Fractional flow reserve in below the knee arteries with critical limb ischemia and validation against gold-standard morphologic, functional measures and long term clinical outcomes

Autor: Balázs Nemes, Kálmán Hüttl, Gabor G. Toth, Béla Merkely, Szilárd Róna, Zoltán Ruzsa, Olivier F. Bertrand, Péter Sótonyi
Rok vydání: 2018
Předmět:
Male
Time Factors
Vasodilator Agents
medicine.medical_treatment
Blood Pressure
Fractional flow reserve
030204 cardiovascular system & hematology
Severity of Illness Index
0302 clinical medicine
Ischemia
Papaverine
Laser-Doppler Flowmetry
Prospective Studies
030212 general & internal medicine
Ultrasonography
Doppler
Duplex
Angiography
Drug-Eluting Stents
General Medicine
Laser Doppler velocimetry
Treatment Outcome
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Critical Illness
Hyperemia
Proof of Concept Study
Peripheral Arterial Disease
03 medical and health sciences
Predictive Value of Tests
Internal medicine
Angioplasty
medicine
Humans
Aged
Leg
business.industry
Arterial stenosis
Quantitative angiography
Gold standard
Reproducibility of Results
Blood Pressure Determination
Critical limb ischemia
medicine.disease
Diabetic foot
Surgery
Regional Blood Flow
Feasibility Studies
business
Angioplasty
Balloon
Zdroj: Cardiovascular Revascularization Medicine. 19:175-181
ISSN: 1553-8389
Popis: The aim of this study was to assess the applicability of fractional flow reserve measurement (FFR) in below-the-knee (BTK) arteries and to evaluate its correlation with non-invasive functional parameters before and after angioplasty.We enrolled 39 patients with severe BTK arterial lesions. Inclusion criteria were critical limb ischemia (Rutherford 4-6) and angiographically proven arterial stenosis of the distal lower limb (percent diameter stenosis ≥70%). Exclusion criteria were chronic total occlusion, diabetic foot syndrome and non-viable distal lower limb. The transstenotic distal/proximal pressure ratio was measured under resting (Pd/Pa) and hyperemic (FFR) conditions induced by 40mg intra-arterial Papaverin and was compared with quantitative angiography-, laser Doppler- and duplex ultrasound-derived measurements before and after percutaneous angioplasty (PTA).Comparing measurements before and after PTA, we found significant improvements in the resting Pd/Pa values (0.79 [0.67-0.90] vs 0.90 [0.85-0.97]; p0.001) and FFR values (0.60±0.19 vs 0.76±0.15; p0.001), respectively. At baseline, Pd/Pa ratio and FFR were significantly albeit weakly correlated with % area stenosis (r:-0.31, p=0.05 and r:-0.31, p=0.05, respectively). After PTA, neither Pd/Pa nor FFR remained correlated with % area stenosis. Similarly, prior PTA, Pd/Pa ratio and FFR were significantly correlated with TcO2% and perfusion unit change (r:0.48, p0.01 and r:0.34, p0.05, respectively), but after intervention, these significant correlations vanished. Pd/Pa and FFR values did not show correlation with duplex ultrasound-derived measurements. At 1year, major adverse events (MAEs) and major adverse cardiovascular and cerebrovascular (MACCEs) were observed in 7 (17.9%) and in 9 (23.1%) patients, respectively.CLI due to severe BTK arterial disease was associated with several impediments of baseline pressure measurements which were significantly improved after successful PTA and stenting. Significant relationships between pressure data and functional and imaging parameters existed prior intervention but vanished after. Further studies are required to determine the clinical value of pre- and post-PTA pressure measurements in BTK arterial disease.
Databáze: OpenAIRE
Externí odkaz: