Efficacy of coronary fractional flow reserve using contrast medium compared to adenosine

Abstract

IntroductionCoronary fractional flow reserve (FFR) is recommended as the gold standard method in evaluating intermediate coronary stenoses. However, there are significant debates concerning the agents and the timing of the measurement.AimTo compare the contrast medium induced Pd/Pa ratio (CMR) with the FFR.Material and methodsWe enrolled 28 consecutive patients with 34 intermediate lesions who underwent coronary FFR measurement by intracoronary (i.c.) adenosine. After baseline Pd/Pa was calculated, a single contrast medium (Iomeron) injection of 6 ml (3 ml/s) was performed manually. Within 10 s after the contrast medium injection, the CMR was calculated. Bolus injection of i.c. adenosine was performed to induce maximal hyperemia (from 60 µg to 600 µg), and when it was ≤ 0.80, the intermediate lesion was considered as significant.ResultsAfter bolus i.c. adenosine, 12 lesions of 34 (35.3%) were identified as significant. The CMR value was 0.86 ±0.06 (range: 0.71–0.97). There were no significant differences between FFR and CMR values (p = 0.108). A substantial positive correlation between adenosine and contrast values was detected (0.886 and p < 0.001). Good agreement in Bland-Altman analysis was revealed (mean bias was 0.027, 95% confidence interval 0.038–0.092). Receiver operating characteristics curve analysis showed 90.9% sensitivity and 91.7% specificity for a cut-off value of 0.85 for the CMR compared to FFR (≤ 0.80).ConclusionsOur study showed that measuring the CMR is a feasible method compared to FFR. The CMR may be used in situations where adenosine cannot be administered.

Contrast medium Pd/Pa ratio in comparison to fractional flow reserve, quantitative flow ratio and instantaneous wave-free ratio for evaluation of intermediate coronary lesions

“…In a study by Topcu et al . cFFR correlated well with FFR ( r = 0.89) and showed good agreement in Bland-Altman analysis (mean bias was 0.027, 95% limits for agreement from –0.038 to 0.092) [ 22 ]. The CONTRAST study [ 12 ] compared the ability of cFFR vs. resting Pd/Pa and iFR to predict FFR.…”

“…The CONTRAST study, comparing the ability of contrast medium Pd/Pa ratio (cFFR) to predict FFR versus resting indices, showed that cFFR was superior to resting Pd/Pa and iFR for predicting FFR while resting Pd/Pa and iFR provided equivalent diagnostic accuracy [ 12 ]. Several studies showed a good correlation of cFFR with FFR [ 13 , 14 ].…”

Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses

“…All pressure tracings were standardized and centrally reviewed by a core laboratory. e other cFFR studies were of moderate quality due to their single-center design, small sample size, nonconsecutive population, and lack of a rigorous blinding method, which may be the source Cerrato et al [19] Johnson et al [4] Kanaji et al [16] Shiode et al [17] Topcu et al [15] Van Wyk et al [18] Leone et al [5] Study ID…”

“…Cerrato et al [19] Johnson et al [4] Kanaji et al [16] Shiode et al [17] Topcu et al [15] Van Wyk et al [18] Leone et al [5] 0.6 1.0 Sensitivity Q = 14.78, df = 6.00, p = 0.02 Emori et al [22] FAVOR Pilot [9] Stahli et al [30] WIFI II et al [21][25]…”

The ongoing search for simplifying fractional flow reserve assessment: the role of contrast medium

“…In the present issue of the journal another piece of evidence in favour of cFFR (also known as CMR, as in our previous RINASCI study) is presented [ 15 ]. The authors clearly confirmed previous reports also using manual injection of contrast medium, again supporting the wide applicability of this novel technique.…”