Bio

Clinical Focus


  • Coronary Physiology
  • Aortic Stenosis
  • Percutaneous aortic valve
  • Interventional Cardiology
  • Cardiology
  • Coronary Artery Disease

Academic Appointments


Administrative Appointments


  • Director, Interventional Cardiology, Stanford University Medical Center (2013 - Present)

Professional Education


  • Medical Education:Columbia University College of Physicians and Surgeons (1994) NY
  • Fellowship:Stanford University School of Medicine (2002) CA
  • Fellowship:Stanford University School of Medicine (1998) CA
  • Residency:Stanford University School of Medicine (1997) CA
  • Board Certification: Cardiovascular Disease, American Board of Internal Medicine (2001)
  • Board Certification: Interventional Cardiology, American Board of Internal Medicine (2002)
  • Internship:Stanford University Medical Center (1995) CA
  • M.D., Columbia University, Medicine (1994)
  • B.A., Dartmouth College, English (1990)

Research & Scholarship

Current Research and Scholarly Interests


Dr. Fearon's general research interest is coronary physiology. In particular, he is investigating invasive methods for evaluating the coronary microcirculation. His research is currently funded by an NIH R01 Award.

Clinical Trials


  • FAME II - Fractional Flow Reserve (FFR) Guided Percutaneous Coronary Intervention (PCI) Plus Optimal Medical Treatment (OMT) Verses OMT Not Recruiting

    The overall purpose of the FAME II trial is to compare the clinical outcomes, safety and cost-effectiveness of FFR-guided PCI plus optimal medical treatment (OMT) versus OMT alone in patients with stable coronary artery disease.

    Stanford is currently not accepting patients for this trial. For more information, please contact Maria Perlas, (650) 723 - 2094.

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  • Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (F.A.M.E.) Not Recruiting

    In this multicenter, international study we are evaluating two approaches to determine which coronary artery narrowings require stent placement in patients with multivessel coronary artery disease. Patients will be randomized to an angiographic strategy, where only coronary angiography is used to determine which lesions to stent or to a pressure wire strategy where fractional flow reserve, an index measured with the pressure wire, will be used to determine which lesions to stent. The primary outcome will be major adverse cardiac events at 1 year. A secondary outcome will be cost-effectiveness.

    Stanford is currently not accepting patients for this trial. For more information, please contact William Fearon, (650) 725 - 2621.

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  • TAXUS Libertē Post Approval Study Not Recruiting

    The TAXUS Libertē Post-Approval Study is an FDA-mandated prospective, multi-center study designed to collect real-world safety and clinical outcomes in approximately 4,200 patients receiving one or more TAXUS Liberté Paclitaxel-Eluting Stents and prasugrel as part of a dual antiplatelet therapy (DAPT) drug regimen. This study will also contribute patient data to an FDA-requested and industry-sponsored research study that will evaluate the optimal duration of dual antiplatelet therapy (DAPT Study).

    Stanford is currently not accepting patients for this trial. For more information, please contact Yvonne Strawa, (650) 498 - 7028.

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  • Angiotensin Converting Enzyme (ACE) Inhibition and Cardiac Allograft Vasculopathy Recruiting

    Cardiac transplantation is the ultimate treatment option for patients with end stage heart failure. Cardiac allograft vasculopathy remains a leading cause of morbidity and mortality after transplantation. Angiotensin converting enzyme inhibitors are used in less than one half of transplant recipients. Preliminary data suggest that angiotensin converting enzyme inhibitors retard the atherosclerotic plaque development that is the hallmark of cardiac allograft vasculopathy. Moreover, this class of drug appears to increase circulating endothelial progenitor cell number and has anti-inflammatory properties, both of which improve endothelial dysfunction, the key precursor to the development of cardiac allograft vasculopathy. The objective of this project is to investigate the role of an angiotensin converting enzyme inhibitor, ramipril, in preventing the development of cardiac allograft vasculopathy. During the first month after cardiac transplantation subjects will undergo coronary angiography with intravascular ultrasound measurements of plaque volume in the left anterior descending coronary artery. Using a coronary pressure wire, epicardial artery and microvascular physiology will be assessed. Finally, endothelial function and mediators of endothelial function, including circulating endothelial progenitor cells, will be measured. Subjects will then be randomized in a double blind fashion to either ramipril or placebo. After 1 year, the above assessment will be repeated. The primary endpoint will be the development of cardiac allograft vasculopathy based on intravascular ultrasound-derived parameters. The second aim will be to assess the effect of ramipril on endothelial dysfunction early after transplantation. The final aim is to determine the impact of ramipril on coronary physiology early after transplantation.

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Teaching

2013-14 Courses


Graduate and Fellowship Programs


Publications

Journal Articles


  • Prognostic Value of the Index of Microcirculatory Resistance Measured after Primary Percutaneous Coronary Intervention. Circulation Fearon, W. F., Low, A. F., Yong, A. C., McGeoch, R., Berry, C., Shah, M. G., Ho, M., Kim, H. S., Loh, J. P., Oldroyd, K. G. 2013

    Abstract

    BACKGROUND: Most methods for assessing microvascular function are not readily available in the cardiac catheterization laboratory. The aim of this study is to determine whether the Index of Microcirculatory Resistance (IMR), measured at the time of primary percutaneous coronary intervention (PCI) is predictive of death and rehospitalization for heart failure. METHODS AND RESULTS: IMR was measured immediately after primary PCI in 253 patients from 3 institutions using a pressure-temperature sensor wire. The primary endpoint was the rate of death or rehospitalization for heart failure. The prognostic value of IMR was compared to coronary flow reserve, TIMI myocardial perfusion grade and clinical variables. The mean IMR was 40.3 ±32.5. Patients with an IMR>40 had a higher rate of the primary end point at one year compared to patients with an IMR?40 (17.1% vs. 6.6%, p=0.027). During a median follow-up period of 2.8 years, 13.8% suffered the primary end point and 4.3% died. An IMR>40 was associated with an increased risk of death or rehospitalization for heart failure (HR 2.1, p=0.034) and of death alone (HR 3.95, p=0.028). On multivariate analysis, independent predictors of death or rehospitalization for heart failure included IMR>40 (HR 2.2, p=0.026), fractional flow reserve ?0.8 (HR 3.24, p=0.008) and diabetes (HR 4.4, p<0.001). An IMR>40 was the only independent predictor of death alone (HR 4.3, p=0.02). CONCLUSIONS: An elevated IMR at the time of primary PCI predicts poor long term outcomes.

    View details for PubMedID 23681066

  • Fractional Flow Reserve-Guided PCI versus Medical Therapy in Stable Coronary Disease NEW ENGLAND JOURNAL OF MEDICINE De Bruyne, B., Pijls, N. H., Kalesan, B., Barbato, E., Tonino, P. A., Piroth, Z., Jagic, N., Mobius-Winckler, S., Rioufol, G., Witt, N., Kala, P., MacCarthy, P., Engstrom, T., Oldroyd, K. G., Mavromatis, K., Manoharan, G., VerLee, P., Frobert, O., Curzen, N., Johnson, J. B., Jueni, P., Fearon, W. F. 2012; 367 (11): 991-1001

    Abstract

    The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone.In patients with stable coronary artery disease for whom PCI was being considered, we assessed all stenoses by measuring FFR. Patients in whom at least one stenosis was functionally significant (FFR, ?0.80) were randomly assigned to FFR-guided PCI plus the best available medical therapy (PCI group) or the best available medical therapy alone (medical-therapy group). Patients in whom all stenoses had an FFR of more than 0.80 were entered into a registry and received the best available medical therapy. The primary end point was a composite of death, myocardial infarction, or urgent revascularization.Recruitment was halted prematurely after enrollment of 1220 patients (888 who underwent randomization and 332 enrolled in the registry) because of a significant between-group difference in the percentage of patients who had a primary end-point event: 4.3% in the PCI group and 12.7% in the medical-therapy group (hazard ratio with PCI, 0.32; 95% confidence interval [CI], 0.19 to 0.53; P<0.001). The difference was driven by a lower rate of urgent revascularization in the PCI group than in the medical-therapy group (1.6% vs. 11.1%; hazard ratio, 0.13; 95% CI, 0.06 to 0.30; P<0.001); in particular, in the PCI group, fewer urgent revascularizations were triggered by a myocardial infarction or evidence of ischemia on electrocardiography (hazard ratio, 0.13; 95% CI, 0.04 to 0.43; P<0.001). Among patients in the registry, 3.0% had a primary end-point event.In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best available medical therapy alone, decreased the need for urgent revascularization. In patients without ischemia, the outcome appeared to be favorable with the best available medical therapy alone. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01132495.).

    View details for DOI 10.1056/NEJMoa1205361

    View details for Web of Science ID 000308649100005

    View details for PubMedID 22924638

  • Functional SYNTAX Score for Risk Assessment in Multivessel Coronary Artery Disease JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Nam, C., Mangiacapra, F., Entjes, R., Chung, I., Sels, J., Tonino, P. A., De Bruyne, B., Pijls, N. H., Fearon, W. F. 2011; 58 (12): 1211-1218

    Abstract

    This study was aimed at investigating whether a fractional flow reserve (FFR)-guided SYNTAX score (SS), termed "functional SYNTAX score" (FSS), would predict clinical outcome better than the classic SS in patients with multivessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).The SS is a purely anatomic score based on the coronary angiogram and predicts outcome after PCI in patients with multivessel CAD. FFR-guided PCI improves outcomes by adding functional information to the anatomic information obtained from the angiogram.The SS was prospectively collected in 497 patients enrolled in the FAME (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) study. FSS was determined by only counting ischemia-producing lesions (FFR ? 0.80). The ability of each score to predict major adverse cardiac events (MACE) at 1 year was compared.The 497 patients were divided into tertiles of risk based on the SS. After determining the FSS for each patient, 32% moved to a lower-risk group as follows. MACE occurred in 9.0%, 11.3%, and 26.7% of patients in the low-, medium-, and high-FSS groups, respectively (p < 0.001). Only FSS and procedure time were independent predictors of 1-year MACE. FSS demonstrated a better predictive accuracy for MACE compared with SS (Harrell's C of FSS, 0.677 vs. SS, 0.630, p = 0.02; integrated discrimination improvement of 1.94%, p < 0.001).Recalculating SS by only incorporating ischemia-producing lesions as determined by FFR decreases the number of higher-risk patients and better discriminates risk for adverse events in patients with multivessel CAD undergoing PCI.

    View details for DOI 10.1016/j.jacc.2011.06.020

    View details for Web of Science ID 000294609400004

    View details for PubMedID 21903052

  • Economic Evaluation of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease CIRCULATION Fearon, W. F., Bornschein, B., Tonino, P. A., Gothe, R. M., De Bruyne, B., Pijls, N. H., Siebert, U. 2010; 122 (24): 2545-2550

    Abstract

    The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study demonstrated significantly improved health outcomes at 1 year in patients randomized to multivessel percutaneous coronary intervention guided by fractional flow reserve (FFR) compared with percutaneous coronary intervention guided by angiography alone. The economic impact of routine measurement of FFR in this setting is not known.In this study, 1005 patients were randomly assigned to FFR-guided or angiography-guided percutaneous coronary intervention and followed up for 1 year. A prospective cost-utility analysis comparing costs and quality-adjusted life-years was performed with a time horizon of 1 year. Quality-adjusted life-years were calculated with the use of utilities determined by the EuroQuol 5 dimension health survey with US weights. Direct medical costs included those of the index procedure and hospitalization and costs for major adverse cardiac events during follow-up. Confidence intervals for both quality-adjusted life-years and costs were estimated by the bootstrap percentile method. Major adverse cardiac events at 1 year occurred in 13.2% of those in the FFR-guided arm and 18.3% of those in the angiography-guided arm (P=0.02). Quality-adjusted life-years were slightly greater in the FFR-guided arm (0.853 versus 0.838; P=0.2). Mean overall costs at 1 year were significantly less in the FFR-guided arm ($14 315 versus $16 700; P<0.001). Bootstrap simulation indicated that the FFR-guided strategy was cost-saving in 90.74% and cost-effective at a threshold of US $50 000 per quality-adjusted life-years in 99.96%. Sensitivity analyses demonstrated robust results.Economic evaluation of the FAME study reveals that FFR-guided percutaneous coronary intervention in patients with multivessel coronary disease is one of those rare situations in which a new technology not only improves outcomes but also saves resources. Clinical Trial Registration- URL: http://ClinicalTrials.gov. Unique identifier: NCT00267774.

    View details for DOI 10.1161/CIRCULATIONAHA.109.925396

    View details for Web of Science ID 000285243200013

    View details for PubMedID 21126973

  • Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention NEW ENGLAND JOURNAL OF MEDICINE Tonino, P. A., De Bruyne, B., Pijls, N. H., Siebert, U., Ikeno, F., van 't Veer, M., Klauss, V., Manoharan, G., Engstrom, T., Oldroyd, K. G., Lee, P. N., MacCarthy, P. A., Fearon, W. F. 2009; 360 (3): 213-224

    Abstract

    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 of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes.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-eluting stents guided by angiography alone or guided by FFR measurements in addition to angiography. Before randomization, lesions requiring PCI were identified on the basis of their angiographic appearance. Patients assigned to angiography-guided PCI underwent stenting of all indicated lesions, whereas those assigned to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80 or less. The primary end point was the rate of death, nonfatal myocardial infarction, and repeat revascularization at 1 year.The mean (+/-SD) number of indicated lesions per patient was 2.7+/-0.9 in the angiography group and 2.8+/-1.0 in the FFR group (P=0.34). The number of stents used per patient was 2.7+/-1.2 and 1.9+/-1.3, respectively (P<0.001). The 1-year event rate was 18.3% (91 patients) in the angiography group and 13.2% (67 patients) in the FFR group (P=0.02). Seventy-eight percent of the patients in the angiography group were free from angina at 1 year, as compared with 81% of patients in the FFR group (P=0.20).Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. (ClinicalTrials.gov number, NCT00267774.)

    View details for Web of Science ID 000262434500004

    View details for PubMedID 19144937

  • Predictive value of the index of microcirculatory resistance in patients with ST-segment elevation myocardial infarction JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Fearon, W. F., Shah, M., Ng, M., Brinton, T., Wilson, A., Trernmel, J. A., Schnittger, I., Lee, D. P., Vagelos, R. H., Fitzgerald, P. J., Yock, P. G., Yeung, A. C. 2008; 51 (5): 560-565

    Abstract

    The objective of this study is to evaluate the predictive value of the index of microcirculatory resistance (IMR) in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).Despite adequate epicardial artery reperfusion, a number of patients with STEMI have a poor prognosis because of microvascular damage. Assessing the status of the microvasculature in this setting remains challenging.In 29 patients after primary PCI for STEMI, IMR was measured with a pressure sensor/thermistor-tipped guidewire. The Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, TIMI frame count, coronary flow reserve, and ST-segment resolution were also recorded.The IMR correlated significantly with the peak creatinine kinase (CK) (R = 0.61, p = 0.0005) while the other measures of microvascular dysfunction did not. In patients with an IMR greater than the median value of 32 U, the peak CK was significantly higher compared with those having values 32 U compared with

    View details for DOI 10.1016/j.jacc.2007.08.062

    View details for Web of Science ID 000252908600007

    View details for PubMedID 18237685

  • Rationale and design of the fractional flow reserve versus angiography for multivessel evaluation (FAME) study AMERICAN HEART JOURNAL Fearon, W. F., Tonino, P. A., De Bruyne, B., Siebert, U., Pijls, N. H. 2007; 154 (4): 632-636

    Abstract

    Although its limitations for diagnosing critical coronary artery disease are well described, coronary angiography remains the predominant method for guiding decisions about stent implantation in patients with multivessel coronary artery disease. However, some have suggested that invasive physiologic guidance may improve decision making.The objective of this multicenter, randomized clinical trial is to compare the efficacy of 2 strategies, one based on angiographic guidance to one based on physiologic guidance with fractional flow reserve (FFR), for deciding which coronary lesions to stent in patients with multivessel coronary disease. Eligible patients must have coronary narrowings > 50% diameter stenosis in > or = 2 major epicardial vessels, > or = 2 of which the investigator feels require drug-eluting stent placement. Patients with previous coronary bypass surgery or left main coronary disease are excluded. Based on angiographic evaluation, the investigator notes the lesions that require stenting. The patient is then randomly assigned to either angiographic guidance or FFR guidance. Patients assigned to angiographic guidance undergo stenting as planned. Patients assigned to FFR guidance first have FFR measured in each diseased vessel and only undergo stenting if the FFR is < or = 0.80. The primary end point of the study is a composite of major adverse cardiac events, including death, myocardial infarction, and repeat coronary revascularization, at 1 year. Secondary end points will include the individual adverse events, cost-effectiveness, quality of life, and 30-day, 6-month, 2-year, and 5-year outcomes.The FAME study will examine for the first time in a large, multicenter, randomized fashion the role of measuring FFR in patients undergoing multivessel percutaneous coronary intervention.

    View details for DOI 10.1016/j.ahj.2007.06.012

    View details for Web of Science ID 000249947300008

    View details for PubMedID 17892983

  • Invasive assessment of the coronary microcirculation - Superior reproducibility and less hemodynamic dependence of index of microcirculatory resistance compared with coronary flow reserve CIRCULATION Ng, M. K., Yeung, A. C., Fearon, W. F. 2006; 113 (17): 2054-2061

    Abstract

    A simple, reproducible invasive method for assessing the coronary microcirculation is lacking. A novel index of microcirculatory resistance (IMR) has been shown in animals to correlate with true microvascular resistance and, unlike coronary flow reserve (CFR), to be independent of the epicardial artery. We sought to compare the reproducibility and hemodynamic dependence of IMR with CFR in humans.Using a pressure-temperature sensor-tipped coronary wire, thermodilution-derived CFR and IMR were measured, along with fractional flow reserve (FFR), in 15 coronary arteries (15 patients) under the following hemodynamic conditions: (1) twice at baseline; (2) during right ventricular pacing at 110 bpm; (3) during intravenous infusion of nitroprusside; and (4) during intravenous dobutamine infusion. Mean CFR did not change during baseline measurements or during nitroprusside infusion but decreased during pacing (from 3.1+/-1.1 at baseline to 2.3+/-1.2 during pacing, P<0.05) and during dobutamine infusion (from 3.0+/-1.0 to 1.7+/-0.6 with dobutamine, P<0.0001). By comparison, mean values for IMR and FFR remained similar throughout all hemodynamic conditions. The mean coefficient of variation between 2 baseline measurements was significantly lower for IMR (6.9+/-6.5%) and FFR (1.6+/-1.6%) than for CFR (18.6+/-9.6%; P<0.01). Mean correlation between baseline measurements and each hemodynamic intervention was superior for IMR (r=0.90+/-0.05) and FFR (r=0.86+/-0.12) compared with CFR (r=0.70+/-0.05; P<0.05).Compared with CFR, IMR provides a more reproducible assessment of the microcirculation, which is independent of hemodynamic perturbations. Simultaneous measurement of FFR and IMR may provide a comprehensive and specific assessment of coronary physiology at both epicardial and microvascular levels, respectively.

