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  • Open Access

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

  • 1,
  • 1,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance201113 (Suppl 1) :P85

https://doi.org/10.1186/1532-429X-13-S1-P85

  • Published:

Keywords

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

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.

A

 

CMR

 

Total

  

Non ischaemic

Ischaemic

 

FFR

Negative

20

0

20

 

Grey

7

2

9

 

Positive

3

1

4

Total

 

30

3

33

B

 

SPECT

  
  

Non ischaemic

Ischaemic

Total

FFR

Negative

18

2

20

 

Grey

9

0

9

 

Positive

3

1

4

Total

 

30

3

33

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.

Authors’ Affiliations

(1)
University of Leeds, Leeds, UK

References

  1. Pijls NH: N Engl J Med. 1996, 334 (26): 1703-8. 10.1056/NEJM199606273342604.View ArticlePubMedGoogle Scholar
  2. Tonino PA: N Engl J Med. 2009, 360 (3): 213-24. 10.1056/NEJMoa0807611.View ArticlePubMedGoogle Scholar
  3. De Bruyne B: Heart. 2008, 94 (7): 949-59. 10.1136/hrt.2007.122838.View ArticlePubMedGoogle Scholar

Copyright

© Fairbairn et al; licensee BioMed Central Ltd. 2011

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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