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Correlation of Fractional Flow Reserve with non-invasive tests for the detection of ischaemia due to intermediate coronary artery stenosis

Objectives

To compare ischaemia assessment by Fractional flow reserve (FFR) with non-invasive testing in patients with intermediate coronary artery stenosis.

Background

FFR was initially validated against SPECT, Dobutamine Stress Echo and Exercise Testing [1]. It is now frequently used to determine the management of intermediate coronary artery stenosis. A cut-off value of 0.75 is used in clinical practice to guide revascularisation supported by long-term outcome data [2], but a ‘grey zone’ of 0.75-0.8 with uncertain clinical significance exists [3]. Advances in non-invasive imaging tests (gated SPECT and CMR) warrant a re-evaluation of FFR at intermediate stenosis severity against non-invasive imaging.

Methods

Patients due for investigation of presumed cardiac chest pain were recruited and underwent SPECT (Discovery, GE Healthcare), perfusion-CMR (1.5T, Intera, Phillips) and coronary angiography. Any vessel that was angiographically determined as intermediate severity (40-70%) was assessed by QCA and pressure wire-derived FFR (RADI medical systems, Uppsala, Sweden).

Results

In 23 study patients (age 57±8, 78% male), 33 FFR measurements were performed (LAD 64%, Cx 18%, RCA 12%, LMS 6%). FFR was classified negative (>0.80) in n=20. Perfusion-CMR detected ischaemia in 3 vessels (2 with positive FFR and one with 'grey' FFR). SPECT also detected ischaemia in 3 vessels (2 negative FFR and one positive FFR), (Table 1). Coronary stenosis by QCA and FFR correlated poorly (r= -0.35, p=0.054) . Chi-squared analysis of FFR severity found no significant association between FFR positivity and perfusion-CMR (p=0.078) or SPECT (p=0.34).

Table 1 Cross tabulation of Fractional Flow Research grading (negative ≥0.8, grey 0.75-0.79 and positive <0.75) and the qualitative result of (A) Perfusion cardiac magnetic resonance (CMR) and (B) SPECT.

Conclusion

Non-invasive imaging does not correlate well with FFR measurements in intermediate coronary lesions. Perfusion-CMR whilst not significantly discriminating between the groups had no false negatives and may thus be the more useful additional test to determine the significance of ‘grey’ lesions on FFR.

References

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Correspondence to Timothy A Fairbairn.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Fairbairn, T.A., Mather, A., Greenwood, J. et al. Correlation of Fractional Flow Reserve with non-invasive tests for the detection of ischaemia due to intermediate coronary artery stenosis. J Cardiovasc Magn Reson 13, P85 (2011). https://doi.org/10.1186/1532-429X-13-S1-P85

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Keywords

  • Dobutamine
  • Fractional Flow Reserve
  • Coronary Stenosis
  • Dobutamine Stress
  • Grey Zone