger form is axial vortices mainly formed by the rolling up of shear layers. Problems are given at the end of each chapter and Appendix, some for helping understanding the basic theories, and some involving specific applications; but the emphasis of both is always on physical thinking.

  10. Vortical flows

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Jie-Zhi [Peking Univ., Beijing (China). College of Engineering; Ma, Hui-Yang [Univ. of Chinese Academy of Sciences, Beijing (China). Dept. of Physics; Zhou, Ming-De [Arizona Univ., Tucson, AZ (United States). Dept. of Aerospace and Mechanical Engineering

    2015-11-01

    This book is a comprehensive and intensive book for graduate students in fluid dynamics as well as scientists, engineers and applied mathematicians. Offering a systematic introduction to the physical theory of vortical flows at graduate level, it considers the theory of vortical flows as a branch of fluid dynamics focusing on shearing process in fluid motion, measured by vorticity. It studies vortical flows according to their natural evolution stages,from being generated to dissipated. As preparation, the first three chapters of the book provide background knowledge for entering vortical flows. The rest of the book deals with vortices and vortical flows, following their natural evolution stages. Of various vortices the primary form is layer-like vortices or shear layers, and secondary but stronger form is axial vortices mainly formed by the rolling up of shear layers. Problems are given at the end of each chapter and Appendix, some for helping understanding the basic theories, and some involving specific applications; but the emphasis of both is always on physical thinking.

  11. Environmental and developmental origins of ovarian reserve.

    Science.gov (United States)

    Richardson, M C; Guo, M; Fauser, B C J M; Macklon, N S

    2014-01-01

    BACKGROUND Oocyte number is established early in life before a gradual loss of this ovarian reserve during reproductive life until oocyte availability becomes limiting at the menopause. Although there is a large genetic component to the ovarian reserve achieved before birth, other influences including the maternal endocrine and nutritional milieu, and environmental factors may represent important developmental determinants. Environmental and nutritional factors may also modify the downward trajectory of ovarian reserve in adult life. The combination of these early and later life influences has the potential to lead to diminished ovarian reserve, compromising fertility in later reproductive years and altering age at natural menopause. METHODS Literature searches of the ISI Web of Knowledge database were carried out using the main terms 'ovarian reserve' and 'menopause AND age' in conjunction with a range of other terms encompassing a variety of factors with potential effects on ovarian reserve. The various searches were inspected manually and the relevant papers selected for critical analysis and interpretation. RESULTS Evidence was identified supporting the view that elevated prenatal androgens have an adverse effect on the early establishment of ovarian reserve, although the implications for ovarian reserve in the polycystic ovary syndrome (which may also be programmed through prenatal androgen exposure) remain uncertain. Recent evidence is cited suggesting that effects of maternal nutrient restriction on ovarian reserve may also involve changes in prenatal androgen exposure. A general rationale is developed through examination of evidence which emphasizes the roles of the aryl hydrocarbon receptor (AHR) and the estrogen receptor (ER) systems in ovarian reserve modulation. Because of their similarity to the natural ligands, many environmental compounds have the ability to bind to these receptors (albeit at lower affinities) and thereby have the potential to

  12. Micro-level stochastic loss reserving

    NARCIS (Netherlands)

    Antonio, K.; Plat, R.

    2010-01-01

    With the introduction of Solvency 2 (in 2012) and IFRS 4 Phase 2 (in 2013) insurers face major challenges. The measurement of future cash flows and its uncertainty becomes more and more important. That also gives rise to the question whether the currently used techniques can be improved. Antonio en

  13. Pricing of reserves. Valuing system reserve capacity against spot prices in electricity markets

    International Nuclear Information System (INIS)

    Just, Sebastian; Weber, Christoph

    2008-01-01

    This paper models the interdependencies between markets for secondary reserve capacity and spot electricity to derive the pricing of reserves under equilibrium conditions. Starting with the indifference condition between offering in both markets, the reservation price is derived from the opportunity cost consideration and the unit commitment conditions in a fundamental interrelated market framework. The reserve market examined compares widely to the German market for secondary reserves, but the general approach may also be used to investigate other reserve markets. The approach explores and formalizes the influence of reserve capacity on the spot market supply function. A numerical solution procedure is provided to this non-trivial case of market interaction. The model is used to estimate the expected reservation price development over the last years in Germany. (author)

