Interindividual Variations in the Adenosine‐Induced Hemodynamics During Fractional Flow Reserve Evaluation: Implications for the Use of Quantitative Flow Ratio in Assessing Intermediate Coronary Stenoses

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Guus A. de Waard¹  Paul Knaapen¹  Niels van Royen¹  Bon‐Kwon Koo²  Joo Myung Lee³  Francesco María Lauri⁴  Antonio Fernández‐Ortiz⁴  Javier Escaned⁴  Nina W. van der Hoeven⁴  Hernán Mejía‐Rentería⁴  Angela McInerney⁴  Carlos Macaya⁴ 

[1] Department of Cardiology VU University Medical Center Amsterdam the Netherlands;Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea;Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea;Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Spain;

关键词: adenosine;    fluid dynamics;    fractional flow reserve;    quantitative flow ratio;    resistive reserve ratio;   

DOI  :  10.1161/JAHA.119.012906

来源: DOAJ

【 摘 要 】

Background Quantitative flow ratio (QFR), a novel functional angiography technique, computes fractional flow reserve (FFR) without pressure wires or adenosine. We investigated interindividual variations in the adenosine‐induced hemodynamics during FFR assessment and their influence on QFR diagnostic performance. Methods and Results Patients with coronary stenoses who underwent intracoronary pressure and flow assessment were analyzed. Adenosine‐induced hemodynamics during FFR measurement were determined by the percentage change in mean aortic pressure (%ΔPa) and the resistive reserve ratio (RRR). The diagnostic performance of QFR was evaluated and compared in each tertile of %ΔPa and RRR using FFR as reference. A total of 294 vessels (245 patients) were analyzed. Mean FFR was 0.80±0.11. Individuals showed a wide variation in the adenosine response in terms of %ΔPa (ranging from −75% to 43%; median, −9% [interquartile range, −3% to −17%]) and the RRR (ranging from 0.45 to 20.15; median, 3.1 [interquartile range, 2.1–4.9]). No significant differences for diagnostic efficiency of QFR were found between tertiles of %ΔPa (area under the curve for the receiver‐operating characteristic analysis, 0.950 in tertile 1, 0.929 in tertile 2, and 0.910 in tertile 3; P=0.270) or between tertiles of the RRR (area under the curve for the receiver‐operating characteristic analysis, 0.909 in tertile 1, 0.923 in tertile 2, and 0.959 in tertile 3; P=0.167). The classification agreement between QFR and FFR was not significantly modified by %ΔPa (tertile 1, 89%; tertile 2, 87%; and tertile 3, 86%; P=0.827) or by the RRR (tertile 1, 86%; tertile 2, 85%; and tertile 3, 91%; P=0.398). Conclusions Patients undergoing FFR assessment show large interindividual variations in the magnitude of adenosine‐induced hemodynamics. However, such variations do not affect the diagnostic performance of QFR in assessing the functional relevance of observed stenoses.

【 授权许可】

Unknown