TCT-254 Intracoronary versus intravenous infusion of adenosine for the accurate assessment of fractional flow reserve: the hyperemic study

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017

RESULTS A total of 347 patients treated with BRS implantation were analyzed. DM was present in 46 patients (mean age 60.9
10.6, 78.3% were male). At one month 60.9% of diabetic patients were free from any angina. Over the two-year follow-up diabetic patients presented with numerically lower rates of freedom from angina (table) and numerically lower SAQ angina frequency score, with statistic significant differences at one (85
21 vs. 92
14, p ¼ 0.016), and two years (90
14 vs. 93
14, p ¼ 0.044), compared to non-diabetic population. From one month onwards, diabetics presented consistently with lower SAQ physical limitation score (table). Despite similar SAQ life quality (64
23 vs. 64
19, p ¼ 0.968) and treatment satisfaction (table), a lower mean EQ VAS score (72
20 vs. 80
12, p ¼ 0.011) was observed in patients with DM suggesting a large impact of other health related problems besides angina on quality of live in diabetic patients. Physical Freedom from

Non-diabetic

Diabetic

Limitation

Non-diabetic

Diabetic

angina

(n [ 301)

(n [ 46)

Score

(n [ 301)

(n [ 46)

1 month

70.2%

60.9%

1 month

84
20

72
24*

6 months

72.5%

64.5%

6 months

86
20

80
21

12 months

67.3%

48.5%*

12 months

85
19

74
25*

18 months

68.8%

54.3%

18 months

83
21

71
27*

24 months

69.4%

48.4%*

24 months

84
21

71
24*

92
12

90
12

Physical

84
19

75
22*

80
12

72
20*

Angina Frequency Score

Limitation Score (Overall)

Treatment

79
18

82
17

EQ VAS Score

Satisfaction Score * p <0.05

* p <0.05

CONCLUSION Diabetes is associated with worse angina frequency, physical limitation scores and quality of life after BRS implantation, which is consistent with previous observations for metallic stents. Even after initial disintegration of BRS this difference persisted. CATEGORIES CORONARY: Bioresorbable Vascular Scaffolds

FFR: TECHNICAL CONSIDERATIONS

Abstract nos: 253 - 257 TCT-253 Clinical feasibility of contrast induced fractional flow reserve (cFFR) Xinye Xu,1 Ruitao Zhang,1 Lijun Guo2 Department of Cardiology, Peking University Third Hospital, Beijing, Beijing, China; 2Peking University Third Hospital, Beijing, Beijing, China 1

BACKGROUND The clinical use of Frational Flow Reserve （ FFR ） is limited by the adverse effects of adenosine or other microvascular dialators. Other physiological lesion assessment procedures independent with adenosine are under consideration. The clinical feasibility of contrast induced fractional flow reserve (cFFR), which is considered one the most promising non-adenosine procedures, is assessed in this study. METHODS 70 patients were involved in this retrospective analysis, with the average age at 60.7
9.6 years old. FFR and cFFR were performed simultaneously 117 times in 87 vessels. Physiological significance of FFR was defined as <0.80. The correlation and the diagnostic consistency between FFR and cFFR, as well as the affecting factors, were analysised. RESULTS The value of FFR and cFFR were 0.80(0.74, 0.87) and 0.86(0.80,0.90) seperately. Significant relationship was observed between two functions (r¼0.92, P<0.0001). Take 0.80 as the cut-off value derived by FFR, the propriate cut-off value of cFFR should be 0.83, with a diagnostic consistency of 84.6%. When taking the sensitivity and specifity as over 95%, the gray zone of cFFR was 0.83 ～ 0.86. The diagnostic consistency could be increased to 90.6% when these grey-zone patients were re-analyzed by FFR, mean while, the FFR usage were reduced by 80.3%.