  14. Design and implementation of land reservation system

    Science.gov (United States)

    Gao, Yurong; Gao, Qingqiang

    2009-10-01

    Land reservation is defined as a land management policy for insuring the government to control primary land market. It requires the government to obtain the land first, according to plan, by purchase, confiscation and exchanging, and then exploit and consolidate the land for reservation. Underlying this policy, it is possible for the government to satisfy and manipulate the needs of land for urban development. The author designs and develops "Land Reservation System for Eastern Lake Development District" (LRSELDD), which deals with the realistic land requirement problems in Wuhan Eastern Lake Development Districts. The LRSELDD utilizes modern technologies and solutions of computer science and GIS to process multiple source data related with land. Based on experiments on the system, this paper will first analyze workflow land reservation system and design the system structure based on its principles, then illustrate the approach of organization and management of spatial data, describe the system functions according to the characteristics of land reservation and consolidation finally. The system is running to serve for current work in Eastern Lake Development Districts. It is able to scientifically manage both current and planning land information, as well as the information about land supplying. We use the LRSELDD in our routine work, and with such information, decisions on land confiscation and allocation will be made wisely and scientifically.

  15. Natural gas reserve growth in Canada

    Energy Technology Data Exchange (ETDEWEB)

    Woronuk, R. [Canadian Gas Potential Committee, Calgary, AB (Canada)]|[GasEnergy Strategies Inc., Calgary, AB (Canada)

    2003-07-01

    An appreciation study of a natural gas reservoir is a component of assessing its ultimate reserve potential. The Canadian Gas Potential Committee (CGPC) defines appreciation as the change in a reserve estimate from a previously booked pool or basin. Basins cannot appreciate through the addition of new pools. Ultimate potential includes all of the following: cumulative production; remaining discovered reserves; adjustments to remaining discovered reserves; and, full appreciated undiscovered reserves. This presentation outlined the procedures used by the CGPC in its appreciation studies. It also reviewed data supplier issues, regulatory practices, and booking issues. A series of graphs were also included depicting pools discovered in 1993 and the average pool gas in place. Reservoir loss from 1993 to 1998 was attributed to the fact that enhanced recovery technology cannot keep pace with the degradation in pool quality. It was noted that beyond 1998, significant increases in gas prices should increase recovery factors. Special studies by the Alberta Energy and Utilities Board have included the depreciation of unconnected gas pools and the appreciation of sheet sands. The challenge of tracking pool appreciation was discussed with reference to estimating new pool discoveries in established fields. 2 tabs., 6 figs.

  16. Modelling information flow along the human connectome using maximum flow.

    Science.gov (United States)

    Lyoo, Youngwook; Kim, Jieun E; Yoon, Sujung

    2018-01-01

    The human connectome is a complex network that transmits information between interlinked brain regions. Using graph theory, previously well-known network measures of integration between brain regions have been constructed under the key assumption that information flows strictly along the shortest paths possible between two nodes. However, it is now apparent that information does flow through non-shortest paths in many real-world networks such as cellular networks, social networks, and the internet. In the current hypothesis, we present a novel framework using the maximum flow to quantify information flow along all possible paths within the brain, so as to implement an analogy to network traffic. We hypothesize that the connection strengths of brain networks represent a limit on the amount of information that can flow through the connections per unit of time. This allows us to compute the maximum amount of information flow between two brain regions along all possible paths. Using this novel framework of maximum flow, previous network topological measures are expanded to account for information flow through non-shortest paths. The most important advantage of the current approach using maximum flow is that it can integrate the weighted connectivity data in a way that better reflects the real information flow of the brain network. The current framework and its concept regarding maximum flow provides insight on how network structure shapes information flow in contrast to graph theory, and suggests future applications such as investigating structural and functional connectomes at a neuronal level. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Pricing the Ramping Reserve and Capacity Reserve in Real Time Markets

    OpenAIRE

    Ye, Hongxing; Li, Zuyi

    2015-01-01

    The increasing penetration of renewable energy in recent years has led to more uncertainties in power systems. In order to maintain system reliability and security, electricity market operators need to keep certain reserves in the Security-Constrained Economic Dispatch (SCED) problems. A new concept, deliverable generation ramping reserve, is proposed in this paper. The prices of generation ramping reserves and generation capacity reserves are derived in the Affine Adjustable Robust Optimizat...

