Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve

• Published in: Arquivos brasileiros de cardiologia 2017-01, Vol.108 (1), p.38-46
• Main Authors: Costantini, Costantino Roberto Frack, Ramires, Jose Antonio, Costantini, Costantino Ortiz, Denk, Marcos Antonio, Tarbine, Sergio Gustavo, Santos, Marcelo de Freitas, Zanuttini, Daniel Aníbal, Silveira, Carmen Weigert, Souza, Admar Moraes de, Macedo, Rafael Michel de
• Format: Article
• Language: eng ; por
• Subjects: Aged; Analysis of Variance; CARDIAC & CARDIOVASCULAR SYSTEMS; Cineangiography - methods; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Coronary Vessels - physiopathology; Doença Arterial Coronariana / mortalidade; Echocardiography, Stress - methods; Female; Fractional Flow Reserve, Myocardial - physiology; Humans; Intervenção Coronária Percutânea; Isquemia Miocárdica; Male; Middle Aged; Miocárdio / fisiologia; Myocardial Perfusion Imaging - methods; Original; Reference Values; Reserva Fracionada de Fluxo; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Statistics, Nonparametric
• ISSN: 0066-782X; 1678-4170; 1678-4170
• DOI: 10.5935/abc.20160184

Functional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used. To evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction. Retrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies. All 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed. Coronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.