Background
Adenosine induced hyperaemic fractional flow reserve (aFFR) is a validated predictor
of clinical outcome and part of routine interventional practice. Protocol issues associated
with the adenosine infusion limit the use of aFFR in clinical practice. Contrast medium
induced hyperaemic FFR (cFFR) is a simpler procedure from a practical standpoint.
We compared the two in a real world setting.
Methods
We analysed 76 patients that had both cFFR and aFFR assessment of 100 angiographically
indeterminate coronary stenosis. cFFR was performed with intracoronary contrast medium
injections (10 ml for left coronary lesions and 8 ml for right coronary lesions). The diagnostic performance of cFFR was analysed and
compared to the gold standard aFFR.
Results
Mean cFFR was 0.87 (±0.07) and mean aFFR was 0.84 (±0.08). Bland-Altman analysis revealed
a close agreement between cFFR and aFFR (0.035 ± 0.032; 95% CI: −0.028 to 0.098) and good linear correlation (r = 0.92, r2 = 0.86; p < 0.0001). Using cFFR cut-off values of ≤0.83 in predicting an aFFR value of ≤0.80 or
a cFFR value ≥0.88, predicting an aFFR value of >0.80 yielded a sensitivity of 100%,
specificity of 96.1%, positive predictive value of 92.3%, negative predictive value
of 100% and diagnostic accuracy of 96%. Only 24% of cFFR values were in the 0.84 to
0.87 range.
Conclusion
Contrast medium induced hyperaemic FFR as an initial assessment may limit the need
for adenosine to when cFFR falls in the 0.84 to 0.87 range. The use of adenosine infusion
potentially could have been avoided in the majority of patients in this study.
Abbreviations:
FFR (Fractional flow reserve), aFFR (Adenosine fractional flow reserve), cFFR (Contrast fractional flow reserve), ml (Millilitre), PCI (Percutaneous coronary intervention), ETT (Exercise treadmill test), DSE (Dobutamine stress echocardiography), MPI (Myocardial perfusion imaging), CTCA (Coronary artery computed tomography), QCA (Quantitative coronary angiography), IC (Intracoronary), IV (Intravenous), mcg (Micgrograms), kg (Kilogram), min (Minute), ROC (Receiver operating characteristic), CI (Confidence interval), AUC (Area under ROC curve), LAD (Left anterior descending artery), iFR (Instantaneous wave-free ratio), CABG (Coronary artery bypass surgery), MI (Myocardial infarction)Keywords
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Article info
Publication history
Published online: April 21, 2017
Accepted:
March 15,
2017
Received in revised form:
March 8,
2017
Received:
August 29,
2016
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
