scholarly journals Respiration‐related variations in Pd/Pa ratio and fractional flow reserve in resting conditions and during intravenous adenosine administration

2021 ◽  
Author(s):  
Rutger G. T. Feenstra ◽  
Martijn A. van Lavieren ◽  
Mauro Echavarria‐Pinto ◽  
Gilbert W. Wijntjens ◽  
Valerie E. Stegehuis ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Adenosine Administration

6114Indications, procedural parameters, complications and consequences of fractional flow reserve measurements in a multicenter cohort

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Troebs ◽  
M Marwan ◽  
L Gaede ◽  
J Feyrer ◽  
B Nazli ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Fractional Flow Reserve ◽  
Pressure Measurement ◽  
Patient Characteristics ◽  
Pressure Measurements ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Adenosine Administration ◽  
Vessel Dissection

Abstract Background Determination of the Fractional Flow Reserve (FFR) has become part of routine clinical practice. Contemporary clinical use, consequences as well as complications in consecutive, large cohorts have not been thoroughly investigated. We report the results of the prospective Fractional Flow Reserve Fax Registry F (FR2) conducted in Germany. Purpose To systematically analyze indications, procedural parameters, complications and consequences of intracoronary pressure measurements in a large contemporary cohort. Methods Data of 2000 consecutive patients undergoing clinically indicated FFR, iFR or pd/pa measurements in 8 interventional centres in Germany were prospectively collected in a systematic fashion. Data included basic patient characteristics, procedural aspects of intracoronary pressure measurements, associated complications, visual stenosis degree, measurement results and treatment decisions. Results Mean patient age was 68±11 years, 73% of patients were male. Of all patients, 300 patients (15%) had an acute coronary syndrome (STEMI: 9; NSTEMI: 94; unstable angina: 197) and 1002 patients (50%) had undergone previous revascularization. A mean of 1.7±0.9 measurements were performed per patient, for which an average of 1.02 pressure wires were required (more than 1 wire in 64 patients). For all 3373 interrogated lesions, median stenosis degree was 60%. Vasodilator-free measurements were performed in 415/3373 cases (12%, iFR: 346; pd/pa: 69). For vasodilation, i.v. adenosine was used in 396 cases (13%), i.c. adenosine in 2628 cases (87%), and other drugs in 10 cases (0.3%). Measurement was performed before potential revascularization in 3232 cases (96%) and during or following PCI in 141 cases. In 2958 lesions analyzed by FFR, mean FFR was 0.87, with 588 FFR measurements ≤0.80 (19.8%). Median FFR values were higher for i.c than i.v. adenosine administration (0.88 vs. 0.84), but not significantly different after adjustment for stenosis degree. In 735 cases (20.2%), intracoronary pressure measurement was followed by revascularization measures, while in 2637 cases (79.8%), no revascularization or no further revascularization was performed. In 36 out of 117 stenoses visually estimated to be ≥90%, revascularization was deferred following pressure measurement (31%). In 75 out of 2958 lesions analyzed by FFR, revascularization was performed even though FFR was >0.80 (3%). Severe complications (vessel dissection or occlusion) occurred in 5 out of 2000 patients as a consequence of intracoronary pressure measurement, resulting in death of 1 patient. Conclusion In clinical practice, the majority of intracoronary pressure measurements are performed in stenoses of intermediate angiographic severity and revascularization is deferred in approximately 80% of lesions. Vasodilator-free measurements are infrequent and route of adenosine administration has no effect on results. Complication rate is low but not negligible. Acknowledgement/Funding Abbott Vascular

scholarly journals Coronary Fractional Flow Reserve (FFR) measurement: which method of adenosine administration is the safest?

2017 ◽  
Vol 9 (1) ◽  
pp. 13-14
Author(s):  
M. Calcaianu ◽  
D. Bresson ◽  
Y. Doghmi ◽  
C. Vilbois ◽  
T. El Nazer ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Adenosine Administration

Retrospective comparison of Resting Full-cycle Ratio (RFR) and Fractional Flow Reserve (FFR) in a coronary artery disease cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Wienemann ◽  
V Mauri ◽  
S Baldus ◽  
M Halbach
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Fractional Flow Reserve ◽  
Funding Source ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Stenoses ◽  
Adenosine Administration ◽  
Artery Disease

Abstract Background The fractional flow reserve (FFR) is the gold standard for the assessment of the physiological severity of coronary artery disease. Measurement of FFR requires administration of a vasodilator (commonly adenosine) to achieve maximum hyperemia. The development of resting indices that do not require the administration of adenosine is of great importance. A novel hyperemia-free resting index is the “resting full cycle ratio” (RFR), which corresponds to the lowest pressure distal to the stenosis in relation to the aortic pressure during the entire cardiac cycle. The aim of the present study was to examine the diagnostic accuracy of RFR compared to FFR. Methods The study included consecutive patients undergoing pressure wire studies for standard indications at our university hospital from March 9, 2015 to February 15, 2019. Lesions with FFR ≤0.80 were classified as functionally significant. The RFR values were calculated retrospectively from the curves of the FFR measurements, using a point in time before adenosine administration, so that non-hyperemic resting conditions were present. Results A total of 635 patients with 733 coronary lesions were investigated using FFR. The average age of the subjects was 68.1±10.7 years. 459 (72.3%) were male. The distribution of the lesions was as follows: LAD: 444 (60.5%), RCA: 140 (19.1%), RCX: 127 (17.3%), RIM: 12 (1.6), LM: 6 (0.9%) and bypasses: 4 (0.5). Overall, the FFR and RFR values were 0.841±0.08 and 0.91±0.06. The RFR showed a significant correlation with the FFR (Table 1). Diagnostic accuracy of the RFR compared to the FFR was highest at a cut-off value of 0.89. This could be demonstrated using the receiver operating characteristic curve (Picture 1). In 408 measurements, coronary stenoses that were not hemodynamically relevant were found (FFR>0.8 and RFR>0.89). 164 measurements showed hemodynamically relevant coronary stenoses (FFR ≤0.8 and RFR ≤0.89). In 66 lesions, the FFR measurement showed hemodynamic relevance and the RFR measurement did not, whereas in 95 patients the RFR measurement showed hemodynamic relevance and the FFR values were normal. Conclusions The RFR as a new resting index has a significant correlation with the FFR after adenosine administration. In 22% of the measurements, a different therapeutic decision would have been made based on the RFR vs. the FFR. A randomized study should therefore investigate whether a RFR-guided approach is non-inferior to a FFR-guided approach in terms of avoiding cardiovascular complications. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott Laboratories

scholarly journals TCT-622 Respiration-Related Variations in Pd/Pa Ratio and Fractional Flow Reserve in Resting Conditions and During Intravenous Adenosine Administration

2019 ◽  
Vol 74 (13) ◽  
pp. B610
Author(s):  
Rutger Feenstra ◽  
Gilbert Wijntjens ◽  
Valérie Stegehuis ◽  
Patrick Serruys ◽  
Amir Lerman ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Adenosine Administration

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

2016 ◽  
Vol 11 (1) ◽  
pp. 17
Author(s):  
Shah R Mohdnazri ◽  
◽  
◽  
◽  
Thomas R Keeble ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Grey Zone ◽  
Fractional Flow ◽  
Non Invasive ◽  
Invasive Test ◽  
Flow Reserve ◽  
A Value ◽  
Percutaneous Coronary ◽  
Value Add

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a ‘grey zone’ for FFR values of between 0.76 and 0.80 was demonstrated, where a 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.

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