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Continuum of Vasodilator Stress From Rest to Contrast Medium to Adenosine Hyperemia for Fractional Flow Reserve Assessment.

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dc.contributor.authorJohnson, N
dc.contributor.authorJeremias, A
dc.contributor.authorZimmermann, F
dc.contributor.authorAdjedj, J
dc.contributor.authorWitt, N
dc.contributor.authorHennigan, B
dc.contributor.authorKoo, B
dc.contributor.authorMaehara, A
dc.contributor.authorMatsumura, M
dc.contributor.authorBarbato, E
dc.contributor.authorEsposito, G
dc.contributor.authorTrimarco, B
dc.contributor.authorRioufol, G
dc.contributor.authorPark, S
dc.contributor.authorYang, H
dc.contributor.authorBaptista, SB
dc.contributor.authorChrysant, G
dc.contributor.authorLeone, A
dc.contributor.authorBerry, C
dc.contributor.authorDe Bruyne, B
dc.contributor.authorGould, K
dc.contributor.authorKirkeeide, R
dc.contributor.authorOldroyd, K
dc.contributor.authorPijls, N
dc.contributor.authorFearon, W
dc.date.accessioned2017-03-13T14:33:02Z
dc.date.available2017-03-13T14:33:02Z
dc.date.issued2016
dc.description.abstractOBJECTIVES: This study compared the diagnostic performance with adenosine-derived fractional flow reserve (FFR) ≤0.8 of contrast-based FFR (cFFR), resting distal pressure (Pd)/aortic pressure (Pa), and the instantaneous wave-free ratio (iFR). BACKGROUND: FFR objectively identifies lesions that benefit from medical therapy versus revascularization. However, FFR requires maximal vasodilation, usually achieved with adenosine. Radiographic contrast injection causes submaximal coronary hyperemia. Therefore, intracoronary contrast could provide an easy and inexpensive tool for predicting FFR. METHODS: We recruited patients undergoing routine FFR assessment and made paired, repeated measurements of all physiology metrics (Pd/Pa, iFR, cFFR, and FFR). Contrast medium and dose were per local practice, as was the dose of intracoronary adenosine. Operators were encouraged to perform both intracoronary and intravenous adenosine assessments and a final drift check to assess wire calibration. A central core lab analyzed blinded pressure tracings in a standardized fashion. RESULTS: A total of 763 subjects were enrolled from 12 international centers. Contrast volume was 8 ± 2 ml per measurement, and 8 different contrast media were used. Repeated measurements of each metric showed a bias <0.005, but a lower SD (less variability) for cFFR than resting indexes. Although Pd/Pa and iFR demonstrated equivalent performance against FFR ≤0.8 (78.5% vs. 79.9% accuracy; p = 0.78; area under the receiver-operating characteristic curve: 0.875 vs. 0.881; p = 0.35), cFFR improved both metrics (85.8% accuracy and 0.930 area; p < 0.001 for each) with an optimal binary threshold of 0.83. A hybrid decision-making strategy using cFFR required adenosine less often than when based on either Pd/Pa or iFR. CONCLUSIONS: cFFR provides diagnostic performance superior to that of Pd/Pa or iFR for predicting FFR. For clinical scenarios or health care systems in which adenosine is contraindicated or prohibitively expensive, cFFR offers a universal technique to simplify invasive coronary physiological assessments. Yet FFR remains the reference standard for diagnostic certainty as even cFFR reached only ∼85% agreement.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJACC Cardiovasc Interv. 2016 Apr 25;9(8):757-67pt_PT
dc.identifier.doi10.1016/j.jcin.2015.12.273pt_PT
dc.identifier.issn1876-7605
dc.identifier.urihttp://hdl.handle.net/10400.10/1821
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttp://ac.els-cdn.com/S1936879815023365/1-s2.0-S1936879815023365-main.pdf?_tid=d54c3d14-07f6-11e7-86dc-00000aacb361&acdnat=1489414418_64e31503d077ad6229fc2102af887168pt_PT
dc.subjectCardiac catheterizationpt_PT
dc.subjectCateterização cardíacapt_PT
dc.subjectCoronary artery diseasept_PT
dc.subjectDoença das artérias coronáriaspt_PT
dc.subjectVasodilatorspt_PT
dc.subjectVasodilatadorespt_PT
dc.titleContinuum of Vasodilator Stress From Rest to Contrast Medium to Adenosine Hyperemia for Fractional Flow Reserve Assessment.pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceNew Yorkpt_PT
oaire.citation.endPage767pt_PT
oaire.citation.startPage757pt_PT
oaire.citation.titleJournal of the American College of Cardiology cardiovascular interventionspt_PT
oaire.citation.volume9pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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