In:
Circulation: Cardiovascular Interventions, Ovid Technologies (Wolters Kluwer Health), Vol. 12, No. 2 ( 2019-02)
Abstract:
Fractional flow reserve (FFR) is commonly used to assess the functional significance of coronary artery disease but is theoretically limited in evaluating individual stenoses in serially diseased vessels. We sought to characterize the accuracy of assessing individual stenoses in serial disease using invasive FFR pullback and the noninvasive equivalent, fractional flow reserve by computed tomography (FFR CT ). We subsequently describe and test the accuracy of a novel noninvasive FFR CT -derived percutaneous coronary intervention (PCI) planning tool (FFR CT-P ) in predicting the true significance of individual stenoses. Methods and Results: Patients with angiographic serial coronary artery disease scheduled for PCI were enrolled and underwent prospective coronary CT angiography with conventional FFR CT -derived post hoc for each vessel and stenosis (FFR CT ). Before PCI, the invasive hyperemic pressure-wire pullback was performed to derive the apparent FFR contribution of each stenosis (FFR pullback ). The true FFR attributable to individual lesions (FFR true ) was then measured following PCI of one of the lesions. The predictive accuracy of FFR pullback , FFR CT , and the novel technique (FFR CT-P ) was then assessed against FFR true . From the 24 patients undergoing the protocol, 19 vessels had post hoc FFR CT and FFR CT-P calculation. When assessing the distal effect of all lesions, FFR CT correlated moderately well with invasive FFR ( R =0.71; P 〈 0.001). For lesion-specific assessment, there was significant underestimation of FFR true using FFR pullback (mean discrepancy, 0.06±0.05; P 〈 0.001, representing a 42% error) and conventional trans-lesional FFR CT (0.05±0.06; P 〈 0.001, 37% error). Using FFR CT-P , stenosis underestimation was significantly reduced to a 7% error (0.01±0.05; P 〈 0.001). Conclusions: FFR pullback and conventional FFR CT significantly underestimate true stenosis contribution in serial coronary artery disease. A novel noninvasive FFR CT -based PCI planner tool more accurately predicts the true FFR contribution of each stenosis in serial coronary artery disease.
Type of Medium:
Online Resource
ISSN:
1941-7640
,
1941-7632
DOI:
10.1161/CIRCINTERVENTIONS.118.007577
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2019
detail.hit.zdb_id:
2450801-9
