Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention

Tonino, Pim A.L.; Bruyne, Bernard De; Pijls, Nico H.J.; Siebert, Uwe; Ikeno, Fumiaki; Veer, Marcel van ’t; Klauß, Volker; Manoharan, Ganesh; Engstrøm, Thomas; Oldroyd, Keith G.; Lee, Peter N Ver; MacCarthy, Philip; Fearon, William F.

doi:10.1056/nejmoa0807611

Cited by 3,715 publications

(2,527 citation statements)

References 37 publications

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“…Various clinical trials demonstrated the benefits of using FFR measurement to more accurately identify stenosis that are obstructive and guide revascularization intervention successfully 11, 12, 23. FFR is currently recommended in clinical guidelines only in stable CAD but the transition from stable to unstable syndromes is a continuum without a clear boundary.…”

Section: Discussionmentioning

confidence: 99%

“…When arteries with stenosis >20% were visually perceived, an FFR pressure wire (Certus, St. Jude Medical, St. Paul, MN) was positioned distal to the stenosis of interest to determine vessel FFR using RadiAnalyzer (St. Jude Medical) under steady‐state hyperemia (intravenous adenosine: 140 μg/kg per minute for 3–6 minutes). FFR ≤0.80 was considered as an evidence‐based physiological threshold indicative of obstructive CAD in clinical practice to perform percutaneous coronary intervention 11, 12…”

Section: Methodsmentioning

confidence: 99%

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Specific Pharmacological Profile of A _2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease

Paganelli

Resseguier

Marlinge

et al. 2018

JAHA

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BackgroundThe rapid and reliable exclusion of myocardial revascularization is a major unmet clinical need in patients with suspected coronary artery disease (CAD) and non‐contributive electrocardiography and troponin. Non‐invasive tests have high rates of false positives and negatives, and there is no biomarker to assess myocardial ischemia. The presence of spare adenosine A2A receptors (A2 AR)—characterized by a high dissociation constant/half maximal effective concentration (KD/EC 50) ratio—expressed on peripheral blood mononuclear cells (PBMC) has been associated with ischemia during exercise stress testing in patients with CAD. In this work, we investigated the diagnostic accuracy of spare A2 AR versus fractional flow reserve (FFR) in patients with suspected CAD.Methods and ResultsSixty patients with suspected CAD, but non‐contributive electrocardiography and troponin, were consecutively enrolled in this prospective study. The binding (KD), functional response (cyclic adenosine monophosphate [cAMP] production; EC 50) on PBMC A2 AR were compared with FFR results. Patients were divided into 3 groups: 17 (group 1) with normal coronary angiography (n=13) or stenosis <20% (n=4); 21 with CAD and non‐significant FFR (group 2); and 22 with CAD and significant FFR (group 3). Median KD/EC 50 was 6‐fold higher in group 3 (4.20; interquartile range: 2.81–5.00) than group 2 (0.66; interquartile range: 0.47–1.25) and 7‐fold higher than group 1 (0.60; interquartile range: 0.30–0.66).ConclusionsIn patients with suspected CAD and non‐contributive electrocardiography and troponin, the absence of spare A2 AR on PBMC may help to rule out myocardial ischemia.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03218007.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Specific Pharmacological Profile of A _2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease

Paganelli

Resseguier

Marlinge

et al. 2018

JAHA

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“…We conservatively considered the upper limit of the small transition zone to limit the number of potentially ischemic lesions left untreated as in the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) study. 9,10,16 As defined by Poiseuille's law of fluid dynamics, pressure gradient is influenced by coronary blood flow and viscosity, minimum radius, and lesion length. In effect, the pressure gradient is inversely proportional to the fourth power of the lesion radius (r 4 ) and is proportional to lesion length.…”

