Author + information
- Hiroyuki Okura1,
- Yuhei Kobayashi2,
- Yoji Neishi3,
- Tomitaka Higa4,
- Yukari Kobayashi5,
- Shiro Uemura6 and
- Kiyoshi Yoshida7
- 1Nara Medical University, Kashihara, Japan
- 2Stanford University, Stanford, California, United States
- 3Kawasaki Medical School, Kurashiki, Japan
- 4Kawasaki Mecical School
- 5Stanford University, Stanford, California, United States
- 6Kawasaki Medical School, Kurashiki, Japan
- 7The Sakakibara Heart Institute of Okayama
Fractional flow reserve (FFR) has been used as an index unaffectd by hemodynamic alteration. However, there is a theoretical concern that the further decrement of aortic pressure may result in artificially elevated FFR value. The aim of this study was to investigate relationship between alterations in aortic blood pressure and changes in FFR after adjunctive intracoronary nicorandil.
A total of 183 intermediate native coronary artery lesions from 112 patients were prospectively enrolled to this study. The mean aortic pressure (Pa), the mean distal coronary pressure (Pd), and FFR were measured during intravenous adenosine 5’-triphosphate (ATP) infusion alone (150 mcg/kg/min) and repeated after further hyperemia induced by adjunctive intracoronary nicorandil injection (2.0 mg). ΔPa, ΔPd, and ΔFFR were defined as the values during ATP and nicorandil minus ATP infusion alone.
No severe adverse effect from ATP and nicorandil was observed. Both Pa and Pd became significantly lower with adjunctive intracoronary nicorandil injection (Pa: 83 (IQR 74-93) vs. 78 (69-89) mmHg, p<0.001, and Pd; 69 (62-80) vs. 65 (57-75) mmHg, p<0.001). As a result, FFR value became slightly lower (0.87 (0.81-0.92) vs. 0.85 (0.79-0.90), p<0.001). ΔPa had weak negative correlation with ΔFFR (ρ=-0.19, p=0.01), whereas ΔPd had non-significant weak positive correlation with ΔFFR (ρ=0.13, p=0.08). When lesions were divided by the median value of ΔPa, lesions with larger drop of Pa had minimal adjunctive effect by nicorandil (Figure).
By inducing further hyperemia with adjunctive intracoronary nicorandil injection, both aortic and distal coronary pressure drop, counterbalancing the effect to FFR value. This is particularly true in lesions with the large drop of aortic pressure.
IMAGING: FFR and Physiologic Lesion Assessment