The validation of fractional flow reserve in patients with coronary multivessel disease: a comparison with SPECT and contrast-enhanced dobutamine stress echocardiography
| Autor: | Thomas M. Schiele, Monika Baylacher, Volker Klauss, Hans-Ulrich Stempfle, Andreas König, Uwe Siebert, Karl Theisen, M. Hacker, Johannes Rieber, Philip Jung, Isabelle Erhard |
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| Rok vydání: | 2005 |
| Předmět: |
Male
Target lesion Chest Pain medicine.medical_specialty Cost effectiveness Myocardial Ischemia Contrast Media Hemodynamics Blood Pressure Coronary Artery Disease Fractional flow reserve Coronary Angiography Sensitivity and Specificity Coronary artery disease Lesion Reference Values Albumins Coronary Circulation Internal medicine medicine Humans Prospective Studies Prospective cohort study Aged Tomography Emission-Computed Single-Photon Fluorocarbons business.industry Coronary Stenosis Middle Aged Image Enhancement Prognosis medicine.disease Myocardial Contraction Cardiology Female Dobutamine medicine.symptom Cardiology and Cardiovascular Medicine business Echocardiography Stress medicine.drug |
| Zdroj: | Zeitschrift für Kardiologie. 94:321-327 |
| ISSN: | 1435-1285 0300-5860 |
| DOI: | 10.1007/s00392-005-0213-6 |
| Popis: | Fractional flow reserve (FFR) is a new but well established parameter for the hemodynamic evaluation of coronary stenoses. A FFR below 0.75 was validated as functionally significant in coronary one or two vessel disease. This study was designed to prospectively define the best FFR cut off value (BCV) in patients with multivessel disease using two noninvasive tests, myocardial perfusion scintigraphy (SPECT) and contrast-enhanced dobutamine stress echocardiography (DSE) as reference methods.47 symptomatic patients (29 male, mean age 64+/-10 yrs) with angiographically intermediate coronary lesions (50-75% diameter stenosis) entered the study. DSE (5-40 microg/min/kg dobutamine) was performed after intravenous injection of a second generation transpulmonary contrast agent. SPECT (Tc-99m-MIBI) was done at peak stress. All tests (DSE, SPECT and FFR) were performed within 4 weeks.SPECT yielded positive results in 15 and DSE in 16 patients, respectively. Mean FFR measured in the target lesion (RCA n=10; LAD n=22, RCX n=15) was 0.80+/-0.13. FFR was0.75 in 15 patients. By performing a ROC analysis the BCV (highest sum of sensitivity and specificity) was found at 0.75. At this cut off value using both non-invasive tests as reference method, sensitivity and specificity were 83 and 77%.In patients with multivessel disease, a FFR0.75 identifies a hemodynamically relevant lesion as compared to DSE and SPECT. This study underlines that FFR criteria are also applicable in patients with complex coronary artery disease. |
| Databáze: | OpenAIRE |
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