Relation between wall thickening on gated perfusion SPECT and functional recovery after coronary revascularization in patients with previous myocardial infarction

Background: Fractional flow reserve (FFR) may provide clinically useful diagnostic information both in patients (pts) with normal left ventricular (LV) function as well as in pts with previous myocardial infarction (MI). However, the question remains to the relation between improvement of FFR and improvement of LV function in pts with previous MI undergoing percutaneous coronary intervention (PCI). Aim: The aim of the study was to evaluate the relation between FFR and simultaneously evaluated coronary flow reserve by thermodilution (CFRthermo), with functional improvement of LV function in pts with previous MI undergoing PCI. Methods: Study population consisted of 50 pts (mean age 53±8 years; 40 male) with previous MI and significant coronary stenosis in one-vessel CAD (33 LAD, 4 Cx, 13 RCA) undergoing PCI of infarct-related coronary artery. In all pts we have evaluated by single pressure/thermo wire FFR and CFRthermo before and immediately after PCI. In all pts, we have evaluated LV ejection fraction by echo and wall motion score index (WMSI) before and 3 months after PCI. Results: Coronary lesions were successfully treated in all pts with decrease of diameter stenosis from 63±7% to 18±9% (p<0.001). FFR increased significantly (p<0.001) from 0.62±0.15 to 0.91±0.06 after PCI, whereas CFRthermo increased significantly (p<0.01) from 1.5±0.3 to 2.5±0.7. LV ejection fraction increased from 49±6% to 55±8% (p<0.0001), and WMSI decreased from 1.44±0.24 to 1.29±0.29 (p<0.0001). LV functional improvement was observed in 33/50 (66%) of pts. In pts with LV functional recovery in comparison to pts with no recovery there was significant difference in FFR before PCI (0.57±0.15 vs. 0.71±0.11, p=0.001), improvement of FFR during PCI (0.34±0.15 vs. 0.21±0.13, p=0.004), improvement of CFRthermo during PCI (1.2±0.6 vs. 0.6±0.5, p=0.001) and CFRthermo after PCI (2.7±0.7 vs. 2.1±0.6, p=0.008), respectively. Conclusion: Evaluation of FFR and CFRthermo provide significant prognostic information on LV functional recovery in pts with previous MI undergoing PCI. Lower FFR before PCI, higher CFRthermo after PCI, as well as higher improvement of FFR and CFRthermo during PCI are indicative of left ventricular functional improvement in pts with previous MI.

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Abstract 3334: Comparison of Medical Treatment and Coronary Revascularization in Patients with Moderate Coronary Lesions and Borderline Fractional Flow Reserve Measurements

Circulation ◽

10.1161/circ.116.suppl_16.ii_751-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Javier Courtis ◽

Olivier F Bertrand ◽

Eric Larose ◽

Can M Nguyen ◽

Jean-Pierre Déry ◽

...

Keyword(s):

Myocardial Infarction ◽

Medical Treatment ◽

Fractional Flow Reserve ◽

Coronary Revascularization ◽

Previous Myocardial Infarction ◽

Cardiac Events ◽

Fractional Flow ◽

Flow Reserve ◽

Coronary Lesions

Background. There is little information available regarding deferral of revascularization in cases of fractional flow reserve (FFR) measurements in the borderline range (between 0.75 to 0.80). The objectives of this study were to evaluate the clinical outcomes of patients with moderate coronary lesions and FFR measurements between 0.75 and 0.80, comparing those who underwent coronary revascularization (CR) to those who had medical treatment (MT), and to determine the predictive factors of major adverse cardiac events (MACE) at follow-up. Methods. A total of 107 consecutive patients (mean age 62 ± 10 years) with at least one moderate coronary lesion (mean percent diameter stenosis 47 ± 12%) evaluated by coronary pressure wire with FFR measurement between 0.75 and 0.80 (mean 0.77 ± 0.02) were included in the study. Maximal hyperemia was obtained by intracoronary administration of adenosine (mean dose 215 ± 84 μg). MACE (coronary revascularization, myocardial infarction, cardiac death) and the presence of angina were evaluated at follow-up. Results. A total of 63 patients (59%) underwent CR and 44 patients (41%) had MT, with no clinical differences between groups. At a mean follow-up of 13 ± 7 months, MACE related to the coronary lesion evaluated by FFR were higher in the MT group compared to CR group (23% vs 5%, difference 18%, 95% CI 5%–30%, p=0.005). FFR measurement in an artery supplying a territory with previous myocardial infarction was the only predictive factor of MACE in the MT group (odds ratio 14.1, 95% CI 1.3–39, p=0.03). The presence of angina at follow-up was more frequent in the MT group compared to the CR group (41% vs 9%, difference 32%, 95% CI 11%–49%, p<0.001). Conclusions. In patients with moderate coronary lesions and FFR measurements in the “grey zone” range deferral of revascularization was associated with a higher rate of cardiac events and a higher prevalence of angina at follow-up, especially in those with previous myocardial infarction in the territory evaluated by FFR. These results suggest that a FFR cut-off point of 0.80 rather than 0.75 might be more appropriate for deferring coronary revascularization in these cases.

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