Value of Delta Fractional Flow Reserve (ΔFFR) For Predicting Coronary Ischemic Lesions
AbstractBackground: 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]
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.
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.
Elgendy IY1, Conti CR, Bavry AA. Fractional flow reserve: an updated review. Clin Cardiol. 2014 Jun;37(6):371-80.
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.
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.
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.
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.
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.
Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol. 2010;55:173-185.
De Bruyne B, Pijls NH, Bartunek J, et al. Fractional flow reserve in patients with prior myocardial infarction. Circulation. 2001;104:157-162.
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.
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.
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.
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
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.
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.
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.
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.
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