Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve

Abstract

BackgroundFunctional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used.ObjectiveTo evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction.MethodsRetrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies.ResultsAll 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed.ConclusionCoronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.

To Defer or Not Defer? The Challenges of Physiology in Acute Coronary Syndromes

“… 4 However, numerous reasons make the translation of the DEFER trial to contemporary clinical practice outdated: i) the excessively restrictive 0.75 cutoff (as used in the study) has been supplanted by the more permissive 0.80 threshold, ii) balloon angioplasty as a stand-alone therapy has been largely replaced by drug-eluting stents, iii) more potent antiplatelet agents and other medical therapies have become available, and iv) the relation between FFR and the obstructive profile of coronary lesion is yet being questioned by some authors. 5 Thus, the contemporary safety of deferring lesions in stable angina pectoris (SAP) and acute coronary syndrome (ACS) on the basis of FFR still deserves investigation.…”