9/14/2016 ObjectiveWayofAssessingneedforAngioplastyAboonforHeartDiseasePatients|ETHealthWorld

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#MedicalDevices #heartdisease #FFRtest #FAME2 #Dr.PraveenChandra #coronaryarterydisease

#angiogram

ObjectiveWayofAssessingneed
forAngioplastyAboonforHeart
DiseasePatients
CADisaconditioninwhichunhealthyfatdepositbuildupcausesnarrowingor
blockageofcoronarybloodvesselsthatsupplybloodtotheheartmuscles.
ETHealthWorld | Aug26,2016,07.00PMIST

A A Newsletter
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ByDr.Praveen
Chandra

Coronaryartery
disease(CAD)is
themost
commonformof
heartdisease
andimpacts
millionsoflives
worldwide.CAD MostRead ThisWeek

isaconditionin ThisMonth
whichunhealthy
fatdeposit Karnataka:Firstmohalla
buildupcausesnarrowingorblockageofcoronaryblood clinicopensinKolartoday
vesselsthatsupplybloodtotheheartmuscles.This

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9/14/2016 ObjectiveWayofAssessingneedforAngioplastyAboonforHeartDiseasePatients|ETHealthWorld

restrictstheflowofbloodtotheheart.AggravatedCAD
mayfurtherleadtootherformsofheartdiseaseslikeheart
attack,heartfailure,andarrhythmia.

TakingacuefromtheAamAadmi
ApatientsufferingfromCADmaybenefitfromangioplasty
Party(AAP)governmentinNew
(alsoknownaspercutaneouscoronaryintervention)or Delhi,theKarnatakagovernment
bypasssurgery(CoronaryArteryBypassGraftingor hasdecidedtosetupMohalla
CABG).While,angioplastyisaminimallyinvasive Clinicsacrossthestate.

procedure,whereameshlikedevicecalleda'stent'isused PfizersuesIndiandrugfirmsto...
toopenblockedbloodvessels,bypasssurgeryisasurgical
MadanKrishnannamedMedtro...
procedurewhichcreatesabypassfortheblockedvessels.
Thebiggestchallengeinhealth...
TreatmentforCADispredominantlydeterminedbyatest
Govtplanningpenalprovisions...
calledtheangiogramorangiography.(SeeFig.1)
MostReadinMedical
Angiogramisanxray Devices
imageoftheblood
ThisWeek ThisMonth
vesselsintheheartand
hasbeenwidelyusedfor
Buyoutfund
severaldecadesto KKRinvests$66
identifyblockedvessels. mlninmedical
devicemaker:
However,angiogram source
beingonlyavisual 3daysago
assessmenthasthe
Another
marginofunderor innovative
overestimatingthe Figure1:Anangiogram
technology
helpscombat
severityofblockage. glaucoma
5daysago
Toovercomethislimitation,anewdiagnosticmodality
GEtobuySLM,
calledtheFFR(orFractionalFlowReserve)canbedone Arcamfor$1.4
afteranangiogramtoobjectivelydeterminetheseverityof bnin3D
printingpush
blockage.FFRmeasurementaidsthetreatingcardiologists
7daysago
indecidingwhetherornottoperformangioplastyonthe
blockedvessels. Newnon
occlusive
deviceoffers
Clinicalstudieshaveshownthatpatientswhohavesuffered hopefor
rheumaticheart
aheartattackorhaveunstableangina(alsocalledacute diseasepatients
coronarysyndrome)arelikelytobenefitfromangioplasty, 3daysago
however,similareffectinpatientswithstableCADwas
debatable.In2007,astudycalled"COURAGEtrial"
investigatedthenecessityofangioplastyinpatientswith
stableCAD,thetrialshowedthatangioplastydidnotreduce
theriskofdeath,heartattack,orothermajorcardiovascular
eventswhenaddedtomedication.

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9/14/2016 ObjectiveWayofAssessingneedforAngioplastyAboonforHeartDiseasePatients|ETHealthWorld

In2009,theresultofanotherstudycalled"FAME"showed
thatpatientswithmultivesseldisease(i.e.patientswith23
blockedcoronaryvessels)havebetteroutcomeswithFFR
guidedangioplastycomparedtoangioplastyguidedonlyby
angiogram.Furthermore,in2012resultsfrom"FAME2"
demonstratedthatinpatientswithstableCAD,FFRguided
angioplastyhadimprovedclinicaloutcomesandreduced
needforurgenttreatment(repeatangioplastyorbypass
surgery)comparedtomedicationalone.