  18. Foreign Exchange Reserves and the Reserve Bank’s Balance Sheet

    OpenAIRE

    Christian Vallence

    2012-01-01

    The Reserve Bank of Australia holds and manages the nation’s foreign exchange reserve assets in order to meet its policy objectives. While Australia’s foreign exchange reserves are relatively modest by international standards, they nonetheless constitute a sizeable portion of the Bank’s balance sheet, and variations in the Australian dollar value of these reserves are usually the most volatile component of the Bank’s profit and loss statement. This article discusses some of the key decisions ...

  19. Prediction of cerebrovascular reserve by the MRI and doppler ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hui Joong; Kim, Yong Sun [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2005-07-15

    We investigated acute stroke patterns on diffusion weighted images and with doppler ultrasonography studies of ICA and MCA steno-occlusive diseases in order to predict the cerbrovascular reserve (CVR), as was measured by acetazolamide (ACZ)-challenged Tc-99m ECD brain perfusion SPECT. A retrospective analysis was performed of 76 patients who underwent MRI/MRA, ACZ-challenged Tc-99m ECD brain perfusion SPECT, and carotid and vertebral artery Doppler sonography. After dividing these patients into four groups-MCA and ICA ateno-occlusions, we analyzed the relationship between the CVR and topologic MR patterns and the flow volume, as was measured by Doppler sonography. The CVRs were preserved in 26 of 76 patients. The CVRs were impaired in those cases of occlusion that were detected on MRA and also by the pattern of the territorial involvement on the diffusion weighted image ({rho} < 0.05, x{sup 2} test). Yet in cases of preserved CVRs, the flow volume of the contralateral ICA, the anterior circulation, and the total cerebral flow volume were increased, as was checked by Doppler sonography ({rho} < 0.05, t-test). As calculated by logistic regression analysis, the accuracy for predicting the preserved CVR by using the statistically significant variables was 78%. We believe that the MRI-SPECT correlation study was helpful for understanding the hemodynamics and topographic patterns of ischemia in patients with ICA and MCA steno-occlusive disease, and that the flow volume measurement, which was done by using duplex US, was useful for predicting the CVR.

  20. RESTAURANT RESERVATION MANAGEMENT CONSIDERING TABLE COMBINATION

    Directory of Open Access Journals (Sweden)

    Qing Miao

    Full Text Available ABSTRACT This paper presents a case study of table reservation practice for restaurant business within Walt Disney World. A unique feature here is to consider table combination to capture revenue potentials from different party sizes and at different time periods. For example, a party of large size can be served by combining two or more small tables. A mixed integer programming (MIP model is developed to make the reservation recommendation. We propose a rolling horizon reservation policy such that the value of a particular table is periodically evaluated and updated. This is a typical revenue management method in the airlines and other industries, the essence of which is to compare the future expected revenue with a currently offered price. Using historical data, numerical test shows a significant revenue improvement potential from our proposed model.

  1. Uranium - raw material reserves for coming generations

    International Nuclear Information System (INIS)

    Keutner, H.

    1981-01-01

    Large uranium occurences have been discovered in the South of Mexico. The deposits are situated in the Sierra Mixteca. Reserves of 9.400 tons had been at Mexico's disposal even before these new discoveries. The quantitiy discovered recentyl amounts to 20.000 tons. The uranium reserves available apart from those in centrally controlled economic systems are presently estimated at five million tons. Meanwhile American scientists have found out that all the rivers of the world transport about 16.000 tons of uranium from the continents into the oceans per annum. The energy value of this washed out amount of uranium corresponds to the 25-fold world power demand of today. US scientists have discovered that the oceans can provide uranium for about seven million years of the present world energy demand. While the petroleum reserves decrease worldwide it seems that the exploration of uranium has just been started. (orig.) [de

