scholarly journals Safety and efficacy of a hyperaemic agent, intracoronary nicorandil 4mg, for invasive physiological assessments during fractional flow reserve measurement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Nishikura ◽  
K Wakabayashi ◽  
N Aizawa ◽  
T Suzuki ◽  
K Shibata ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Artery Stenosis ◽  
Wilcoxon Test ◽  
Funding Source ◽  
Cyclic Change ◽  
Reliable Index ◽  
Chest Discomfort ◽  
Fractional Flow ◽  
Safety And Efficacy ◽  
Flow Reserve

Abstract Background Fractional flow reserve (FFR) is one of most reliable index for the determining the functional severity coronary artery stenosis. Adenosine is the most commonly used agent for maximal hyperaemia. However, adenosine can cause chest discomfort, bronchial hyper-reactivity, and atrioventricular block. The aim of this study is to evaluate the safety and efficacy of intracoronary nicorandil as an alternative hyperaemic agent for FFR. Methods and results We enrolled consecutive 82 patients (87 lesions) who underwent FFR measurement in our center from Nov. 2018. We compared three groups; intravenous infusion of adenosine (150 μg/kg/min); and adenosine added intracoronary nicorandil 2mg; and intracoronary nicorandil 4mg. Mean FFR value was 0.83±0.09, 0.82±0.09, 0.82±0.08, There was a strong correlation among three groups (R2>0.9). Mean cyclic change in FFR was 0.026±0.023, 0.019±0.010, 0.016±0.014, respectively, cyclic change was smallest in intracoronary nicorandil 4mg group (vs ATP; p<0.001, vs ATP + nicorandil 2mg; p<0.001). By Wilcoxon test, mean FFR value of nicorandil 4mg was significant lower than ATP (p=0.0021), and equal to ATP + nicorandil 2mg (p=0.98). Conclusions Intracoronary nicorandil 4mg is a simple, safe, and effective way to induce steady-state hyperaemia for FFR. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Correlations between fractional flow reserve and a novel non-hyperemic index: resting full-cycle ratio in patients with an ambiguous coronary artery stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Szolc ◽  
L Niewiara ◽  
B Guzik ◽  
G Horszczaruk ◽  
J Podolec ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Coronary Artery Stenosis ◽  
Invasive Coronary Angiography ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
Artery Stenosis ◽  
Funding Source ◽  
Fractional Flow ◽  
Flow Reserve

Abstract Background Fractional flow reserve (FFR) measurement has been the gold standard for invasive assessment of coronary ischemia. Resting full cycle ratio (RFR) is a new non-hyperemic index used to define physiologic significance of coronary artery stenosis. However, there are limited data available to establish optimal cut-off value of RFR for decision making on revascularization. Aim The aim of our study was to assess optimal cut-off value of RFR at which to predict FFR of 0.8. Methods The RFR and FFR values were recorded during invasive coronary angiography in vessels with angiographic stenosis 40–70% according to visual assessment. Maximum hyperemia for FFR measurement was achieved with adenosine iv. infusion at 140 μg/kg/min. Left main disease, acute myocardial infarction and systolic left ventricular dysfunction (EF <40%) were the main exclusion criteria. Results We evaluated 332 vessels, including 189 (56.9%) left anterior descending arteries, 77 (23.2%) left circumflex arteries and 66 (19.9%) right coronary arteries. Median diameter stenosis as assed by QCA was 45% (IQR 40; 50). Median RFR and FFR values were 0.90 [IQR 0.85; 0.94] and 0.86 [IQR 0.81; 0.92] respectively, with significant correlation (p<0.001, Figure 1, panel A). Optimal cut-off value for RFR to detect FFR 0.80 was 0.90 with area under the curve of 90.3%, sensitivity of 81.4% and specificity 88.0% (Figure 1, panel B). Conclusions Our data confirm RFR cut-off value ≤0.90 as an optimal threshold to detect ischemic lesions with good sensitivity and specificity in comparison to FFR assessment. Further research is necessary to assess outcomes of RFR-guided revascularization strategy. Figure 1. RFR–FFR correlation and ROC analysis Funding Acknowledgement Type of funding source: Other. Main funding source(s): Jagiellonian University statutory grant

