Author + information
- Sergio Baptista1,
- João Augusto1,
- Pedro Magno1,
- Mariana Faustino1,
- Jose Loureiro2,
- Miguel Santos1,
- Luis Brizida1,
- Paulo Leal1,
- Célia Monteiro1,
- Maura Nedio1,
- Pedro Farto e Abreu1 and
- Carlos Morais1
The lack of concordance between resting and hyperemic indexes in the evaluation of intermediate coronary lesions has been the subject of intense debate. Hemodynamic effects of adenosine (both on the central blood pressure and coronary microcirculation) and inadequate hyperemia have been proposed to explain it. Contrast hyperemia, although not so effective in producing sustained hyperemia does not have the hemodynamic effects associated with adenosine. Our purpose was to evaluate the discordance between resting (PdPa), hemodynamic-independent hyperemia (contrast) and adenosine hyperemia.
Resting PdPa, FFR after an intracoronary contrast bolus (FFRc) and FFR after hyperemia induced with intravenous adenosine (FFRad) were recorded in patients with intermediate coronary lesions.
258 lesions in 189 patients were included. PdPa, FFRc and FFRad mean values were 0.92±0.06, 0.86±0.07 and 0.82±0.09. Both PdPA (r=0.798) and FFRc (r=0.914) strongly correlated with FRFad (p<0.0001). The AUC ROC curves for predicting an FFRad ≤0.80 were respectively 0.894 and 0.955 (p<0.0001). Using the established cutoff of ≤0.92, PdPA values were concordant with FFRad values in 199 lesions (77.1%). Using a cutoff of ≤0.85, FFRc values were concordant with FFRad values in 227 lesions (88.0%). Concordance between all 3 evaluations was observed in 191 lesions (74.0%). Discordant values are described in the Table. Concordance was lower in female patients (67.7% vs. 78.0% in males, p=0.046) and tended to be lower in proximal LAD and LM lesions (64.7% vs. 76.3% in other locations, p=0.067). Among the 31 (12%) cases in which FFRc and FFRa were not concordant, 6 (2.3% of all lesions) significant (≤0.80) lesions by FFRad had an FFRc >0.85. Importantly, in all these lesions, PdPA was >0.92. On the other hand, 17 (6.6%) non-significant (>0.80) lesions by FFRad had both significant PdPa (≤0.92) and FFRc (≤0.85) values. Importantly, all cases with significant PdPA and FFRad also showed significant FFRc.
|PdPa ≤0.92||FFRc ≤0.85||FFRa ≤0.80||Number (%)|
|Concordant cases (n=191; 74.0%)||Yes||Yes||Yes||78 (30.2)|
|PdPA discordant (n=36, 14.0%)||Yes||No||No||25 (9.7)|
|FFRc discordant (n=8, 3.1%)||No||Yes||No||8 (3.1)|
|FFRa discordant (n=23, 8.9%)||Yes||Yes||No||17 (6.6)|
Overall, resting and hyperemic measurements are concordant in ¾ of the patients. Among patients with discordance between FFRc and FFRad, PdPa values may help to identify cases in which FFRad may eventually have some pitfalls. While the exact physiological significance of these differences is not clear, careful may be advisable in using discordant information in the clinical decisions in patients with intermediate lesions.
IMAGING: FFR and Physiologic Lesion Assessment