  2. Wind offering in energy and reserve markets

    DEFF Research Database (Denmark)

    Soares, Tiago; Pinson, Pierre; Morais, Hugo

    2016-01-01

    The increasing penetration of wind generation in power systems to fulfil the ambitious European targets will make wind power producers to play an even more important role in the future power system. Wind power producers are being incentivized to participate in reserve markets to increase...... their revenue, since currently wind turbine/farm technologies allow them to provide ancillary services. Thus, wind power producers are to develop offering strategies for participation in both energy and reserve markets, accounting for market rules, while ensuring optimal revenue. We consider a proportional...... offering strategy to optimally decide upon participation in both markets by maximizing expected revenue from day-ahead decisions while accounting for estimated regulation costs for failing to provide the services. An evaluation of considering the same proportional splitting of energy and reserve in both...

  3. Granular flow

    DEFF Research Database (Denmark)

    Mitarai, Namiko; Nakanishi, Hiizu

    2012-01-01

    Granular material is a collection of macroscopic particles that are visible with naked eyes. The non-equilibrium nature of the granular materials makes their rheology quite different from that of molecular systems. In this minireview, we present the unique features of granular materials focusing...... on the shear flow of dry granular materials and granule-liquid mixture....

  4. Risk spreading, connectivity, and optimal reserve spacing.

    Science.gov (United States)

    Blowes, Shane A; Connolly, Sean R

    2012-01-01

    Two important processes determining the dynamics of spatially structured populations are dispersal and the spatial covariance of demographic fluctuations. Spatially explicit approaches to conservation, such as reserve networks, must consider the tension between these two processes and reach a balance between distances near enough to maintain connectivity, but far enough to benefit from risk spreading. Here, we model this trade-off. We show how two measures of metapopulation persistence depend on the shape of the dispersal kernel and the shape of the distance decay in demographic covariance, and we consider the implications of this trade-off for reserve spacing. The relative rates of distance decay in dispersal and demographic covariance determine whether the long-run metapopulation growth rate, and quasi-extinction risk, peak for adjacent patches or intermediately spaced patches; two local maxima in metapopulation persistence are also possible. When dispersal itself fluctuates over time, the trade-off changes. Temporal variation in mean distance that propagules are dispersed (i.e., propagule advection) decreases metapopulation persistence and decreases the likelihood that persistence will peak for adjacent patches. Conversely, variation in diffusion (the extent of random spread around mean dispersal) increases metapopulation persistence overall and causes it to peak at shorter inter-patch distances. Thus, failure to consider temporal variation in dispersal processes increases the risk that reserve spacings will fail to meet the objective of ensuring metapopulation persistence. This study identifies two phenomena that receive relatively little attention in empirical work on reserve spacing, but that can qualitatively change the effectiveness of reserve spacing strategies: (1) the functional form of the distance decay in covariance among patch-specific demographic rates and (2) temporal variation in the shape of the dispersal kernel. The sensitivity of metapopulation

  5. Transformation of Taiwan’s Reserve Force

    Science.gov (United States)

    2017-01-01

    benefited tremen- dously from their deep knowledge across the range of issues associated with reserve force reforms generally, and reserve force...Penghu Wude Joint Counter Amphibious Exercise [澎湖五德聯信聯合反登陸操演],” 2013. 18 For details on Taiwan’s short-range air defense capabilities, see Kuo Wen ...opinion/national-service-for-the-21st-century Kuo Wen -liang, National Defense Education: Defense Science and Technology [全民國防教育國防科技], Taipei: NWCD

  6. Optimal drawdown patterns for strategic petroleum reserves

    Energy Technology Data Exchange (ETDEWEB)

    Kuenne, R E; Blankenship, J W; McCoy, P F

    1979-01-01

    An optimization model is described for determining optimal drawdown trajectories for strategic petroleum reserves during an embargo. Development of the model includes the derivation of a GNP response function which relates GNP (used as a measure of social welfare) and crude oil supply reductions. Two alternative forms of this function are used with the model. Simple algorithms are presented which give rapid solutions for the model. The pattern is one of saving some of the reserve to protect against a possible second embargo occurring beforee refill, and of allocating the remainder during the first embargo subperiod so as to equalize monthly marginal benefits. 6 references.

