Fractional Flow Reserve Method in Cardiac Catheterization Laboratory without Cardiosurgical Backup: Initial Experiences

Authors

  • Ivan Simic Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, Kragujevac
  • Vladimir Zdravkovic Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, Kragujevac
  • Rada Vucic Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, Kragujevac
  • Violeta Iric-Cupic Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, Kragujevac
  • Goran Davidovic Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovica 69, Kragujevac
  • Vladimir Ignjatovic Clinic for Cardiology, Clinical Center Kragujevac, Zmaj Jovina 30, Kragujevac
  • Dragic Bankovic Department of Mathematics and Informatics, Faculty of Science, University of Kragujevac, Radoja Domanovica 12, Kragujevac

DOI:

https://doi.org/10.3889/oamjms.2013.010

Keywords:

FFR, intermediate stenosis, PCI, cardiosurgical backup, QCA.

Abstract

Background: Coronary artery disease is the most common cause of death in a modern world. This dictates the development a network of Catheterization laboratories without cardiosurgical capabilities.

Aim: We postulate that the most valuable tool in the decision process on myocardial revascularization is fractional flow reserve (FFR), especially when we deal with borderline coronary lesions.

Material and Methods: A total of 72 patients with 94 intermediate coronary stenosis (30%-70% diameter reduction) were included in this study. We tested FFR and angiography based decision model on myocardial revascularization.

Results:  Mean FFR value on left anterior descending coronary artery (LAD) was lower than in others two arteries (p=0.017). FFR after percutaneous coronary intervention (PCI) was significantly better (p<0.0001). The decision for PCI predominates before FFR diagnostics, but after FFR the decision is quite opposite. There is a weak negative correlation between FFR and diameter of stenosis assessed by angiography (r= - 0.245 p=0.038) and positive correlation between diameter of stenosis assessed by angiography and by quantitative coronary angiography (QCA) (r=0.406 p<0.0005).

Conclusion:  Our results strongly suggest that FFR is necessary tool in centers without possibilities of heart team onsite consultation and that prevents numerous unnecessary PCI.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

De Bruyne B, Pijls NH, Paulus WJ, et al. Transstenotic coronary pressure gradient measurement in humans: in vitro and in vivo evaluation of a new pressure monitoring angioplasty guide wire. J Am Coll Cardiol. 1993; 22:119–26.

De Bruyne B, Bartunek J, Sys SU, et al. Simultaneous coronary pressure and flow velocity measurements in humans. Feasibility, reproducibility, and hemodynamic dependence of coronary flow velocity reserve, hyperemic flow versus pressure slope index, and fractional flow reserve. Circulation. 1996; 94:1842–49.

Pijls NH, Van Gelder B, Van der Voort P, et al. Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation. 1995; 92:3183- 93.

Pijls NH, De Bruyne B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996; 334:1703 -8.

Topol EJ, Ellis SG, Cosgrove DM, et al. Analysis of coronary angioplasty practice in the United States with an insurance-claims data base. Circulation. 1993;87:1489-97.

De Bruyne B, Bartunek J, Sys SU et al. Relation between myocardial fractional flow reserve calculated from coronary pressure measurements and exercise-induced myocardial ischemia. Circulation. 1995; 92:39-46.

Simic I, Zdravkovic V, Vucic R, et al. Fractional flow reserve in patients with intermediate values of Duke treadmill score and borderline coronary lesions. Arch Biol Sci. 2013;65:1285-92.

Fearon WF, Takagi A, Jeremias A, et al. Use of fractional myocardial flow reserve to assess the functional significance of intermediate coronary stenoses. Am J Cardiol. 2000; 86:1013-4.

Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49:2105–11.

Heyndrickx GR and Wijns W. Coronary flow reserve calculated from pressure measurements in humans. Validation with positron emission tomography. Circulation. 1994; 89:1013–22.

Pijls N, van Son J, Kirkeeide R, De Bruyne B and Gould K. Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation. 1993;87:1354–67.

Pijls NH, Klauss V, Siebert U, et al. Coronary pressure measurement after stenting predicts adverse events at follow-up. Circulation. 2002; 105:2950–4.

De Bruyne B, Hersbach F, Pijls NH, et al. Abnormal epicardial coronary resistance in patients with diffuse atherosclerosis but ‘‘normal’’ coronary angiography. Circulation. 2001;104:2401–6.

Carrick D, Behan M, Foo F, et al. Usefulness of fractional flow reserve to improve diagnostic efficiency in patients with non-ST elevation myocardial infarction. Am J Cardiol. 2013; 111:45-50.

Fearon WF, Yeung AC, Lee DP, Yock PG and Heidenreich PA. Cost-effectiveness of measuring fractional flow reserve to guide coronary interventions. Am Heart J. 2003;145:882-7.

Downloads

Published

2013-12-15

How to Cite

1.
Simic I, Zdravkovic V, Vucic R, Iric-Cupic V, Davidovic G, Ignjatovic V, Bankovic D. Fractional Flow Reserve Method in Cardiac Catheterization Laboratory without Cardiosurgical Backup: Initial Experiences. Open Access Maced J Med Sci [Internet]. 2013 Dec. 15 [cited 2021 Apr. 12];1(1):50-3. Available from: https://oamjms.eu/index.php/mjms/article/view/oamjms.2013.010

Issue

Section

B - Clinical Sciences

Most read articles by the same author(s)