Thread by @CardioOBDoc

#Tweetorial on #ASNC2020 session

⚡Selecting Between Different Functional Tests⚡

☢ vs 🧲 vs ⏺ ❓

🔘 Strengths/Limits of Lesion Specific vs Myocardial Ischemia
🔘 Comparing Dx Accuracy of Tests
🔘 Ischemia Testing in #INOCA
🔘 How to Select Best Noninvasive Test

1/9

https://twitter.com/coronarydoc/status/1309649449162092544

#ASNC2020 #cvNuc
2/9
Dr Di Carli

☢ Issues with proposed #FFR threshold 0.8
☢ Exercise MPI correlates well with FFR but not at 0.8
☢ Benefit of FFR-guided revasc dominantly occurs w/ thresholds <0.8
☢ Quantification of lesion-specific #ischemia insufficient for patient mgmt

#ASNC2020 #cvNuc
3/9
Dr Di Carli

Lesion-specific #ischemia measurements (FFR/#FFRCT)

☢ Strength
Validated against ETT/MPI
Strong outcome data
Guidelines supported

☢ Limit
Controversial threshold (0.80 vs MPI-validated 0.66)
⬆ microvasc resist causes FFR pseudonormalization

#ASNC2020 #cvNuc
4/9
Dr Di Carli

Myocardial-specific #ischemia measurements

☢ Strength
High prognostic value
Widely available

☢ Limit
Moderate accuracy w/o flow measurement
Affected by more factors than epicardial stenosis

#ASNC2020 #cvNuc
5/9
Dr Knaapen

⚡️ FFR-CT is best of both worlds:
plaque burden + stenosis severity

☢ FFR guided revasc reduces revasc & QoL but doesn’t significantly reduce MI/death
☢ Not every CT can be analyzed for FFR-CT
☢ PACIFIC: FFR-CT outperformed other modalities

#ASNC2020 #cvNuc
6/9
Dr Taqueti @VTaqMD

☢ Large portion of pts with angina have no evidence of obstructive #CAD on anatomical testing
☢ Traditional perfusion imaging does not identify pts with #CMD
☢ #CMD (#CFR<2.0) present in ~50% of pts with angina

#ASNC2020 #cvNuc @InocaInternati1
7/9
Dr Taqueti @VTaqMD

☢ #CFR is more prognostic in♀than ♂
☢ CFR is a better prognostic factor than traditional img abnormalities
☢ #thinkPET is gold standard for eval of #CMD
☢ #whyCMR can be complementary to PET specially in #MINOCA

#ASNC2020 #cvNuc
8/9
Dr Berman

How to select?
• Dx
• Guiding mgmt (survival benefit & Sx)

☢ Knowing plaque burden beyond lumen is important b/c quantitative plaque assessment predicts outcome

☢ #CFR is important b/c FFR does not assess diffuse atherosclerosis, #CMD #INOCA

#ASNC2020 #cvNuc
9/9
Dr Berman

☢ In PACIFIC intention to Dx, PET was superior (17% could not have FFRCT)

☢ Dx of #INOCA needs presence of ischemia & absence of obst CAD

☢ If interested in knowing CAD, knowledge of coronary anatomy (stenosis, plaque burden/type) is critical

@venkmurthy @Allison_Dupont @mhammadah @ozlembilen2 @Bob_the_PA @Arzanauskaite @PanithayaC @a_l_bailey @MinnowWalsh @DrSheilaSahni @DocSavageTJU @DavidWienerMD @EGarciaSayan @JGrapsa @heartdocandcrew @Piotr_JSlomka @fischman_david @lamelaspablo @Pooh_Velagapudi @DrToniyaSingh

A Bonus Summary Slide from Dr Berman @danielbermanmd

⚡Selecting Between Different Functional Tests⚡

#Tweetorial #ASNC2020 #thinkPET #cvNuc #yesCCT #whyCMR #CardioTwitter #INOCA #MINOCA #ACCImaging
@MyASNC @Heart_SCCT @SCMRorg @venkmurthy @DavidLBrownMD @InocaInternati1