Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses

Tóth, Gábor G.; Hamilos, Michalis; Pyxaras, Stylianos A.; Mangiacapra, Fabio; Nelis, Olivier; Vroey, Frederic De; Serafino, Luigi Di; Müller, Olivier; Mieghem, Carlos Van; Wyffels, Eric; Heyndrickx, Guy R.; Bartúnek, Jozef; Vanderheyden, Marc; Barbato, Emanuele; Wijns, William; Bruyne, Bernard De

doi:10.1093/eurheartj/ehu094

Cited by 288 publications

(145 citation statements)

References 44 publications

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“…[179][180][181] Quantitative noninvasive and invasive techniques are now available that go beyond standard interpretation of anatomic coronary stenosis in making this functional assessment. These include noninvasive assessment of maximum MBF and MFR with PET, as well as invasive measurement of CFR and FFR.…”

Section: Physiologic Relationships Among Mfr Ffr and Relative Flow mentioning

confidence: 99%

Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC

Murthy

Bateman²,

Beanlands

et al. 2018

Journal of Nuclear Cardiology

173

111

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Section: Physiologic Relationships Among Mfr Ffr and Relative Flow mentioning

confidence: 99%

Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC

Murthy

Bateman²,

Beanlands

et al. 2018

Journal of Nuclear Cardiology

173

111

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“…33 In the present analysis, we compared side-by-side VE and QCA to FFR and studied the effect of risk factors on these relationships.…”

Section: Discussionmentioning

confidence: 99%

Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve

Adjedj

Xaplanteris

Tóth

et al. 2017

Circ: Cardiovascular Imaging

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“…The relationship between angiographic stenosis severity and functional significance assessed by FFR and the mismatch between these 2 measures have been extensively investigated to optimize percutaneous coronary intervention (PCI) 16, 24, 25, 26. Clinical factors, including age, sex, angiographical lesion‐related factors, and physiological factors, have been reported to contribute to visual‐functional mismatch and reverse mismatch 15, 16, 26, 27, 28. Our results were in line with these previous studies and further suggested the importance of microvascular function in both mismatch and reverse mismatch.…”

Section: Discussionmentioning

confidence: 99%

Significance of Microvascular Function in Visual—Functional Mismatch Between Invasive Coronary Angiography and Fractional Flow Reserve

Yonetsu

Murai

Kanaji

et al. 2017

JAHA

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BackgroundDespite a moderate correlation between angiographical stenosis and physiological significance, the mechanism of discordance has not been fully elucidated, particularly regarding the significance of microvascular function. This study sought to clarify whether microvascular function affects visual‐functional mismatch between quantitative coronary angiography (QCA) and fractional flow reserve (FFR).Methods and ResultsWe assessed QCA, FFR, coronary flow reserve, and the index of microcirculatory resistance in 849 non‐left‐main coronary lesions with visually estimated intermediate stenoses from 532 patients. Clinical and lesion‐specific characteristics and physiological parameters associated with mismatch and reverse mismatch were studied. Coronary flow reserve and index of microcirculatory resistance showed a weak, but significant, correlation with FFR (R=0.306, P<0.001 and R=0.158, P<0.001, respectively). Four hundred twenty‐two lesions were visually nonsignificant (diameter stenosis assessed by QCA [QCA‐DS] ≤50%) and 427 lesions were visually significant (QCA‐DS >50%). Among visually nonsignificant lesions, FFR ≤0.80 (reverse mismatch) was observed in 129 lesions (30.6%). Among visually significant lesions, FFR >0.80 (mismatch) were observed in 179 lesions (41.9%). The significant predictors of reverse mismatch were male sex, nonculprit lesions of acute coronary syndrome, left anterior descending artery location, smaller QCA reference diameter, greater QCA‐DS, lower coronary flow reserve, and lower index of microcirculatory resistance. Mismatch was associated with right coronary artery location, greater QCA reference diameter, smaller QCA‐DS, lesion length, higher coronary flow reserve, and higher index of microcirculatory resistance.ConclusionsThere was a high prevalence of visual‐functional mismatches between QCA and FFR. The discrepancy was related to clinical characteristics, lesion‐specific factors, and microvascular resistance that was undistinguishable by coronary angiography, thus suggesting the importance of physiological lesion assessment.

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Evolving concepts of angiogram: fractional flow reserve discordances in 4000 coronary stenoses

Cited by 288 publications

References 44 publications

Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC

Clinical Quantification of Myocardial Blood Flow Using PET: Joint Position Paper of the SNMMI Cardiovascular Council and the ASNC

Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve

Significance of Microvascular Function in Visual—Functional Mismatch Between Invasive Coronary Angiography and Fractional Flow Reserve

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