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Variability of fractional flow reserve according to the methods of hyperemia induction
Author(s) -
Lim WooHyun,
Koo BonKwon,
Nam ChangWook,
Doh JoonHyung,
Park Jin Joo,
Yang HanMo,
Park Kyung Woo,
Kim HyoSoo,
Takashima Hiroaki,
Waseda Katsuhisa,
Amano Tetsuya,
Kato Daiki,
Kurita Akiyoshi,
Oi Maki,
Toyofuku Mamoru,
van Nunen Lokien,
Pijls Nico H.J.
Publication year - 2015
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25752
Subject(s) - fractional flow reserve , medicine , nicorandil , adenosine , regadenoson , cardiology , coronary artery disease , anesthesia , myocardial perfusion imaging , coronary angiography , myocardial infarction
Objectives We performed this study to evaluate the variability of fractional flow reserve (FFR) values which were measured from various methods of hyperemia induction. Background Concerns have been raised regarding the variability of FFR due to different routes for hyperemic agent administration and different hyperemic agents targeting different receptors to induce maximal hyperemia. Methods A total of 656 intermediate coronary lesions from 628 patients with coronary artery disease were analyzed. Among them, 238 lesions underwent FFR measurement with hyperemia induced by both intravenous (IV) and intracoronary (IC) adenosine administration, 318 by IV adenosine/adenosine triphosphate (ATP) and IC nicorandil injection, and 100 by IV adenosine and regadenoson infusion. Results Excellent correlation and close classification agreement (FFR ≤ 0.80) were observed between IV vs. IC adenosine ( r = 0.980, CA = 92.9%, Cohen's Kappa = 0.887, P < 0.001), between IV adenosine/ATP vs. IC nicorandil ( r = 0.962, CA = 91.2%, Cohen's Kappa = 0.817, P < 0.001), and between IV adenosine vs. regadenoson ( r = 0.990, CA = 100%, Cohen's Kappa = 1.000, P < 0.001). When changes in blood pressure (ΔBP) or heart rate (ΔHR) were compared with changes in FFR (ΔFFR) between IV adenosine/ATP and IC nicorandil administration, there were no significant correlations between ΔBP and ΔFFR nor between ΔHR and ΔFFR ( r = −0.122, P = 0.076; r = 0.036, P = 0.605, respectively). Conclusions This study suggests that the measurement of FFR is reproducible regardless of the hemodynamic changes, hyperemic agents used, or the route of administration. © 2014 Wiley Periodicals, Inc.