Skip Navigation


European Heart Journal Advance Access originally published online on October 24, 2007
European Heart Journal 2007 28(23):2951-2952; doi:10.1093/eurheartj/ehm463
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
28/23/2951-a    most recent
ehm463v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Biondi-Zoccai, G. G.L.
Right arrow Articles by Vetrovec, G. W.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Biondi-Zoccai, G. G.L.
Right arrow Articles by Vetrovec, G. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org.

Recurrent angina and the problem of inadequate/inappropriate revascularization: reply

Giuseppe G.L. Biondi-Zoccai

University of Turin
Turin, Italy

Antonio Abbate

Virginia Commonwealth University VCU Pauley Heart Center
Richmond VA, USA

Pierfrancesco Agostoni

Antwerp Cardiovascular Institute Middelheim AZ Middelheim
Antwerp, Belgium

Michael J. Lipinski

University of Virginia
Charlottesville VA, USA

George W. Vetrovec

Virginia Commonwealth University VCU Pauley Heart Center
Richmond VA, USA

Tel: +1 804 6281215 Fax: +1 840 6281215 E-mail address: gvetrovec{at}mcvh-vcu.edu

We thank Drs Gori and Fineschi for their interest in our work and the opportunity to engage in a scholarly discussion focusing on recurrent angina after coronary revascularization, which indeed is still a major clinical challenge.1

They clarify that anginal status and non-invasive imaging tests may not be enough to guide revascularization strategies in order to correctly identify inadequately revascularized patients, yet avoiding inappropriate revascularizations. In this setting, other invasive tests such as intracoronary ultrasound (ICUS) and measurement of fractional flow reserve (FFR) have established roles. Nonetheless, ICUS and FFR, while useful, are also far from perfect. A recent systematic review of 21 studies concluded that there is only moderate concordance between FFR and the reference non-invasive imaging tests which, despite their limitations, were used to establish its clinical role.2 Actually, FFR had 76% sensitivity and 76% specificity in comparison to imaging studies.

Moreover, there is incomplete correlation between ICUS and FFR, as Takagi et al.3 reported that differences in ICUS minimal lumen area explain only 62% of the variability in FFR measurements.

Thus, clinical decision can be helped by non-invasive or invasive tests, but most complex decisions still rely on comprehensive clinical judgement. Nonetheless, appropriate supportive diagnostic tools should certainly be encouraged to resolve equivocal or uncertain circumstances.

References

  1. Abbate A, Biondi-Zoccai GG, Agostoni P, Lipinski MJ, Vetrovec GW. Recurrent angina after coronary revascularization: a clinical challenge. Eur Heart J (2007) 28:1057–1065.[Abstract/Free Full Text]
  2. Christou MA, Siontis GC, Katritsis DG, Ioannidis JP. Meta-analysis of fractional flow reserve versus quantitative coronary angiography and noninvasive imaging for evaluation of myocardial ischemia. Am J Cardiol (2007) 99:450–456.[CrossRef][Web of Science][Medline]
  3. Takagi A, Tsurumi Y, Ishii Y, Suzuki K, Kawana M, Kasanuki H. Clinical potential of intravascular ultrasound for physiological assessment of coronary stenosis: relationship between quantitative ultrasound tomography and pressure-derived fractional flow reserve. Circulation (1999) 100:250–255.[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
28/23/2951-a    most recent
ehm463v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Biondi-Zoccai, G. G.L.
Right arrow Articles by Vetrovec, G. W.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Biondi-Zoccai, G. G.L.
Right arrow Articles by Vetrovec, G. W.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?