    View details for DOI 10.1161/CIRCULATIONAHA.105.603522

    View details for Web of Science ID 000237208100007

    View details for PubMedID 16636168

  • Microvascular resistance is not influenced by epicardial coronary artery stenosis severity - Experimental validation CIRCULATION Fearon, W. F., Aarnoudse, W., Pijls, N. H., De Bruyne, B., Balsam, L. B., Cooke, D. T., Robbins, R. C., Fitzgerald, P. J., Yeung, A. C., Yock, P. G. 2004; 109 (19): 2269-2272

    Abstract

    The effect of epicardial artery stenosis on myocardial microvascular resistance remains controversial. Recruitable collateral flow, which may affect resistance, was not incorporated into previous measurements.In an open-chest pig model, distal coronary pressure was measured with a pressure wire, and the apparent minimal microvascular resistance was calculated during peak hyperemia as pressure divided by flow, measured either with a flow probe around the coronary artery (R(micro app)) or with a novel thermodilution technique (apparent index of microcirculatory resistance [IMR(app)]). These apparent resistances were compared with the actual R(micro) and IMR after the coronary wedge pressure and collateral flow were incorporated into the calculation. Measurements were made at baseline (no stenosis) and after creation of moderate and severe epicardial artery stenoses. In 6 pigs, 189 measurements of R(micro) and IMR were made under the various epicardial artery conditions. Without consideration of collateral flow, R(micro app) (0.43+/-0.12 to 0.46+/-0.10 to 0.51+/-0.11 mm Hg/mL per minute) and IMR(app) (14+/-4 to 17+/-7 to 20+/-10 U) increased progressively and significantly with increasing epicardial artery stenosis (P<0.001 for both). With the incorporation of collateral flow, neither R(micro) nor IMR increased as a result of increasing epicardial artery stenosis.After collateral flow is taken into account, the minimum achievable microvascular resistance is not affected by increasing epicardial artery stenosis.

    View details for DOI 10.1161/01.CIR.0000128669.99355.CB

    View details for Web of Science ID 000221477800004

    View details for PubMedID 15136503

  • Novel index for invasively assessing the coronary microcirculation CIRCULATION Fearon, W. F., Balsam, L. B., Farouque, H. M., Robbins, R. C., Fitzgerald, P. J., Yock, P. G., Yeung, A. C. 2003; 107 (25): 3129-3132

    Abstract

    A relatively simple, invasive method for quantitatively assessing the status of the coronary microcirculation independent of the epicardial artery is lacking.By using a coronary pressure wire and modified software, it is possible to calculate the mean transit time of room-temperature saline injected down a coronary artery. The inverse of the hyperemic mean transit time has been shown to correlate with absolute flow. We hypothesize that distal coronary pressure divided by the inverse of the hyperemic mean transit time provides an index of microcirculatory resistance (IMR) that will correlate with true microcirculatory resistance (TMR), defined as the distal left anterior descending (LAD) pressure divided by hyperemic flow, measured with an external ultrasonic flow probe. A total of 61 measurements were made in 9 Yorkshire swine at baseline and after disruption of the coronary microcirculation, both with and without an epicardial LAD stenosis. The mean IMR (16.9+/-6.5 U to 25.9+/-14.4 U, P=0.002) and TMR (0.51+/-0.14 to 0.79+/-0.32 mm Hg x mL(-1) x min(-1), P=0.0001), as well as the % change in IMR (147+/-66%) and TMR (159+/-105%, P=NS versus IMR % change), increased significantly and to a similar degree after disruption of the microcirculation. These changes were independent of the status of the epicardial artery. There was a significant correlation between mean IMR and TMR values, as well as between the % change in IMR and % change in TMR.Measuring IMR may provide a simple, quantitative, invasive assessment of the coronary microcirculation.

    View details for DOI 10.1161/01.CIR.0000080700.98607.D1

    View details for Web of Science ID 000183887100004

    View details for PubMedID 12821539

  • Coronary Microvascular Dysfunction After ST-Segment-Elevation Myocardial Infarction: Local or Global Phenomenon? Circulation. Cardiovascular interventions Yong, A. S., Fearon, W. F. 2013; 6 (3): 201-203
  • Fractional flow reserve assessment of left main stenosis in the presence of downstream coronary stenoses. Circulation. Cardiovascular interventions Yong, A. S., Daniels, D., De Bruyne, B., Kim, H., Ikeno, F., Lyons, J., Pijls, N. H., Fearon, W. F. 2013; 6 (2): 161-165

    Abstract

    Several studies have shown that fractional flow reserve (FFR) measurement can aid in the assessment of left main coronary stenosis. However, the impact of downstream epicardial stenosis on left main FFR assessment with the pressure wire in the nonstenosed downstream vessel remains unknown.Variable stenoses were created in the left main coronary arteries and downstream epicardial vessels in 6 anaesthetized male sheep using balloon catheters. A total of 220 pairs of FFR assessments of the left main stenosis were obtained, before and after creation of a stenosis in a downstream epicardial vessel, by having a pressure-sensor wire in the other nonstenosed downstream vessel. The apparent left main FFR in the presence of downstream stenosis (FFR(app)) was significantly higher compared with the true FFR in the absence of downstream stenosis (FFR(true); 0.80±0.05 versus 0.76±0.05; estimate of the mean difference, 0.035; P<0.001). The difference between FFR(true) and FFR(app) correlated with composite FFR of the left main plus stenosed artery (r=-0.31; P<0.001) indicating that this difference was greater with increasing epicardial stenosis severity. Among measurements with FFR(app) >0.80, 9% were associated with an FFR(true) of <0.75. In all instances, the epicardial lesion was in the proximal portion of the stenosed vessel, and the epicardial FFR (combined FFR of the left main and downstream stenosed vessel) was ?0.50.A clinically relevant effect on the FFR assessment of left main disease with the pressure wire in a nonstenosed downstream vessel occurs only when the stenosis in the other vessel is proximal and very severe.

    View details for DOI 10.1161/CIRCINTERVENTIONS.112.000104

    View details for PubMedID 23549643

  • ST-Elevation Myocardial Infarction Following Heart Transplantation as an Unusual Presentation of Coronary Allograft Vasculopathy: A Case Report TRANSPLANTATION PROCEEDINGS Peter, S., HULME, O., Deuse, T., Vrtovec, B., Fearon, W. F., Hunt, S., Haddad, F. 2013; 45 (2): 787-791

    Abstract

    The presentation, mechanisms, and incidence of ST elevation myocardial infarction (STEMI) in heart transplant recipients have been characterized only to a limited degree in the current literature. Herein, we present a unique case of STEMI years after heart transplantation with a focus on the salient features of its diagnosis and interventions. We also provide a review of the epidemiology of this phenomenon.A 33-year-old woman who was status post cardiac transplantation for dilated cardiomyopathy presented to the clinic with mild nonspecific fatigue and concern after having noticed relative bradycardia compared with her posttransplantation baseline heart rate. Electrocardiogram (ECG) showed junctional rhythm and inferior ST elevations, likely reflecting nodal ischemia. Troponins were grossly positive and echocardiogram showed marked right ventricular dysfunction.Successful percutaneous coronary intervention (PCI) with aspiration thrombectomy and drug-eluting stent placement was emergently performed. The heart's rhythm soon returned to sinus tachycardia. Right ventricular wall-motion abnormalities resolved. The patient suffered no clinical sequelae of her STEMI.This case illustrated that "classic" symptoms of STEMI may not occur at all in the setting of heart transplantation. To our knowledge, this is the first case of posttransplantation STEMI presenting as asymptomatic bradycardia, and highlights the importance of maintaining high clinical suspicion for ischemia in transplant recipients with subtle changes. In reviewing the epidemiology of this case, we locate and bundle different types of studies that have directly or indirectly looked at STEMI in heart transplantation. For a variety of putative pathophysiological reasons, STEMI is indeed a rare manifestation of the common transplant phenomenon of coronary artery vasculopathy (CAV).

    View details for DOI 10.1016/j.transproceed.2012.08.021

    View details for Web of Science ID 000316772500055

    View details for PubMedID 23498821

  • Physiologic approach for coronary intervention. The Korean journal of internal medicine Fearon, W. F. 2013; 28 (1): 1-7

    Abstract

    When invasively assessing coronary artery disease, the primary goal should be to determine whether the disease is causing a patient's symptoms and whether it is likely to cause future cardiac events. The presence of myocardial ischemia is our best gauge of whether a lesion is responsible for symptoms and likely to result in a future cardiac event. In the catheterization laboratory, fractional flow reserve (FFR) measured with a coronary pressure wire is the reference standard for identifying ischemia-producing lesions. Its spatial resolution is unsurpassed with it not only being vessel-specific, but also lesion-specific. There is now a wealth of data supporting the accuracy of measuring FFR to identify ischemia-producing lesions. FFR-guided percutaneous coronary intervention of these lesions results in improved outcomes and saves resources. Non-hemodynamically significant lesions can be safely managed medically with a low rate of subsequent cardiac events.

    View details for DOI 10.3904/kjim.2013.28.1.1

    View details for PubMedID 23345989

  • Variability in quantitative and qualitative analysis of intravascular ultrasound and frequency domain optical coherence tomography. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Abnousi, F., Waseda, K., Kume, T., Otake, H., Kawarada, O., Yong, C. M., Fitzgerald, P. J., Honda, Y., Yeung, A. C., Fearon, W. F. 2013

    Abstract

    BACKGROUND: Frequency-domain optical coherence tomography (FD-OCT) is an intravascular imaging technique now available in the United States. However, the importance of level of training required for analysis using intravascular ultrasound (IVUS) and FD-OCT is unclear. The aim of this study was to evaluate inter- and intra-observer variability between expert and beginner analysts interpreting IVUS and FD-OCT images. METHODS AND RESULTS: Two independent expert analysts and two independent beginner analysts evaluated a total of 226?±?2 stent cross-sections with IVUS and 232?±?2 stent cross-sections with FD-OCT in 14 patients after stenting. Inter- and intra-observer variability for determining stent volume index (VI), as well as identifying incomplete stent apposition and dissection were assessed. The inter- and intra-observer variability of stent VI was minimal for both beginner and expert analysts regardless of imaging technology (random variability: 0.38 vs. 0.05 mm(3) /mm for IVUS, 0.26 vs. 0.08 mm(3) /mm for FD-OCT). Although qualitative IVUS analysis at the patient level revealed no significant difference between beginners and experts, this was not the case for FD-OCT. The number of overall qualitative findings noted by beginner and expert analysts were more variable (overestimated or underestimated) with FD-OCT. CONCLUSION: Despite varying levels of training, the increased resolution of FD-OCT compared to IVUS provides better detection and less variability in quantitative image analysis. On the contrary, this increased resolution not only increases the rate but also the variability of detection of qualitative image analysis, especially for beginner analysts. © 2013 Wiley Periodicals, Inc.

    View details for PubMedID 23412754

  • Calculation of the Index of Microcirculatory Resistance Without Coronary Wedge Pressure Measurement in the Presence of Epicardial Stenosis JACC-CARDIOVASCULAR INTERVENTIONS Yong, A. S., Layland, J., Fearon, W. F., Ho, M., Shah, M. G., Daniels, D., Whitbourn, R., MacIsaac, A., Kritharides, L., Wilson, A., Ng, M. K. 2013; 6 (1): 53-58

    Abstract

    This study sought to investigate a novel method to calculate the index of microcirculatory resistance (IMR) in the presence of significant epicardial stenosis without the need for balloon dilation to measure the coronary wedge pressure (P(w)).The IMR provides a quantitative measure of coronary microvasculature status. However, in the presence of significant epicardial stenosis, IMR calculation requires incorporation of the coronary fractional flow reserve (FFR(cor)), which requires balloon dilation within the coronary artery for P(w) measurement.A method to calculate IMR by estimating FFR(cor) from myocardial FFR (FFR(myo)), which does not require P(w) measurement, was developed from a derivation cohort of 50 patients from a single institution. This method to calculate IMR was then validated in a cohort of 72 patients from 2 other different institutions. Physiology measurements were obtained with a pressure-temperature sensor wire before coronary intervention in both cohorts.From the derivation cohort, a strong linear relationship was found between FFR(cor) and FFR(myo) (FFR(cor) = 1.34 × FFR(myo) - 0.32, r(2) = 0.87, p < 0.001) by regression analysis. With this equation to estimate FFR(cor) in the validation cohort, there was no significant difference between IMR calculated from estimated FFR(cor) and measured FFR(cor) (21.2 ± 12.9 U vs. 20.4 ± 13.6 U, p = 0.161). There was good correlation (r = 0.93, p < 0.001) and agreement by Bland-Altman analysis between calculated and measured IMR.The FFR(cor), and, by extension, microcirculatory resistance can be derived without the need for P(w). This method enables assessment of coronary microcirculatory status before or without balloon inflation, in the presence of epicardial stenosis.

    View details for DOI 10.1016/j.jcin.2012.08.019

    View details for Web of Science ID 000314090400010

    View details for PubMedID 23347861

  • Clinical and Functional Correlates of Early Microvascular Dysfunction After Heart Transplantation CIRCULATION-HEART FAILURE Haddad, F., Khazanie, P., Deuse, T., Weisshaar, D., Zhou, J., Nam, C. W., Vu, T. A., Gomari, F. A., Skhiri, M., Simos, A., Schnittger, I., Vrotvec, B., Hunt, S. A., Fearon, W. F. 2012; 5 (6): 759-768

    Abstract

    Microvascular dysfunction is emerging as a strong predictor of outcome in heart transplant recipients. At this time, the determinants and consequences of early microvascular dysfunction are not well established. The objective of the study was to determine the risk factors and functional correlates associated with early microvascular dysfunction in heart transplant recipients.Sixty-three heart transplant recipients who had coronary physiology assessment, right heart catheterization, and echocardiography performed at the time of their first annual evaluation were included in the study. Microvascular dysfunction was assessed using the recently described index of microcirculatory resistance. The presence of microvascular dysfunction, predefined by an index of microcirculatory resistance >20, was observed in 46% of patients at 1 year. A history of acute rejection and undersized donor hearts were associated with microvascular dysfunction at 1 year, with odds ratio of 4.0 (1.3-12.8) and 3.6 (1.2-11.1), respectively. Patients with microvascular dysfunction had lower cardiac index (3.1±0.7 versus 3.5±0.7 L/min per m(2); P=0.02) and mild graft dysfunction measured by echocardiography-derived left and right myocardial performance indices ([0.54±0.09 versus 0.43±0.09; P<0.01] and [0.47±0.14 versus 0.32±0.05; P<0.01], respectively). Microvascular dysfunction was also associated with a higher likelihood of death, graft failure, or allograft vasculopathy at 5 years after transplant (hazard ratio, 2.52 [95% CI, 1.04-5.91]).A history of acute rejection during the first year and smaller donor hearts were identified as risk factors for early microvascular dysfunction. Microvascular dysfunction assessed using index of microcirculatory resistances at 1 year was also associated with worse graft function and possibly worse clinical outcomes.

    View details for DOI 10.1161/CIRCHEARTFAILURE.111.962787

    View details for Web of Science ID 000313580100023

    View details for PubMedID 22933526

  • The Impact of Downstream Coronary Stenoses on Fractional Flow Reserve Assessment of Intermediate Left Main Disease JACC-CARDIOVASCULAR INTERVENTIONS Daniels, D. V., van't Veer, M., Pijls, N. H., van der Horst, A., Yong, A. S., De Bruyne, B., Fearon, W. F. 2012; 5 (10): 1021-1025

    Abstract

    The aim of this study was to assess the validity of measuring fractional flow reserve (FFR) of the left main (LM) coronary artery in the setting of concomitant left anterior descending (LAD) or left circumflex (LCX) stenoses.The theoretical impact of a stenosis in the LAD on the FFR assessment of intermediate LM disease with the pressure wire in an unobstructed LCX is currently unknown.A previously validated in vitro model of the coronary circulation was used to create a fixed intermediate stenosis of the LM and a variable downstream LAD or LCX stenosis. The true LM FFR (FFR(LM true)), with no concomitant downstream disease, was compared to the apparent LM FFR (FFR(LM apparent)), with concomitant downstream disease measured with different degrees of LAD or LCX disease. Additionally, an equation based on a resistors model was derived to predict the effect of downstream stenosis on LM FFR (FFR(LM predicted)).In the setting of isolated moderate LM disease (FFR 0.72 ± 0.08), mild to moderate proximal LAD or LCX lesions did not significantly affect LM FFR. Lesions with a composite FFR (LM + downstream disease) ?0.65 resulted in an FFR(LM apparent) that was not significantly different from FFR(LM true) (0.76 ± 0.06 vs. 0.76 ± 0.05, p = 0.124). Our equation for FFR(LM predicted) accurately modeled the effects of concomitant disease (r = 0.95, p < 0.001).These data suggest that in the presence of proximal mild to moderate LAD or LCX disease, LM FFR can be reliably measured with the pressure wire placed in the uninvolved epicardial artery.