  7. Estimating Quartz Reserves Using Compositional Kriging

    Directory of Open Access Journals (Sweden)

    J. Taboada

    2013-01-01

    Full Text Available The aim of this study was to determine spatial distribution and volume of four commercial quartz grades, namely, silicon metal, ferrosilicon, aggregate, and kaolin (depending on content in impurities in a quartz seam. The chemical and mineralogical composition of the reserves in the seam were determined from samples collected from outcrops, blasting operations, and exploratory drilling, and compositional kriging was used to calculate the volume and distribution of the reserves. A more accurate knowledge of the deposit ensures better mine planning, leading to higher profitability and an improved relationship with the environment.

  8. Creation of Power Reserves Under the Market Economy Conditions

    Science.gov (United States)

    Mahnitko, A.; Gerhards, J.; Lomane, T.; Ribakov, S.

    2008-09-01

    The main task of the control over an electric power system (EPS) is to ensure reliable power supply at the least cost. In this case, requirements to the electric power quality, power supply reliability and cost limitations on the energy resources must be observed. The available power reserve in an EPS is the necessary condition to keep it in operation with maintenance of normal operating variables (frequency, node voltage, power flows via the transmission lines, etc.). The authors examine possibilities to create power reserves that could be offered for sale by the electric power producer. They consider a procedure of price formation for the power reserves and propose a relevant mathematical model for a united EPS, the initial data being the fuel-cost functions for individual systems, technological limitations on the active power generation and consumers' load. As the criterion of optimization the maximum profit for the producer is taken. The model is exemplified by a concentrated EPS. The computations have been performed using the MATLAB program.

  9. 40 CFR 80.605 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false [Reserved] 80.605 Section 80.605 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Motor Vehicle Diesel Fuel; Nonroad, Locomotive, and Marine Diesel Fuel; and ECA...

  10. 40 CFR 80.609 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false [Reserved] 80.609 Section 80.609 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Motor Vehicle Diesel Fuel; Nonroad, Locomotive, and Marine Diesel Fuel; and ECA...

  11. 40 CFR 80.534 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false [Reserved] 80.534 Section 80.534 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) REGULATION OF FUELS AND FUEL ADDITIVES Motor Vehicle Diesel Fuel; Nonroad, Locomotive, and Marine Diesel Fuel; and ECA...

  12. 40 CFR 407.43 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.43 Section 407.43 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Frozen Potato Products...

  13. 40 CFR 407.63 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.63 Section 407.63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Canned and Preserved Fruits...

  14. 40 CFR 407.23 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.23 Section 407.23 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Apple Products Subcategory...

  15. 40 CFR 407.33 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.33 Section 407.33 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Citrus Products Subcategory...

  16. 40 CFR 407.65 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.65 Section 407.65 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Canned and Preserved Fruits...

  17. 40 CFR 407.53 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.53 Section 407.53 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Dehydrated Potato Products...

  18. 40 CFR 407.85 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.85 Section 407.85 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Canned and Miscellaneous...

  19. 40 CFR 407.13 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.13 Section 407.13 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Apple Juice Subcategory § 407...

  20. 40 CFR 407.83 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 407.83 Section 407.83 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS CANNED AND PRESERVED FRUITS AND VEGETABLES PROCESSING POINT SOURCE CATEGORY Canned and Miscellaneous...

  1. 50 CFR 216.42 - Photography. [Reserved

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Photography. [Reserved] 216.42 Section 216.42 Wildlife and Fisheries NATIONAL MARINE FISHERIES SERVICE, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION, DEPARTMENT OF COMMERCE MARINE MAMMALS REGULATIONS GOVERNING THE TAKING AND IMPORTING OF MARINE MAMMALS Special Exceptions § 216.42...

