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RELATIONSHIP BETWEEN QUANTITATIVE SEVERITY OF CORONARY STENOSIS, FRACTIONAL FLOW RESERVE FINDINGS, AND DEMAND STRESS MYOCARDIAL PERFUSION FINDINGS IN PATIENT WITH SYMPTOMATIC CORONARY ARTERY DISEASE
A1243 JACC April 1, 2014 Volume 63, Issue 12
Non Invasive Imaging Relationship Between Quantitative Severity of Coronary Stenosis, Fractional Flow Reserve Findings, and Demand Stress Myocardial Perfusion Findings in Patient with Symptomatic Coronary Artery Disease Poster Contributions Hall C Monday, March 31, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Non Invasive Imaging: Stress and Contrast Echocardiography Abstract Category: 15. Non Invasive Imaging: Echo Presentation Number: 1248-45 Authors: Juefei Wu, Feng Xie, Edward O’Leary, John Steuter, Thomas Porter, University of Nebraska Medical Center, Omaha, NE, USA Background. Fractional flow reserve (FFR) has been utilized to assess the functional significance of intermediate (50% - 80%) coronary lesions. However, during hyperemic stress, regulation of coronary blood flow is more often controlled by capillary resistance and not stenosis resistance. Real time myocardial contrast echocardiography (RTMCE) can evaluate capillary resistance, and thus may be a more ideal for assessing the physiologic relevance of a coronary stenosis. The aim of this study was evaluate differences in capillary resistance assessed with RTMCE during stress echocardiography and coronary resistance assessed with FFR during vasodilator stress in patients with angiographically significant coronary stenoses. Methods. A total of 54 vessels in 45 consecutive patients with quantitatively significant stenoses (all with stenosis diameter >50%) undergoing FFR were evaluated (mean age 61 ± 10 years; 15 women). All patients had normal resting wall motion in the affected coronary artery territory. RTMCE was performed during dobutamine (n= 26) or exercise (n= 19) stress using a continuous infusion of ultrasound contrast (3% Definity). The presence or absence of inducible perfusion defects (greater than 2 second delay in myocardial contrast replenishment at peak stress) were correlated with FFR measurements, and QCA severity. Abnormal FFR was defined as hyperemic distal pressure divided by mean aortic pressure <0.8. Results. The mean percent diameter stenosis by QCA was 62% ± 10 %. Fourteen of the stenoses (24%) had FFR ≤ 0.8, of which 13 were abnormal by RTMCE. However, overall agreement between perfusion assessed with RTMCE and FFR was only 64%. In the 16 stenosed vessels where there was disagreement, RTMCE was abnormal in 15 despite normal FFR. Conclusions. RTMCE during stress echocardiography has excellent sensitivity for detecting coronary stenoses with impaired FFR. However, there are instances where inducible perfusion defects during demand stress are seen in stenosed vessels that have normal FFR. Since FFR cannot measure capillary resistance, there may be instances where it fails to completely assess the physiologic relevance of a coronary stenosis.
Non Invasive Imaging Relationship Between Quantitative Severity of Coronary Stenosis, Fractional Flow Reserve Findings, and Demand Stress Myocardial Perfusion Findings in Patient with Symptomatic Coronary Artery Disease Poster Contributions Hall C Monday, March 31, 2014, 9:45 a.m.-10:30 a.m.
Session Title: Non Invasive Imaging: Stress and Contrast Echocardiography Abstract Category: 15. Non Invasive Imaging: Echo Presentation Number: 1248-45 Authors: Juefei Wu, Feng Xie, Edward O’Leary, John Steuter, Thomas Porter, University of Nebraska Medical Center, Omaha, NE, USA Background. Fractional flow reserve (FFR) has been utilized to assess the functional significance of intermediate (50% - 80%) coronary lesions. However, during hyperemic stress, regulation of coronary blood flow is more often controlled by capillary resistance and not stenosis resistance. Real time myocardial contrast echocardiography (RTMCE) can evaluate capillary resistance, and thus may be a more ideal for assessing the physiologic relevance of a coronary stenosis. The aim of this study was evaluate differences in capillary resistance assessed with RTMCE during stress echocardiography and coronary resistance assessed with FFR during vasodilator stress in patients with angiographically significant coronary stenoses. Methods. A total of 54 vessels in 45 consecutive patients with quantitatively significant stenoses (all with stenosis diameter >50%) undergoing FFR were evaluated (mean age 61 ± 10 years; 15 women). All patients had normal resting wall motion in the affected coronary artery territory. RTMCE was performed during dobutamine (n= 26) or exercise (n= 19) stress using a continuous infusion of ultrasound contrast (3% Definity). The presence or absence of inducible perfusion defects (greater than 2 second delay in myocardial contrast replenishment at peak stress) were correlated with FFR measurements, and QCA severity. Abnormal FFR was defined as hyperemic distal pressure divided by mean aortic pressure <0.8. Results. The mean percent diameter stenosis by QCA was 62% ± 10 %. Fourteen of the stenoses (24%) had FFR ≤ 0.8, of which 13 were abnormal by RTMCE. However, overall agreement between perfusion assessed with RTMCE and FFR was only 64%. In the 16 stenosed vessels where there was disagreement, RTMCE was abnormal in 15 despite normal FFR. Conclusions. RTMCE during stress echocardiography has excellent sensitivity for detecting coronary stenoses with impaired FFR. However, there are instances where inducible perfusion defects during demand stress are seen in stenosed vessels that have normal FFR. Since FFR cannot measure capillary resistance, there may be instances where it fails to completely assess the physiologic relevance of a coronary stenosis.