    View details for DOI 10.1016/j.jcin.2012.07.005

    View details for Web of Science ID 000310197800006

    View details for PubMedID 23078730

  • The Impact of Sex Differences on Fractional Flow Reserve-Guided Percutaneous Coronary Intervention A FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) Substudy JACC-CARDIOVASCULAR INTERVENTIONS Kim, H., Tonino, P. A., De Bruyne, B., Yong, A. S., Tremmel, J. A., Pijls, N. H., Fearon, W. F. 2012; 5 (10): 1037-1042

    Abstract

    This study sought to evaluate the impact of sex differences on fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI).The FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study demonstrated that FFR-guided PCI improves outcomes compared with an angiography-guided strategy. The role of FFR-guided PCI in women versus men has not been evaluated.We analyzed 2-year data from the FAME study in the 744 men and 261 women with multivessel coronary disease, who were randomized to angiography- or FFR-guided PCI. Statistical comparisons based on sex were stratified by treatment method.Although women were older and had significantly higher rates of hypertension than men did, there were no differences in the rates of major adverse cardiac events (20.3% vs. 20.2%, p = 0.923) and its individual components at 2 years. FFR values were significantly higher in women than in men (0.75 ± 0.18 vs. 0.71 ± 0.17, p = 0.001). The proportion of functionally significant lesions (FFR ? 0.80) was lower in women than in men for lesions with 50% to 70% stenosis (21.1% vs. 39.5%, p < 0.001) and for lesions with 70% to 90% stenosis (71.9% vs. 82.0%, p = 0.019). An FFR-guided strategy resulted in similar relative risk reductions for death, myocardial infarction, and repeat revascularization in men and in women. There were no interactions between sex and treatment method for any outcome variables.In comparison with men, angiographic lesions of similar severity are less likely to be ischemia-producing in women. An FFR-guided PCI strategy is equally beneficial in women as it is in men.

    View details for DOI 10.1016/j.jcin.2012.06.016

    View details for Web of Science ID 000310197800009

    View details for PubMedID 23078733

  • The Index of Microcirculatory Resistance Predicts Myocardial Infarction Related to Percutaneous Coronary Intervention CIRCULATION-CARDIOVASCULAR INTERVENTIONS Ng, M. K., Yong, A. S., Ho, M., Shah, M. G., Chawantanpipat, C., O'Connell, R., Keech, A., Kritharides, L., Fearon, W. F. 2012; 5 (4): 515-522

    Abstract

    Periprocedural myocardial infarction (MI) occurs in a significant proportion of patients undergoing percutaneous coronary intervention (PCI) and portends poor outcomes. Currently, no clinically applicable method predicts periprocedural MI in the cardiac catheterization laboratory before it occurs. We hypothesized that impaired baseline coronary microcirculatory reserve, which reduces the ability to tolerate ischemic insults, is a risk for periprocedural MI and that the index of microcirculatory resistance (IMR) measured during PCI can predict occurrence of periprocedural MI.Consecutive patients undergoing elective PCI of a single lesion in the left anterior descending coronary artery were recruited. A pressure-temperature sensor wire was used to measure IMR before PCI. Of the 50 patients studied, 10 had periprocedural MI. From binary logistic regression analyses of all clinical, procedural, and physiological parameters, univariable predictors of periprocedural MI were pre-PCI IMR (P=0.003) and the number of stents used (P=0.039). Pre-PCI IMR was the only independent predictor in bivariable regression analyses performed by adjusting for each available covariate one at a time (all P?0.02). Pre-PCI IMR ?27 U had 80.0% sensitivity and 85.0% specificity for predicting periprocedural MI (C statistic, 0.80; P=0.003). Pre-PCI IMR ?27 U was independently associated with a 23-fold risk of developing periprocedural MI (odds ratio, 22.7; 95% CI, 3.8-133.9).These data suggest that the status of the coronary microcirculation plays a role in determining susceptibility toward periprocedural MI at the time of elective PCI. The IMR can predict subsequent risk of developing myocardial necrosis and may guide adjunctive prevention strategies.

    View details for DOI 10.1161/CIRCINTERVENTIONS.112.969048

    View details for Web of Science ID 000313575600014

    View details for PubMedID 22874078

  • Most accurate definition of a high femoral artery puncture: Aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Tremmel, J. A., Tibayan, Y. D., O'Loughlin, A. J., Chan, T., Fearon, W. F., Yeung, A. C., Lee, D. P. 2012; 80 (1): 37-42

    Abstract

    Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown.We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified.Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p < 0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p < 0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, ? = 0.79; B, ? = 0.59; C, ? = 0.19).Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.

    View details for DOI 10.1002/ccd.23175

    View details for Web of Science ID 000305692100005

    View details for PubMedID 22511409

  • Coronary Microcirculatory Resistance Is Independent of Epicardial Stenosis CIRCULATION-CARDIOVASCULAR INTERVENTIONS Yong, A. S., Ho, M., Shah, M. G., Ng, M. K., Fearon, W. F. 2012; 5 (1): 103-U180

    Abstract

    Recent studies show that coronary microcirculatory impairment is an independent predictor of poor outcomes in patients with cardiovascular disease. However, controversy exists over whether microcirculatory resistance, a measure of coronary microcirculatory status, is dependent on epicardial stenosis severity. Previous studies demonstrating that microcirculatory resistance is dependent on epicardial stenosis severity have not accounted for collateral flow in their measurement of microcirculatory resistance. We investigated whether the index of microcirculatory resistance is independent of epicardial stenosis by comparing the index of microcirculatory resistance (IMR) levels in patients before and after percutaneous coronary intervention (PCI).Consecutive patients undergoing elective PCI of the left anterior descending artery were recruited. Patients who developed periprocedural myocardial infarction were excluded. A pressure-temperature sensor wire was used to measure the apparent IMR (IMR(app)), which does not adjust for collateral flow, and the true IMR (IMR(true)), which incorporates wedge pressure measurement to account for collateral flow, before and after PCI. In 43 patients, there was no difference between pre- and post-PCI IMR(true) (mean difference=0.8±11.7, P=0.675). IMR(app) was higher pre-PCI compared with post-PCI (mean difference=10.0±14.5, P<0.001). IMR(app) was higher than IMR(true) (mean difference=9.3±14.2, P<0.001), and the difference between the IMR(app) and IMR(true) became greater with decreasing fractional flow reserve and increasing coronary wedge pressure. Pre-PCI fractional flow reserve correlated modestly with IMR(app) (r=-0.33, P=0.03), but not IMR(true) (r=0.26, P=0.10).Coronary microcirculatory resistance is independent of functional epicardial stenosis severity when collateral flow is taken into account.

    View details for DOI 10.1161/CIRCINTERVENTIONS.111.966556

    View details for Web of Science ID 000300610900020

    View details for PubMedID 22298800

  • Comparison of the Frequency of Coronary Artery Disease in Alcohol-Related Versus Non-Alcohol-Related Endstage Liver Disease AMERICAN JOURNAL OF CARDIOLOGY Patel, S., Kiefer, T. L., Ahmed, A., Ali, Z. A., Tremmel, J. A., Lee, D. P., Yeung, A. C., Fearon, W. F. 2011; 108 (11): 1552-1555

    Abstract

    There are conflicting data as to the prevalence of coronary artery disease (CAD) in patients with end-stage liver disease (ESLD) being assessed for liver transplantation (LT). The aims of this study were to compare the prevalence of CAD in patients with alcohol-related versus non-alcohol-related ESLD and to assess the diagnostic utility of dobutamine stress echocardiography (DSE) in predicting angiographically important CAD. Consecutive patients with ESLD being assessed for LT (n = 420, mean age 56 ± 8 years) were identified and divided into groups of those with alcohol-related ESLD (n = 125) and non-alcohol-related ESLD (n = 295). Demographic characteristics, CAD risk factors, results of DSE, and coronary angiographic characteristics were recorded. There were no significant differences in age or CAD risk factors between groups. The incidence of severe CAD (>70% diameter stenosis) was 2% in the alcohol-related ESLD group and 13% in the non-alcohol-related ESLD group (p <0.005). In the 2 groups, the presence of ?1 CAD risk factor was associated with significant CAD (p <0.05 for all). Absence of cardiac risk factors was highly predictive in ruling out angiographically significant disease (negative predictive value 100% for alcohol-related ESLD and 97% for non-alcohol-related ESLD). DSE was performed in 205 patients. In the 2 groups, DSE had poor predictive value for diagnosing significant CAD but was useful in ruling out patients without significant disease (negative predictive value 89% for alcohol-related ESLD and 80% for non-alcohol-related ESLD). In conclusion, there was a significantly lower prevalence of severe CAD in patients with alcohol-related ESLD. These findings suggest that invasive coronary angiography may not be necessary in this subgroup, particularly in the absence of CAD risk factors and negative results on DSE.

    View details for DOI 10.1016/j.amjcard.2011.07.013

    View details for Web of Science ID 000297880000006

    View details for PubMedID 21890080

  • Is a Myocardial Infarction More Likely to Result From a Mild Coronary Lesion or an Ischemia-Producing One? CIRCULATION-CARDIOVASCULAR INTERVENTIONS Fearon, W. F. 2011; 4 (6): 539-541
  • Comparison of Drug-Eluting Versus Bare Metal Stents in Cardiac Allograft Vasculopathy AMERICAN JOURNAL OF CARDIOLOGY Tremmel, J. A., Ng, M. K., Ikeno, F., Hunt, S. A., Lee, D. P., Yeung, A. C., Fearon, W. F. 2011; 108 (5): 665-668

    Abstract

    Although not a definitive treatment, percutaneous coronary intervention offers a palliative benefit to patients with cardiac allograft vasculopathy. Given the superior outcomes with drug-eluting stents (DESs) over bare metal stents (BMSs) in native coronary artery disease, similar improvements might be expected in transplant patients; however, the results have been mixed. Consecutive cardiac transplantation recipients at a single center receiving a stent for de novo cardiac allograft vasculopathy from 1997 to 2009 were retrospectively analyzed according to receipt of a DES versus a BMS. The angiographic and clinical outcomes were subsequently evaluated at 1 year. The baseline clinical and procedural characteristics were similar among those receiving DESs (n = 18) and BMSs (n = 16). Quantitative coronary angiography revealed no difference in the reference diameter, lesion length, or pre-/postprocedural minimal luminal diameter. At the 12-month angiographic follow-up visit, the mean lumen loss was significantly lower in the DES group than in the BMS group (0.19 ± 0.73 mm vs 0.76 ± 0.97 mm, p = 0.02). The DES group also had a lower rate of in-stent restenosis (12.5% vs 33%, p = 0.18), as well as a significantly lower rate of target lesion revascularization (0% vs 19%, p = 0.03). At 1 year, DESs were associated with a lower composite rate of cardiac death and nonfatal myocardial infarction (12% vs 38%, p = 0.04). In conclusion, DESs are safe and effective in the suppression of neointimal hyperplasia after percutaneous coronary intervention for cardiac allograft vasculopathy, resulting in significantly lower rates of late lumen loss and target lesion revascularization, as well as a reduced combined rate of cardiac death and nonfatal myocardial infarction.

    View details for DOI 10.1016/j.amjcard.2011.04.014

    View details for Web of Science ID 000294751000009

    View details for PubMedID 21684511

  • Impact of Donor-Transmitted Atherosclerosis on Early Cardiac Allograft Vasculopathy: New Findings by Three-Dimensional Intravascular Ultrasound Analysis TRANSPLANTATION Yamasaki, M., Sakurai, R., Hirohata, A., Honda, Y., Bonneau, H. N., Luikart, H., Yock, P. G., Fitzgerald, P. J., Yeung, A. C., Valantine, H. A., Fearon, W. F. 2011; 91 (12): 1406-1411

    Abstract

    The influence of donor-transmitted coronary atherosclerosis (DA) on plaque progression during the first year after cardiac transplantation (Tx) is unknown.Serial 3-dimensional intravascular ultrasound (IVUS) studies were performed within 8 weeks (baseline; BL) and at 1 year after Tx in 38 recipients. On the basis of maximum intimal thickness (MIT) at BL, recipients were divided into DA group (DA+; MIT?0.5 mm, n=23) or non-DA group (DA-; MIT<0.5 mm, n=15). Plaque, lumen, and vessel volume indexes were calculated by volume/measured length (mm/mm) in the left anterior descending artery. Univariate and multivariate regression analyses were attempted to reveal clinical predictors of change in coronary dimensions.During the first year after Tx, plaque volume index increased significantly in DA+ group, but did not change in DA- Group (DA+, 3.0±1.5 to 4.1±1.5 mm/mm, P<0.0001: DA-, 1.2±0.4 to 1.3±0.5 mm/mm, P=0.53). In both groups vessel volume index decreased significantly (DA+, 16.3±3.6 to 14.6±3.3 mm/mm, P=0.003: DA-, 13.5±4.1 to 12.0±3.3 mm/mm, P=0.01), as did lumen volume index (DA+, 13.2±3.1 to 10.5±2.7 mm/mm, P<0.0001: DA-, 12.2±3.7 to 10.7±3.0 mm/mm, P=0.004). Univariate and multivariate regression analyses revealed that DA was one of the strongest predictors for plaque progression.DA was associated with significant plaque progression during the first year after Tx, and in conjunction with negative remodeling, may be an important determinant of cardiac allograft vasculopathy.

    View details for DOI 10.1097/TP.0b013e31821ab91b

    View details for Web of Science ID 000291430500019

    View details for PubMedID 21512436

  • The Index of Microcirculatory Resistance (IMR) in Takotsubo Cardiomyopathy CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Daniels, D. V., Fearon, W. F. 2011; 77 (1): 128-131

    Abstract

    We report a patient who presents with acute chest pain and positive cardiac enzymes clinically consistent with an acute coronary syndrome (ACS). Coronary angiography revealed normal epicardial arteries and the left ventriculogram was notable for apical ballooning. This was strongly suggestive of takotsubo cardiomyopathy. Pressure wire measurements of Fractional flow reserve (FFR) and IMR demonstrated a normal FFR, but significant microcirculatory dysfunction. This is the first such case that documents this abnormality invasively using the IMR, which unlike CFR is specific for the microcirculation and reproducible through a range of hemodynamic states.

    View details for DOI 10.1002/ccd.22599

    View details for Web of Science ID 000285770000030

    View details for PubMedID 20506131

  • Long-Term Outcomes After Percutaneous Coronary Intervention of Left Main Coronary Artery for Treatment of Cardiac Allograft Vasculopathy After Orthotopic Heart Transplantation AMERICAN JOURNAL OF CARDIOLOGY Lee, M. S., Yang, T., Fearon, W. F., Ho, M., Tarantini, G., Xhaxho, J., Gerosa, G., Weston, M., Ehdaie, A., Rabbani, L., Kirtane, A. J. 2010; 106 (8): 1086-1089

    Abstract

    The present study evaluated the safety and efficacy of percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (ULMCA) for the treatment of cardiac allograft vasculopathy (CAV) in consecutive unselected patients with orthotopic heart transplantation (OHT). PCI in patients with OHT and develop CAV has been associated with greater restenosis rates compared to PCI in patients with native coronary artery disease. A paucity of short- and long-term data is available from patients with OHT who have undergone PCI for ULMCA disease. The present retrospective, multicenter, international registry included 21 patients with OHT and CAV who underwent ULMCA PCI from 1997 to 2009. Angiographic success was achieved in all patients. Drug-eluting stents were used in 14 of the 21 patients. No major adverse cardiac events or repeat OHT occurred within the first 30 days. At a mean follow-up of 4.9 ± 3.2 years, 3 patients (14%) had died, myocardial infarction had occurred in 1 patient (5%), and target lesion revascularization had been required in 4 patients (19%). Follow-up angiography was performed in 16 patients (76%), and restenosis was observed in 4 (19%). No stent thrombosis of the ULMCA was observed. One patient (5%) underwent coronary artery bypass grafting, and 5 patients (24%) underwent repeat OHT. In conclusion, the results of our study have shown ULMCA PCI to be safe and reasonably effective in patients with OHT and represents a viable treatment strategy for CAV in these patients.

    View details for DOI 10.1016/j.amjcard.2010.06.019

    View details for Web of Science ID 000283568700005

    View details for PubMedID 20920643

  • Outcomes of Percutaneous Coronary Intervention in Intermediate Coronary Artery Disease Fractional Flow Reserve-Guided Versus Intravascular Ultrasound Guided JACC-CARDIOVASCULAR INTERVENTIONS Nam, C., Yoon, H., Cho, Y., Park, H., Kim, H., Hur, S., Kim, Y., Chung, I., Koo, B., Tahk, S., Fearon, W. F., Kim, K. 2010; 3 (8): 812-817

    Abstract

    This study sought to evaluate the long-term clinical outcomes of a fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) strategy compared with intravascular ultrasound (IVUS)-guided PCI for intermediate coronary lesions.Both FFR- and IVUS-guided PCI strategies have been reported to be safe and effective in intermediate coronary lesions.The study included 167 consecutive patients, with intermediate coronary lesions evaluated by FFR or IVUS (FFR-guided, 83 lesions vs. IVUS-guided, 94 lesions). Cutoff value of FFR in FFR-guided PCI was 0.80, whereas that for minimal lumen cross sectional area in IVUS-guided PCI was 4.0 mm(2). The primary outcome was defined as a composite of major adverse cardiac events including death, myocardial infarction, and ischemia-driven target vessel revascularization at 1 year after the index procedure.Baseline percent diameter stenosis and lesion length were similar in both groups (51 +/- 8% and 24 +/- 12 mm in the FFR group vs. 52 +/- 8% and 24 +/- 13 mm in the IVUS group, respectively). However, the IVUS-guided group underwent revascularization therapy significantly more often (91.5% vs. 33.7%, p < 0.001). No significant difference was found in major adverse cardiac event rates between the 2 groups (3.6% in FFR-guided PCI vs. 3.2% in IVUS-guided PCI). Independent predictors for performing intervention were guiding device: FFR versus IVUS (relative risk [RR]: 0.02); left anterior descending coronary artery versus non-left anterior descending coronary artery disease (RR: 5.60); and multi- versus single-vessel disease (RR: 3.28).Both FFR- and IVUS-guided PCI strategy for intermediate coronary artery disease were associated with favorable outcomes. The FFR-guided PCI reduces the need for revascularization of many of these lesions.

