BACKGROUND:Adenosine induced hyperaemic fractional flow reserve (aFFR) is a validated predictor of clinical outcome and part of routine interventional practice. Protocol issues associated with the adenosine infusion limit the use of aFFR in clinical practice. Contrast medium induced hyperaemic FFR (cFFR) is a simpler procedure from a practical standpoint. We compared the two in a real world setting. METHODS:We analysed 76 patients that had both cFFR and aFFR assessment of 100 angiographically indeterminate coronary stenosis. cFFR was performed with intracoronary contrast medium injections (10ml for left coronary lesions and 8ml for right coronary lesions). The diagnostic performance of cFFR was analysed and compared to the gold standard aFFR. RESULTS:Mean cFFR was 0.87 (±0.07) and mean aFFR was 0.84 (±0.08). Bland-Altman analysis revealed a close agreement between cFFR and aFFR (0.035±0.032; 95% CI: -0.028 to 0.098) and good linear correlation (r=0.92, r2=0.86; p<0.0001). Using cFFR cut-off values of ≤0.83 in predicting an aFFR value of ≤0.80 or a cFFR value ≥0.88, predicting an aFFR value of >0.80 yielded a sensitivity of 100%, specificity of 96.1%, positive predictive value of 92.3%, negative predictive value of 100% and diagnostic accuracy of 96%. Only 24% of cFFR values were in the 0.84 to 0.87 range. CONCLUSION:Contrast medium induced hyperaemic FFR as an initial assessment may limit the need for adenosine to when cFFR falls in the 0.84 to 0.87 range. The use of adenosine infusion potentially could have been avoided in the majority of patients in this study.

译文

背景:腺苷诱导的高血流分数储备(aFFR)是临床结果的有效预测指标,是常规干预措施的一部分。与腺苷输注相关的协议问题限制了aFFR在临床实践中的使用。从实际的角度来看,造影剂诱导的高血FFR(cFFR)是一种更简单的方法。我们在现实世界中比较了两者。
方法:我们分析了76例同时进行了cFFR和aFFR评估的100例血管造影不确定的冠状动脉狭窄患者。 cFFR通过冠状动脉内造影剂注射(左冠状动脉病变为10ml,右冠状动脉病变为8ml)进行。分析了cFFR的诊断性能,并将其与金标准aFFR进行了比较。
结果:平均cFFR为0.87(±0.07),平均aFFR为0.84(±0.08)。 Bland-Altman分析显示cFFR和aFFR之间有密切的一致性(0.035±0.032; 95%CI:-0.028至0.098)和良好的线性相关性(r = 0.92,r2 = 0.86; p <0.0001)。在预测aFFR值≤0.80或cFFR值≥0.88时,使用cFFR截止值≤0.83,预测aFFR值> 0.80时,灵敏度为100%,特异性为96.1%,阳性预测值为92.3%,阴性预测值为100%,诊断准确性为96%。 cFFR值中只有24%在0.84至0.87范围内。
结论:造影剂诱导的高血流FFR作为初始评估可能将对腺苷的需求限制在cFFR降至0.84至0.87范围内时。在这项研究中,大多数患者都可能避免使用腺苷输注。

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