Document Detail


Importance of diffuse atherosclerosis in the functional evaluation of coronary stenosis in the proximal-mid segment of a coronary artery by myocardial fractional flow reserve measurements.
MedLine Citation:
PMID:  21624549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objective of this study was to evaluate the impact of diffuse coronary atherosclerosis on the functional evaluation of moderate coronary lesions in the proximal-mid segment of a coronary artery and its clinical implications. This was a prospective study including 100 consecutive patients with a moderate lesion (45 ± 9% diameter stenosis) in the proximal-mid coronary segment who were evaluated with fractional flow reserve (FFR) measurement. No patient had any other angiographic stenosis distal to the evaluated coronary stenosis. FFR measurements were obtained just distal (~2 to 3 cm) to the lesion (FFR proximal measurement [FFR-PM]) and as distally as possible in the artery (FFR distal measurement [FFR-DM]) after administration of the same dose of intracoronary adenosine. Thirty-nine patients underwent dipyridamole or exercise myocardial single-photon emission computed tomography within 3 months of the FFR study. Mean FFR-PM was significantly higher compared to FFR-DM (0.84 ± 0.08 vs 0.78 ± 0.09, median gradient 0.06, 25th to 75th interquartile range 0.02 to 0.10, p <0.0001). FFR-DM was <0.75 in 33% of patients with FFR-PM ≥0.75, leading to the decision of revascularization in these patients. Performing FFR measurement in the left main/left anterior descending artery predicted a higher gradient between FFR-DM and FFR-PM (odds ratio 4.58, 95% confidence interval 1.4 to 15.03, p = 0.007). FFR-DM exhibited a better correlation with results of myocardial single-photon emission computed tomography compared to FFR-PM (kappa 0.33 vs 0.22, p <0.0001). In conclusion, significant differences between FFR-DM and FFR-PM were observed in patients with moderate coronary stenosis in the proximal-mid segment of a coronary artery, with FFR-DM exhibiting a better correlation with results of noninvasive functional tests. These differences influenced the treatment decision in about 1/3 of patients and highlight the potential clinical relevance of coronary pressure wire positioning for functional evaluation of lesions in the proximal-mid segment of the coronary arteries.
Authors:
Josep Rodés-Cabau; Marcos Gutiérrez; Javier Courtis; Eric Larose; Jean-Pierre Déry; Mélanie Côté; Can Mahn Nguyen; Onil Gleeton; Guy Proulx; Louis Roy; Bernard Noël; Gerald Barbeau; Robert De Larochellière; Stéphane Rinfret; Olivier F Bertrand
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-05-31
Journal Detail:
Title:  The American journal of cardiology     Volume:  108     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-02     Completed Date:  2011-09-29     Revised Date:  2011-12-19    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  483-90     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Interventional Cardiology Laboratories, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. josep.rodes@criucpq.ulaval.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Angiography
Coronary Artery Disease / physiopathology*,  radiography*
Coronary Stenosis / physiopathology*,  radiography*
Female
Fractional Flow Reserve, Myocardial*
Humans
Male
Middle Aged
Predictive Value of Tests
Severity of Illness Index
Comments/Corrections
Comment In:
Am J Cardiol. 2011 Dec 1;108(11):1687   [PMID:  22077979 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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