    View details for DOI 10.1016/j.jcin.2010.04.016

    View details for Web of Science ID 000281458700005

    View details for PubMedID 20723852

  • 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 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Pijls, N. H., Fearon, W. F., Tonino, P. A., Siebert, U., Ikeno, F., Bornschein, B., van't Veer, M., Klauss, V., Manoharan, G., Engstrom, T., Oldroyd, K. G., Lee, P. N., MacCarthy, P. A., De Bruyne, B. 2010; 56 (3): 177-184

    Abstract

    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).In patients with multivessel CAD undergoing PCI, coronary angiography is the standard method for guiding stent placement. The FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study showed that routine FFR in addition to angiography improves outcomes of PCI at 1 year. It is unknown if these favorable results are maintained at 2 years of follow-up.At 20 U.S. and European medical centers, 1,005 patients with multivessel CAD were randomly assigned to PCI with drug-eluting stents guided by angiography alone or guided by FFR measurements. Before randomization, lesions requiring PCI were identified based on their angiographic appearance. Patients randomized to angiography-guided PCI underwent stenting of all indicated lesions, whereas those randomized to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80, the rate of myocardial infarction was 0.2% and the rate of revascularization was 3.2 % after 2 years.Routine measurement of FFR in patients with multivessel CAD undergoing PCI with drug-eluting stents significantly reduces mortality and myocardial infarction at 2 years when compared with standard angiography-guided PCI. (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [FAME]; NCT00267774).

    View details for DOI 10.1016/j.jacc.2010.04.012

    View details for Web of Science ID 000279520200002

    View details for PubMedID 20537493

  • Balloon aortic valvuloplasty: modern indications and techniques for a niche therapy. Expert review of cardiovascular therapy Yamen, E., Fearon, W. F. 2010; 8 (7): 885-887

    View details for DOI 10.1586/erc.10.68

    View details for PubMedID 20602546

  • Angiographic Versus Functional Severity of Coronary Artery Stenoses in the FAME Study Fractional Flow Reserve Versus Angiography in Multivessel Evaluation JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Tonino, P. A., Fearon, W. F., De Bruyne, B., Oldroyd, K. G., Leesar, M. A., Lee, P. N., MacCarthy, P. A., van't Veer, M., Pijls, N. H. 2010; 55 (25): 2816-2821

    Abstract

    The purpose of this study was to investigate the relationship between angiographic and functional severity of coronary artery stenoses in the FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation) study.It can be difficult to determine on the coronary angiogram which lesions cause ischemia. Revascularization of coronary stenoses that induce ischemia improves a patient's functional status and outcome. For stenoses that do not induce ischemia, however, the benefit of revascularization is less clear.In the FAME study, routine measurement of the fractional flow reserve (FFR) was compared with angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease. The use of the FFR in addition to angiography significantly reduced the rate of all major adverse cardiac events at 1 year. Of the 1,414 lesions (509 patients) in the FFR-guided arm of the FAME study, 1,329 were successfully assessed by the FFR and are included in this analysis.Before FFR measurement, these lesions were categorized into 50% to 70% (47% of all lesions), 71% to 90% (39% of all lesions), and 91% to 99% (15% of all lesions) diameter stenosis by visual assessment. In the category 50% to 70% stenosis, 35% were functionally significant (FFR 0.80). In the category 71% to 90% stenosis, 80% were functionally significant and 20% were not. In the category of subtotal stenoses, 96% were functionally significant. Of all 509 patients with angiographically defined multivessel disease, only 235 (46%) had functional multivessel disease (>or=2 coronary arteries with an FFR

    View details for DOI 10.1016/j.jacc.2009.11.096

    View details for Web of Science ID 000278779300005

    View details for PubMedID 20579537

  • Intriguing Pen-Strut Low-Intensity Area Detected by Optical Coherence Tomography After Coronary Stent Deployment CIRCULATION JOURNAL Teramoto, T., Ikeno, F., Otake, H., Lyons, J. K., van Beusekom, H. M., Fearon, W. F., Yeung, A. C. 2010; 74 (6): 1257-1259

    Abstract

    Although peri-strut low-intensity area (PLIA) is frequently observed on post-stenting optical coherence tomography (OCT) images, the histology associated with PLIA is undocumented.The 36 porcine coronary lesions treated with bare-metal (BMS: n=16) or drug-eluting (DES: n=20) stents were assessed by OCT and histology at 28 days. DES showed a significantly higher incidence of PLIA than BMS. Also, +PLIA stents had greater neointima than PLIA stents. Histological analysis revealed the existence of fibrinoid and proteoglycans at the site of PLIA.PLIA might be represented by the presence of fibrinoid and proteoglycans, and associated with neointimal proliferation after stenting.

    View details for DOI 10.1253/circj.CJ-10-0189

    View details for Web of Science ID 000278211900036

    View details for PubMedID 20453394

  • Quantitative assessment of coronary microvascular function in patients with and without epicardial atherosclerosis EUROINTERVENTION Melikian, N., Vercauteren, S., Fearon, W. F., Cuisset, T., MacCarthy, P. A., Davidavicius, G., Aarnoudse, W., Bartunek, J., Vanderheyden, M., Wyffels, E., Wijns, W., Heyndrickx, G. R., Pijls, N. H., De Bruyne, B. 2010; 5 (8): 939-945

    Abstract

    The influence of atherosclerosis and its risk factors on coronary microvascular function remain unclear as current methods of assessing microvascular function do not specifically test the microcirculation in isolation. We examined the influence of epicardial vessel atherosclerosis on coronary microvascular function using the index of myocardial resistance (IMR).IMR (a measure of microvascular function) and fractional flow reserve (FFR, a measure of the epicardial compartment) were measured in 143 coronary arteries (116 patients). Fifteen patients (22 arteries, mean age 48+/-16 years) had no clinical evidence of atherosclerosis (control group). One hundred and one patients (121 arteries, mean age 63+/-11 years) had established atherosclerosis and multiple cardiovascular risk factors (atheroma group). Mean IMR in the control group (19+/-5, range 8-28) was significantly lower than in the atheroma group (25+/-13, range 6-75) (P<0.01). However, there was large overlap between IMR in both groups, with 69% of IMR values in patients with atheroma being within the control range. Mean FFR was also higher in the control group (0.96+/-0.02, range 0.93-1.00) than in the atheroma group (0.85+/-0.14, range 0.19-1.00) (P<0.01). There was no correlation between IMR and FFR (r=0.09; P=0.24), even when results in the control (r=0.02; P=0.92) and atheroma (r=0.15; P=0.10) groups were analysed in isolation. Using stepwise multiple regression analysis presence/absence of atheroma (ss=0.42; P=0.02) was the only independent determinant of IMR.Mean IMR is higher in patients with epicardial atherosclerosis. However, there is a large overlap between IMR in patients with and without epicardial atherosclerosis.

    View details for Web of Science ID 000294134000011

    View details for PubMedID 20542779

  • Anatomic and Functional Evaluation of Bifurcation Lesions Undergoing Percutaneous Coronary Intervention CIRCULATION-CARDIOVASCULAR INTERVENTIONS Koo, B., Waseda, K., Kang, H., Kim, H., Nam, C., Hur, S., Kim, J., Choi, D., Jang, Y., Hahn, J., Gwon, H., Yoon, M., Tahk, S., Chung, W., Cho, Y., Choi, D., Hasegawa, T., Kataoka, T., Oh, S. J., Honda, Y., Fitzgerald, P. J., Fearon, W. F. 2010; 3 (2): 113-119

    Abstract

    We sought to investigate the mechanism of geometric changes after main branch (MB) stent implantation and to identify the predictors of functionally significant "jailed" side branch (SB) lesions.Seventy-seven patients with bifurcation lesions were prospectively enrolled from 8 centers. MB intravascular ultrasound was performed before and after MB stent implantation, and fractional flow reserve was measured in the jailed SB. The vessel volume index of both the proximal and distal MB was increased after stent implantation. The plaque volume index decreased in the proximal MB (9.1+/-3.0 to 8.4+/-2.4 mm(3)/mm, P=0.001), implicating plaque shift, but not in the distal MB (5.4+/-1.8 to 5.3+/-1.7 mm(3)/mm, P=0.227), implicating carina shifting to account for the change in vessel size (N=56). The mean SB fractional flow reserve was 0.71+/-0.20 (N=68) and 43% of the lesions were functionally significant. Binary logistic-regression analysis revealed that preintervention % diameter stenosis of the SB (odds ratio=1.05; 95% CI, 1.01 to 1.09) and the MB minimum lumen diameter located distal to the SB ostium (odds ratio=3.86; 95% CI, 1.03 to 14.43) were independent predictors of functionally significant SB jailing. In patients with > or =75% stenosis and Thrombolysis In Myocardial Infarction grade 3 flow in the SB, no difference in post-stent angiographic and intravascular ultrasound parameters was found between SB lesions with and without functional significance.Both plaque shift from the MB and carina shift contribute to the creation/aggravation of an SB ostial lesion after MB stent implantation. Anatomic evaluation does not reliably predict the functional significance of a jailed SB stenosis.

    View details for DOI 10.1161/CIRCINTERVENTIONS.109.887406

    View details for Web of Science ID 000276873400005

    View details for PubMedID 20407111

  • Use of a Low-Profile, Compliant Balloon for Percutaneous Aortic Valvuloplasty CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Yamen, E., Daniels, D. V., Van, H., Yeung, A. C., Fearon, W. F. 2010; 75 (5): 794-798

    Abstract

    To determine the safety and immediate efficacy after balloon aortic valvuloplasty (BAV) with a new, low-profile balloon.BAV has a continuing role in the management of high-risk patients with severe aortic stenosis (AS). BAV with traditional noncompliant balloons requires a large femoral arteriotomy and is associated with high rates of access site complications.We retrospectively reviewed medical records of 20 consecutive patients undergoing BAV for severe AS. Retrograde transfemoral BAV was performed with a low-profile, compliant valvuloplasty balloon. Before and after BAV, transaortic gradients were measured invasively and by echocardiography, and aortic valve area (AVA) calculated. Access site complications, functional class and survival were recorded.Patients were 79 +/- 12 years old and had an estimated mortality from open aortic valve replacement of (12.5 +/- 9.6)%. By catheterization, mean aortic gradient fell from 44 +/- 15 to 29 +/- 10 mm Hg (P < 0.001) and AVA increased from 0.63 +/- 0.22 to 0.89 +/- 0.33 cm(2) (P < 0.001). New York Heart Association functional class improved from 3.5 +/- 0.7 to 2.7 +/- 0.8. Procedural mortality was 0%. There were no vascular complications or significant worsening of aortic regurgitation.Transfemoral BAV using a low-profile compliant balloon is feasible with acceptable immediate results and safety.

    View details for DOI 10.1002/ccd.22355

    View details for Web of Science ID 000276589300032

    View details for PubMedID 20146311

  • Fractional Flow Reserve and Myocardial Perfusion Imaging in Patients With Angiographic Multivessel Coronary Artery Disease JACC-CARDIOVASCULAR INTERVENTIONS Melikian, N., De Bondt, P., Tonino, P., De Winter, O., Wyffels, E., Bartunek, J., Heyndrickx, G. R., Fearon, W. F., Pijls, N. H., Wijns, W., De Bruyne, B. 2010; 3 (3): 307-314

    Abstract

    The aim of this study was to investigate the correlation between myocardial ischemia detected by myocardial perfusion imaging (MPI) with single-photon emission computed tomography with intracoronary pressure-derived fractional flow reserve (FFR) in patients with multivessel coronary disease at angiography.Myocardial perfusion imaging can underestimate the number of ischemic territories in patients with multivessel disease. However, there are limited data comparing MPI and FFR, a highly accurate functional index of myocardial ischemia, in multivessel coronary disease.Sixty-seven patients (201 vascular territories) with angiographic 2- or 3-vessel coronary disease were prospectively scheduled to undergo within 2 weeks MPI (rest/stress adenosine) and FFR in each vessel.In 42% of patients, MPI and FFR detected identical ischemic territories (mean number of territories 0.9 +/- 0.8 for both; p = 1.00). In the remaining 36% MPI underestimated (mean number of territories; MPI: 0.46 +/- 0.6, FFR: 2.0 +/- 0.6; p < 0.001) and in 22% overestimated (mean number of territories; MPI: 1.9 +/- 0.8, FFR: 0.5 +/- 0.8; p < 0.001) the number of ischemic territories in comparison with FFR. There was poor concordance between the ability of the 2 methods to detect myocardial ischemia on both a per-patient (kappa = 0.14 [95% confidence interval: -0.10 to 0.39]) and per-vessel (kappa = 0.28 [95% confidence interval: 0.15 to 0.42]) basis.Myocardial perfusion imaging with single-photon emission computed tomography has poor concordance with FFR and tends to underestimate or overestimate the functional importance of coronary stenosis seen at angiography in comparison with FFR in patients with multivessel disease. These findings might have important consequences in using MPI to determine the optimal revascularization strategy in patients with multivessel coronary disease.

    View details for DOI 10.1016/j.jcin.2009.12.010

    View details for Web of Science ID 000278972100008

    View details for PubMedID 20298990

  • Impact of Drug-Eluting Stent Length on Outcomes Less Is More ... More or Less JACC-CARDIOVASCULAR INTERVENTIONS Fearon, W. F. 2010; 3 (2): 189-190

    View details for DOI 10.1016/j.jcin.2009.12.006

    View details for Web of Science ID 000278972000008

    View details for PubMedID 20170876

  • Expanding role of fractional flow reserve in the cardiac catheterization laboratory. Expert review of cardiovascular therapy Fearon, W. F. 2009; 7 (5): 447-449

    View details for DOI 10.1586/erc.09.27

    View details for PubMedID 19419250

  • Baseline Fractional Flow Reserve and Stent Diameter Predict Optimal Post-Stent Fractional Flow Reserve and Major Adverse Cardiac Events After Bare-Metal Stent Deployment JACC-CARDIOVASCULAR INTERVENTIONS Samady, H., McDaniel, M., Veledar, E., De Bruyne, B., Pijls, N. H., Fearon, W. F., Vaccarino, V. 2009; 2 (4): 357-363

    Abstract

    We sought to identify baseline clinical, angiographic, and hemodynamic variables associated with optimal bare-metal stent (BMS) deployment, allowing selection of patients for treatment with BMS.Patients with fractional flow reserve (FFR) >0.90 after BMS have low (<6%) major adverse cardiac event rates (MACE). We hypothesized that baseline variables can predict post-stent FFR >0.90 and MACE after BMS.In 586 patients from the multicenter post-BMS FFR registry, we developed multivariable logistic regression models to identify clinical, angiographic, and hemodynamic variables associated with post-stent FFR >or=0.90 and 6-month MACE.After adjusting for potential confounders, baseline FFR (odds ratio [OR]: 5.0) and stent diameter (OR: 2.5 per millimeter) were predictive of post-stent FFR >0.90. Lower FFR (OR: 7.8); smaller stent diameter (OR: 3.7 per millimeter); longer stent length (OR: 1.0 per millimeter); and larger minimal luminal diameter (OR: 2.2 per millimeter) were predictors of MACE. In patients receiving 3-mm diameter stents, baseline FFR >0.70 yielded significantly higher likelihood of achieving post-stent FFR >0.90 than baseline FFR 0.70 (40% vs. 15% vs. 13%, p < 0.05).In patients receiving BMS, baseline FFR and stent diameter are predictors of post-stent FFR >0.90; and baseline FFR, stent diameter, stent length, and minimal luminal diameter are predictors of MACE. These variables may allow selection of patients who will have excellent results with BMS.

    View details for DOI 10.1016/j.jcin.2009.01.008

    View details for Web of Science ID 000278970900015

    View details for PubMedID 19463450

  • Safety and Performance of Targeted Renal Therapy: The Be-RITe! Registry JOURNAL OF ENDOVASCULAR THERAPY Weisz, G., Filby, S. J., Cohen, M. G., Allie, D. E., Weinstock, B. S., Kyriazis, D., Walker, C. M., Moses, J. W., Danna, P., Fearon, W. F., Sachdev, N., Wiechmann, B. N., Vora, K., Findeiss, L., Price, M. J., Mehran, R., Leon, M. B., Teirstein, P. S. 2009; 16 (1): 1-12

    Abstract

    To evaluate the safety and patterns of use of targeted renal therapy (TRT) with the Benephit system. TRT, the delivery of therapeutic agents directly to the kidneys by renal arterial infusion, has the advantage of providing a higher local effective dose with potentially greater renal effects, while limiting systemic adverse effects due to renal first-pass elimination.The Benephit System Renal Infusion Therapy (Be-RITe!) Multicenter Registry was a post-market registry following patients treated using the Benephit systems for TRT. The registry enrolled 501 patients (332 men; mean age 72.2+/-9.5 years) at high risk for contrast-induced nephropathy (CIN) during coronary or peripheral angiography/intervention or cardiovascular surgery. The Mehran score was used to compare the actual to predicted incidence of CIN within 48 hours post procedure.Bilateral renal artery cannulation was successful in 94.2%, with a mean cannulation time of 2.0 minutes. Either fenoldopam mesylate, sodium bicarbonate, alprostadil, or B-type natriuretic peptide (BNP) was infused for 184+/-212 minutes. Mean creatinine levels did not change significantly (baseline, 24, and 48 hours post procedure: 1.95, 1.99, and 1.98 mg/dL, respectively; p = NS). In 285 patients who received TRT with fenoldopam and were followed for at least 48 hours, the incidence of CIN was 71% lower than predicted (8.1% actual CIN versus 28.0% predicted; p<0.0001). Only 4 (1.4%) patients required dialysis (versus the 2.6% predicted rate, p = NS).The Benephit system and TRT during coronary and endovascular procedures in patients at high risk for renal failure is simple to use and safe. With the infusion of intrarenal fenoldopam, the incidence of CIN was significantly lower than predicted by risk score calculations.

