Thanks to measurements provided by Abbott’s Coroventis CoroFlow Cardiovascular System, Richard Shlofmitz, MD, and his son, Evan Shlofmitz, DO, were able to adjust their plan of treatment on the fly during a recent live case at CRT 2021 Virtual.
The patient was a 68-year-old man with a calcium score of 1722 and severe diffuse calcification who came in St. Francis Hospital, The Heart Center, Roslyn, New York, for a staged percutaneous coronary intervention (PCI) of the left anterior descending artery. The patient was significantly symptomatic, presenting with increased angina with palpitations.
Based on a diagnostic angiogram, the father-son duo saw a severely calcified lesion and felt it would need to be treated with Shockwave Intravascular Lithotripsy (IVL, Shockwave Medical) and stent implantation.
But as they proceeded with intravascular imaging and physiology assessments, including tri-registration with instant wave-free ratio, they found discordance.
“We realized the lesion wasn’t significant for ischemia, and it completely changed our management,” the younger Shlofmitz said in an interview.
Thus a unique father-son live case took an unexpected turn.
“You have to have an open-mind in what we do,” Shlofmitz’s father said.
The team decided to begin a microcirculation assessment and booted up the Coroventis CoroFlow Cardiovascular system, a device that can measure physiological indices such as fractional flow reserve, coronary flow reserve (CFR), and index of microvascular resistance (IMR). Assisted by Ziad Ali, MD, of St. Francis Hospital’s DeMatteis Cardiovascular Institute, the team measured the patient’s IMR and CFR and assessed for microvascular dysfunction in real time.
Their testing confirmed the presence of coronary microvascular dysfunction (CMD), and the team decided to prepare a treatment plan consisting of an increase of titrate beta-blockers and calcium channel blockers.
Historically, the elder Shlofmitz explained, when a patient came to a physician with chest pain, “our mindset was if you saw a blockage, that explained the person’s pain, and if you didn’t, (then) that pain was not from the heart.”
But the Coroventis CoroFlow system changes that, he said.
The device, said Richard Shlofmitz, allows physicians to “look one step further” into a patient’s physiology and see what an angiogram or other invasive testing cannot, allowing for a more accurate diagnosis. In the case of their patient, he said, the Coroventis CoroFlow prevented implanting an unnecessary stent.
Without the Coroventis CoroFlow, “we would’ve just been guessing,” said Evan Shlofmitz, adding, “we took something from an assumption to a definitive diagnosis.”
The Coroventis CoroFlow Cardiovascular system received commercial approval from the U.S. Food and Drug Administration in November 2020.
With its ability to facilitate a diagnosis of CMD, the system can help physicians save resources and time.
“We’re not sending [the patient] for 50 different tests looking for some non-cardiac cause of the problem,” Richard Shlofmitz said.
“These are cases we see all the time on a regular basis where a patient has discordant angiographic findings from the clinical symptoms and their non-invasive testing,” the younger Shlofmitz said. “The more tools we have available, the better.”
He said Abbott plans to establish “two microvascular dysfunction centers of excellence” to promote education and application of their cardiovascular system. One will be at Stanford University and the other at the Shlofmitzes’ institution, St. Francis Hospital, The Heart Center.
Abbott spokeswoman Alicia Swanson wrote in an email: “We are working with these hospitals on training programs to better treat Coronary Microvascular Dysfunction.”
CRT 2021 Virtual takes place Fridays and Saturdays through April 24. On-demand content from the meeting is available here.