Greetings

Dear Sir/Madam,

This year marks the 10th anniversary of POPAI since its inception in 2014.

Last year, we held POPAI Innovation and the traditional POPAI Physiology and Imaging course in two separate sessions. This time, we plan to consolidate the two sessions into a single day.

It is becoming increasingly clear that more detailed risk assessment of cardiovascular events is possible by incorporating complementary information from physiology and imaging.

Stenting has been shown to improve exercise tolerance by reducing coronary vascular resistance and increasing coronary blood flow during exercise. However, the effectiveness of cardiac intervention in stabilizing plaque and preventing cardiovascular events (plaque sealing effect) has unfortunately not been demonstrated. Furthermore, negative aspects of stent placement, known as "stent disease," have also been reported. However, potent drug therapy has also been reported to stabilize and even shrink plaque. Coronary artery imaging is effective in detecting high-risk plaque, which may be a cause of future cardiac events. Plaque imaging techniques such as CT, IVUS, OCT, and OFDI are useful for assessing future event risk and may indicate the need for aggressive medical therapy. Currently, a growing body of evidence shows that accurately determining whether a lesion is a potential cause of ischemia in the catheterization laboratory by measuring intracoronary pressure, followed by optimal stent optimization using IVUS or OCT, is the most effective method for improving patient outcomes.

In imaging, too, efforts are being made to utilize fluid dynamics to obtain information comparable to FFR from intraluminal information obtained from CT, angiography, IVUS, OCT, and other techniques. It has also been shown that the lesion pressure gradient assessed by physiology is strongly correlated with plaque vulnerability. While physiology and imaging provide different information, the two appear to be converging in terms of the occurrence of coronary events. FFRCT was approved for health insurance coverage in December 2018, FFRangio in December 2020, and QFR in December 2023, and is already being used at many facilities. However, in the 2024 TCT, the FAVOR III Europe study failed to demonstrate non-inferiority of QFR-guided decision-making to FFR-guided PCI. As such, there is still much to discuss.

In the mature field of PCI, successful treatment of complex lesions is crucial to improving patient outcomes. To achieve this goal, mastering catheterization techniques alone is not enough; understanding physiology and imaging is also essential.

By attending POPAI 2025 for two days, you will be able to learn the latest information on physiology and imaging. We promise it will be a valuable opportunity for everyone to discuss cardiovascular event prediction. All of the staff at Gifu Heart Center look forward to your participation.

PCI Optimization by Physiology And ImagingRepresentative organizer: Hitoshi Matsuo