    View details for Web of Science ID 000263307900001

    View details for PubMedID 19281283

  • Inflammation and cardiovascular disease - Role of the interleukin-1 receptor antagonist CIRCULATION Fearon, W. F., Fearon, D. T. 2008; 117 (20): 2577-2579
  • Effect of rapamycin therapy on coronary artery physiology early after cardiac transplantation AMERICAN HEART JOURNAL Sinha, S. S., Pham, M. X., Vagelos, R. H., Perlroth, M. G., Hunt, S. A., Lee, D. P., Valantine, H. A., Yeung, A. C., Fearon, W. F. 2008; 155 (5)

    Abstract

    Rapamycin has been shown to reduce anatomical evidence of cardiac allograft vasculopathy, but its effect on coronary artery physiology is unknown.Twenty-seven patients without angiographic evidence of coronary artery disease underwent measurement of fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR) within 8 weeks and then 1 year after transplantation using a pressure sensor/thermistor-tipped guidewire. Measurements were compared between consecutive patients who were on rapamycin for at least 3 months during the first year after transplantation (rapamycin group, n = 9) and a comparable group on mycophenolate mofetil (MMF) instead (MMF group, n = 18).At baseline, there was no significant difference in FFR, CFR, or IMR between the 2 groups. At 1 year, FFR declined significantly in the MMF group (0.87 +/- 0.06 to 0.82 +/- 0.06, P = .009) but did not change in the rapamycin group (0.91 +/- 0.05 to 0.89 +/- 0.04, P = .33). Coronary flow reserve and IMR did not change significantly in the MMF group (3.1 +/- 1.7 to 3.2 +/- 1.0, P = .76; and 27.5 +/- 18.1 to 19.1 +/- 7.6, P = .10, respectively) but improved significantly in the rapamycin group (2.3 +/- 0.8 to 3.8 +/- 1.4, P < .03; and 27.0 +/- 11.5 to 17.6 +/- 7.5, P < .03, respectively). Multivariate regression analysis revealed that rapamycin therapy was an independent predictor of CFR and FFR at 1 year after transplantation.Early after cardiac transplantation, rapamycin therapy is associated with improved coronary artery physiology involving both the epicardial vessel and the microvasculature.

    View details for DOI 10.1016/j.ahj.2008.02.004

    View details for Web of Science ID 000256001500014

    View details for PubMedID 18440337

  • In Vivo Comparison Between Optical Coherence Tomography and Intravascular Ultrasound for Detecting Small Degrees of In-Stent Neointima After Stent Implantation JACC-CARDIOVASCULAR INTERVENTIONS Suzuki, Y., Ikeno, F., Koizumi, T., Tio, F., Yeung, A. C., Yock, P. G., Fitzgerald, P. J., Fearon, W. F. 2008; 1 (2): 168-173

    Abstract

    The purpose of this study was to evaluate optical coherence tomography (OCT) for detecting small degrees of in-stent neointima (ISN) after stent implantation compared with intravascular ultrasound (IVUS).The importance of detecting neointimal coverage of stent struts has grown with the appreciation of the increased risk for late stent thrombosis after drug-eluting stent (DES) implantation. Intravascular ultrasound, the current standard for evaluating the status of DES, lacks the resolution to detect the initial neointimal coverage. Optical coherence tomography has greater resolution but has not yet been compared with IVUS in vivo with histological correlation for validation.Intravascular ultrasound and OCT were performed with motorized pullback imaging in 6 pigs across 33 stents, 1 month after implantation. Each pig was euthanized, and histological measurements of vessel, stent, and lumen dimensions were performed in 3 sections of each stent. A small degree of ISN was defined as occupying <30% of the stent area measured with histology. The IVUS, OCT, and histological assessment of ISN were compared in matched cross-sections of the stents with a small degree of ISN.Eleven stents had a small degree of ISN (average ISN area: 1.26 +/- 0.46 mm(2), and percent area obstruction: 21.4 +/- 5.2%). Compared with histology, the diagnostic accuracy of OCT (area under the receiver operating characteristic curve [AUC] = 0.967, 95% confidence interval [CI] 0.914 to 1.019) was higher than that of IVUS (AUC = 0.781, 95% CI 0.621 to 0.838).Optical coherence tomography detects smaller degrees of ISN more accurately than IVUS and might be a useful method for identifying neointimal coverage of stent struts after DES implantation.

    View details for DOI 10.1016/j.jcin.2007.12.007

    View details for Web of Science ID 000207586100011

    View details for PubMedID 19463295

  • Asymmetric dimethylarginine and cardiac allograft vasculopathy progression: Modulation by sirolimus TRANSPLANTATION Potena, L., Fearon, W. F., Sydow, K., Holweg, C., Luikart, H., Chin, C., Weisshaar, D., Mocarski, E. S., Lewis, D. B., Valantine, H. A., Cooke, J. P. 2008; 85 (6): 827-833

    Abstract

    Cardiac allograft vasculopathy (CAV) is a major cause of death after heart transplantation (HT). The reduced bioavailability of endothelium-derived nitric oxide may play a role in endothelial vasodilator dysfunction and thus in the structural changes characterizing CAV. A potential contributor to endothelial pathobiology is asymmetric dimethylarginine (ADMA), an endogenous nitric oxide synthase inhibitor. It was hypothesized that ADMA concentrations may influence CAV progression during the first postoperative year.Thirty-two consecutive HT recipients underwent intravascular ultrasound evaluation at month 1 and year 1 after HT. Immunosuppression included mycophenolate mofetil (MMF, n=16) and sirolimus (n=16). Change in intimal volume greater than the median and vascular remodeling were major outcome measures.Plasma ADMA levels were associated with subsequent development of intimal hyperplasia (risk ratio [95% confidence interval] =2.72 [1.06-6.94]; P=0.038), and plasma ADMA levels greater than 0.70 micromol/L most accurately identified patients who would have developed intimal hyperplasia. However, ADMA levels did not correlate with negative coronary remodeling. Treatment with sirolimus, as compared with MMF, was associated with significantly lower ADMA levels (0.65+/-0.12 vs. 0.77+/-0.10 micromol/L; P<0.01) and less intimal hyperplasia (risk ratio [95% confidence interval] = 0.08 [0.01-0.56]; P=0.01).Elevated plasma ADMA is associated with coronary intimal hyperplasia, supporting the importance of nitric oxide synthase inhibition in CAV pathogenesis. Treatment with sirolimus (rather than MMF) is associated with lower ADMA levels and reduced risk of accelerated CAV.

    View details for DOI 10.1097/TP.0b013e318166a3a4

    View details for Web of Science ID 000254592000008

    View details for PubMedID 18360263

  • The pathophysiology and clinical course of the normal coronary angina syndrome (cardiac syndrome x) PROGRESS IN CARDIOVASCULAR DISEASES Melikian, N., De Bruyne, B., Fearon, W. F., MacCarthy, P. A. 2008; 50 (4): 294-310

    View details for DOI 10.1016/j.pcad.2007.01.003

    View details for Web of Science ID 000252208300006

    View details for PubMedID 18156008

  • Determinants of lumen loss between years 1 and 2 after cardiac transplantation TRANSPLANTATION Sakurai, R., Yamasaki, M., Nakamura, M., Hirohata, A., Honda, Y., Bonneau, H. N., Luikart, H., Yock, P. G., Fitzgerald, P. J., Yeung, A. C., Valantine, H. A., Fearon, W. F. 2007; 84 (9): 1097-1102

    Abstract

    We previously reported that negative remodeling, not plaque progression, correlated with lumen loss during the first year after cardiac transplantation and that cytomegalovirus antibody seropositivity correlated with increased negative remodeling and greater lumen loss. Whether these findings persist between years 1 and 2 after transplantation is unknown.Serial 3-dimensional intravascular ultrasound analysis in the left anterior descending coronary artery was performed in 30 cardiac transplant recipients at year 1 and 2 after transplantation. Vessel, lumen, and plaque area were determined at 0.5-mm axial intervals in the first 50 mm of the left anterior descending coronary artery, and volumes were computed using Simpson's method. Univariate and multivariate regression analyses were performed to identify clinical predictors of change in coronary dimensions.Although mean vessel area did not change (13.6+/-3.4 to 13.4+/-3.3 mm/mm(3), P=0.45), mean plaque area increased (3.4+/-2.3 to 3.8+/-2.2 mm/mm(3), P=0.012), resulting in significant mean lumen area loss (10.3+/-2.5 to 9.6+/-2.3 mm/mm(3), P=0.016). However, the degree of luminal change strongly correlated with the degree of change in vessel size (R=0.81, P<0.0001), but not with change in plaque amount (R=-0.19, P=0.32). In fact, in 57% of the patients who demonstrated lumen loss, negative remodeling contributed more to lumen loss than did plaque progression. Diabetes at 2 years was the only significant independent clinical predictor of plaque progression and lumen loss.Despite significant plaque progression, negative remodeling correlated with coronary lumen loss between years 1 and 2 after cardiac transplantation.

    View details for DOI 10.1097/01.tp.0000285987.27033.65

    View details for Web of Science ID 000251030600006

    View details for PubMedID 17998863

  • Changes in coronary anatomy and physiology after heart transplantation AMERICAN JOURNAL OF CARDIOLOGY Hirohata, A., Nakamura, M., Waseda, K., Honda, Y., Lee, D. P., Vagelos, R. H., Hunt, S. A., Valantine, H. A., Yock, P. G., Fitzgerald, P. J., Yeung, A. C., Fearon, W. F. 2007; 99 (11): 1603-1607

    Abstract

    Cardiac allograft vasculopathy (CAV) is a progressive process involving the epicardial and microvascular coronary systems. The timing of the development of abnormalities in these 2 compartments and the correlation between changes in physiology and anatomy are undefined. The invasive evaluation of coronary artery anatomy and physiology with intravascular ultrasound, fractional flow reserve, coronary flow reserve, and the index of microcirculatory resistance (IMR) was performed in the left anterior descending coronary artery during 151 angiographic evaluations of asymptomatic heart transplant recipients from 0 to >5 years after heart transplantation (HT). There was no angiographic evidence of significant CAV, but during the first year after HT, fractional flow reserve decreased significantly (0.89 +/- 0.06 vs 0.85 +/- 0.07, p = 0.001), and percentage plaque volume derived by intravascular ultrasound increased significantly (15.6 +/- 7.7% to 22.5 +/- 12.3%, p = 0.0002), resulting in a significant inverse correlation between epicardial physiology and anatomy (r = -0.58, p <0.0001). The IMR was lower in these patients compared with those > or =2 years after HT (24.1 +/- 14.3 vs 29.4 +/- 18.8 units, p = 0.05), suggesting later spread of CAV to the microvasculature. As the IMR increased, fractional flow reserve increased (0.86 +/- 0.06 to 0.90 +/- 0.06, p = 0.0035 comparing recipients with IMRs < or =20 to those with IMRs > or =40), despite no difference in percentage plaque volume (21.0 +/- 11.2% vs 20.5 +/- 10.5%, p = NS). In conclusion, early after HT, anatomic and physiologic evidence of epicardial CAV was found. Later after HT, the physiologic effect of epicardial CAV may be less, because of increased microvascular dysfunction.

    View details for DOI 10.1016/j.amjcard.2007.01.039

    View details for Web of Science ID 000247121700024

    View details for PubMedID 17531589

  • Prognostic significance of PVCs and resting heart rate ANNALS OF NONINVASIVE ELECTROCARDIOLOGY Engel, G., Cho, S., Ghayoumi, A., Yamazaki, T., Chun, S., Fearon, W. F., Froelicher, V. F. 2007; 12 (2): 121-129

    Abstract

    We sought to evaluate the prognostic significance of premature ventricular contractions (PVCs) on a routine electrocardiogram (ECG) and to evaluate the relationship between heart rate and PVCs.Computerized 12-lead ECGs of 45,402 veterans were analyzed. Vital status was available through the California Health Department Service.There were 1731 patients with PVCs (3.8%). Compared to patients without PVCs, those with PVCs had significantly higher all-cause (39% vs 22%, P < 0.001) and cardiovascular mortality (20% vs 8%, P < 0.001). PVCs remain a significant predictor even after adjustment for age and other ECG abnormalities. The presence of multiple PVCs or complex morphologies did not add significant additional prognostic information. Those patients with PVCs had a significantly higher heart rate than those without PVCs (mean +/- SD: 78.6 +/- 15 vs 73.5 +/- 16 bpm, P < 0.001). When patients were divided into groups by heart rate (<60, 60-79, 80-99 and >100 bpm) and by the presence or absence of PVCs, mortality increased progressively with heart rate and doubled with the presence of PVCs. Using regression analysis, heart rate was demonstrated to be an independent and significant predictor of PVCs.PVCs on a resting ECG are a significant and independent predictor of all-cause and cardiovascular mortality. Increased heart rate predicts mortality in patients with and without PVCs and the combination dramatically increases mortality. These findings together with the demonstrated independent association of heart rate with PVCs suggest that a hyperadrenergic state is present in patients with PVCs and that it likely contributes to their adverse prognosis.

    View details for Web of Science ID 000246155700005

    View details for PubMedID 17593180

  • Interplay between systemic inflammation and markers of insulin resistance in cardiovascular prognosis after heart transplantation JOURNAL OF HEART AND LUNG TRANSPLANTATION Biadi, O., Potena, L., Fearon, W. F., Luikart, H. I., Yeung, A., Ferrara, R., Hunt, S. A., Mocarski, E. S., Valantine, H. A. 2007; 26 (4): 324-330

    Abstract

    Metabolic and immuno-inflammatory risk factors contribute to cardiac allograft vasculopathy (CAV) pathogenesis. Although systemic inflammation, as detected by C-reactive protein (CRP), predicts CAV development, the relationship between CRP and markers of metabolic abnormalities remains unexplored.CRP and the entire metabolic panel were evaluated in 98 consecutive heart transplant recipients at the time of annual coronary angiography, 5.8 years after transplant (range, 1-12 years). A ratio of triglycerides (TG) to high-density lipoproteins (HDL) of 3.0 or more was considered a marker of insulin resistance. CAV prevalence was defined by angiography, and subsequent prognosis was evaluated as incidence of major cardiac adverse events.CRP was higher in the 34 patients with angiographic CAV than in those without CAV (1.10 +/- 0.20 vs 0.50 +/- 0.05 mg/dl, p < 0.001). Patients with insulin resistance had higher CRP concentrations (p = 0.023) and higher CAV prevalence (p = 0.005). High CRP and a TG/HDL of 3.0 or more were independently associated with an increased likelihood of CAV (odds ratio, > or = 3.9; p = 0.02) and predicted an increased risk of major cardiac adverse events. The combination of high CRP and a TG/HDL of 3.0 or more identified a subgroup of patients having a 4-fold increased risk for CAV and a 3-fold increased risk for major cardiac adverse events compared with patients with low CRP and normal values for metabolic indicators.Both CRP and insulin resistance, as estimated by TG/HDL, appear to be strong, synergic risk factors for CAV and for major cardiac adverse events. These findings support the hypothesis that in heart transplant recipients, systemic inflammation may be an important mediator of graft vascular injury associated with metabolic syndrome.

    View details for DOI 10.1016/j.healun.2007.01.020

    View details for Web of Science ID 000245725100004

    View details for PubMedID 17403472

  • Changes in coronary arterial dimensions early after cardiac transplantation TRANSPLANTATION Fearon, W. F., Potena, L., Hirohata, A., Sakurai, R., Yamasaki, M., Luikart, H., Lee, J., Vana, M. L., Cooke, J. P., Mocarski, E. S., Yeung, A. C., Valantine, H. A. 2007; 83 (6): 700-705

    Abstract

    Significant changes in coronary artery structure, including intimal thickening and vessel remodeling, occur early after cardiac transplantation. The degree to which these changes compromise coronary lumen dimensions, and the clinical factors that affect these changes, remain controversial.Thirty-eight adult cardiac transplant recipients underwent coronary angiography and volumetric intravascular ultrasound (IVUS) evaluation of the left anterior descending artery within 8 weeks of transplantation and at 1 year. Clinical parameters including donor and recipient characteristics, rejection episodes, and serology were prospectively recorded. Two-dimensional IVUS measurements and vessel, lumen and plaque volume were calculated at both time points and compared. Multivariate regression analysis was performed to reveal clinical predictors of change in coronary dimensions.During the first year after transplantation, significant decreases in vessel size (negative remodeling) and lumen size were observed with significant increases in plaque burden based on IVUS analyses. Loss of lumen volume correlated significantly with the degree of negative remodeling (R=0.82, P<0.0001), but not with changes in plaque burden (R=0.08, P=0.64). Patients with the greatest increase in plaque volume had significantly less negative remodeling (R=0.53, P=0.0006). Transplant recipient cytomegalovirus (CMV) antibody seropositivity and lack of aggressive prophylaxis against CMV infection/reactivation were significant independent predictors of greater negative remodeling (P<0.01 and P=0.03, respectively) and greater lumen loss (P=0.02 and P=0.03, respectively).Negative remodeling is primarily responsible for coronary artery lumen loss during the first year after cardiac transplantation. CMV seropositivity and lack of aggressive CMV prophylaxis correlate with increased negative remodeling, resulting in greater lumen loss.

    View details for DOI 10.1097/01.tp.0000256335.84363.9b

    View details for Web of Science ID 000245411400009

    View details for PubMedID 17414701

  • Physiologic assessment of renal artery stenosis - Will history repeat itself? Editorial comment JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Fearon, W. F. 2006; 48 (9): 1856-1858

    View details for DOI 10.1016/j.jacc.2006.08.005

    View details for Web of Science ID 000241804400021

    View details for PubMedID 17084262

  • T-cell immunity to subclinical cytomegalovirus infection reduces cardiac allograft disease CIRCULATION Tu, W., Potena, L., Stepick-Biek, P., Liu, L., Dionis, K. Y., Luikart, H., Fearon, W. F., Holmes, T. H., Chin, C., Cooke, J. P., Valantine, H. A., Mocarski, E. S., Lewis, D. B. 2006; 114 (15): 1608-1615

    Abstract

    Asymptomatic cytomegalovirus (CMV) replication is frequent after cardiac transplantation in recipients with pretransplantation CMV infection. How subclinical viral replication influences cardiac allograft disease remains poorly understood, as does the importance of T-cell immunity in controlling such replication.Thirty-nine cardiac recipients who were pretransplantation CMV antibody positive were longitudinally studied for circulating CMV-specific CD4 and CD8 T-cell responses, CMV viral load in blood neutrophils, and allograft rejection during the first posttransplantation year. Nineteen of these recipients were also analyzed for changes of coronary artery intimal, lumen, and whole-vessel area. All recipients received early prophylactic therapy with ganciclovir. No recipients developed overt CMV disease. Those with detectable levels of CMV-specific CD4 T cells in the first month after transplantation were significantly protected from high mean and peak posttransplantation viral load (P<0.05), acute rejection (P<0.005), and loss of allograft coronary artery lumen (P<0.05) and of whole-vessel area (P<0.05) compared with those who lacked this immune response. The losses of lumen and vessel area were both significantly correlated with the time after transplantation at which a CD4 T-cell response was first detected (P<0.05) and with the cumulative graft rejection score (P<0.05).The early control of subclinical CMV replication after transplantation by T-cell immunity may limit cardiac allograft rejection and vascular disease. Interventions to increase T-cell immunity might be clinically useful in limiting these adverse viral effects.

