English Polski
Vol 19 (2024): Continuous Publishing
Original paper
Published online: 2023-12-20

open access

Page views 837
Article views/downloads 79
Get Citation

Connect on Social Media

Connect on Social Media

Usefulness of assessment of fractional flow reserve and coronary flow velocity reserve in determination of the significance of borderline stenoses in the anterior descending artery in patients with multivessel disease

Łukasz Jankowski1, Jan Zbigniew Peruga1, Karina Wierzbowska-Drabik2, Dawid Miśkowiec1, Marcin Ojrzanowski1, Błażej Michalski1, Jarosław Damian Kasprzak1, Michał Plewka3
DOI: 10.5603/fc.97001

Abstract

Introduction. Assessment of the significance of borderline stenosis in the area of the anterior descending artery in patients with multivessel coronary artery disease is a challenge. Currently, ractional flow reserve (FFR) and coronary flow reverse (CFR) methods are available. Aim. The aim of the study was to compare the usefulness of fractional flow reverse (FFR) and CFR methods in the assessment of left anterior descending artery (LAD) borderline stenosis in patients with multivessel coronary disease (MVD) and isolated LAD stenosis.

Material and methods. We examined 100 patients with suspected ischemic heart disease. The examination revealed MVD disease with borderline stenosis of the LAD in 23 patients. Significant changes were confirmed with FFR and CFR.

Results. Abnormal FFR (82% vs. 22%; p < 0.001) and abnormal CFR (32% vs. 12%; p = 0.029) were significantly more commonly observed in patients with MVD. The mean FFR (0.76 vs. 0.84; p < 0.001), the mean CFR (2.13 vs. 2.31; p = 0.075). Positive CFR and FFR values were found in 7 MVD patients and in 3 patients with single-vessel lesions (32% vs. 4%; p < 0.001). Negative CFR and positive FFR values were noted in 11 patients with MVD and 14 with lesions only in LAD (50% vs. 18%; p < 0.001). Positive CFR and negative FFR 0 vs 6 patients (0% vs. 8%; p < 0.001). Negative CFR and negative FFR were obtained in 4 patients from the MVD group and in 55 patients from the group of borderline stenosis only in LAD (18% vs. 71%; p < 0.001). MACE was observed significantly more frequently in the MVD group than in the group of patients with borderline lesions only in LAD (47% vs. 6%; p = 0.004).

Conclusions. Positive FFR and CFR results correlate with more frequent MACE episodes.

Article available in PDF format

View PDF Download PDF file

References

  1. Dzavik V, Ghali WA, Norris C, et al. Long-term survival in 11,661 patients with multivessel coronary artery disease in the era of stenting: a report from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. Am Heart J. 2001; 142(1): 119–126.
  2. Botman KJ, Pijls NHJ, Bech JW, et al. Percutaneous coronary intervention or bypass surgery in multivessel disease? A tailored approach based on coronary pressure measurement. Catheter Cardiovasc Interv. 2004; 63(2): 184–191.
  3. Zimarino M, Curzen N, Cicchitti V, et al. The adequacy of myocardial revascularization in patients with multivessel coronary artery disease. Int J Cardiol. 2013; 168(3): 1748–1757.
  4. Toth G, De Bruyne B, Casselman F, et al. Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery. Circulation. 2013; 128(13): 1405–1411.
  5. Pijls NHJ, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007; 49(21): 2105–2111.
  6. Pijls NHJ, Fearon WF, Tonino PAL, et al. FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol. 2010; 56(3): 177–184.
  7. De Bruyne B, Pijls NHJ, Kalesan B, et al. FAME 2 Trial Investigators. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012; 367(11): 991–1001.
  8. Head SJ, Kaul S, Mack MJ, et al. The rationale for Heart Team decision-making for patients with stable, complex coronary artery disease. Eur Heart J. 2013; 34(32): 2510–2518.
  9. De Bruyne B, Paulus WJ, Pijls NH. Rationale and application of coronary transstenotic pressure gradient measurements. Cathet Cardiovasc Diagn. 1994; 33(3): 250–261.
  10. De Luca G, Venegoni L, Iorio S, et al. Effects of increasing doses of intracoronary adenosine on the assessment of fractional flow reserve. JACC Cardiovasc Interv. 2011; 4(10): 1079–1084.
  11. Leone AM, Porto I, De Caterina AR, et al. Maximal hyperemia in the assessment of fractional flow reserve: intracoronary adenosine versus intracoronary sodium nitroprusside versus intravenous adenosine: the NASCI (Nitroprussiato versus Adenosina nelle Stenosi Coronariche Intermedie) study. JACC Cardiovasc Interv. 2012; 5(4): 402–408.
  12. Lopez-Palop R, Saura D, Pinar E, et al. Adequate intracoronary adenosine doses to achieve maximum hyperaemia in coronary functional studies by pressure derived fractional flow reserve: a dose response study. Heart. 2004; 90(1): 95–96.
  13. McGeoch RJ, Oldroyd KG. Pharmacological options for inducing maximal hyperaemia during studies of coronary physiology. Catheter Cardiovasc Interv. 2008; 71(2): 198–204.
  14. Meimoun P, Tribouilloy C. Non-invasive assessment of coronary flow and coronary flow reserve by transthoracic Doppler echocardiography: a magic tool for the real world. Eur J Echocardiogr. 2008; 9(4): 449–457.
  15. Dimitrow PP. Transthoracic Doppler echocardiography - noninvasive diagnostic window for coronary flow reserve assessment. Cardiovasc Ultrasound. 2003; 1: 4.
  16. Rigo F, Murer B, Ossena G, et al. Transthoracic echocardiographic imaging of coronary arteries: tips, traps, and pitfalls. Cardiovasc Ultrasound. 2008; 6: 7.
  17. Rigo F. Coronary flow reserve in stress-echo lab. From pathophysiologic toy to diagnostic tool. Cardiovasc Ultrasound. 2005; 3: 8.
  18. Nohtomi Y, Takeuchi M, Nagasawa K, et al. Simultaneous assessment of wall motion and coronary flow velocity in the left anterior descending coronary artery during dipyridamole stress echocardiography. J Am Soc Echocardiogr. 2003; 16(5): 457–463.
  19. Caiati C, Montaldo C, Zedda N, et al. New noninvasive method for coronary flow reserve assessment: contrast-enhanced transthoracic second harmonic echo Doppler. Circulation. 1999; 16(6): 771–778.
  20. Takeuchi M, Miyazaki C, Yoshitani H, et al. Which is the better method in detecting significant left anterior descending coronary artery stenosis during contrast-enhanced dobutamine stress echocardiography: coronary flow velocity reserve or wall-motion assessment? J Am Soc Echocardiogr. 2003; 16(6): 614–621.
  21. Matsumura Y, Hozumi T, Watanabe H, et al. Cut-off value of coronary flow velocity reserve by transthoracic Doppler echocardiography for diagnosis of significant left anterior descending artery stenosis in patients with coronary risk factors. Am J Cardiol. 2003; 92(12): 1389–1393.
  22. Meimoun P, Benali T, Sayah S, et al. Evaluation of left anterior descending coronary artery stenosis of intermediate severity using transthoracic coronary flow reserve and dobutamine stress echocardiography. J Am Soc Echocardiogr. 2005; 18(12): 1233–1240.
  23. Galderisi M, Cicala S, Caso P, et al. Coronary flow reserve and myocardial diastolic dysfunction in arterial hypertension. Am J Cardiol. 2002; 90(8): 860–864.