B105

CONCLUSION There is a significant linear correlation between cFFR and FFR, which indicating cFFR as a good substitute for FFR. The cFFR and FFR hybridization strategies reduce the use of adenosine by around 80% when the diagnostic consensus rate is guaranteed to reach 90%. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-254 Intracoronary versus intravenous infusion of adenosine for the accurate assessment of fractional flow reserve: the hyperemic study Ahmed Elghamaz,1 Aung Myat,2 Adam De Belder,3 Damien Collison,4 Keith Oldroyd,4 Gregg Stone5 1 Northwick Park Hospital, London, United Kingdom; 2Brighton and Sussex Medical School, Brighton, United Kingdom; 3Brighton and Sussex University Hospitals, Overijse, United Kingdom; 4Golden Jubilee National Hospital, Glasgow, United Kingdom; 5Cardiovascular Research Foundation, Columbia University Medical Center/NewYorkPresbyterian Hospital, New York, New York, United States BACKGROUND To evaluate the safety and efficacy of intracoronary (IC) adenosine infusion using a HYPEREMÔ FFR infusion microcatheter compared with the standard intravenous (IV) method. METHODS The HYPEREMIC study was a randomized single blinded crossover investigation to evaluate the effectivenes and safety of a novel dedicated over-the-wire infusion micro-catheter (HYPEREMÔIC) for measuring FFR using IC non-weight adjusted adenosine infusion versus the standard IV method. FFR measurements were performed sequentially using standard IV adenosine (140-180mcg/kg/ min) followed by the HYPEREMÔIC FFR microcatheter with nonweight adjusted IC adenosine (360mcg/min) or vice versa. All patients were blinded to the order in which they received adenosine with a 3 minute washout period. The primary endpoint was non-inferiority between the IC infusion versus the IV. Secondary endpoints were incidence and severity of side effects, time to hyperemia, dose and duration of adenosine. RESULTS A total of 41 patients were randomized in 3 UK sites. The mean (SD) peak FFR was 0.84 (
0.09) IV versus 0.82 (
0.09) IC (p¼0.0008). There was no evidence of a period effect (p¼0.90) or a period/procedure interaction (p¼0.75) allowing for the planned analysis to proceed using within-patient differences. Differences in FFR (IC minus IV), revealed a mean of -0.02 with a 95% confidence interval of -0.03 to -0.01, which confirmed that IC was non-inferior. 31.7% (13/ 41) of lesions were at or below the 0.8 threshold with IC infusion method compared to only 22% (9/41) with the IV method. No patients with a functionally ischaemic stenosis(es) were classified incorrectly by IC infusion. Time (mean
SD) in seconds to achieve peak FFR was 84 (
37) IV vs. 40 (
24) IC (p<0.0001). Duration of adenosine infusion was 105 (
33) for IV vs. 57 (
35) for IC (p<0.0001). Patients experienced more chest discomfort during IV 78% vs. 29% during IC. No patients reported severe chest discomfort with IC infusion compared to 12.2% during IV. CONCLUSION IC adenosine infusion is a reliable, faster and better tolerated method of achieving maximal hyperemia compared to IV. The total IC dose required is about 1.5% of the equivalent IV dose yet achieved a more rapid and stable state of hyperemia. Moreover, FFR values were consistently lower with IC infusion with more lesions classified as ischemic. This suggests we may be failing to achieve maximal hyperemia in a proportion of patients undergoing physiological assessment. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-255 Impact of right atrial pressure on fractional flow reserve calculation in the presence of a chronic total occlusion Grigoris Karamasis,1 Shah Mohdnazri,1 Firas Al-Janabi,1 Andreas Kalogeropoulos,2 Rohan Jagathesan,1 Gerald Clesham,1 Kare Tang,1 Paul Kelly,1 John Davies,1 Thomas Keeble1 1 Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom; 2Bart’S Heart Centre, London, United Kingdom BACKGROUND Fractional flow reserve (FFR) is calculated as the ratio of mean distal coronary pressure (Pd) to mean aortic pressure (Pa) during maximal hyperemia. The right atrial pressure (Pra) is