  2. Unanswered Quibbles with Fractional Reserve Free Banking

    Directory of Open Access Journals (Sweden)

    Philipp Bagus

    2011-07-01

    Full Text Available In this article we reply to George Selgin’s counterarguments to our article “Fractional Reserve Free Banking: Some Quibbles”. Selgin regards holding cash as saving while we focus on the real savings necessary to maintain investment projects. Real savings are unconsumed real income. Variations in real savings are not necessarily equal to variations in cash holdings. We show that a coordinated credit expansion in a fractional reserve free banking (FRFB system is possible and that precautionary reserves consequently do not pose a necessary limit. We discuss various instances in which a FRFB system may expand credit without a prior increase in real savings. These facets all demonstrate why a fractional reserve banking system – even a free banking one – is inherently unstable, and incentivized to impose a stabilizing central bank. We find that at the root of our disagreements with Selgin lies a different approach to monetary theory. Selgin subscribes to the aggregative equation of exchange, which impedes him from seeing the microeconomic problems that the stabilization of “MV” by a FRFB system causes.

  3. 7 CFR 3560.306 - Reserve account.

    Science.gov (United States)

    2010-01-01

    ... be deemed to contain surplus funds when the balance at the end of the housing project's fiscal year...) As projects age, the required reserve account level may be adjusted to meet anticipated “life-cycle..., identity-of-interest, cost-reasonableness, and construction management apply to any work or services paid...

  4. 40 CFR 417.164 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 417.164 Section 417.164 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS SOAP AND DETERGENT MANUFACTURING POINT SOURCE CATEGORY Manufacture of Liquid Detergents Subcategory § 417...

  5. 41 CFR 101-26.504 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true [Reserved] 101-26.504 Section 101-26.504 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.5-GSA...

  6. 41 CFR 101-26.601 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true [Reserved] 101-26.601 Section 101-26.601 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.6...

  7. Oak Ridge Reservation Waste Management Plan

    International Nuclear Information System (INIS)

    Turner, J.W.

    1995-02-01

    This report presents the waste management plan for the Oak Ridge Reservation facilities. The primary purpose is to convey what facilities are being used to manage wastes, what forces are acting to change current waste management systems, and what plans are in store for the coming fiscal year

  8. 34 CFR 300.326 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false [Reserved] 300.326 Section 300.326 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION OF CHILDREN WITH...

  9. What are the reserves made of

    International Nuclear Information System (INIS)

    Laherrere, J.

    1998-01-01

    The oil geologists worry about the oil reserves. An inventory of the oil resources estimations was carried out by the OECD-IEA. Some of the subjects covered by this inventory are commented with the arguments of the two schools : optimists and pessimists. The analysis takes account of the influence of the costs and the offshore technology. (A.L.B.)

  10. 45 CFR 400.10 - [Reserved

    Science.gov (United States)

    2010-10-01

    ... Regulations Relating to Public Welfare OFFICE OF REFUGEE RESETTLEMENT, ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES REFUGEE RESETTLEMENT PROGRAM Grants to States for Refugee Resettlement The State Plan § 400.10 [Reserved] Award of Grants to States ...

  11. Mental Reservation and Military Testimony before Congress

    National Research Council Canada - National Science Library

    Roberts, Gordon R

    2008-01-01

    .... The cause for this apparent mental reservation on the part of military leaders can be found in their organizational bias and environmental influences, but the solution can be found in history. It is vital for the military to understand that a currency of truth is the most important contribution it can make to the civilian-military relationship.

  12. Reserve design to maximize species persistence

    Science.gov (United States)

    Robert G. Haight; Laurel E. Travis

    2008-01-01

    We develop a reserve design strategy to maximize the probability of species persistence predicted by a stochastic, individual-based, metapopulation model. Because the population model does not fit exact optimization procedures, our strategy involves deriving promising solutions from theory, obtaining promising solutions from a simulation optimization heuristic, and...

