Reactive Myocardial Hyperemia for Functional Assessment of Coronary Stenosis Severity.

Stoller, Michael; Seiler, Christian (2017). Reactive Myocardial Hyperemia for Functional Assessment of Coronary Stenosis Severity. EuroIntervention, 13(2), e201-e209. Europa Digital & Publishing 10.4244/EIJ-D-16-00579

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AIM

To compare functional assessment of coronary stenosis severity by fractional flow reserve (FFR) measurement as induced by systemic adenosine and by regional reactive myocardial hyperemia.

METHODS AND RESULTS

The primary study endpoints were coronary pressure-derived FFR values in response to intravenous adenosine infusion (140µg/min/kg) and to a 1-minute proximal coronary artery balloon occlusion (reactive hyperemia) for the same stenosis of interest. The secondary study endpoint was coronary collateral flow index (CFI) during the same occlusion. CFI is the ratio between simultaneous mean arterial occlusive pressure and mean aortic pressure both subtracted by central venous pressure. As a reference, coronary artery stenoses were assessed quantitatively as percent diameter reduction (%S). Hundred-and-twentyfive patients with coronary artery disease were included in the study. There was an inverse association between quantitatively determined structural stenosis severity and adenosine-induced FFR as well as post-ischemic reactive hyperemia FFR (%S=1-0.004FFR; both at p<0.0001). Sensitivity and specificity for detecting a stenosis of ≥50% at an FFR threshold of 0.80 was 0.891 and 0.605 (adenosine-induced FFR), and 0.817 and 0.684 (post-ischemic FFR), respectively. The FFR difference for a given stenosis (post-ischemic minus adenosine-induced FFR) was directly related to CFI.

CONCLUSIONS

Regional reactive hyperemia FFR is not inferior to systemic adenosine FFR in detecting structurally relevant coronary stenosis. Depending on the absence or presence of functional collaterals, systemic adenosine-induced FFR may underestimate or overestimate stenosis severity, respectively.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology 04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
UniBE Contributor:	Stoller, Michael
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1774-024X
Publisher:	Europa Digital & Publishing
Language:	English
Submitter:	Jacques Donzé
Date Deposited:	16 Feb 2017 10:53
Last Modified:	05 Dec 2022 15:02
Publisher DOI:	10.4244/EIJ-D-16-00579
PubMed ID:	27993753
URI:	https://boris.unibe.ch/id/eprint/94677