Comparison between fractional flow reserve and visual assessment for moderate coronary artery stenosis

Abstract

A b s t r a c tBackground: Fractional flow reserve (FFR) is an interventional diagnostic method, based on intracoronary pressure measurement, used for the assessment of the severity of coronary artery stenoses. Aim:Our study aimed to compare visual measurements made by multiple observers with FFR measurement in the assessment of angiographically moderate coronary artery stenosis. Methods:The angiographic images of moderate coronary artery lesions of 359 patients enrolled in the study were interpreted independently by three interventional cardiologists assigned as observers (O1, O2, O3). Results:In FFR, 37.9% were haemodynamically significant, while 62.1% were insignificant. 40.3% of the lesions were considered severe by O1, 39.9% by O2, and 44.4% by O3. When we compare the FFR results to the observers' decisions about lesion severity, the serious lesion percentages of all three observers were different both from each other and from the FFR result, at a statistically significant level (respectively, p < 0.001, p < 0.001). The kappa analysis performed to check the agreement between the observers' decisions and FFR revealed significant difference between FFR results and the decisions made by all observers (p < 0.001). The kappa agreement analysis performed by matching observers' decisions in pairs revealed a good agreement between O1 and O2 and a moderate agreement between O2 and O3 as well as O1 and O3, although there was still a significant disagreement between all pairs of observers (p < 0.001). Conclusions:Visual assessment, even when performed by experienced interventional cardiologists, does not yield similar results with FFR procedure in the process of determination of the functional importance of moderately severe coronary artery stenoses.

Impact of fractional flow reserve on decision-making in daily clinical practice: A single center experience in Egypt

“…Similarly, in a study conducted by Bilge et al 21 to determine whether results similar to FFR can be obtained with visual assessment conducted with 3 observers independent from each other, interestingly, there was statistically significant differences exist between the individual results of observers and the FFR result.…”

Fractional flow reserve and visual assessment for moderate coronary artery stenosis

“…We read with great interest the article written by Duran Karaduman et al, titled "Comparison between fractional flow reserve and visual assessment for moderate coronary artery stenosis", published in a recent issue of Kardiologia Polska [1]. The authors can be congratulated for their results, succeeding in demonstrating that in angiographically moderate coronary artery lesions, functional assessment using fractional flow reserve (FFR) is superior to visual estimation of stenosis severity.…”

“…A French registry confirmed that FFR led to treatment reclassification in 43% of patients, with similar MACE rates at one year in 464 reclassified patients as in 611 non-reclassified ones (MACE, 11.2% vs. 11.9%, log-rank p = 0.78) [4]. Therefore, in our opinion, in the study of Duran Karaduman et al [1] it would be interesting to present and discuss the influence of FFR in guiding the therapeutic decision in patients with multivessel disease presenting one or more moderate coronary lesions, and to show if use of FFR in moderate lesions led to any change in the revascularisation strategy or to any reclassification of lesion severity in these cases.Another issue that was only partially addressed in the manuscript, in our opinion, refers to the location of the lesions. The index coronary artery was the left anterior descending artery (LAD) in 68.7% of the cases.…”

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We read with great interest the article written by Duran Karaduman et al, titled "Comparison between fractional flow reserve and visual assessment for moderate coronary artery stenosis", published in a recent issue of Kardiologia Polska [1]. The authors can be congratulated for their results, succeeding in demonstrating that in angiographically moderate coronary artery lesions, functional assessment using fractional flow reserve (FFR) is superior to visual estimation of stenosis severity.

The recent FFR-based trials indicate the superiority of physiological assessment over the anatomical one for guiding the therapy of coronary artery stenosis, and this study brings new and relevant insights into the field of functional assessment of coronary lesions [2].

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Fractional flow reserve measurements and long-term mortality—results from the FLORIDA study

“…While early benefits of FFR guidance were observed in patients undergoing conservative management, a trend towards long-term benefits of FFR guidance was also observed in patients undergoing coronary revascularization with numerical mortality differences emerging after 1 year. Since previous studies demonstrated overor underestimation of coronary lesions using angiographic guidance (30,31), FFR guidance allowed improved identification of stenotic coronary lesions with or without functional significance (3). Therefore, early benefits of FFR-based deferral of revascularization observed in our study might be attributed to a reduction of unnecessary revascularization compared to isolated angiographic guidance (6) thus potentially reducing the early risk of bleeding and stent-related complications.…”