Document Detail


Fractional Flow Reserve Assessment of Left Main Stenosis in the Presence of Downstream Coronary Stenoses.
MedLine Citation:
PMID:  23549643     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: SEVERAL STUDIES HAVE SHOWN THAT FRACTIONAL FLOW RESERVE (FFR) MEASUREMENT CAN AID IN THE ASSESSMENT OF LEFT MAIN CORONARY STENOSIS. HOWEVER, THE IMPACT OF DOWNSTREAM EPICARDIAL STENOSIS ON LEFT MAIN FFR ASSESSMENT WITH THE PRESSURE WIRE IN THE NONSTENOSED DOWNSTREAM VESSEL REMAINS UNKNOWN.METHODS AND RESULTS: VARIABLE STENOSES WERE CREATED IN THE LEFT MAIN CORONARY ARTERIES AND DOWNSTREAM EPICARDIAL VESSELS IN 6 ANAESTHETIZED MALE SHEEP USING BALLOON CATHETERS. A TOTAL OF 220 PAIRS OF FFR ASSESSMENTS OF THE LEFT MAIN STENOSIS WERE OBTAINED, BEFORE AND AFTER CREATION OF A STENOSIS IN A DOWNSTREAM EPICARDIAL VESSEL, BY HAVING A PRESSURE-SENSOR WIRE IN THE OTHER NONSTENOSED DOWNSTREAM VESSEL. THE APPARENT LEFT MAIN FFR IN THE PRESENCE OF DOWNSTREAM STENOSIS (FFRAPP) WAS SIGNIFICANTLY HIGHER COMPARED WITH THE TRUE FFR IN THE ABSENCE OF DOWNSTREAM STENOSIS (FFRTRUE; 0.800.05 VERSUS 0.760.05; ESTIMATE OF THE MEAN DIFFERENCE, 0.035; P0.001). THE DIFFERENCE BETWEEN FFRTRUE AND FFRAPP CORRELATED WITH COMPOSITE FFR OF THE LEFT MAIN PLUS STENOSED ARTERY (R=0.31; P0.001) INDICATING THAT THIS DIFFERENCE WAS GREATER WITH INCREASING EPICARDIAL STENOSIS SEVERITY. AMONG MEASUREMENTS WITH FFRAPP 0.80, 9% WERE ASSOCIATED WITH AN FFRTRUE OF 0.75. IN ALL INSTANCES, THE EPICARDIAL LESION WAS IN THE PROXIMAL PORTION OF THE STENOSED VESSEL, AND THE EPICARDIAL FFR (COMBINED FFR OF THE LEFT MAIN AND DOWNSTREAM STENOSED VESSEL) WAS 0.50.CONCLUSIONS: A clinically relevant effect on the FFR assessment of left main disease with the pressure wire in a nonstenosed downstream vessel occurs only when the stenosis in the other vessel is proximal and very severe.
Authors:
Andy S C Yong; David Daniels; Bernard De Bruyne; Hyun-Sook Kim; Fumiaki Ikeno; Jennifer Lyons; Nico H J Pijls; William F Fearon
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-4-2
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  -     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-4-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA.
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