Variability of fractional flow reserve according to the methods of hyperemia induction.

Abstract

OBJECTIVES:

We performed this study to evaluate the variability of fractional flow reserve (FFR) values which were measured from various methods of hyperemia induction.

BACKGROUND:

Concerns have been raised regarding the variability of FFR due to different routes for hyperemic agent administration and different hyperemic agents targeting different receptors to induce maximal hyperemia.

METHODS:

A total of 656 intermediate coronary lesions from 628 patients with coronary artery disease were analyzed. Among them, 238 lesions underwent FFR measurement with hyperemia induced by both intravenous (IV) and intracoronary (IC) adenosine administration, 318 by IV adenosine/adenosine triphosphate (ATP) and IC nicorandil injection, and 100 by IV adenosine and regadenoson infusion.

RESULTS:

Excellent correlation and close classification agreement (FFR ≤ 0.80) were observed between IV vs. IC adenosine (r = 0.980, CA = 92.9%, Cohen's Kappa = 0.887, P < 0.001), between IV adenosine/ATP vs. IC nicorandil (r = 0.962, CA = 91.2%, Cohen's Kappa = 0.817, P < 0.001), and between IV adenosine vs. regadenoson (r = 0.990, CA = 100%, Cohen's Kappa = 1.000, P < 0.001). When changes in blood pressure (ΔBP) or heart rate (ΔHR) were compared with changes in FFR (ΔFFR) between IV adenosine/ATP and IC nicorandil administration, there were no significant correlations between ΔBP and ΔFFR nor between ΔHR and ΔFFR (r = -0.122, P = 0.076; r = 0.036, P = 0.605, respectively).

CONCLUSIONS:

This study suggests that the measurement of FFR is reproducible regardless of the hemodynamic changes, hyperemic agents used, or the route of administration.

• Authors: Woo-Hyun Lim, Bon-Kwon Koo, Chang-Wook Nam, Joon-Hyung Doh, Jin Joo Park, Han-Mo Yang, Kyung Woo Park, Hyo-Soo Kim, Hiroaki Takashima, Katsuhisa Waseda, Tetsuya Amano, Daiki Kato, Akiyoshi Kurita, Maki Oi, Mamoru Toyofuku, Lokien van Nunen, Nico H J Pijls
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 85 Issue 6 Pg. 970-6 (May 2015) ISSN: 1522-726X [Electronic] United States
• PMID: 25413590 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 Wiley Periodicals, Inc.

Chemical References

• Purines
• Pyrazoles
• Vasodilator Agents
• Nicorandil
• regadenoson
• Adenosine

Topics

• Adenosine (administration & dosage)
• Aged
• Coronary Artery Disease (diagnostic imaging, physiopathology)
• Coronary Circulation (physiology)
• Female
• Fractional Flow Reserve, Myocardial (physiology)
• Hemodynamics (physiology)
• Humans
• Hyperemia (chemically induced, physiopathology)
• Infusions, Intra-Arterial
• Infusions, Intravenous
• Male
• Middle Aged
• Nicorandil (administration & dosage)
• Purines (administration & dosage)
• Pyrazoles (administration & dosage)
• Radiography
• Reproducibility of Results
• Vasodilator Agents (administration & dosage)