The validation of fractional flow reserve in patients with coronary multivessel disease: a comparison with SPECT and contrast-enhanced dobutamine stress echocardiography

Erhard, Isabelle; Rieber, Johannes; Jung, Philip; Hacker, Markus; Schiele, Thomas M.; Stempfle, Hans‐Ulrich; König, Andreas; Baylacher, Monika; Theisen, K.; Siebert, Uwe; Klauß, Volker

doi:10.1007/s00392-005-0213-6

Cited by 16 publications

(10 citation statements)

References 20 publications

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“…Abbreviations as in Figure 4. between SPECT and QCA data have been reported (47,48). The present data correlate favorably with a recent meta-analysis demonstrating a sensitivity of 89% and specificity of 65% when SPECT was compared with coronary angiography in detecting CAD (48).…”

Section: Figure 5 Sensitivity and Specificity Of Mpr To Detect Cad Wisupporting

confidence: 89%

Quantitative Magnetic Resonance Perfusion Imaging Detects Anatomic and Physiologic Coronary Artery Disease as Measured by Coronary Angiography and Fractional Flow Reserve

Costa

Shoemaker

Futamatsu

et al. 2007

Journal of the American College of Cardiology

141

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Section: Figure 5 Sensitivity and Specificity Of Mpr To Detect Cad Wisupporting

confidence: 89%

Quantitative Magnetic Resonance Perfusion Imaging Detects Anatomic and Physiologic Coronary Artery Disease as Measured by Coronary Angiography and Fractional Flow Reserve

Costa

Shoemaker

Futamatsu

et al. 2007

Journal of the American College of Cardiology

141

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“…Actually, this concordance between MPI SPECT and FFR results can be already expected and understood from the early validation studies on FFR itself that used MPI SPECT to assess the validity of FFR. In one study; I. Erhard, J. Rieber et al [14] SPECT MPI and dobutamine stress Echocardiography were used as reference tests to evaluate FFR and by performing ROC analysis, the best cut-off value (highest sum of sensitivity and specificity) was found at 0.75. At this cut-off value using both noninvasive tests as a reference method, sensitivity and specificity were 83% and 77%.…”

Section: Discussionmentioning

confidence: 99%

Myocardial perfusion imaging by single-photon emission tomography (MPI SPECT) versus Instantaneous wave-free ratio (IFR) for assessment of functional significance of intermediate coronary artery lesions

2019

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Background: The aim of our work was to compare the myocardial perfusion imaging by single-photon emission tomography (MPI-SPECT) as a non-invasive, relatively non-expensive test versus the instantaneous wave-free ratio (IFR) for the evaluation of functional significance of the borderline coronary artery lesions in the view of results of fractional flow reserve (FFR) which is considered the gold standard reference test. Results: Our study was conducted in the Cardiology Department. It included 50 patients with borderline coronary artery lesions; they underwent physiological evaluation by stress/rest myocardial perfusion imaging using followed by an invasive physiological assessment by Instantaneous wave-free ratio (IFR) and Fractional flow reserve (FFR). Finally, the results of both SPECT MPI and IFR were compared to FFR as a gold standard reference. There was a strong (kappa = 0.754) significant (P value < 0.001) agreement between the MPI results and FFR results and the overall agreement was 88%. The sensitivity of the MPI was 81.8%, the specificity was 92.9%, the positive predictive value was 90%, the negative predictive value was 86.7%, the positive likelihood ratio was 11.45, and the negative likelihood ratio was 0.20. There was a strong (kappa = 0.918) significant (P value < 0.001) agreement between the IFR results and FFR results and the overall agreement was 96%. The sensitivity of the IFR was 90.9%, the specificity was 100%, the positive predictive value was 100 %, the negative predictive value was 93.3%, and the negative likelihood ratio was 0.09. Conclusions: The instantaneous wave-free ratio (IFR) may be a valid alternative to fractional flow reserve to assess the functional significance of intermediate coronary lesions. The myocardial perfusion imaging may be an alternative, non-invasive, relatively non-expensive test for the evaluation of the physiological significance of intermediate coronary lesions.