    View details for DOI 10.1161/CIRCULATIONAHA.105.607549

    View details for Web of Science ID 000241077600011

    View details for PubMedID 17015794

  • Physiological assessment of coronary artery disease in the cardiac catheterization laboratory - A scientific statement from the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology CIRCULATION Kern, M. J., Lerman, A., Bech, J., De Bruyne, B., Eeckhout, E., Fearon, W. F., Higano, S. T., Lim, M. J., Meuwissen, M., Piek, J. J., Pijls, N. H., Siebes, M., Spaan, J. A. 2006; 114 (12): 1321-1341

    Abstract

    With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.

    View details for DOI 10.1161/CIRCULATIONAHA.106.177276

    View details for Web of Science ID 000240556700017

    View details for PubMedID 16940193

  • Acute rejection and cardiac allograft vascular disease is reduced by suppression of subclinical cytomegalovirus infection TRANSPLANTATION Potena, L., Holweg, C. T., Chin, C., Luikart, H., Weisshaar, D., Narasimhan, B., Fearon, W. F., Lewis, D. B., Cooke, J. P., Mocarski, E. S., Valantine, H. A. 2006; 82 (3): 398-405

    Abstract

    Anticytomegalovirus (CMV) prophylaxis prevents the acute disease but its impact on subclinical infection and allograft outcome is unknown. We sought to determine whether CMV prophylaxis administered for three months after heart transplant would improve patient outcomes.This prospective cohort study of 66 heart transplant recipients compared aggressive CMV prophylaxis (n = 21, CMV hyperimmune globulin [CMVIG] plus four weeks of intravenous ganciclovir followed by two months of valganciclovir); with standard prophylaxis (n = 45, intravenous ganciclovir for four weeks). Prophylaxis was based on pretransplant donor (D) and recipient (R) CMV serology: R-/D+ received aggressive prophylaxis; R+ received standard prophylaxis. Outcome measures were: CMV infection assessed by DNA-polymerase chain reaction on peripheral blood polymorphonuclear leukocytes, acute rejection, and cardiac allograft vascular disease (CAV) assessed by intravascular ultrasound. All patients completed one year of follow-up. RESULTS.: CMV infection was subclinical in all but four patients (two in each group). Aggressively treated patients had a lower incidence of CMV infection (73 +/- 10% vs. 94 +/- 4%; P = 0.038), and an independent reduced relative risk for acute rejection graded > or =3A (relative risk [95% CI] = 0.55 [0.26-0.96]; P = 0.03), as compared with the standard prophylaxis group. Aggressively prophylaxed patients also showed a slower progression of CAV, in terms of coronary artery lumen loss (lumen volume change=-21 +/- 13% vs. -10+/-14%; P = 0.05); and vessel shrinkage (vessel volume change = -15 +/- 11% vs. -3 +/- 18%; P = 0.03).Prolonged (val)ganciclovir plus CMVIG reduces viral levels, acute rejection, and allograft vascular disease, suggesting a role for chronic subclinical infection in the pathophysiology of the most common diseases affecting heart transplant recipients.

    View details for DOI 10.1097/01.tp.0000229039.87735.76

    View details for Web of Science ID 000239884800018

    View details for PubMedID 16906040

  • Discordant changes in epicardial and microvascular coronary physiology after cardiac transplantation: Physiologic investigation for transplant arteriopathy II (PITA II) study JOURNAL OF HEART AND LUNG TRANSPLANTATION Fearon, W. F., Hirohata, A., Nakamura, M., Luikart, H., Lee, D. P., Vagelos, R. H., Hunt, S. A., Valantine, H. A., Fitzgerald, P. J., Yock, P. G., Yeung, A. C. 2006; 25 (7): 765-771

    Abstract

    Investigating changes in coronary physiology that occur after cardiac transplantation has been challenging. Simultaneous and independent assessment of the epicardial artery by measuring fractional flow reserve (FFR) and of the microvasculature by calculating the index of microvascular resistance (IMR) with a single coronary pressure wire may be useful.Twenty-five asymptomatic patients with normal coronary angiograms underwent FFR, thermodilution-derived IMR and coronary flow reserve (CFR) and intravascular ultrasound (IVUS) evaluation soon after cardiac transplantation and 1 year later.FFR significantly worsened (0.90 +/- 0.05 at baseline to 0.85 +/- 0.06 at 1 year, p = 0.004). FFR correlated strongly with percent plaque volume as measured by IVUS (r = -0.58, p < 0.0001). IMR improved significantly (29.2 +/- 15.9 at baseline to 19.3 +/- 7.6 units at 1 year, p = 0.007). CFR increased, but not significantly (2.6 +/- 1.4 at baseline to 3.2 +/- 1.2 at 1 year, p = not significant). Diabetes and donor heart ischemic time independently predicted baseline IMR. Treatment with rapamycin independently predicted FFR at 1 year.New coronary physiologic measures, FFR and IMR, show that epicardial artery physiology worsens and correlates with anatomic changes, whereas microvascular physiology improves during the first year after cardiac transplantation. CFR, the traditional method for evaluating coronary circulatory physiology, did not identify these changes.

    View details for DOI 10.1016/j.healun.2006.03.003

    View details for Web of Science ID 000239019700003

    View details for PubMedID 16818118

  • Selective renal arterial infusion of fenoldopam for the prevention of contrast-induced nephropathy. Journal of interventional cardiology Ng, M. K., Tremmel, J., Fitzgerald, P. J., Fearon, W. F. 2006; 19 (1): 75-79

    Abstract

    Contrast-induced nephropathy (CIN) remains an important complication of angiographic procedures, particularly among patients with significant renal impairment. To date, vasodilator therapies such as fenoldopam have failed to prevent CIN, possibly because significant hypotension as a result of systemic infusion has limited the ability to deliver adequate drug levels to the renal vasculature. We present a case of averted CIN after multivessel coronary intervention in a diabetic patient with severe renal insufficiency, potentially due to bilateral renal arterial infusion of fenoldopam. Our subsequent experience with intrarenal fenoldopam in nine additional procedures in eight other high risk patients resulted in one case of asymptomatic transient CIN. Further studies are warranted to evaluate the efficacy of intrarenal administration of vasodilator therapies such as fenoldopam for the prevention of CIN.

    View details for PubMedID 16483344

  • Risk factors for the development of retroperitoneal hematoma after percutaneous coronary intervention in the era of glycoprotein IIb/IIIa inhibitors and vascular closure devices JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Farouque, H. M., Tremmel, J. A., Shabari, F. R., Aggarwal, M., Fearon, W. F., Ng, M. K., Rezaee, M., Yeung, A. C., Lee, D. P. 2005; 45 (3): 363-368

    Abstract

    We sought to determine the incidence, clinical features, and risk factors for retroperitoneal hematoma (RPH) after percutaneous coronary intervention (PCI).Little is known about the clinical features, outcomes, and determinants of this serious complication in the contemporary era of PCI.A retrospective analysis yielded 26 cases of RPH out of 3,508 consecutive patients undergoing PCI between January 2000 and January 2004. Cases were compared with a randomly selected sample of 50 control subjects without RPH.The incidence of RPH was 0.74%. Features of RPH included abdominal pain (42%), groin pain (46%), back pain (23%), diaphoresis (58%), bradycardia (31%), and hypotension (92%). The mean systolic blood pressure nadir was 75 mm Hg. The hematocrit dropped by 11.5 +/- 5.1 points from baseline in RPH patients, as compared with 2.3 +/- 3.3 points in controls (p < 0.0001). The mean hospital stay was longer in RPH patients (2.9 +/- 3.8 days vs. 1.7 +/- 1.5 days, p = 0.06). The following variables were found to be independent predictors of RPH: female gender (odds ratio [OR] 5.4, p = 0.005), low body surface area (BSA <1.73 m(2); OR 7.1, p = 0.008), and higher femoral artery puncture (OR 5.3, p = 0.013). There was no association between RPH and arterial sheath size, use of glycoprotein IIb/IIIa inhibitors, or deployment of a vascular closure device.Female gender, low BSA, and higher femoral artery puncture are significant risk factors for RPH. Awareness of the determinants and clinical features of RPH may aid in prevention, early recognition, and prompt treatment.

    View details for DOI 10.1016/j.jacc.2004.10.042

    View details for Web of Science ID 000226673400006

    View details for PubMedID 15680713

  • Pioglitazone-induced heart failure despite normal left ventricular function AMERICAN JOURNAL OF MEDICINE Shah, M., Kolandaivelu, A., Fearon, W. E. 2004; 117 (12): 973-974

    View details for Web of Science ID 000226106300019

    View details for PubMedID 15629744

  • "Tako-tsubo-like left ventricular dysfunction": a clinical entity mimicking acute myocardial infarction with a favorable prognosis. American journal of geriatric cardiology Farouque, H. M., Kaltenbach, T., Ako, J., Tremmel, J. A., Fearon, W. F., Yeung, A. C., Vagelos, R. H. 2004; 13 (6): 323-326

    Abstract

    An emotionally-distressed, elderly Caucasian woman presented with chest pain and hypertension. Electrocardiogram showed inferior ST-segment elevation, and an urgent cardiac catheterization was performed. Coronary angiography revealed normal appearing coronary arteries; however, left ventriculography showed extensive left ventricular apical akinesis. The patient had a mild rise in cardiac enzyme levels indicative of myocardial injury. She was discharged after an uncomplicated in-hospital course. One month later, the left ventricular wall motion abnormality had improved. In this report, the authors discuss this compilation of findings known as tako-tsubo-like left ventricular dysfunction.

    View details for PubMedID 15538070

  • Epicardial stenosis severity does not affect minimal microcirculatory resistance CIRCULATION Aarnoudse, W., Fearon, W. F., Manoharan, G., Geven, M., Van De Vosse, F., Rutten, M., De Bruyne, B., Pijls, N. H. 2004; 110 (15): 2137-2142

    Abstract

    Whether minimal microvascular resistance of the myocardium is affected by the presence of an epicardial stenosis is controversial. Recently, an index of microcirculatory resistance (IMR) was developed that is based on combined measurements of distal coronary pressure and thermodilution-derived mean transit time. In normal coronary arteries, IMR correlates well with true microvascular resistance. However, to be applicable in the case of an epicardial stenosis, IMR should account for collateral flow. We investigated the feasibility of determining IMR in humans and tested the hypothesis that microvascular resistance is independent of epicardial stenosis.Thirty patients scheduled for percutaneous coronary intervention were studied. The stenosis was stented with a pressure guidewire, and coronary wedge pressure (P(w)) was measured during balloon occlusion. After successful stenting, a short compliant balloon with a diameter 1.0 mm smaller than the stent was placed in the stented segment and inflated with increasing pressures, creating a 10%, 50%, and 75% area stenosis. At each of the 3 degrees of stenosis, fractional flow reserve (FFR) and IMR were measured at steady-state maximum hyperemia induced by intravenous adenosine. A total of 90 measurements were performed in 30 patients. When uncorrected for P(w), an apparent increase in microvascular resistance was observed with increasing stenosis severity (IMR=24, 27, and 37 U for the 3 different degrees of stenosis; P<0.001). In contrast, when P(w) is appropriately accounted for, microvascular resistance did not change with stenosis severity (IMR=22, 23, and 23 U, respectively; P=0.28).Minimal microvascular resistance does not change with epicardial stenosis severity, and IMR is a specific index of microvascular resistance when collateral flow is properly taken into account.

    View details for DOI 10.1161/01.CIR.0000143893.18451.0E

    View details for Web of Science ID 000224407000011

    View details for PubMedID 15466646

  • The current and future role of percutaneous coronary intervention in patients with coronary artery disease. Journal of interventional cardiology Lipinski, M. J., Fearon, W. F., Froelicher, V. F., Vetrovec, G. W. 2004; 17 (5): 283-294

    Abstract

    With increasing research on vulnerable plaques and uncertainty regarding which lesions require revascularization, the goal of this review is to clarify the indications for percutaneous coronary intervention and discuss which lesions do not warrant treatment by intervention. This paper also briefly reviews the potential advantages and limitations of technology that may enable detection of atherosclerotic plaques that are prone to rupture and discusses the future utility of these technologies in prevention of acute coronary syndromes. Providing an evidence-based understanding of lesion morphology and clinical variables that influence outcome enables the interventional cardiologist to determine which atherosclerotic plaques require PCI.

    View details for PubMedID 15491331

  • Evaluation of high-pressure retrograde coronary venous delivery of FGF-2 protein CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Fearon, W. F., Ikeno, F., Bailey, L. R., Hiatt, B. L., Herity, N. A., Carter, A. J., Fitzgerald, P. J., Rezaee, M., Yeung, A. C., Yock, P. G. 2004; 61 (3): 422-428

    Abstract

    Delivery of angiogenic factors to ischemic myocardium remains a practical challenge. We evaluated the efficiency and efficacy of delivery of fibroblast growth factor-2 (FGF-2) protein via high-pressure retrograde injection into the anterior interventricular vein (AIV) in a porcine model of chronic myocardial ischemia. Labeled FGF-2 protein was delivered to the myocardium of three pigs via the AIV and the left anterior descending (LAD) coronary artery in three others. At 1 hr, the amount of protein in the left ventricle and the LAD region was quantified. Copper stents were implanted in the LAD of 25 pigs, resulting in chronic myocardial ischemia. At 4 weeks, microsphere-derived myocardial blood flow was assessed at rest and during pacing. In eight pigs (AIV FGF), FGF-2 protein (6 microg/kg) was delivered via high-pressure retrograde injection into the AIV. Six pigs (intracoronary FGF) received the same amount of FGF-2 by intracoronary delivery. Five pigs (AIV saline) received a placebo injection into the AIV and six pigs (control) served as controls. Four weeks later, myocardial blood flow was reassessed. At 1 hr, significantly more FGF remained in the left ventricle (1.3 vs. 0.82 microg; P < 0.04) and in the LAD region (1.2 vs. 0.64 microg; P = 0.03) after AIV compared to intracoronary delivery. Four weeks after treatment, resting LAD blood flow (normalized to right ventricular flow) improved slightly in the AIV FGF and intracoronary FGF arms (1.32-1.37 for both; P = 0.11), while it decreased significantly in the AIV saline (1.32-1.23; P = 0.02) and the control arms (1.32-1.19; P = 0.0004). Pacing LAD blood flow decreased significantly in the control arm (1.30-1.23; P < 0.05), but did not change significantly in the other three arms. High-pressure retrograde injection into the AIV may represent an efficient and effective means for delivering angiogenic factors to ischemic myocardium.

    View details for DOI 10.1002/ccd.10790

    View details for Web of Science ID 000220022500027

    View details for PubMedID 14988909

  • Comparison of coronary thermodilution and Doppler velocity for assessing coronary flow reserve CIRCULATION Fearon, W. F., Farouque, H. M., Balsam, L. B., Cooke, D. T., Robbins, R. C., Fitzgerald, P. J., Yeung, A. C., Yock, P. G. 2003; 108 (18): 2198-2200

    Abstract

    Thermodilution coronary flow reserve (CFRthermo) is a new technique for invasively measuring coronary flow reserve (CFR) with a coronary pressure wire and is based on the ability of the pressure transducer to also measure temperature changes. Whether CFRthermo correlates well enough with absolute flow-derived CFR (CFRflow) to replace Doppler wire-derived CFR (CFRDoppler) remains unclear.In an open-chest pig model, CFRthermo was measured in the left anterior descending (LAD) artery and compared with CFRDoppler and CFRflow, measured with an external flow probe placed around the LAD. In 9 pigs, CFR was measured simultaneously by all 3 means in the normal LAD and after creation of an epicardial LAD stenosis. To determine the added effect of microvascular disease, measurements of flow reserve were also performed after disruption of the coronary microcirculation with embolized microspheres. Intracoronary papaverine (20 mg) was used to induce hyperemia. In a total of 61 paired measurements, CFRthermo correlated strongly with the reference standard CFRflow (r=0.85, P<0.001). CFRDoppler correlated less well with CFRflow (r=0.72, P<0.001). Bland-Altman analysis showed a closer agreement between CFRthermo and CFRflow.CFRthermo correlates better with CFRflow than does CFRDoppler.

    View details for DOI 10.1161/01.CIR.0000099521.31396.9D

    View details for Web of Science ID 000186340900005

    View details for PubMedID 14568891

  • Simultaneous assessment of fractional and coronary flow reserves in cardiac transplant recipients - Physiologic investigation for transplant arteriopathy (PITA study) CIRCULATION Fearon, W. F., Nakamura, M., Lee, D. P., Rezaee, M., Vagelos, R. H., Hunt, S. A., Fitzgerald, P. J., Yock, P. G., Yeung, A. C. 2003; 108 (13): 1605-1610

    Abstract

    The utility of measuring fractional flow reserve (FFR) to assess cardiac transplant arteriopathy has not been evaluated. Measuring coronary flow reserve (CFR) as well as FFR could add information about the microcirculation, but until recently, this has required two coronary wires. We evaluated a new method for simultaneously measuring FFR and CFR with a single wire to investigate transplant arteriopathy.In 53 cases of asymptomatic cardiac transplant recipients without angiographically significant coronary disease, FFR and thermodilution-derived CFR (CFRthermo) were measured simultaneously with the same coronary pressure wire in the left anterior descending artery and compared with volumetric intravascular ultrasound (IVUS) imaging. The average FFR was 0.88+/-0.07; in 75% of cases, the FFR was less than the normal threshold of 0.94; and in 15% of cases, the FFR was < or =0.80, the upper boundary of the gray zone of the ischemic threshold. There was a significant inverse correlation between FFR and IVUS-derived measures of plaque burden, including percent plaque volume (r=0.55, P<0.0001). The average CFRthermo was 2.5+/-1.2; in 47% of cases, CFRthermo was < or =2.0. In 14%, the FFR was normal (> or =0.94) and the CFR was abnormal (<2.0), suggesting predominant microcirculatory dysfunction.FFR correlates with IVUS findings and is abnormal in a significant proportion of asymptomatic cardiac transplant patients with normal angiograms. Simultaneous measurement of CFR with the same pressure wire, with the use of a novel coronary thermodilution technique, is feasible and adds information to the physiological evaluation of these patients.