  13. Diminished ovarian reserve in patients with psoriasis

    Directory of Open Access Journals (Sweden)

    Burcu Tuğrul Ayanoğlu

    2018-04-01

    Full Text Available Objective: Psoriasis is a multi-systemic chronic inflammatory skin disease. Previous data suggests that women with some chronic inflammatory diseases have diminished ovarian reserve. This study explores ovarian reserve in patients with psoriasis. Materials and methods: We prospectively analyzed 14 female patients with psoriasis and 35 healthy age and body mass index matched controls. An interview explored demographic characteristics, obstetrical history and menstrual characteristics. Psoriatic area severity index (PASI in patients was assessed. Estrogen, follicle-stimulating hormone (FSH, luteinizing hormone (LH, thyroid stimulating hormone and with gynecologic ultrasonography, ovarian volume and antral follicular count (AFC were measured in both study and control groups. These values were analyzed with changes of the PASI in the patient group. Results: Patients with psoriasis had significantly higher levels of FSH and FSH/LH ratio than healthy controls (p = 0.039, p = 0.005 respectively. AFC of psoriasis patients were significantly lower than healthy controls (p = 0.002.There were no significant difference among other hormone levels and ovarian volumes (p > 0.05. The hormone levels, ovarian volume and AFC were not correlated with PASI of the patients. Conclusion: The results of the study suggest that patients with psoriasis may have diminished ovarian reserve. Keywords: Psoriasis, Ovarian reserve, Psoriatic area severity index, Antral follicular count, Follicle-stimulating hormone

  14. Wind offering in energy and reserve markets

    Science.gov (United States)

    Soares, T.; Pinson, P.; Morais, H.

    2016-09-01

    The increasing penetration of wind generation in power systems to fulfil the ambitious European targets will make wind power producers to play an even more important role in the future power system. Wind power producers are being incentivized to participate in reserve markets to increase their revenue, since currently wind turbine/farm technologies allow them to provide ancillary services. Thus, wind power producers are to develop offering strategies for participation in both energy and reserve markets, accounting for market rules, while ensuring optimal revenue. We consider a proportional offering strategy to optimally decide upon participation in both markets by maximizing expected revenue from day-ahead decisions while accounting for estimated regulation costs for failing to provide the services. An evaluation of considering the same proportional splitting of energy and reserve in both day- ahead and balancing market is performed. A set of numerical examples illustrate the behavior of such strategy. An important conclusion is that the optimal split of the available wind power between energy and reserve strongly depends upon prices and penalties on both market trading floors.

  15. Denmark. Self-sufficiency and reserves management

    International Nuclear Information System (INIS)

    Erceville, H. d'.

    1997-01-01

    Since 1991, Denmark is a self-sufficient and a net petroleum and natural gas exporting country. Like all neighboring countries of the North sea, this country enjoys many advantages. However, Denmark exports and imports about a third of its hydrocarbons. This policy is a way to control its reserves for the future. (J.S.)

  16. Oak Ridge Reservation Waste Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    Turner, J.W. [ed.

    1995-02-01

    This report presents the waste management plan for the Oak Ridge Reservation facilities. The primary purpose is to convey what facilities are being used to manage wastes, what forces are acting to change current waste management systems, and what plans are in store for the coming fiscal year.

  17. Study on Online Hotel Reservation Systems

    OpenAIRE

    Alleweldt, Frank; Tonner, Klaus; McDonald, Marc

    2009-01-01

    This study, conducted by Civic Consulting, looks at both pre-contractual and contractual matters concerning online hotel reservation systems, examines relevant Community rules, identifies gaps and, where needed, discusses possible policy options. Key conclusions The study shows that the impact of Community law on online hotel

  18. 40 CFR 600.406-77 - [Reserved

    Science.gov (United States)

    2010-07-01

    ...-77 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) ENERGY POLICY FUEL ECONOMY AND CARBON-RELATED EXHAUST EMISSIONS OF MOTOR VEHICLES Fuel Economy Regulations for 1977 and Later Model Year Automobiles-Dealer Availability of Fuel Economy Information § 600.406-77 [Reserved] ...

  19. 40 CFR 405.83 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 28 2010-07-01 2010-07-01 true [Reserved] 405.83 Section 405.83 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS DAIRY PRODUCTS PROCESSING POINT SOURCE CATEGORY Ice Cream, Frozen Desserts, Novelties and Other Dairy Desserts...

  20. 41 CFR 105-74.301 - [Reserved

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false [Reserved] 105-74.301 Section 105-74.301 Public Contracts and Property Management Federal Property Management Regulations System...-GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (FINANCIAL ASSISTANCE) Requirements for Recipients Who Are...