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 journalArticlepeer-review

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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