| 1. |
- Escaned, Javier, et al.
(author)
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Safety of the Deferral of Coronary Revascularization on the Basis of Instantaneous Wave-Free Ratio and Fractional Flow Reserve Measurements in Stable Coronary Artery Disease and Acute Coronary Syndromes
- 2018
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In: JACC. - : Elsevier. - 1936-8798 .- 1876-7605. ; 11:15, s. 1437-1449
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Journal article (peer-reviewed)abstract
- OBJECTIVES The aim of this study was to investigate the clinical outcomes of patients deferred from coronary revascularization on the basis of instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) measurements in stable angina pectoris (SAP) and acute coronary syndromes (ACS). BACKGROUND Assessment of coronary stenosis severity with pressure guidewires is recommended to determine the need for myocardial revascularization. METHODS The safety of deferral of coronary revascularization in the pooled per-protocol population (n = 4,486) of the DEFINE-FLAIR (Functional Lesion Assessment of Intermediate Stenosis to Guide Revascularisation) and iFR-SWEDEHEART (Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve in Patients With Stable Angina Pectoris or Acute Coronary Syndrome) randomized clinical trials was investigated. Patients were stratified according to revascularization decision making on the basis of iFR or FFR and to clinical presentation (SAP or ACS). The primary endpoint was major adverse cardiac events (MACE), defined as the composite of all-cause death, nonfatal myocardial infarction, or unplanned revascularization at 1 year. RESULTS Coronary revascularization was deferred in 2,130 patients. Deferral was performed in 1,117 patients (50%) in the iFR group and 1,013 patients (45%) in the FFR group (p < 0.01). At 1 year, the MACE rate in the deferred population was similar between the iFR and FFR groups (4.12% vs. 4.05%; fully adjusted hazard ratio: 1.13; 95% confidence interval: 0.72 to 1.79; p = 0.60). A clinical presentation with ACS was associated with a higher MACE rate compared with SAP in deferred patients (5.91% vs. 3.64% in ACS and SAP, respectively; fully adjusted hazard ratio: 0.61 in favor of SAP; 95% confidence interval: 0.38 to 0.99; p = 0.04). CONCLUSIONS Overall, deferral of revascularization is equally safe with both iFR and FFR, with a low MACE rate of about 4%. Lesions were more frequently deferred when iFR was used to assess physiological significance. In deferred patients presenting with ACS, the event rate was significantly increased compared with SAP at 1 year. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
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| 2. |
- Hamngren Blomqvist, Charlotte, 1984, et al.
(author)
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Interconnectivity imaged in three dimensions : Nano-particulate silica-hydrogel structure revealed using electron tomography
- 2017
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In: Micron. - : Elsevier BV. - 0968-4328 .- 1878-4291. ; 100, s. 91-105
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Journal article (peer-reviewed)abstract
- We have used Electron Tomography (ET) to reveal the detailed three-dimensional structure of particulate hydrogels, a material category common in e.g. controlled release, food science, battery and biomedical applications. A full understanding of the transport properties of these gels requires knowledge about the pore structure and in particular the interconnectivity in three dimensions, since the transport takes the path of lowest resistance. The image series for ET were recorded using High-Angle Annular Dark Field Scanning Transmission Electron Microscopy (HAADF-STEM). We have studied three different particulate silica hydrogels based on primary particles with sizes ranging from 3.6 nm to 22 nm and with pore-size averages from 18 nm to 310 nm. Here, we highlight the nanostructure of the particle network and the interpenetrating pore network in two and three dimensions. The interconnectivity and distribution of width of the porous channels were obtained from the three-dimensional tomography studies while they cannot unambiguously be obtained from the two-dimensional data. Using ET, we compared the interconnectivity and accessible pore volume fraction as a function of pore size, based on direct images on the nanoscale of three different hydrogels. From this comparison, it was clear that the finest of the gels differentiated from the other two. Despite the almost identical flow properties of the two finer gels, they showed large differences concerning the accessible pore volume fraction for probes corresponding to their (two-dimensional) mean pore size. Using 2D pore size data, the finest gel provided an accessible pore volume fraction of over 90%, but for the other two gels the equivalent was only 10–20%. However, all the gels provided an accessible pore volume fraction of 30–40% when taking the third dimension into account.
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| 3. |
- Hamngren Blomqvist, Charlotte, 1984, et al.
(author)
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Pore size effects on convective flow and diffusion through nanoporous silica gels
- 2015
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In: Colloids and Surfaces A: Physicochemical and Engineering Aspects. - : Elsevier BV. - 0927-7757 .- 1873-4359. ; 484, s. 288-296
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Journal article (peer-reviewed)abstract
- Material structure has great impact on mass transport properties, a relationship that needs to be understood on several length scales. Describing and controlling the properties of flow through soft materials are both challenges concerning the industrial use of gel structures. This paper reports on how the porous structure in nanoporous materials affects the water transport through them. We used three different silica gels with large differences in the pore sizes but of equal silica concentration. Particle morphology and gel structure were studied using high-resolution transmission electron microscopy and image analysis to estimate the pore size distribution and intrinsic surface area of each gel. The mass transport was studied using a flow measurement setup and nuclear magnetic resonance diffusometry. The average pore size ranged from approximately 500. nm down to approximately 40. nm. An acknowledged limit for convective flow to occur is in the pore size range between 100 and 200. nm. The results verified the existence of a non-linear relationship between pore size and liquid flow at length scales below 500. nm, experimentally. A factor of 4.3 in flow speed separated the coarser gel from the other two, which presented almost identical flow speed data despite a factor 3 in pore size difference. In the setup, the mass transport in the gel with the largest pores was flow dominated, while the mass transport in the finer gels was diffusion dominated. Besides providing new insights into mass transport as a function of pore sizes, we conclude that three-dimensional analysis of the structures is needed for a comprehensive understanding of the correlation between structure and mass transport properties.
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