Impact of accuracy of fractional flow reserve to reduction of Microvascular resistance after intracoronary adenosine in patients with angina pectoris or non-ST-segment elevation myocardial infarction

Giampaolo Niccoli, Elena Falcioni, Nicola Cosentino, Francesco Fracassi, Marco Roberto, Alessandro Fabretti, Mario Panebianco, Giancarla Scalone, Francesco Burzotta, Carlo Trani, Antonio Maria Leone, Justin Davies, Filippo Crea

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Our study aimed to elucidate mechanisms underlying discordance between fractional flow reserve (FFR) and hyperemic stenosis resistance (hSR) in some patient subsets. To do this, we enrolled 30 consecutive patients with stable angina or non-ST elevation myocardial infarction (non-STEMI) and with a nonculprit intermediate coronary lesion (40% to 70%) by coronary angiography. We measured aortic pressure, flow velocity, and pressure distal to lesion simultaneously at basal level and during adenosine-induced (fixed intracoronary dose of 120 μg) hyperemia using a dual-sensor-equipped guidewire. Microvascular resistance (MR; pressure distal to lesion/flow velocity, mm Hg/cm/s) and variation (Δ) in MR levels were calculated both at baseline and after hyperemia, whereas FFR (cutoff 0.80 mm Hg/cm/s] were assessed after intracoronary adenosine. Twenty-three patients (76.7%) showed concordance and 7 patients (23.3%) showed discordance between FFR and hSR (all cases with FFR >0.80 and hSR >0.80). Discordant patients presented more frequently with non-STEMI (85.7% vs 39.1%, p = 0.04), significantly higher C-reactive protein serum levels (median [interquartile range] 5.9 [5.1 to 6.8] vs 4.9 [3.7 to 6.2] mg/L, p = 0.007), and lower ΔMR (p = 0.03) values compared with concordant patients. In conclusion, patients with non-STEMI and those with increased C-reactive protein levels show a lower reduction in MR after intracoronary adenosine-induced hyperemia, leading to FFR underestimation.

Original languageEnglish
Pages (from-to)1461-1467
Number of pages7
JournalThe American Journal of Cardiology
Volume113
Issue number9
DOIs
Publication statusPublished - May 1 2014

Fingerprint

Angina Pectoris
Adenosine
Hyperemia
Pathologic Constriction
C-Reactive Protein
Pressure
Stable Angina
Non-ST Elevated Myocardial Infarction
Coronary Angiography
Arterial Pressure
Serum

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of accuracy of fractional flow reserve to reduction of Microvascular resistance after intracoronary adenosine in patients with angina pectoris or non-ST-segment elevation myocardial infarction. / Niccoli, Giampaolo; Falcioni, Elena; Cosentino, Nicola; Fracassi, Francesco; Roberto, Marco; Fabretti, Alessandro; Panebianco, Mario; Scalone, Giancarla; Burzotta, Francesco; Trani, Carlo; Leone, Antonio Maria; Davies, Justin; Crea, Filippo.

In: The American Journal of Cardiology, Vol. 113, No. 9, 01.05.2014, p. 1461-1467.

Research output: Contribution to journalArticle

Niccoli, Giampaolo ; Falcioni, Elena ; Cosentino, Nicola ; Fracassi, Francesco ; Roberto, Marco ; Fabretti, Alessandro ; Panebianco, Mario ; Scalone, Giancarla ; Burzotta, Francesco ; Trani, Carlo ; Leone, Antonio Maria ; Davies, Justin ; Crea, Filippo. / Impact of accuracy of fractional flow reserve to reduction of Microvascular resistance after intracoronary adenosine in patients with angina pectoris or non-ST-segment elevation myocardial infarction. In: The American Journal of Cardiology. 2014 ; Vol. 113, No. 9. pp. 1461-1467.
@article{ad63ae7f657047ecaca6e3b5789cffb5,
title = "Impact of accuracy of fractional flow reserve to reduction of Microvascular resistance after intracoronary adenosine in patients with angina pectoris or non-ST-segment elevation myocardial infarction",
abstract = "Our study aimed to elucidate mechanisms underlying discordance between fractional flow reserve (FFR) and hyperemic stenosis resistance (hSR) in some patient subsets. To do this, we enrolled 30 consecutive patients with stable angina or non-ST elevation myocardial infarction (non-STEMI) and with a nonculprit intermediate coronary lesion (40{\%} to 70{\%}) by coronary angiography. We measured aortic pressure, flow velocity, and pressure distal to lesion simultaneously at basal level and during adenosine-induced (fixed intracoronary dose of 120 μg) hyperemia using a dual-sensor-equipped guidewire. Microvascular resistance (MR; pressure distal to lesion/flow velocity, mm Hg/cm/s) and variation (Δ) in MR levels were calculated both at baseline and after hyperemia, whereas FFR (cutoff 0.80 mm Hg/cm/s] were assessed after intracoronary adenosine. Twenty-three patients (76.7{\%}) showed concordance and 7 patients (23.3{\%}) showed discordance between FFR and hSR (all cases with FFR >0.80 and hSR >0.80). Discordant patients presented more frequently with non-STEMI (85.7{\%} vs 39.1{\%}, p = 0.04), significantly higher C-reactive protein serum levels (median [interquartile range] 5.9 [5.1 to 6.8] vs 4.9 [3.7 to 6.2] mg/L, p = 0.007), and lower ΔMR (p = 0.03) values compared with concordant patients. In conclusion, patients with non-STEMI and those with increased C-reactive protein levels show a lower reduction in MR after intracoronary adenosine-induced hyperemia, leading to FFR underestimation.",
author = "Giampaolo Niccoli and Elena Falcioni and Nicola Cosentino and Francesco Fracassi and Marco Roberto and Alessandro Fabretti and Mario Panebianco and Giancarla Scalone and Francesco Burzotta and Carlo Trani and Leone, {Antonio Maria} and Justin Davies and Filippo Crea",
year = "2014",
month = "5",
day = "1",
doi = "10.1016/j.amjcard.2014.01.422",
language = "English",
volume = "113",
pages = "1461--1467",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "9",