    View details for DOI 10.1161/01.CIR.0000091116.84926.6F

    View details for Web of Science ID 000185624500027

    View details for PubMedID 12963639

  • Cost-effectiveness of measuring fractional flow reserve to guide coronary interventions AMERICAN HEART JOURNAL Fearon, W. F., Yeung, A. C., Lee, D. P., Yock, P. G., Heidenreich, P. A. 2003; 145 (5): 882-887

    Abstract

    Most patients come to the catheterization laboratory without prior functional tests, which makes the cost-effective treatment of patients with intermediate coronary lesions a practical challenge.We developed a decision model to compare the long-term costs and benefits of 3 strategies for treating patients with an intermediate coronary lesion and no prior functional study: 1) deferring the decision for percutaneous coronary intervention (PCI) to obtain a nuclear stress imaging study (NUC strategy); 2) measuring fractional flow reserve (FFR) at the time of angiography to help guide the decision for PCI (FFR strategy); and 3) stenting all intermediate lesions (STENT strategy). On the basis of the literature, we estimated that 40% of intermediate lesions would produce ischemia, 70% of patients treated with PCI and 30% of patients treated medically would be free of angina after 4 years, and the quality-of-life adjustment for living with angina was 0.9 (1.0 = perfect health). We estimated the cost of FFR to be 761 dollars, the cost of nuclear stress imaging to be 1093 dollars, and the cost of medical treatment for angina to be 1775 dollars per year. The extra cost of splitting the angiogram and PCI as dictated by the NUC strategy was 3886 dollars by use of hospital cost-accounting data. Sensitivity and threshold analyses were performed to determine which variables affected our results.The FFR strategy saved 1795 dollars per patient compared with the NUC strategy and 3830 dollars compared with the STENT strategy. Quality-adjusted life expectancy was similar among the 3 strategies (NUC-FFR = 0.8 quality-adjusted days, FFR-STENT = 6 quality-adjusted life days). Compared with the FFR strategy, the NUC strategy was expensive (>800,000 dollars per quality-adjusted life year gained). Both screening strategies were superior to (less cost, better outcomes) the STENT strategy. Sensitivity analysis indicated that the NUC strategy would only become attractive (<50,000 dollars/quality-adjusted life years compared with FFR) if the specificity of nuclear stress imaging was >25% better than FFR. Our results were not altered significantly by changing the other assumptions.In patients with an intermediate coronary lesion and no prior functional study, measuring FFR to guide the decision to perform PCI may lead to significant cost savings compared with performing nuclear stress imaging or with simply stenting lesions in all patients.

    View details for DOI 10.1016/S0002-8703(03)00072-3

    View details for Web of Science ID 000183258300020

    View details for PubMedID 12766748

  • Adjunctive platelet glycoprotein IIb/IIIa receptor inhibition with tirofiban before primary Angioplasty improves angiographic outcomes - Results of the TIrofiban given in the emergency room before primary angioplasty (TIGER-PA) pilot trial CIRCULATION Lee, D. P., Herity, N. A., Hiatt, B. L., Fearon, W. F., Rezaee, M., Carter, A. J., Huston, M., Schreiber, D., DiBattiste, P. M., Yeung, A. C. 2003; 107 (11): 1497-1501

    Abstract

    Previous work has suggested that platelet glycoprotein IIb/IIIa receptor blockade may confer benefit in the treatment of acute myocardial infarction. The TIGER-PA pilot trial was a single-center randomized study to evaluate the safety, feasibility, and utility of early tirofiban administration before planned primary angioplasty in patients presenting with acute myocardial infarction.A total of 100 patients presenting with acute myocardial infarction were randomized to either early administration of tirofiban in the emergency room or later administration in the catheterization laboratory. The primary outcome measures were initial TIMI grade flow, corrected TIMI frame counts, and TIMI grade myocardial perfusion ("blush"). Thirty-day major adverse cardiac events were also assessed. Angiographic outcomes demonstrate a significant improvement in initial TIMI grade flow, corrected TIMI frame counts, and TIMI grade myocardial perfusion when patients are given tirofiban in the emergency room before primary angioplasty. The rate of 30-day major adverse cardiac events suggests that early administration may be beneficial.This pilot study suggests that early administration of tirofiban improves angiographic outcomes and is safe and feasible in patients undergoing primary angioplasty for acute myocardial infarction.

    View details for DOI 10.1161/01.CIR.0000056120.00513.7A

    View details for Web of Science ID 000181764600010

    View details for PubMedID 12654606

  • Evaluating intermediate coronary lesions in the cardiac catheterization laboratory. Reviews in cardiovascular medicine Fearon, W. F., Yeung, A. C. 2003; 4 (1): 1-7

    Abstract

    Angiography is notoriously poor at distinguishing ischemia-producing from non-ischemia-producing intermediate coronary lesions. Here, three invasive modalities for evaluating the physiologic significance of moderate coronary stenoses are reviewed: Doppler wire-derived measurement of coronary flow reserve (CFR), coronary pressure wire-derived fractional flow reserve (FFR), and intravascular ultrasound (IVUS) imaging. Studies investigating the correlation between each of these modalities and various noninvasive tests (eg, nuclear perfusion imaging or stress echocardiography) are discussed. Each of these invasive modalities has its limitations: CFR is limited by its dependence on heart rate and blood pressure, calling into question its reproducibility; both FFR and CFR are limited by their reliance upon achieving maximal hyperemia; and IVUS is limited by the fact that it provides anatomic information only. Ultimately, FFR appears to be the ideal method for interrogating intermediate coronary lesions.

    View details for PubMedID 12684598

  • Coronary pressure measurement after stenting predicts adverse events at follow-up - A multicenter registry CIRCULATION Pijls, N. H., Klauss, V., Siebert, U., Powers, E., Takazawa, K., Fearon, W. F., Escaned, J., Tsurumi, Y., Akasaka, T., Samady, H., De Bruyne, B. 2002; 105 (25): 2950-2954

    Abstract

    Coronary stenting is associated with a restenosis rate of 15% to 20% at 6-month follow-up, despite optimum angiographic stent implantation. In this multicenter registry, we investigated the relation between optimum physiological stent implantation as assessed by poststent fractional flow reserve (FFR) and outcome at 6 months.In 750 patients, coronary pressure measurement at maximum hyperemia was performed after angiographically apparently satisfactory stent implantation. Poststenting FFR was calculated and related to major adverse events (including need for repeat target vessel revascularization) at 6 months. In 76 patients (10.2%), at least 1 adverse event occurred. Five patients died, 19 experienced myocardial infarction, and 52 underwent at least 1 repeat target vessel revascularization. By multivariate analysis, FFR immediately after stenting was the most significant independent variable related to all types of events. In 36% of the patients, FFR normalized (>0.95), and event rate was 4.9% in that group. In 32% of the patients, poststent FFR was between 0.90 and 0.95, and event rate was 6.2%. In 32% of patients, poststent FFR was <0.90, and event rate was 20.3%. In 6% of the patients, FFR was <0.80, and event rate was 29.5% (P<0.001).FFR after stenting is a strong independent predictor of outcome at 6 months.

    View details for DOI 10.1161/01.CIR.0000020547.92091.76

    View details for Web of Science ID 000176818800016

    View details for PubMedID 12081986

  • A comparison of treadmill scores to diagnose coronary artery disease CLINICAL CARDIOLOGY Fearon, W. F., Gauri, A. J., Myers, J., Raxwal, V. K., Atwood, J. E., Froelicher, V. F. 2002; 25 (3): 117-122

    Abstract

    Recently, several treadmill scores have been proposed as means for improving the diagnostic accuracy of the exercise treadmill test (ETT). Questions remain regarding the diagnostic accuracy of treadmill scores when applied to a different patient population than that from which they were derived; furthermore, many treadmill scores have not been compared with one another in the same population.The diagnostic accuracy of treadmill scores may not be the same.A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. All patients underwent a standard ETT followed by coronary angiography. Using angiographic evidence of coronary artery disease (CAD) as a reference, the area under the curve (AUC) of receiver operator characteristic (ROC) plots of the ST response alone, the Duke Treadmill Score (DTS), the Morise score, the Detrano score, the VA score, and a Consensus score consisting of the Morise, Detrano, and VA scores together were calculated and compared. The predictive accuracies of the DTS and the Consensus score to stratify patients for the likelihood of CAD were calculated and compared.In all, 1,282 patients without a prior myocardial infarction had an ETT and coronary angiography. The AUC (+/- standard error) was 0.67+/-0.01 for the ST response, 0.73+/-0.01 for DTS, 0.76+/-0.01 for Detrano score, 0.77+/-0.01 for Morise score, 0.78+/-0.01 for VA score, and 0.78+/-0.01 for Consensus score. The AUC for each treadmill score was significantly higher (z-score > 1.96) than for the ST response alone. The AUC of DTS was significantly lower than all other treadmill scores (z-score > 1.96). The predictive accuracy (+/-95% confidence interval) of the DTS to risk stratify patients into high and low likelihood for CAD was 71 (65-77)%, versus 80 (74-86)% for the Consensus score (p < 0.0001).In this population, the DTS remains useful for diagnosing CAD and stratifying for the likelihood of CAD, although it is less accurate than other treadmill scores.

    View details for Web of Science ID 000174135800006

    View details for PubMedID 11890370

  • Fractional flow reserve compared with intravascular ultrasound guidance for optimizing stent deployment CIRCULATION Fearon, W. F., Luna, J., Samady, H., Powers, E. R., Feldman, T., Dib, N., Tuzcu, E. M., Cleman, M. W., Chou, T. M., Cohen, D. J., Ragosta, M., Takagi, A., Jeremias, A., Fitzgerald, P. J., Yeung, A. C., Kern, M. J., Yock, P. G. 2001; 104 (16): 1917-1922

    Abstract

    Determination of fractional flow reserve (FFR) has been proposed as a means to assess stent deployment. In this prospective, multicenter trial, we evaluate the use of FFR to optimize stenting by comparing it with standard intravascular ultrasound (IVUS) criteria.Eighty-four stable patients with isolated coronary lesions underwent coronary stent deployment starting at 10 atm and increased serially by 2 atm until the FFR was >/=0.94 or 16 atm was achieved. IVUS was then performed. FFR was measured with a coronary pressure wire with intracoronary adenosine to induce hyperemia. The diagnostic characteristics of an FFR <0.94 to predict suboptimal stent expansion by IVUS, defined in both absolute and relative terms, were calculated. Over a range of IVUS criteria, the highest sensitivity, specificity, and predictive accuracy of FFR were 80%, 30%, and 42%, respectively. Receiver operator characteristic analysis defined an optimal FFR cut point at >/=0.96; at this threshold, the sensitivity, specificity, and predictive accuracy of FFR were 75%, 58%, and 62%, respectively (P=0.03 for comparison of predictive accuracy, P=0.01 for concordance between FFR and IVUS). The negative predictive value was 88%. Significantly better diagnostic performance was achieved in a subgroup that received higher doses (>30 microgram) of intracoronary adenosine during pressure measurements, suggesting that FFR might be overestimated in the other group.A fractional flow reserve <0.96, measured after stent deployment, predicts a suboptimal result based on validated intravascular ultrasound criteria; however, an FFR >/=0.96 does not reliably predict an optimal stent result. Higher doses of intracoronary adenosine than previously used to measure FFR improve these results.

    View details for Web of Science ID 000171828700011

    View details for PubMedID 11602494

  • Effects of chronotropic incompetence and beta-blocker use on the exercise treadmill test in men AMERICAN HEART JOURNAL Gauri, A. J., Raxwal, V. K., Roux, L., Fearon, W. F., Froelicher, V. F. 2001; 142 (1): 136-141

    Abstract

    Our purpose was to assess the diagnostic characteristics of the exercise test in patients who fail to reach conventional target heart rates and in patients on beta-blockers.Exercise test results are often considered "inadequate" or "nondiagnostic" in patients taking beta-blockers and in patients who do not achieve 85% of their age-predicted maximal heart rate.The results of exercise tests and coronary angiography performed to evaluate chest pain in 1282 male patients without a prior history of myocardial infarction, coronary revascularization, diagnostic Q wave on the baseline electrocardiogram, or previous cardiac catheterization were analyzed with respect to beta-blocker exposure and failure to reach 85% age-predicted maximal heart rate. Sensitivity, specificity, and predictive accuracy of exercise testing, as well as area under the curve for the receiver operating characteristic plots were calculated for these subgroups with use of coronary angiography as the reference. The angiographic criterion for significant coronary artery disease was 50% narrowing or greater in one or more major coronary arteries.The population was divided into 4 exclusive groups on the basis of whether they reached their target heart rates and whether they were receiving beta-blockers. Sixty to 40 percent of this clinical population failed to reach target heart rate, of which 24% (n = 303) were receiving beta-blockers and 40% (n = 518) were not. The group of patients who reached target heart rate and were not taking beta-blockers was taken as the reference group (n = 409). The group of patients supposedly beta-blocked but who reached the target heart rate (n = 52) had hemodynamic and test characteristics similar to those of the reference group and most likely were not taking their beta-blockers or were not adequately dosed. The prevalence of angiographic coronary disease was significantly higher in the 2 groups failing to reach target heart rate, both in the presence and absence of beta-blockers, compared with the reference group (68% and 64%, respectively, vs 49%, P <.01). Although the areas under the curve of the receiver operating characteristic curves for ST depression of the groups failing to reach target heart rate were not significantly different from the reference group, the predictive accuracy and sensitivity were significantly lower for 1 mm of ST depression in the beta-blocked group who did not reach target heart rate (predictive accuracy of 56% vs 67%, sensitivity of 44% vs 58%, P <.01). The only way to maintain sensitivity with the standard exercise test in the beta-blocker group who failed to reach target heart rate was to use a treadmill score or 0.5-mm ST depression as the criteria for abnormal.Sensitivity and predictive accuracy of standard ST criteria for exercise-induced ST depression are significantly decreased in male patients who are taking beta-blockers and do not reach target heart rate. In those who fail to reach target heart rate and are not beta-blocked, sensitivity and predictive accuracy are maintained.

    View details for Web of Science ID 000169677700022

    View details for PubMedID 11431669

  • Clinical utility of the exercise ECG in patients with diabetes and chest pain CHEST Lee, D. P., Fearon, W. F., Froelicher, V. F. 2001; 119 (5): 1576-1581

    Abstract

    The purpose of this study was to determine the characteristics of exercise treadmill testing in diabetic patients presenting with chest pain.The diagnosis of coronary artery disease (CAD) in diabetic patients is confounded by different manifestations of coronary disease than are seen in the general population. Because of the association of diabetes with accelerated CAD, it is critical to assess the diagnostic utility of the standard exercise test in diabetic patients with chest pain.This study was a retrospective analysis of standard exercise test results in 1,282 male patients without prior myocardial infarction who had undergone coronary angiography and were being evaluated for possible CAD at two Veterans' Administration institutions.In patients with diabetes, 38% had an abnormal exercise test result, and the prevalence of angiographic CAD was 69%; the sensitivity of the exercise test was 47% (95% confidence interval [CI], 41 to 58), and specificity was 81% (95% CI, 68 to 89). In patients without diabetes, 38% had an abnormal exercise test result, and the prevalence of angiographic CAD was 58%; the sensitivity of the exercise test was 52% (95% CI, 48 to 56), and specificity was 80% (95% CI, 76 to 83). The receiver operating characteristic curves were also similar in both diabetic and nondiabetic patients (0.67 and 0.68, respectively).These data demonstrate that the standard exercise test has similar diagnostic characteristics in diabetic as in nondiabetic patients.

    View details for Web of Science ID 000168711400042

    View details for PubMedID 11348969

  • Images in cardiology. Giant left ventricular pseudoaneurysm. Clinical cardiology Fearon, W. F., Lo, S., Stertzer, S. 2001; 24 (4): 345-?

    View details for PubMedID 11303706

  • Use of fractional myocardial flow reserve to assess the functional significance of intermediate coronary stenoses AMERICAN JOURNAL OF CARDIOLOGY Fearon, W. F., Takagi, A., Jeremias, A., Yeung, A. C., Joye, J. D., Cohen, D. J., Chou, T. M., Kern, M. J., Yock, P. G. 2000; 86 (9): 1013-1014

    Abstract

    The goal of the present study was to compare the use of pressure-derived myocardial fractional flow reserve for detecting ischemia with nuclear stress imaging in patients undergoing stent placement for intermediate coronary lesions. We demonstrated that myocardial fractional flow reserve detects ischemia in intermediate coronary lesions accurately when compared with nuclear stress imaging.

    View details for Web of Science ID 000165096000023

    View details for PubMedID 11053717

  • The effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Fearon, W. F., Lee, D. P., Froelicher, V. F. 2000; 35 (5): 1206-1211

    Abstract

    The aim of this study is to demonstrate the effect of resting ST segment depression on the diagnostic characteristics of the exercise treadmill test.Previous studies evaluating the effect of resting ST segment depression on the diagnostic characteristics of exercise treadmill test have been conducted on relatively small patient groups and based only on visual electrocardiogram (ECG) analysis.A retrospective analysis of data collected prospectively was performed on consecutive patients referred for evaluation of chest pain. One thousand two hundred eighty-two patients without a prior myocardial infarction underwent standard exercise treadmill tests followed by coronary angiography, with coronary artery disease defined as a 50% narrowing in at least one major epicardial coronary artery. Sensitivity, specificity, predictive accuracy and area under the curve of the receiver operating characteristic (ROC) plots were calculated for patients with and without resting ST segment depression as determined by visual or computerized analysis of the baseline ECG.Sensitivity of the exercise treadmill test increased in 206 patients with resting ST segment depression determined by visual ECG analysis compared with patients without resting ST segment depression (77 +/- 7% vs. 45 +/- 4%) and specificity decreased (48 +/- 12% vs. 84 +/- 3%). With computerized analysis, sensitivity of the treadmill test increased in 349 patients with resting ST segment depression compared with patients without resting ST segment depression (71 +/- 6% vs. 42 +/- 4%) and specificity decreased (52 +/- 9% vs. 87 +/- 3%) (p < 0.0001 for all comparisons). There was no significant difference in the area under the curve of the ROC plots (0.66-0.69) or the predictive accuracy (62-68%) between the four subgroups.The diagnostic accuracy and high sensitivity of the exercise treadmill test in a large cohort of patients with resting ST segment depression and no prior myocardial infarction support the initial use of the test for diagnosis of coronary artery disease. The classification of resting ST segment depression by method of analysis (visual vs. computerized) did not affect the results.