Section: Discussionmentioning

confidence: 99%

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Iguchi

Hasegawa

Nishimura

et al. 2012

Clinical Cardiology

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Background: Myocardial fractional flow reserve (FFR) is useful in the evaluation of coronary lesion ischemia. However, the impact of lesion length on FFR has not been adequately assessed. Hypothesis: We hypothesized that lesion length would influence functional significance in intermediate coronary lesions. Methods: FFR measurements were assessed in 136 patients (163 lesions) with stable angina who had >40% stenotic coronary lesion by quantitative coronary angiography (QCA). One hundred sixty-three lesions were classified as intermediate (40%-70% stenosis; n=107; group I) or significant (≥70%; n=56; group S) by QCA. We assessed the relationships between lesion length, coronary stenosis, and FFR in these 163 lesions. Results: Regression analysis revealed an inverse correlation between the percentage of diameter stenosis (%DS) and FFR in group S (r = −0.83, P < 0.0001). In group I, no significant correlation was found between %DS and FFR (r = −0.06, P = 0.55), whereas lesion length was significantly inversely correlated with FFR (r = −0.79, P < 0.0001). Receiver operating characteristic curve analysis demonstrated that the best cutoff value for predicting an FFR value <0.80 was a lesion length >16.1 mm in group I (sensitivity, 86%; specificity, 94%). Conclusions: These study findings suggest that lesion length has a physiologically significant impact on intermediate-grade coronary lesions.

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“…Between April 2013 and July 2015, we recruited 42 patients (62±9 years) from routine coronary angiography waiting lists, in 2 distinct groups (Figure 1): Patients with obstructive coronary stenoses (n=32): defined by either a coronary artery stenosis >50% on quantitative coronary angiography15 or fractional flow reserve ≤0.8 16. These patients had typical anginal symptoms and multiple risk factors, or known obstructive coronary artery stenoses awaiting percutaneous coronary intervention.…”

Section: Methodsmentioning

confidence: 99%

Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease

Williams

Asrress

Lumley

et al. 2018

JAHA

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BackgroundCold air inhalation during exercise increases cardiac mortality, but the pathophysiology is unclear. During cold and exercise, dual‐sensor intracoronary wires measured coronary microvascular resistance (MVR) and blood flow velocity (CBF), and cardiac magnetic resonance measured subendocardial perfusion.Methods and ResultsForty‐two patients (62±9 years) undergoing cardiac catheterization, 32 with obstructive coronary stenoses and 10 without, performed either (1) 5 minutes of cold air inhalation (5°F) or (2) two 5‐minute supine‐cycling periods: 1 at room temperature and 1 during cold air inhalation (5°F) (randomized order). We compared rest and peak stress MVR, CBF, and subendocardial perfusion measurements. In patients with unobstructed coronary arteries (n=10), cold air inhalation at rest decreased MVR by 6% (P=0.41), increasing CBF by 20% (P<0.01). However, in patients with obstructive stenoses (n=10), cold air inhalation at rest increased MVR by 17% (P<0.01), reducing CBF by 3% (P=0.85). Consequently, in patients with obstructive stenoses undergoing the cardiac magnetic resonance protocol (n=10), cold air inhalation reduced subendocardial perfusion (P<0.05). Only patients with obstructive stenoses performed this protocol (n=12). Cycling at room temperature decreased MVR by 29% (P<0.001) and increased CBF by 61% (P<0.001). However, cold air inhalation during cycling blunted these adaptations in MVR (P=0.12) and CBF (P<0.05), an effect attributable to defective early diastolic CBF acceleration (P<0.05) and associated with greater ST‐segment depression (P<0.05).ConclusionsIn patients with obstructive coronary stenoses, cold air inhalation causes deleterious changes in MVR and CBF. These diminish or abolish the normal adaptations during exertion that ordinarily match myocardial blood supply to demand.

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Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention

Cited by 3,715 publications

References 37 publications

Specific Pharmacological Profile of A _2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease

Specific Pharmacological Profile of A _2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease

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Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention

Cited by 3,715 publications

References 37 publications

Specific Pharmacological Profile of A 2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease

Specific Pharmacological Profile of A 2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease

Impact of Lesion Length on Functional Significance in Intermediate Coronary Lesions

Deleterious Effects of Cold Air Inhalation on Coronary Physiological Indices in Patients With Obstructive Coronary Artery Disease

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Product

Resources

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Specific Pharmacological Profile of A _2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease

Specific Pharmacological Profile of A _2A Adenosine Receptor Predicts Reduced Fractional Flow Reserve in Patients With Suspected Coronary Artery Disease