Comparison of resting and adenosine-free pressure indices with adenosine-induced hyperemic fractional flow reserve in intermediate coronary lesions.

Authors:
Deep Chandh Raja
Deep Chandh Raja
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Vijayakumar Subban
Vijayakumar Subban
Institute of Cardiovascular Diseases
India
Rony Mathew
Rony Mathew
Lisie Hospital
Kochi | India
Jabir Abdullakutty
Jabir Abdullakutty
Lisie Hospital
Ernakulam | India
Jimmy George
Jimmy George
Canadian Institutes of Health Research Team in Aboriginal Antidiabetic Medicines
Canada
Subash Chandra
Subash Chandra
Manipal Hospital
Jaipur | India
Nandhini Livingston
Nandhini Livingston
Department of Cardiology

Indian Heart J 2019 Jan - Feb;71(1):74-79. Epub 2018 Dec 10.

Department of Cardiology, Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, Tamilnadu, India. Electronic address:

Objective: Fractional flow reserve (FFR) using adenosine has been the gold standard in the functional assessment of intermediate coronary stenoses in the catheterization laboratory. We aim to study the correlation of adenosine-free indices such as whole cycle Pd/Pa [the ratio of mean distal coronary pressure (Pd) to the mean pressure observed in the aorta (Pa)], instantaneous wave-free ratio (iFR), and contrast-induced submaximal hyperemia (cFFR) with FFR.

Methods: This multicenter, prospective, observational study included patients with stable angina or acute coronary syndrome (>48 h since onset) with discrete intermediate coronary lesions (40-70% diameter stenosis). All patients underwent assessment of whole cycle Pd/Pa, iFR, cFFR, and FFR. We then evaluated the correlation of these indices with FFR and assessed the diagnostic efficiencies of them against FFR ≤0.80.

Results: Of the 103 patients from three different centers, 83 lesions were included for analysis. The correlation coefficient (r value) of whole cycle Pd/Pa, iFR, and cFFR in relation to FFR were +0.84, +0.77, and +0.70 (all p values < 0.001), respectively, and the c-statistic against FFR ≤0.80 were 0.92 (0.86-0.98), 0.89(0.81-0.97), and 0.91 (0.85-0.97) (all p values < 0.001), respectively. The best cut-off values identified by receiver-operator characteristic curve for whole cycle Pd/Pa, iFR, and cFFR were 0.94, 0.90, and 0.88, respectively, for an FFR ≤0.80. By the concept of "adenosine-free zone" (iFR = 0.86-0.93), 59% lesions in this study would not require adenosine.

Conclusion: All the three adenosine-free indices had good correlation with FFR. There is no difference in the diagnostic accuracies among the indices in functional evaluation of discrete intermediate coronary stenoses. However, further validation is needed before adoption of adenosine-free pressure parameters into clinical practice.

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Source
http://dx.doi.org/10.1016/j.ihj.2018.11.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477165PMC
December 2018
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