    View details for Web of Science ID 000086265900015

    View details for PubMedID 10758962

  • Pneumocephalus due to invasive fungal sinusitis CLINICAL INFECTIOUS DISEASES Engel, G., Fearon, W. F., Kosek, J. C., Loutit, J. S. 2000; 30 (1): 215-217

    View details for Web of Science ID 000085004800043

    View details for PubMedID 10619764

  • Does elevated cardiac troponin I in patients with unstable angina predict ischemia on stress testing? AMERICAN JOURNAL OF CARDIOLOGY Fearon, W. F., Lee, F. H., Froelicher, V. F. 1999; 84 (12): 1440-?

    Abstract

    To help guide physicians in their evaluation of patients with acute coronary syndromes, we investigated whether elevated cardiac troponin I in patients presenting with unstable angina predicts ischemia on stress testing. Elevated cardiac troponin I in patients who present with chest pain and normal creatine kinase levels is associated with ischemia on stress testing, as well as with future cardiac events.

    View details for Web of Science ID 000084147800014

    View details for PubMedID 10606119

  • Lessons learned from studies of the standard exercise ECG test CHEST Froelicher, V. F., Fearon, W. F., Ferguson, C. M., Morise, A. P., Heidenreich, P., West, J., Atwood, J. E. 1999; 116 (5): 1442-1451

    View details for Web of Science ID 000083723900049

    View details for PubMedID 10559110

  • Should only the squeaky wheel get the grease? The prognostic significance of silent ischemia detected by exercise treadmill testing AMERICAN HEART JOURNAL Fearon, W. F., Voodi, L., Atwood, J. E., Froelicher, V. 1998; 136 (5): 759-761

    View details for Web of Science ID 000076852300003

    View details for PubMedID 9812067

  • Iliofemoral venous thrombosis treated by catheter-directed thrombolysis, angioplasty, and endoluminal stenting WESTERN JOURNAL OF MEDICINE Fearon, W. F., Semba, C. P. 1998; 168 (4): 277-279

    View details for Web of Science ID 000073259300017

    View details for PubMedID 9584676

  • Acute myocardial infarction in a young woman with systemic lupus erythematosus. Vascular medicine Fearon, W. F., Cooke, J. P. 1996; 1 (1): 19-23

    Abstract

    A young woman was diagnosed with systemic lupus erythematosus at the age of 7 years and incurred an acute myocardial infarction at the age of 17 years. Her risk factors for coronary artery disease include hypertension, hypercholesterolemia, a relatively long disease duration, a fairly active disease as evidenced by the history of nephrotic syndrome and other organ system involvement, and a long history of prednisone use. It is difficult to determine the etiology of this patient's acute myocardial infarction without coronary artery histopathology, but aspects of her presentation (a history of virulent systemic lupus erythematosus, and the angiographic findings of ectasia and aneurysm) suggest that coronary arteritis was the etiology of her accelerated coronary artery disease and subsequent myocardial infarction. Acute myocardial infarction is an uncommon occurrence in premenopausal women less than 30 years old.35 These patients are typically found to have an associated systemic disease such as diabetes mellitus or familial hypercholesterolemia. Systemic lupus erythematosus is a less common systemic disease associated with premature coronary artery disease. Mechanisms of acute coronary syndromes in these patients include accelerated atherosclerosis, active coronary vasculitis, and/or vasospasm with superimposed thrombosis.

    View details for PubMedID 9546909

Conference Proceedings


  • PROGNOSTIC VALUE OF THE INDEX OF MICROCIRCULATORY RESISTANCE AFTER PRIMARY PERCUTANEOUS CORONARY INTERVENTION Yong, A., Loh, J., McGeoch, R., Shah, M., Ho, M., Daniels, D., Berry, C., Low, A., Oldroyd, K., Fearon, W. ELSEVIER SCIENCE INC. 2012: E48-E48
  • CCR2 Antagonist Inhibits Neointimal Proliferation Post CoronaryStent Deployment Teramoto, T., Ikeno, F., Nakatani, D., Otake, H., Lyons, J. K., Sullivan, T., Jaen, J., Schall, T., Tio, F., Yeung, A. C., Fearon, W. F. LIPPINCOTT WILLIAMS & WILKINS. 2010
  • 3 ',4-Dihydroxyflavonol reduces infarct size in a porcine acute myocardial ischaemia-reperfusion model Teramoto, T., Ikeno, F., Lyons, J., Thomas, C. J., May, C. N., Woodman, O. L., Jarrott, B., Yeung, A. C., Fearon, W. F. OXFORD UNIV PRESS. 2010: 493-494
  • CCR2 antagonist inhibits neointimal proliferation post coronary stent deployment Teramoto, T., Ikeno, F., Nakatani, D., Otake, H., Lyons, J. K., Sullivan, T., Jaen, J., Schall, T., Yeung, A. C., Fearon, W. F. OXFORD UNIV PRESS. 2010: 368-368
  • 3 ', 4-Dihydroxyflavonol Reduces Infarct Size in a Porcine Acute Myocardial Infarction-Reperfusion Model Tomohiko, T., Ikeno, F., Lyons, J. K., Jarrott, B., Woodman, O. L., May, C. N., Thomas, C. J., Yeung, A. C., Fearon, W. LIPPINCOTT WILLIAMS & WILKINS. 2009: S1174-S1174
  • Safety and Efficacy of Drug Eluting Stents for Treatment of Cardiac Allograft Vasculopathy: A Prospective Clinical and Angiographic Study Ng, M. K., Tremmel, J., Ikeno, F., Lee, D. P., Yeung, A. C., Fearon, W. F. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 2009: 138D-138D
  • Microvascular Dysfunction and Suboptimal Glycemic Control Predicts Poor Outcome Following Heart Transplantation Khazanie, P., Haddad, F., Simos, A. M., Pham, M., Weisshaar, D. M., Desai, S. V., Shah, M. G., McLaughlin, T. L., Hunt, S. A., Valantine, H. A., Fearon, W. ELSEVIER SCIENCE INC. 2009: A182-A182
  • Microvascular Drysfunction and Suboptimal Glycemic Control Predicts Poor Outcome Following Heart Transplantation Khazanie, P., Haddad, F., Simos, A. M., Weissbaar, D. M., Desai, S. V., Pham, M., McLaugblin, T. L., Shah, M. G., Hunt, S. A., Valantine, H. A., Fearon, W. ELSEVIER SCIENCE INC. 2009: S228-S228
  • Optical coherence tomography compared to intravascular ultrasound for detecting small degrees of neointimal hyperplasia Ikeno, F., Suzuki, Y., Koizumi, T., Yeung, A. C., Fitzgerald, P. J., Fearon, W. F. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 2007: 143L-143L
  • Aggressive prophylaxis against cytomegalovirus plays a key role in preseving epicardial artery flow early after cardiac transplantation Sakurai, R., Yamasaki, M., Potena, L., Hirohata, A., Honda, Y., Yock, P. G., Fitzgerald, P. J., Yeung, A. C., Valantine, H. A., Fearon, W. F. ELSEVIER SCIENCE INC. 2007: 78A-78A
  • Impact of donor-transmitted atherosclerosis on early cardiac allograft vasculopathy; New findings by 3-D IVUS Yamasaki, M., Sakurai, R., Hirohata, A., Honda, Y., Yock, P. G., Fitzgerald, P. J., Yeung, A. C., Valantine, H. A., Fearon, W. F. LIPPINCOTT WILLIAMS & WILKINS. 2006: 533-533
  • Index of microcirculatory resistance: A novel measure for predicting myocardial damage in patients with acute myocardial infarction Shah, M., Tremmel, J., Brinton, T., Wilson, A., Schnittger, I., Lee, D. P., Yeung, A. C., Fearon, W. F. LIPPINCOTT WILLIAMS & WILKINS. 2006: 586-587
  • Optical coherence tomography: In-vivo correlation withhistology Ikeno, F., Koizumi, T., Yeung, A. C., Yock, P. G., Fitzgerald, P. J., Fearon, W. F. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 2006: 93M-93M
  • Rapamycin therapy improves coronary physiology after cardiac transplantation Sinha, S. S., Lee, D. P., Pham, M. X., Vagelos, R. H., Hunt, S. A., Valentine, H. A., Yeung, A. C., Fearon, W. F. ELSEVIER SCIENCE INC. 2006: 51A-51A
  • Index of microcirculatory resistance: A novel measure for predicting myocardial damage in patients with acute myocardial infarction Shah, M. G., Tremmel, J., Brinton, T., Wilson, A., Schnittger, I., Lee, D. P., Yeung, A. C., Fearon, W. F. ELSEVIER SCIENCE INC. 2006: 182A-182A
  • Prevention of subclinical CMV infection reduces cardiac allograft disease progression by positively affecting coronary remodeling Potena, L., Fearon, W., Holweg, C., Luikart, H., Chin, C., Cooke, J., Lewis, D., Mocarski, E., Valantine, H. ELSEVIER SCIENCE INC. 2006: S138-S139
  • Inhibition of cardiac allograft vasculopathy by sirolimus and mycofenolate: Asymmetric dimethyl arginine as a potential therapeutic target Potena, L., Fearon, W., Sydow, K., Holweg, C., Luikart, H., Mocarski, E., Valantine, H., Cooke, J. ELSEVIER SCIENCE INC. 2006: S100-S100
  • Changes in the anatomy and physiology of the coronary circulation after cardiac transplantation: Novel structural and physiologic evidence of cardiac transplant arteriopathy Hirohata, A., Nakamura, M., Waseda, K., Valantine, H. A., Hunt, S. A., Honda, Y., Yock, P. G., Fitzgerald, P. J., Yeung, A. C., Fearon, W. F. LIPPINCOTT WILLIAMS & WILKINS. 2005: U517-U517
  • Invasive assessment of the coronary microcirculation: Superior reproducibility and less hemodynamic dependence of index of microcirculatory resistance as compared to coronary flow reserve Ng, M. K., Yeung, A. C., Fearon, W. F. LIPPINCOTT WILLIAMS & WILKINS. 2005: U830-U830
  • Design and rationale for the targeted intra-renal fenoldopam for avoidance of nephropathy (TIFFANY) trial Price, M. J., Garcia, L., Davidson, C., McNeil, J., Cohen, M. G., Mathur, V., Fearon, W. F., Weisz, G., Rogers, C., Madyoon, H., Feit, F., Low, R., Reisman, M., Teirstein, P. S. EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC. 2005: 117H-117H
  • Impact of direct coronary stenting on neointimal distribution within sirolimus-eluting stents - IVUS subanalysis from the DIRECT trial Hirohata, A., Ako, J., Sakurai, R., Fearon, W. F., Caputo, R., Mishkel, G., Mooney, M., O'Shaughnessy, C., Raizner, A., Wilensky, R., Williams, D., Wong, S. C., Karas, S., Yock, P. G., Honda, Y., Moses, J., Fitzgerald, P. J. ELSEVIER SCIENCE INC. 2005: 70A-70A
  • Coronary endothelial dysfunction in cardiac transplant recipients is related to elevated levels of ADMA Fearon, W. F., Wang, B. Y., Hirohata, A., Nakamura, M., Potena, L., Valentine, H. A., Yeung, A. C., Cooke, J. P. ELSEVIER SCIENCE INC. 2005: 150A-150A
  • Systemic inflammation links impaired glucose metabolism to cardiac allograft vasculopathy development Potena, L., Biadi, O., Fearon, W. B., Holweg, C. T., Luikart, H. I., Mocarski, E. S., Lewis, D. B., Valantine, H. A. LIPPINCOTT WILLIAMS & WILKINS. 2004: 753-753
  • Coronary endothelial dysfunction in cardiac transplant recipients is related to elevated levels of ADMA Fearon, W. F., Wang, B. Y., Nakamura, M., Potena, L., Valantine, H. A., Yeung, A. C., Cooke, J. P. LIPPINCOTT WILLIAMS & WILKINS. 2004: 73-73
  • Minimal microvascular resistance is not influenced by epicardial stenosis severity: animal validation Fearon, W. F., Aarnoudse, W., De Bruyne, B., Cooke, D. T., Balsam, L. B., Yeung, A. C., Yock, P. G., Pijls, N. H. OXFORD UNIV PRESS. 2004: 431-431
  • Cytomegalovirus infectious burden is proportional to cardiac allograft vasculopathy in heart transplant recipients Potena, L., Magelli, C., Ortolani, P., Fearon, W. F., Grigioni, F., Magnani, G., Coccolo, F., Yeung, A. C., Luikart, H. I., Hunt, S. A., Mocarski, E. S., Cooke, J. P., Lewis, D. B., Branzi, A., Valantine, H. A. ELSEVIER SCIENCE INC. 2004: 185A-185A
  • Women remain at higher risk for retroperitoneal hematoma after percutaneous coronary intervention in the era of glycoprotein IIb/IIIa inhibitors and vascular closure devices Farouque, H. M., Tremmel, J. A., Aggarwal, M., Shabari, F. R., Fearon, W. F., Rezaee, M., Yeung, A. C., Lee, D. P. ELSEVIER SCIENCE INC. 2004: 63A-63A
  • Exaggeration of neointimal hyperplasia following stent deployment in type B bifurcation lesions Hirohata, A., Nakamura, M., Fearon, W. F., Honda, Y., Yock, P. G., Fitzgerald, P. J. ELSEVIER SCIENCE INC. 2004: 55A-55A
  • Endothelial nitric oxide synthesis is severely impaired after cardiac transplantation: Role of ADMA Fearon, W. F., Wang, B. Y., Valantine, H. A., Mocarsky, E. S., Yeung, A. C., Cooke, J. P. LIPPINCOTT WILLIAMS & WILKINS. 2003: 303-303
  • Is coronary thermodilution as accurate as Doppler velocity for measuring coronary flow reserve? Fearon, W. F., Balsam, L. B., Farouque, H. M., Caffarelli, A. D., Robbins, R. C., Fitzgerald, P. J., Yeung, A. C., Yock, P. G. ELSEVIER SCIENCE INC. 2003: 59A-59A
  • Physiologic interrogation of transplant arterioparthy: Final results Fearon, W. F., Nakamura, M., Lee, D. P., Rezaee, M., Vagelos, R. H., Hunt, S. A., Fitzgerald, P. J., Yock, P. G., Yeung, A. C. ELSEVIER SCIENCE INC. 2003: 29A-29A
  • A novel invasive assessment of the coronary microcirculation Fearon, W. F., Balsam, L. B., Farouque, H. M., Caffarelli, A. D., Robbins, R. C., Fitzgerald, P. J., Yock, P. G., Yeung, A. C. ELSEVIER SCIENCE INC. 2003: 10A-10A
  • Physiologic interrogation of transplant arteriopathy Fearon, W. F., Nakamura, M., Lee, D. P., Rezaee, M., Vagelos, R. H., Hunt, S. A., Yock, P. G., Yeung, A. C. LIPPINCOTT WILLIAMS & WILKINS. 2002: 591-591
  • Myocardial delivery of labeled fibroblast growth factor-2 protein by high pressure, retrograde coronary venous injection is more efficient than intracoronary administration Fearon, W. F., Ikeno, F., Price, E., Bailey, L. R., Herity, N. A., Fitzgerald, P. J., Rezaee, M., Yeung, A. C., Yock, P. G. LIPPINCOTT WILLIAMS & WILKINS. 2002: 656-656
  • High pressure, retrograde, coronary venous delivery of FGF-2 protein improves coronary blood flow in a porcine model of myocardial ischemia Fearon, W. F., Rezaee, M., Hiatt, B. L., Ikeno, F., Bailey, L., Suzuki, T., Herity, N., Fitzgerald, P. J., Carter, A. J., Yeung, A. C., Yock, P. G. ELSEVIER SCIENCE INC. 2002: 10A-10A
  • A comparison of angiographic and physiologic correlates to myocardial perfusion Fearon, W., Hiatt, B., Rezaee, M., Herity, N., Suzuki, T., Ikeno, F., Yeung, A. G., Carter, A. J., Yock, P. LIPPINCOTT WILLIAMS & WILKINS. 2001: 580-580
  • Safety and efficacy of high pressure retrograde cardiac venous injection. Implications for regional myocardial delivery Herity, N. A., Fearon, W., Hiatt, B. L., Rezaee, M., Suzuki, T., Lee, D. P., Yeung, A. C., Carter, A. J., Fitzgerald, P. J., Yock, P. G. ELSEVIER SCIENCE INC. 2001: 6A-6A
  • Fractional flow reserve compared to intravascular ultrasound guidance for optimal stent deployment: Final results of the FUSION study Fearon, W. F., Takagi, A., Luna, J., Jeremias, A., Samady, H., Powers, E. R., Feldman, T., Dib, N., Tuzcu, E. M., Cleman, M. W., Chou, T. M., Cohen, D. J., Yeung, A. C., Kern, M. J., Yock, P. G. ELSEVIER SCIENCE INC. 2001: 85A-85A
  • Is the use of fractional flow reserve to guide coronary interventions cost-effective? Fearon, W. F., Yeung, A. C., Honda, Y., Yock, P. G., Heidenreich, P. A. ELSEVIER SCIENCE INC. 2001: 12A-12A
  • A comparison between the use of fractional flow reserve and intravascular ultrasound for determining optimal stent deployment (FUSION study) Fearon, W. F., Takagi, A., Luna, J., Samady, H., Powers, E. R., Feldman, T., Cleman, M. W., Chou, T. M., Cohen, D. J., Dib, N., Yeung, A. C., Kern, M. J. LIPPINCOTT WILLIAMS & WILKINS. 2000: 635-?

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