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“…[17][18][19][20][21][22][23][24][25][26][27] Note that, as with all in vivo tests, variability was seen across the studies. One value for FFR did not consistently predict the same thing in different populations; nor did it consistently predict response again the same test.…”

Section: Ffr Cut-off Valuesmentioning

confidence: 99%

“…What appeared consistent across several studies, was that values between 0.76 and 0.80 showed sub-optimal specificity for predicting non-invasive test results and these values were, therefore, labelled as being in the 'grey zone', whereby clinician judgement would be required to decide whether a lesion was ischaemia-producing, based on the broader clinical picture. [17][18][19][20][21][22][23][24][25][26][27] Despite the obvious minor variability in the measurement and predictive performance of FFR in clinical studies, it is clear from these studies that using an FFR cut-off value of ≤0.75 has a good chance of identifying ischaemia in the vessel being examined.…”

Section: Ffr Cut-off Valuesmentioning

confidence: 99%

“…1,14,15,[17][18][19][20][21][22][23][24][25][26][27][34][35][36][37][38] The adenosine doses that had diagnostic ability to identify ischaemiaproducing lesions against non-invasive tests were 140 μg/kg/min and up to maximum of 40-60 μg for intravenous administration of adenosine and intracoronary adenosine, respectively (see Table 1). …”

Section: Routes and Doses Of Adenosine Administrationmentioning

confidence: 99%

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Fractional Flow Reserve: Does a Cut-off Value add Value?

Mohdnazri

Sharp

2016

Interventional Cardiology Review

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CoronaryFractional flow reserve (FFR) is an index used to describe the physiological significance of a coronary stenosis. It measures the pressure drop under conditions of maximal hyperaemia between the aorta and a selected vessel location distal to an angiographic lesion. 1 Several FFR studies have identified patient groups in whom coronary stenting is associated with improved outcomes when compared with medical therapy (and vice versa). FFR-guided treatment prevents unnecessary stenting and therefore coronary physiology has been associated with improved outcomes at reduced cost, a rare combination in a new technology.2-7 Coronary physiological assessment is now an integral part of the modern catheterisation laboratory, with a level 1A recommendation by the European Society of Cardiology (ESC) for use in stable patients in whom evidence of ischaemia is not already available. Ischaemic Heart Disease and Coronary RevascularisationAngina is the clinical manifestation of myocardial ischaemia in patients with stable coronary artery disease (CAD). It is caused by transient imbalance between blood supply and metabolic demand. The myocardial ischemia that causes angina is, however, not simply a question of a 'blocked pipe'; rather, ischaemia is a result of complex pathophysiological mechanisms that include obstructive epicardial CAD, inflammation, microvascular coronary dysfunction, endothelial dysfunction, thrombosis and angiogenesis (see Figure 1). 10Obstructive epicardial CAD is only one of the factors that contributes to myocardial ischaemia and yet, in the treatment of ischaemic heart disease (IHD), great (some would say overwhelming) emphasis is given to identifying and eliminating obstructive epicardial CAD over other potential causes of ischaemia, some of which may have key therapeutic roles in treating patients with IHD. The reason for this emphasis is obvious -obstructive epicardial CAD is easily identified, easily understood and relatively easily treated by angiography and stenting or bypass grafting. Doing so, however, does not always relieve ischaemia. Concept and Validation of Fractional Flow ReserveWhen FFR is used to identify a potentially ischaemia-causing lesion, the aim is to identify deficient blood flow distal to a coronary lesion.However, unlike coronary pressure, measurement of coronary blood flow in the catheter laboratory is not technically straightforward. positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI. KeywordsCoronary physiology, fractional flow reserve, pressure wire Disclosure: SRM and TRK have received rese...

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The validation of fractional flow reserve in patients with coronary multivessel disease: a comparison with SPECT and contrast-enhanced dobutamine stress echocardiography

Abstract: In patients with multivessel disease, a FFR <0.75 identifies a hemodynamically relevant lesion as compared to DSE and SPECT. This study underlines that FFR criteria are also applicable in patients with complex coronary artery disease.

Cited by 16 publications

References 20 publications

Quantitative Magnetic Resonance Perfusion Imaging Detects Anatomic and Physiologic Coronary Artery Disease as Measured by Coronary Angiography and Fractional Flow Reserve

Quantitative Magnetic Resonance Perfusion Imaging Detects Anatomic and Physiologic Coronary Artery Disease as Measured by Coronary Angiography and Fractional Flow Reserve

Myocardial perfusion imaging by single-photon emission tomography (MPI SPECT) versus Instantaneous wave-free ratio (IFR) for assessment of functional significance of intermediate coronary artery lesions

Fractional Flow Reserve: Does a Cut-off Value add Value?

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