Myocardial Fractional Flow Reserve Measurement Using Contrast Media as a First-Line Assessment of Coronary Lesions in Current Practice

Spagnoli, Vincent; Amabile, Nicolas; Dillinger, Jean Guillaume; Veugeois, Aurélie; Logeart, Damien; Henry, Patrick; Caussin, Christophe; Slama, Michel

doi:10.1016/j.cjca.2015.09.009

Cited by 16 publications

(19 citation statements)

References 24 publications

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“…In the RINASCI study, a substantial correlation ( r = 0.98) and good agreement (mean bias: 0.02, 95% CI: –0.03 to 0.07) were determined in the measurements of 102 intermediate lesions between FFR and the CMR [16]. Similarly, in the study by Spagnoli et al a substantial correlation was determined ( r = 0.90) [17]. The same was confirmed in our study.…”

Section: Discussionsupporting

confidence: 88%

Efficacy of coronary fractional flow reserve using contrast medium compared to adenosine

Topçu

Tanboğa

Aksakal

et al. 2016

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IntroductionCoronary fractional flow reserve (FFR) is recommended as the gold standard method in evaluating intermediate coronary stenoses. However, there are significant debates concerning the agents and the timing of the measurement.AimTo compare the contrast medium induced Pd/Pa ratio (CMR) with the FFR.Material and methodsWe enrolled 28 consecutive patients with 34 intermediate lesions who underwent coronary FFR measurement by intracoronary (i.c.) adenosine. After baseline Pd/Pa was calculated, a single contrast medium (Iomeron) injection of 6 ml (3 ml/s) was performed manually. Within 10 s after the contrast medium injection, the CMR was calculated. Bolus injection of i.c. adenosine was performed to induce maximal hyperemia (from 60 µg to 600 µg), and when it was ≤ 0.80, the intermediate lesion was considered as significant.ResultsAfter bolus i.c. adenosine, 12 lesions of 34 (35.3%) were identified as significant. The CMR value was 0.86 ±0.06 (range: 0.71–0.97). There were no significant differences between FFR and CMR values (p = 0.108). A substantial positive correlation between adenosine and contrast values was detected (0.886 and p < 0.001). Good agreement in Bland-Altman analysis was revealed (mean bias was 0.027, 95% confidence interval 0.038–0.092). Receiver operating characteristics curve analysis showed 90.9% sensitivity and 91.7% specificity for a cut-off value of 0.85 for the CMR compared to FFR (≤ 0.80).ConclusionsOur study showed that measuring the CMR is a feasible method compared to FFR. The CMR may be used in situations where adenosine cannot be administered.

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Section: Discussionsupporting

confidence: 88%

Efficacy of coronary fractional flow reserve using contrast medium compared to adenosine

Topçu

Tanboğa

Aksakal

et al. 2016

pwki

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“…Spagnoli et al reported that the mean recovery time from hyperemia with nonionic iso-osmolar contrast iodixanol (Visipaque 270 mg/mL) 10 mg was 12.6±0.95 seconds (14). Performing FFR measurement with contrast-induced coronary hyperemia is therefore not considered to be suitable for the functional assessment of tandem lesions using the pull-back method.…”

Section: Discussionmentioning

confidence: 99%

“…Several investigators have reported the relationship between conventional FFR and contrast-induced FFR (14-16). Kanaji et al found that the value of standard FFR was 0.03 higher than by contrast-induced FFR, and the optimal cut-off value for FFR ≤0.80 calculated from the ROC curve analysis was 0.76.…”

Section: Discussionmentioning

confidence: 99%

Contrast-induced Hyperemia as an Alternative to Drug-induced Hyperemia in the Evaluation of the Fractional Flow Reserve in Coronary Lesions

et al. 2017

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Objective Measuring the fractional flow reserve (FFR) requires the induction of coronary hyperemia, usually with adenosine, adenosine triphosphate (ATP), or papaverine. However, adenosine can induce rhythmic complications, and intracoronary boluses of papaverine that prolong the QT interval can cause ventricular tachycardia. Injection of contrast media, which is routinely performed to validate the FFR guidewire placement, also induces hyperemia and may be an alternative method of measuring the FFR. We evaluated the diagnostic accuracy of the FFR after contrast hyperemia (FFRcont) compared to FFR evaluated after intracoronary papaverine (FFRpp). Methods This study included 109 lesions in 93 patients (mean age 70.4±8.7 years) with stable coronary disease. The FFR was measured as follows: 1) baseline pressure value; 2) FFRcont after intracoronary contrast injection (iopamidol, 8 mL for left coronary artery [LCA] or 6 mL for right coronary artery [RCA]); 3) FFRpp after intracoronary injection of papaverine (12 mg for LCA or 8 mg for RCA). Results FFRcont values were strongly correlated with FFRpp (R=0.940, p<0.0001; FFRpp = FFRcont ×1.007-0.032). The best cut-off point in the receiver operator curve analysis for predicting a FFRpp <0.80 was 0.82 (area under the curve =0.980; sensitivity 95.1%, specificity 91.2%, positive predictive value 86.7%, negative predictive value 96.9%). Conclusion FFRcont is highly accurate for predicting FFRpp. An FFRcont threshold value of 0.82 provides excellent sensitivity and a negative predictive value. FFRcont is an alternative method of inducing hyperemia.

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“…Saline solution decreases coronary resistances and increases vasodilatation (11,12). Contrast media, on the other hand has already been evaluated as a hyperemic agent in FFR (14)(15)(16)(17). In one multicenter study, adjudicated by a central core laboratory, contrast mediated FFR compared favorably to adenosine mediated FFR and was superior to iFR for predicting CAS severity (15).…”

Section: Discussionmentioning

confidence: 99%

“…In order to facilitate FFR adoption, two different approaches have been proposed: intra coronary adenosine administration (13), and more recently introduction of contrast medium as an alternative hyperemic agent. Contrast medium induced FFR, studies have shown a good correlation between contrast induced Pd/Pa and adenosine mediated FFR (14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 99%

Simplifying the assessment of coronary artery stenosis by enhancing instantaneous wave free ratio

Spagnoli

Picard

Tadros

et al. 2018

Cardiovasc. Diagn. Ther.

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Background: Instantaneous wave free ratio (iFR) does not require adenosine, but has a relatively wide intermediate range where functional assessment remains inconclusive. In this pilot study, we sought to enhance iFR through with the use of intracoronary (IC) saline (iFRs) and contrast media (iFRc) and determine whether these techniques correlated well with fractional flow reserve (FFR). Conclusions: When iFR is in the intermediate zone, functional assessment of CAS by iFR is enhanced with the use of contrast media but not saline. This pilot study could be hypothesis generating for further study to enhance iFR specificity and sensibility.

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Myocardial Fractional Flow Reserve Measurement Using Contrast Media as a First-Line Assessment of Coronary Lesions in Current Practice

Cited by 16 publications

References 24 publications

Efficacy of coronary fractional flow reserve using contrast medium compared to adenosine

Efficacy of coronary fractional flow reserve using contrast medium compared to adenosine

Contrast-induced Hyperemia as an Alternative to Drug-induced Hyperemia in the Evaluation of the Fractional Flow Reserve in Coronary Lesions

Simplifying the assessment of coronary artery stenosis by enhancing instantaneous wave free ratio

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