scholarly journals P1751Integrated physiological assessment of increased coronary flow after elective percutaneous coronary intervention in patients with grey zone fractional flow reserve

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
T. Niida ◽  
T. Murai ◽  
T. Yonetsu ◽  
Y. Kanaji ◽  
E. Usui ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Coronary Intervention ◽  
Grey Zone ◽  
Fractional Flow ◽  
Elective Percutaneous Coronary Intervention ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Physiological Assessment

scholarly journals Percutaneous coronary intervention versus medical therapy in patients with angina and grey-zone fractional flow reserve values: a randomised clinical trial

Heart ◽  
2020 ◽  
Vol 106 (10) ◽  
pp. 758-764 ◽  
Author(s):  
Barry Hennigan ◽  
Colin Berry ◽  
Damien Collison ◽  
David Corcoran ◽  
Hany Eteiba ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Medical Therapy ◽  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Stress Perfusion ◽  
Grey Zone ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary

IntroductionThere is conflicting evidence regarding the benefits of percutaneous coronary intervention (PCI) in patients with grey zone fractional flow reserve (GZFFR artery) values (0.75–0.80). The prevalence of ischaemia is unknown. We wished to define the prevalence of ischaemia in GZFFR artery and assess whether PCI is superior to optimal medical therapy (OMT) for angina control.MethodsWe enrolled 104 patients with angina with 1:1 randomisation to PCI or OMT. The artery was interrogated with a Doppler flow/pressure wire. Patients underwent Magnetic Resonance Imaging (MRI) with follow-up at 3 and 12 months. The primary outcome was angina status at 3 months using the Seattle Angina Questionnaire (SAQ).Results104 patients (age 60±9 years), 79 (76%) males and 79 (76%) Left Anterior Descending (LAD) stenoses were randomised. Coronary physiology and SAQ were similar. Of 98 patients with stress perfusion MRI data, 17 (17%) had abnormal perfusion (≥2 segments with ≥25% ischaemia or ≥1 segment with ≥50% ischaemia) in the target GZFFR artery. Of 89 patients with invasive physiology data, 26 (28%) had coronary flow velocity reserve <2.0 in the target GZFFR artery. After 3 months of follow-up, compared with patients treated with OMT only, patients treated by PCI and OMT had greater improvements in SAQ angina frequency (21 (28) vs 10 (23); p=0.026) and quality of life (24 (26) vs 11 (24); p=0.008) though these differences were no longer significant at 12 months.ConclusionsNon-invasive evidence of major ischaemia is uncommon in patients with GZFFR artery. Compared with OMT alone, patients randomised to undergo PCI reported improved symptoms after 3 months but these differences were no longer significant after 12 months.Trial registration numberNCT02425969.

scholarly journals Improvement of Fractional Flow Reserve after Percutaneous Coronary Intervention Does Not Necessarily Indicate Increased Coronary Flow

2019 ◽  
Vol 14 (1) ◽  
pp. 10-12 ◽  
Author(s):  
Rikuta Hamaya ◽  
Yoshihisa Kanaji ◽  
Eisuke Usui ◽  
Masahiro Hoshino ◽  
Tadashi Murai ◽  
...  
Keyword(s):  
Blood Flow ◽  
Percutaneous Coronary Intervention ◽  
Coronary Blood Flow ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Coronary Intervention ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary ◽  
Microvascular Resistance

Coronary flow is expected to increase by epicardial lesion modification after successful percutaneous coronary intervention (PCI) in stable angina. According to the concept of fractional flow reserve (FFR), the improvement in FFR after PCI reflects the extent of coronary flow increase. However, this theory assumes that hyperaemic microvascular resistance does not change after PCI, which is being refuted in recent studies. The authors quantitated regional absolute coronary blood flow (ABF) before and after PCI using a thermodilution method and compared it with FFR in 28 patients with stable coronary artery disease who had undergone successful PCI. Although FFR indicated changes in ABF, with a mean difference of −5.5 ml/min, there was no significant relationship between individual changes in FFR and in ABF (R=0.27, p=0.16). The discrepancy was partly explained by changes in microvascular resistance following PCI. These results suggest that changes in FFR do not necessarily indicate an increase in absolute coronary blood flow following PCI in individual patients, although they could be correlated in a cohort level.

Fractional Flow Reserve: Does a Cut-off Value add Value?

2016 ◽  
Vol 11 (1) ◽  
pp. 17
Author(s):  
Shah R Mohdnazri ◽  
◽  
◽  
◽  
Thomas R Keeble ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Intervention ◽  
Grey Zone ◽  
Fractional Flow ◽  
Non Invasive ◽  
Invasive Test ◽  
Flow Reserve ◽  
A Value ◽  
Percutaneous Coronary ◽  
Value Add

Fractional flow reserve (FFR) has been shown to improve outcomes when used to guide percutaneous coronary intervention (PCI). There have been two proposed cut-off points for FFR. The first was derived by comparing FFR against a series of non-invasive tests, with a value of ≤0.75 shown to predict a positive ischaemia test. It was then shown in the DEFER study that a vessel FFR value of ≥0.75 was associated with safe deferral of PCI. During the validation phase, a ‘grey zone’ for FFR values of between 0.76 and 0.80 was demonstrated, where a positive non-invasive test may still occur, but sensitivity and specificity were sub-optimal. Clinical judgement was therefore advised for values in this range. The FAME studies then moved the FFR cut-off point to ≤0.80, with a view to predicting outcomes. The ≤0.80 cut-off point has been adopted into clinical practice guidelines, whereas the lower value of ≤0.75 is no longer widely used. Here, the authors discuss the data underpinning these cut-off values and the practical implications for their use when using FFR guidance in PCI.

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