Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion

Stegehuis, Valérie E.; Wijntjens, Gilbert; Piek, Jan J.; Hoef, Tim P. van de

doi:10.1007/s11886-018-1017-4

Cited by 20 publications

(11 citation statements)

References 66 publications

(70 reference statements)

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“…This can only be accounted for by direct regional assessment of myocardial ischaemia as with icECG. In a broader sense and in the context of coronary blood flow as the source for the myocardium, 4 icECG reflects the adequacy of regional myocardial perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…IcECG in combination with coronary pressure-derived indices allow comprehensive assessment of myocardial perfusion and thus, also an appraisal of the regional extent of atherosclerotic disease. Taken into account the results of the FAME-II-trial, where 80% of patients with abnormal FFR values did not experience cardiac events throughout the 2-year follow-up period, 4 25 an optimal functional assessment should be preferred.…”

Section: Discussionmentioning

confidence: 99%

“…Given temporary paralysis of the coronary microcirculation, pressure is, theoretically, directly related to coronary flow. 4 Thus, the pressure drop across a coronary stenosis, that is, fractional flow reserve (FFR 5 ), respectively, instantaneous wave-free ratio (iFR 6 7 ) provides an estimate of its restrictive effect on flow. However and despite their prognostic value derived from large randomised clinical trials, both FFR and iFR rely on the, so far, untested concept of their being stenosis-specific, 5 and not stenosis-plus microcirculatory-specific, the fact of which limits their usefulness in defining a true ischaemic threshold.…”

Section: Introductionmentioning

confidence: 99%

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Functional assessment of myocardial ischaemia by intracoronary ECG

et al. 2021

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IntroductionIn patients with chronic coronary syndrome, percutaneous coronary intervention targets haemodynamically significant stenoses, that is, those thought to cause ischaemia. Intracoronary ECG (icECG) detects ischaemia directly where it occurs. Thus, the goal of this study was to test the accuracy of icECG during pharmacological inotropic stress to determine functional coronary lesion severity in comparison to the structural parameter of quantitative angiographic per cent diameter stenosis (%S), as well as to the haemodynamic indices of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).MethodThe primary study endpoint of this prospective trial was the maximal change in icECG ST-segment shift during pharmacological inotropic stress induced by dobutamine plus atropine obtained within 1 min after reaching maximal heart rate(=220 - age). IcECG was acquired by attaching an alligator clamp to the angioplasty guidewire positioned downstream of the stenosis. For the pressure-derived stenosis severity ratios, coronary perfusion pressure and simultaneous aortic pressure were continuously recorded.ResultsThere was a direct linear relation between icECG ST-segment shift and %S: icECG=−0.8+0.03*%S (r2=0.164; p<0.0001). There were inverse linear correlations between FFR and %S: FFR=1.1–6.1*10–3*%S (r2=0.494; p<0.0001), and between iFR and %S: iFR=1.27–8.6*10–3*%S (r2=0.461; p<0.0001). Using a %S-threshold of ≥50% as the reference for structural stenosis relevance, receiver operating characteristics-analysis of absolute icECG ST-segment shift during hyperemia showed an area under the curve (AUC) of 0.678±0.054 (p=0.002; sensitivity=85%, specificity=50% at 0.34 mV). AUC for FFR was 0.854±0.037 (p<0.0001; sensitivity=64%, specificity=96% at 0.78), and for iFR it was 0.816±0.043 (p<0.0001;sensitivity=62%, specificity=96% at 0.83).ConclusionsHyperaemic icECG ST-segment shift detects structurally relevant coronary stenotic lesions with high sensitivity, while they are identified highly specific by FFR and iFR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional assessment of myocardial ischaemia by intracoronary ECG

et al. 2021

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“…Myocardial infarction is induced by cardiac coronary vascular and branch occlusion, resulting in nutrient and oxygen insufficiency (21,22). As a result, the ischemic myocardium dies and is replaced by fibrotic scar tissue (23).…”

Section: Discussionmentioning

confidence: 99%

p27kip1 haploinsufficiency preserves myocardial function in the early stages of myocardial infarction via Atg5‑mediated autophagy flux restoration

et al. 2019

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Myocardial infarction (MI) is a leading cause of mortality in adults worldwide. Over the last two decades, gene therapy has been a hot topic in cardiology, and there has been a focus on cell cycle inhibitors and their protective effects on the myocardium post-MI. In our previous study, the haploinsufficiency of p27kip1 (p27) was demonstrated to improve cardiac function in mice post-MI by promoting angiogenesis and myocardium protection through the secretion of growth factors. Autophagy is an adaptive response of cells to environmental changes, such as nutrient deprivation, ischemia and hypoxia. The appropriate regulation of autophagy may improve myocardial function by preventing apoptosis of cardiomyocytes. In this study, we used immunoassays, transmission electron microscopy and cardiac ultrasound to confirm that p27 haploinsufficiency prevents myocardial apoptosis by restoring autophagy protein 5-mediated autophagy flux in the early stages of MI. The present study provides a novel method for studying MI or ischemic heart disease therapy.

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“…Coronary flow reserve (CFR) is a direct measure of coronary blood flow, and has been validated in a number of nonrandomised studies. 22 CFR is calculated as the ratio of coronary blood during maximal vasodilation divided by coronary blood flow during resting conditions, and can be measured using a thermodilution technique or assessment of Doppler flow velocity. Since coronary flow is more clinically relevant than perfusion pressure in the context of stenotic disease, CFR is a technique of great potential.…”

Section: Coronary Flow Reserve and Absolute Coronary Blood Flowmentioning

confidence: 99%

Assessment of coronary physiology – the evidence and implications

2019

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Use of angiography for the assessment of coronary lesions is limited by its inability to provide information regarding the functional significance of stenoses. A number of studies have demonstrated the presence of ischaemia to be the most important determinant of the benefit associated with coronary revascularisation in stable coronary artery disease. Assessment of intra-coronary physiology can guide percutaneous coronary intervention, and is often used for angiographically borderline stenoses. There is now increasing evidence to suggest that more routine use can improve clinical outcomes. Fractional flow reserve (FFR) is the most established measure of intra-coronary physiology, but is currently underutilised. The main drawback of FFR is the dependence on a pharmacological infusion to maintain hyperaemia. An alternative technique which measures flow at a specific point in the cardiac cycle (instantaneous wave-free ratio) has been developed which obviates the need for hyperaemia and may replace FFR as the default measure.

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Fractional Flow Reserve or Coronary Flow Reserve for the Assessment of Myocardial Perfusion

Cited by 20 publications

References 66 publications

Functional assessment of myocardial ischaemia by intracoronary ECG

Functional assessment of myocardial ischaemia by intracoronary ECG

p27kip1 haploinsufficiency preserves myocardial function in the early stages of myocardial infarction via Atg5‑mediated autophagy flux restoration

Assessment of coronary physiology – the evidence and implications

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