CRT at CIT
Innovations in Interventional Cardiology: The U.S. Perspectives
IVUS vs. FFR for PCI with DES
——Interview with Professor Ron Waksman
<International Circulation>: It is the first time for CRT to be a partner with CIT; could you please give a brief introduction of CRT and the nature of the CRT participation at CIT?
Dr. Waksman: Although this is the first time for CRT to have a session at CIT I have personally lectured at and attended CIT several times previously. We are very excited to have a session at CIT this year as this will enable us to bring the attendees of CIT the highlights from CRT 2010 that was conducted in February 2010 in Washington DC. What we are trying to bring to CIT this year are an array of topics on valves， imaging， regulatory issues， and stent technology in the time allotted for the CRT symposium at CIT. We also are hoping to reach out through our website to Chinese physicians and maintain this relationship on an electronic relationship.
<International Circulation>: Both IVUS and FFR are valuable in evaluating and guiding PCI and DES implantation， so how do you comment the role and significance of each one of the 2 modalities? More and more researches have shown great evaluating and prognostic value of FFR， can FFR totally replace IVUS in the future?
Dr. Waksman: These are two separate tests. The IVUS assesses more anatomical features and the FFR assesses the physiological status. Sometimes， they are complimentary， with FFR telling us if the lesion is significant， while IVUS tells us about the morphology of the lesion and it also assesses some technical issues such as whether we must pre-dilate， post-dilate， etc. What we are trying to find out is if we can correlate the relationship between the anatomical luminology to the physiology and find out if we can do it with a one-stop shop approach. So， if you do IVUS for other reasons， can you also translate the lumen area to a physiological correlation? In essence， these are two complimentary technologies， with one helping us more to decide if we should intervene and the other one is used to optimize the intervention.
<International Circulation>:
OCT has higher resolution than IVUS; do you agree that OCT will take the place of IVUS in the future? If not， what is the necessity of IVUS being continuously used in future clinical practice?
Dr. Waksman: Obviously there is an advantage of OCT in terms of resolution but not deep penetration; it’s relatively superficial. It primarily helps to look at stent apposition and identifying thrombosis and dissection more clearly and accurately compared to IVUS. These technologies require much more training in terms of training but have a good image that gives us a lot of detail in terms of stent apposition. The question is whether or not you can combine all of these technologies in one catheter. Presently this is not feasible but some companies have two or three of them. All of these technologies are not used that much， with less than 10% use for FFR and 10-15% for IVUS， with OCT used only as a research tool. I think with integration of the systems we may use them more.
<International Circulation>: Would you please summarize the new highlights in the latest research on HDL therapy?
Dr. Waksman: Currently we have a lot of limitations with the available pharmaceuticals. We are gearing towards more innovative approaches to raise HDL because patients with a high HDL seem to have less cardiovascular events. One methodology I will describe at the meeting is using plasmapheresis and isolating pre-beta HDL， which is the more protective HDL， and re-infusing the patient’s own pre-beta HDL back into the system. We have demonstrated by IVUS reduction of atheroma in patients with acute coronary syndrome. The ApoA-1 Milan that made a lot of news about a decade ago has been licensed to a pharmaceutical company that will first conduct an imaging study to see the impact of infusion of those molecules within 7~8 weeks and will assess reduction of the plaque atheroma. When you give statins for 2~3 years you can see a halt in progression or very minimal regression but we feel with HDL therapy we can do it within several weeks and that is an exciting new direction in atherosclerosis management. Also， there are some other molecules that are being proposed for study soon. Although we had some failures with the CETP inhibitors， but the concept as a whole is valid and the question is how to implement it in an efficient and affordable way.
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