Fractional flow reserve is the most widely used physiologic index to establish the functional significance of epicardial coronary artery disease (CAD). Fractional flow reserve guides clinical decisions toward or against coronary revascularization based on a single binary decision threshold indicative of myocardial ischemia. CAD pathophysiological patterns can be evaluated by assessing the distribution of pressure losses along the coronary vessel, often displayed as a "pullback curve." Until recently, the information provided by the pullback curves was visually and subjectively interpreted, which is associated with interobserver variability. The pullback pressure gradient is a novel index that addresses this gap by assessing the longitudinal distribution of the CAD, quantifying it on a scale from 0 to 1, with higher values indicative of predominantly focal CAD and lower values of predominantly diffuse CAD. This review provides a comprehensive analysis and critical appraisal of pullback pressure gradient and future directions.

Background: Currently available risk stratification models for acute pulmonary embolism (PE) include hemodynamic status, cardiac biomarkers, right ventricle (RV) dysfunction on imaging, and clinical scores. Focusing on the length–tension relationship of the ventricle might have a superior predictive capability over RV dysfunction in terms of mortality and classification of patients with acute PE. In this study, our hypothesis suggests that the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio has superior predictive capability for in-hospital mortality in patients with acute PE compared to TAPSE or sPAP as distinct measures. Materials and Methods: This single-center study comprised retrospectively evaluated 703 patients referred to our tertiary cardiovascular center with acute PE. We divided patients into quartiles based on the TAPSE/sPAP ratio. Different models were developed to quantify the predictive relationship between in-hospital death and echocardiographic measurements. A base model was created with variables including risk status and RV/LV ratio >1. Then, to evaluate the predictive contribution of each measurement; TAPSE/sPAP, TAPSE, and sPAP were sequentially added to the base model. After that, the performance of each model was evaluated. Results: Predictive and discriminative power was the highest in model containing TAPSE/sPAP. There was still a significant inverse association between TAPSE/sPAP and the risk of in-hospital death even after adjusting for risk status and RV/LV ratio >1. Receiver operating characteristic curve analysis for TAPSE/sPAP revealed the best cut-off value as 0.34. Conclusion: The outcomes of our study reveal that the ratio of TAPSE/sPAP serves as a more potent predictor of mortality than either of the 2 measurements taken separately. The interpretation and utilization of the TAPSE/sPAP cut-off value in acute PE can assist in identifying patients at risk of deterioration and guide the consideration of more intensive treatment options across all risk groups.

Background and Aim: Recent studies have reported that the widely accepted range of upper limits of normal (ULN) alanine aminotransferase (ALT) levels (ULN