Katritsis DG, Korovesis S, Karvouni E, Giazitzoglou E, Karabinos I, Tzanalaridou E, Panagiotakos D, Webb-Peploe MM. Handgrip-enhanced myocardial fractional flow reserve for assessment of coronary artery stenoses.
Am Heart J 2006;
151:1107.e1-7. [PMID:
16644345 DOI:
10.1016/j.ahj.2005.09.023]
[Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 09/29/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND
Fractional flow reserve (FFR) may yield false-negative results in up to 12% of lesions tested, and there is a zone of uncertainty at borderline values.
METHODS
Forty-eight patients were investigated by means of dobutamine stress echocardiography (DSE), coronary angiography, and FFR assessment of 48 coronary lesions before, during, and immediately after handgrip exercise.
RESULTS
Mean FFR values were lower during and immediately after handgrip exercise as compared with baseline (0.86 +/- 0.09 vs 0.87 +/- 0.08 vs 0.88 +/- 0.08, P < .05, respectively). The sensitivity of FFR < or = 0.75 for predicting myocardial ischemia on DSE was 17.6% before handgrip exercise, 52.9% during, and 35.5% immediately after exercise. The specificity of FFR < or = 0.75 before, during, and immediate after exercise was 100%, 93.5%, and 96.8%, respectively. In 10 patients, FFR values > 0.75 before handgrip became < or = 0.75 during or immediately after handgrip exercise (P = .01). All these patients had angina and/or DSE indicating ischemia in the territory of the vessel studied, and underwent coronary intervention. At 6 months follow-up, all patients were asymptomatic with negative DSE tests.
CONCLUSIONS
The addition of handgrip exercise can significantly lower the FFR and potentially improve its ability to detect physiologically significant stenoses.
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