Theselandmarkstudies(COURAGE,FAME,andFAME2)
havedemonstratedthattheangiographyaloneis
inadequatetodeterminetheseverityofvesselblockages
andangioplastymaynotbenecessaryforallpatientswith
CAD,andtherefore,itisimportanttoexaminepatientswith
theFFRtestpriortodeterminetreatmentasadvisedin
globalclinicalguidelines.

HowistheFFRtestperformed?
FFRtestisperformedbyguidingathinwire(witha
pressuresensoratthetip)intotheblockedbloodvessel(s)
throughacatheter(thinhollowtube)andameasurementis
made.(SeeFig.2)

Figure2:IllustrationofanFFRTest

HowtointerprettheFFRmeasurement?
Inanormalbloodvessel,FFRvalueequals1.Whenthe
FFRvalueisgreaterthan0.80,itindicatesanonsignificant
blockageandthatpatientmaynotbenefitfromangioplasty,
andhencecouldbemanagedonmedicationalone.In
contrast,iftheFFRvalueislessthan0.80,itindicatesa
significantblockageandthepatientislikelytobenefitfrom
intervention,henceangioplastymaybeperformed.(See

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9/14/2016 ObjectiveWayofAssessingneedforAngioplastyAboonforHeartDiseasePatients|ETHealthWorld

Fig.3)

HowFFR
technologyhelps
CADpatients?
Thecourseof
treatmentfor
patientswithCAD
dependson
diseaseseverity
(i.e.bloodflowin
thebloodvessel). Figure3:Fractionalmeasurementofbloodshownin
FFRhelpsthe FFR

treating
cardiologistintreatmentdecisionmakingthatimproves
patientoutcomesandhelpstoavoidunnecessary
procedures.FFRguidedtreatmenthasbeenprovento
reducetheincidencesofadverseeventssuchasheart
attacks,repeatangioplasty(orbypasssurgery),and
repeatedhospitalizations.

IstheFFRtestapprovedandrecommendedin
guidelines?
TheFFRtechnologyisasafeandestablishedprocedure.
TheEuropeanSocietyofCardiologyandEuropean
AssociationforCardioThoracicSurgeryandtheAmerican
CollegeofCardiologyFoundation/AmericanHeart
Association/SocietyforCardiovascularAngiographyand
InterventionsclinicalguidelinesrecommendFFRguided
treatmentinspecifiedpopulations.

DoesFFRtestrequireadditionalhospitalization?
FFRtestcanbeperformedatthetimeofanangiogram.No
additionalhospitalizationisrequiredtoperformanFFRtest.
MostoftheleadinghospitalsinIndiahavethefacilityfor
FFRtest.Thepatientmayconsulthis/hertreatingdoctorfor
advice.

Dr.PraveenChandra,IndianCardiologistandChairmanof
InterventionalCardiologyatMedantaMedicity,Gurgaon,
India.HeisrecognizedasoneoftheleadersinAngioplasty
inthecountry.Hehasbeenawardedforsuccessand
achievementinthefieldofmedicinewith"PadmaShri"in
2016bythePresidentofIndia.

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Patel Bhograj Damodaran

Dr.Tejas Dr.Charit Vikram
Chairman&Chief Cardiologist, ChiefInnovation
Interventional Interventional Officer,GEHealthcare
CardiologistatApex Cardiology
HeartInstitute

Newnonocclusivedeviceoffers
hopeforrheumaticheartdisease
patients
Researchershavedevelopedanewheartvalvereplacementdevicethatdoesnot
requireadvancedcardiacsurgicalfacilitiesorsophisticatedcardiovascular
imagingandoffershopeforthethousandsofpatientssufferingfromrheumatic
heartdisease.
IANS | Sep10,2016,08.36PMIST

ClickHeretoReadThisStory

BuyoutfundKKRinvests$66mln
inmedicaldevicemaker:source
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9/14/2016 ObjectiveWayofAssessingneedforAngioplastyAboonforHeartDiseasePatients|ETHealthWorld

PrivateequityfirmKKR&CoLPisinvestingaround$66millioninAcuFocus,a
medicaldevicesmakerwhichspecialisesintechnologythatcorrectsnearvision,a
sourcefamiliarwiththemattersaidonFriday.
Reuters | Sep10,2016,05.36PMIST

ClickHeretoReadThisStory

Anotherinnovativetechnology
helpscombatglaucoma
Innovativeopticalconceptofferssimple,affordable,fastglaucomascreeningtest
ETHealthWorld | Sep08,2016,03.28PMIST

ClickHeretoReadThisStory

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