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 language | English |
|---|---|
| Pages (from-to) | 1461-1467 |
| Number of pages | 7 |
| Journal | The American Journal of Cardiology |
| Volume | 113 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - May 1 2014 |
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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 journal › Article
}
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 -