Author + information
- Giulia Arenaa,b,
- Alberto Morelloa,b,
- Antonello D'Andreaa,b,
- Bernardino Tuccilloa,b,
- Francesco Punzoa,b,
- Fortunato Scotto Di Uccioa,b,
- Wanda Acampaa,b,
- Letizia Spinellia,b,
- Roberta Assantea,b,
- Emilia Zampellaa,b,
- Giovanni Cimminoa,b,
- Alberto Cuocoloa,b and
- Paolo Golinoa,b
Background: Coronary physiology plays an increasingly clinical role in cardiology. However, the relationship between the clinical tools of CFR and FFR is not well defined. Thus, the aim of this study was to investigate the relationship between PET-measured CFR and invasively-measured FFR in patients with stable coronary artery disease (CAD).
Methods: Fifty-three patients with moderate (30%-70%) pretest likelihood of CAD underwent 82Rb PET/CT cardiac imaging at rest and after pharmacological stress with dipyridamole (0.142 mg/kg/min for 4 min). CFR was considered abnormal if ≤1.74. FFR was then measured during intracoronary administration of adenosine (200 μg). FFR was considered abnormal if ≤0.8. A total of 63 stenoses were studied. To determine whether CFR and FFR actually identify coronary stenoses causing myocardial ischemia, 19 additional patients underwent an echocardiographic study at rest and after pharmacological stress (dobutamine, up to 40 μg/kg/min), followed by a 18F-FDG PET/CT and a 82Rb PET/CT cardiac imaging, as above described.
Results: A significant, albeit modest, correlation was found between CFR and FFR (r2=0.15, p=0.02). However, of the 37 stenoses with a pathological FFR value ≤0.8, only 16 showed a pathological CFR, while the other 21 had a normal CFR; in contrast, of the 26 lesions with an FFR value above 0.8, only 4 showed a reduced CFR, while the other 23 had a normal CFR. Interestingly, in the 19 additional patients undergoing the 18F-FDG PET/CT study, a CFR <1.74 was associated with myocardial 18F-FDG uptake, indicating ischemia, in 15 out of 19 patients, while an FFR <0.8 was associated with myocardial 18F-FDG uptake in only 8 of 19 patients (p<0.05 by χ2).
Conclusions: In this study, FFR values >0.8, indicating a non-significant stenosis, well correlate with CFR, while pathological FFR values poorly correlate with a reduced CFR. CFR values <1.74 positively identified coronary stenoses causing myocardial ischemia, while an FFR value <0.8 did not. This discordance between CFR and FFR should be taken into account when recommending revascularization solely on the basis of FFR values.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1166-341
- 2017 American College of Cardiology Foundation