Fractional flow reserve and instantaneous wave-free ratio discordance in patients with severe aortic valve stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Yamanaka ◽  
K Shishido ◽  
S Yokota ◽  
N Moriyama ◽  
Y Mashimo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Fractional Flow Reserve ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Aortic Valve Area ◽  
Fractional Flow ◽  
Left Anterior Descending Artery ◽  
Flow Reserve

Abstract Background It has been reported that discordance between fractional flow reserve (FFR) and Instantaneous Wave-Free Ratio (iFR) could occur in up to 20% of cases. However, there are no reports regarding discordance between FFR and iFR in patients with severe aortic valve stenosis (AS). Purpose We aimed to investigate the discordance between FFR and iFR in patients with severe AS. Methods Severe AS was defined as an aortic-valve area of ≤1.0 cm2, a mean aortic-valve gradient of 40mmHg or more, or a peak aortic-jet velocity of 4.0 m/s or more. Intermediate coronary artery stenosis was defined as 30% to 70% stenosis (visual estimation). FFR and iFR were calculated in 4 quadrants based on values of FFR ≤0.8 and iFR ≤0.89 (positive discordance; low FFR and high iFR, negative discordance; high FFR and low iFR). Results We examined consecutive 140 patients (164 intermediate coronary artery stenosis vessels). Mean FFR and iFR ± standard deviation was 0.82±0.09 and 0.82±0.14, respectively. The discordance was observed in 48 vessels (29.3%). In the discordant group, most of cases were negative discordance (45 cases, 93.6%). Binary logistic regression analysis showed that left anterior descending artery (Hazard Ratio 3.80; 1.55 to 9.31, p=0.0036) was independently associated with negative discordance. Conclusions In patients with severe AS, the discordance between FFR and iFR could be observed in 29.3% of the vessels, mostly negative discordance. The left anterior descending artery is an independent predictor for negative discordance. Funding Acknowledgement Type of funding source: None

Influence of caffeine intake on intravenous adenosine-induced fractional flow reserve

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Ishibuchi ◽  
K Fujii ◽  
S Otsuji ◽  
S Takiuchi ◽  
K Hasegawa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Adenosine Triphosphate ◽  
Fractional Flow Reserve ◽  
Japanese Patients ◽  
Caffeine Intake ◽  
Time Interval ◽  
Funding Source ◽  
Reference Standard ◽  
Fractional Flow ◽  
Flow Reserve

Abstract Background This study evaluated whether caffeine abstention is required before fractional flow reserve (FFR) measurement by intravenous adenosine triphosphate (ATP) administration in Japanese patients. Methods and results This study was a subanalysis of a previously published study and a total of 208 intermediate lesions that underwent FFR measurements were enrolled for this analysis. Hyperemia was induced by continuous intravenous ATP infusion at 150μg/kg/min (IVATP150) and 210μg/kg/min (IVATP210), and by intracoronary administration of nicorandil 2mg (ICNIC2mg) as a reference standard. The degree of change in the FFR value both after IVATP150 and after IVATP210, as compared with the FFR value after ICNIC2mg was similar between the caffeine and non-caffeine groups (−0.04±0.05 vs. −0.04±0.07, and 0.00±0.02 vs. 0.01±0.02, respectively). In patients who consumed caffeine before the FFR measurement, the degree of FFR change was independent of the time interval (<12 hours, 12–24 hours, and 24–48 hours) between caffeine intake and catheterization both after IVATP150 and ICNIC2mg and after IVATP210 and ICNIC2mg. Conclusion When compared with the FFR value after ICNIC2mg, the degree of change in the FFR value both after IVATP150 and after IVATP210 remained similar regardless of caffeine intake. Strict caffeine abstention before intravenous ATP-induced FFR measurement may not be required in clinical practice. Funding Acknowledgement Type of funding source: None

Correlation between fractional flow reserve and intravascular ultrasound lumen area in intermediate coronary artery stenosis

2011 ◽  
Vol 7 (2) ◽  
pp. 225-233 ◽  
Author(s):  
Itsik Ben-Dor ◽  
Rebecca Torguson ◽  
Michael A. Gaglia ◽  
Manuel A. Gonzalez ◽  
Gabriel Maluenda ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Intravascular Ultrasound ◽  
Fractional Flow Reserve ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Lumen Area ◽  
Fractional Flow ◽  
Flow Reserve
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