}

TY - JOUR

T1 - Impact of accuracy of fractional flow reserve to reduction of Microvascular resistance after intracoronary adenosine in patients with angina pectoris or non-ST-segment elevation myocardial infarction

AU - Niccoli, Giampaolo

AU - Falcioni, Elena

AU - Cosentino, Nicola

AU - Fracassi, Francesco

AU - Roberto, Marco

AU - Fabretti, Alessandro

AU - Panebianco, Mario

AU - Scalone, Giancarla

AU - Burzotta, Francesco

AU - Trani, Carlo

AU - Leone, Antonio Maria

AU - Davies, Justin

AU - Crea, Filippo

PY - 2014/5/1

Y1 - 2014/5/1

N2 - Our study aimed to elucidate mechanisms underlying discordance between fractional flow reserve (FFR) and hyperemic stenosis resistance (hSR) in some patient subsets. To do this, we enrolled 30 consecutive patients with stable angina or non-ST elevation myocardial infarction (non-STEMI) and with a nonculprit intermediate coronary lesion (40% to 70%) by coronary angiography. We measured aortic pressure, flow velocity, and pressure distal to lesion simultaneously at basal level and during adenosine-induced (fixed intracoronary dose of 120 μg) hyperemia using a dual-sensor-equipped guidewire. Microvascular resistance (MR; pressure distal to lesion/flow velocity, mm Hg/cm/s) and variation (Δ) in MR levels were calculated both at baseline and after hyperemia, whereas FFR (cutoff 0.80 mm Hg/cm/s] were assessed after intracoronary adenosine. Twenty-three patients (76.7%) showed concordance and 7 patients (23.3%) showed discordance between FFR and hSR (all cases with FFR >0.80 and hSR >0.80). Discordant patients presented more frequently with non-STEMI (85.7% vs 39.1%, p = 0.04), significantly higher C-reactive protein serum levels (median [interquartile range] 5.9 [5.1 to 6.8] vs 4.9 [3.7 to 6.2] mg/L, p = 0.007), and lower ΔMR (p = 0.03) values compared with concordant patients. In conclusion, patients with non-STEMI and those with increased C-reactive protein levels show a lower reduction in MR after intracoronary adenosine-induced hyperemia, leading to FFR underestimation.

AB - Our study aimed to elucidate mechanisms underlying discordance between fractional flow reserve (FFR) and hyperemic stenosis resistance (hSR) in some patient subsets. To do this, we enrolled 30 consecutive patients with stable angina or non-ST elevation myocardial infarction (non-STEMI) and with a nonculprit intermediate coronary lesion (40% to 70%) by coronary angiography. We measured aortic pressure, flow velocity, and pressure distal to lesion simultaneously at basal level and during adenosine-induced (fixed intracoronary dose of 120 μg) hyperemia using a dual-sensor-equipped guidewire. Microvascular resistance (MR; pressure distal to lesion/flow velocity, mm Hg/cm/s) and variation (Δ) in MR levels were calculated both at baseline and after hyperemia, whereas FFR (cutoff 0.80 mm Hg/cm/s] were assessed after intracoronary adenosine. Twenty-three patients (76.7%) showed concordance and 7 patients (23.3%) showed discordance between FFR and hSR (all cases with FFR >0.80 and hSR >0.80). Discordant patients presented more frequently with non-STEMI (85.7% vs 39.1%, p = 0.04), significantly higher C-reactive protein serum levels (median [interquartile range] 5.9 [5.1 to 6.8] vs 4.9 [3.7 to 6.2] mg/L, p = 0.007), and lower ΔMR (p = 0.03) values compared with concordant patients. In conclusion, patients with non-STEMI and those with increased C-reactive protein levels show a lower reduction in MR after intracoronary adenosine-induced hyperemia, leading to FFR underestimation.

UR - http://www.scopus.com/inward/record.url?scp=84898665295&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84898665295&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2014.01.422

DO - 10.1016/j.amjcard.2014.01.422

M3 - Article

C2 - 24731651

AN - SCOPUS:84898665295

VL - 113

SP - 1461

EP - 1467

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 9

ER -