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Value of Delta Fractional Flow Reserve (ΔFFR) For Predicting Coronary Ischemic Lesions

Vahid Eslami, Morteza Safi, Mohammad hasan Namazi, Mehdi Pishgahi, Amir Eftekharzade, Sayyed Ali Eftekharzadeh
Background: The decrease in fractional flow reserve (FFR) after adenosine administration from baseline FFR value (termed as ΔFFR) may reflect the compensatory capacity of the microvascular circulation and thus may predict significant coronary stenotic lesions. We aimed to investigate whether baseline FFR and ΔFFR can help identify the coronary ischemic lesion and its severity. Materials and Methods: This cross-sectional study was performed on 154 consecutive patients (Mean age 62.42 ± 9.36 years) that underwent coronary angiography and with definitive intermediate coronary lesions at any of the coronary vessels. FFR was calculated by dividing the mean distal intracoronary pressure by the mean arterial pressure. ΔFFR was also defined as the difference between baseline FFR and hyperemic FFR (considering FFR<0.75 as the criteria for ischemia). Results: The area under receiver-operating characteristic curve for baseline FFR was found as 0.933, and for ΔFFR was 0.946 indicated high values of both indices for predicting ischemic lesions. The best cut-off point for baseline FFR and ΔFFR for discriminating ischemic lesions from the normal condition was 89.5 (yielding a sensitivity of 92.2% and a specificity of 68.0%) and 9.5 (yielding a sensitivity of 96.0% and a specificity of 85.3%), respectively. Conclusion: Our study could successfully demonstrate the high value of both baseline FFR and ΔFFR for predicting coronary ischemic lesions with the cut-off values of <89.5 and >9.5, respectively. [GMJ.2020;9:e1528]
Fractional Flow Reserve; Coronary Artery Diseases; Myocardial Infarction; Stenosis

Nakanishi R1, Budoff MJ1. Noninvasive FFR derived from coronary CT angiography in the management of coronary artery disease: technology and clinical update. Vasc Health Risk Manag. 2016 Jun 22;12:269-78.

https://doi.org/10.2147/VHRM.S79632

PMid:27382296 PMCid:PMC4922813

Ahn JM1, Park DW1, Shin ES1, Koo BK1, Nam CW1, Doh JH1, et al. Fractional Flow Reserve and Cardiac Events in Coronary Artery Disease: Data From a Prospective IRIS-FFR Registry (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve). Circulation. 2017 Jun 6;135(23):2241-2251.

https://doi.org/10.1161/CIRCULATIONAHA.116.024433

PMid:28356440

Elgendy IY1, Conti CR, Bavry AA. Fractional flow reserve: an updated review. Clin Cardiol. 2014 Jun;37(6):371-80.

https://doi.org/10.1002/clc.22273

PMid:24652785 PMCid:PMC6649528

De Bruyne B, Bartunek J, Sys SU, et al. Simultaneous coronary pressure and flow velocity measurements in humans: feasibility, reproducibility, and hemodynamic dependence of coronary flow velocity reserve, hyperemic flow versus pressure slope index, and fractional flow reserve. Circulation. 1996;94:1842-1849.

https://doi.org/10.1161/01.CIR.94.8.1842

PMid:8873658

Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996;334:1703-1708.

https://doi.org/10.1056/NEJM199606273342604

PMid:8637515

Misaka T, Kunii H, Mizukami H, et al. Long-term clinical outcomes after deferral of percutaneous coronary intervention of intermediate coronary stenoses based on coronary pressure-derived fractional flow reserve. J Cardiol. 2011;58:32-37.

https://doi.org/10.1016/j.jjcc.2011.03.007

PMid:21620679

Costa MA, Sabate M, Staico R, et al. Anatomical and physiologic assessments in patients with small coronary artery disease: final results of the Physiologic and Anatomical Evaluation Prior to and After Stent Implantation in Small Coronary Vessels (PHANTOM) trial. Am Heart J. 2007;153:296.e1-296.e7.

https://doi.org/10.1016/j.ahj.2006.10.036

PMid:17239692

Hirota M, Iwasaki K, Yamamoto K, et al. Coronary pressure measurement to identify the lesion requiring percutaneous coronary intervention in equivocal tandem lesions. Coron Artery Dis. 2006;17:181-186.

https://doi.org/10.1097/00019501-200603000-00013

PMid:16474238

Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol. 2010;55:173-185.

https://doi.org/10.1016/j.jacc.2009.06.062

PMid:20117397

De Bruyne B, Pijls NH, Bartunek J, et al. Fractional flow reserve in patients with prior myocardial infarction. Circulation. 2001;104:157-162.

https://doi.org/10.1161/01.CIR.104.2.157

PMid:11447079

Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49:2105-2111.

https://doi.org/10.1016/j.jacc.2007.01.087

PMid:17531660

De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012;367:991-1001.

https://doi.org/10.1056/NEJMoa1205361

PMid:22924638

De Bruyne B, Bartunek J, Sys SU, Heyndrickx GR. Relation between myocardial fractional flow reserve calculated from coronary pressure measurements and exercise-induced myocardial ischemia. Circulation 1995;92:3183-93.

https://doi.org/10.1161/01.CIR.92.1.39

PMid:7788914

Nahser Jr PJ, Brown RE, Oskarsson H, Winniford MD, Rossen JD. Maximal coronary flow reserve and metabolic coronary vasodilation in patients with diabetes mellitus. Circulation 1995;91: 635-40

https://doi.org/10.1161/01.CIR.91.3.635

PMid:7828287

Kocaman SA1, Sahinarslan A, Arslan U, Timurkaynak T. The delta fractional flow reserve can predict lesion severity and long-term prognosis. Atherosclerosis. 2009;203(1):178-84.

https://doi.org/10.1016/j.atherosclerosis.2008.06.009

PMid:18644595

Xaplanteris P, Ntalianis A, De Bruyne B, Strisciuglio T, Pellicano M, Ciccarelli G, et al. Coronary lesion progression as assessed by fractional flow reserve(FFR) and angiography. EuroIntervention. 2018;14(8):907-14.

https://doi.org/10.4244/EIJ-D-17-00872

PMid:29769166

Agarwal SK, Kasula S, Hacioglu Y, Ahmed Z, Uretsky BF, Hakeem A. Utilizing Post-Intervention Fractional Flow Reserve to Optimize Acute Results and the Relationship to Long-Term Outcomes. JACC Cardiovasc Interv. 2016;9(10):1022-31.

https://doi.org/10.1016/j.jcin.2016.01.046

PMid:27198682

Matsuo A, Shimoo S, Takamatsu K, Tsuji Y, Kyodo A, Mera K, et al. Visualization of the improvement of myocardial perfusion aftercoronary intervention using motorized fraction al flow reservepullback curve. Cardiovasc Interv Ther. 2018;33(2):99-108.

https://doi.org/10.1007/s12928-016-0448-3

PMid:27943219 PMCid:PMC5880845

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