1
|
Stegehuis V, Boerhout C, Kikuta Y, Cambero-Madera M, van Royen N, Matsuo H, Nakayama M, de Waard G, Knaapen P, Nijjer S, Petraco R, Siebes M, Davies J, Escaned J, van de Hoef T, Piek J. Impact of stenosis resistance and coronary flow capacity on fractional flow reserve and instantaneous wave-free ratio discordance: a combined analysis of DEFINE-FLOW and IDEAL. Neth Heart J 2023; 31:434-443. [PMID: 37594612 PMCID: PMC10602988 DOI: 10.1007/s12471-023-01796-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The pressure-derived parameters fractional flow reserve (FFR) and the emerging instantaneous wave-free ratio (iFR) are the most widely applied invasive coronary physiology indices to guide revascularisation. However, approximately 15-20% of intermediate stenoses show discordant FFR and iFR, and therapeutical consensus is lacking. AIMS We sought to associate hyperaemic stenosis resistance index, coronary flow reserve (CFR) and coronary flow capacity (CFC) to FFR/iFR discordance. METHODS We assessed pressure and flow measurements of 647 intermediate lesions (593 patients) of two multi-centre international studies. RESULTS FFR and iFR were discordant in 15% of all lesions (97 out of 647). FFR+/iFR- lesions had similar hyperaemic average peak velocity (hAPV), CFR and CFC as FFR-/iFR- lesions, whereas FFR-/iFR+ lesions had similar hAPV, CFR and CFC as FFR+/iFR+ lesions (p > 0.05 for all). FFR+/iFR- lesions were associated with lower baseline stenosis resistance, but not hyperaemic stenosis resistance, compared with FFR-/iFR+ lesions (p < 0.001). CONCLUSIONS Discordance with FFR+/iFR- is characterised by maximal flow values, CFR, and CFC patterns similar to FFR-/iFR- concordance that justifies conservative therapy. Discordance with FFR-/iFR+ on the other hand, is characterised by low flow values, CFR, and CFC patterns similar to iFR+/FFR+ concordance that may benefit from percutaneous coronary intervention.
Collapse
Affiliation(s)
- Valérie Stegehuis
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Coen Boerhout
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | | | | | - Guus de Waard
- Amsterdam UMC-location VUMC, Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, VU University, Amsterdam, The Netherlands
| | - Paul Knaapen
- Amsterdam UMC-location VUMC, Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, VU University, Amsterdam, The Netherlands
| | | | | | - Maria Siebes
- Department of Biomedical Engineering and Physics, Amsterdam UMC-location AMC, Amsterdam, The Netherlands
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain
| | - Tim van de Hoef
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Piek
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC-location AMC, Department of Cardiology, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
2
|
Collard D, Velde LVD, Stegehuis V, Delewi R, Beijk M, Zijlstra I, Winter RD, Vogt L, Born BJVD. ASSESSMENT OF RENAL SYMPATHETIC CONTROL USING INVASIVE PRESSURE AND FLOW VELOCITY MEASUREMENTS IN HUMANS. J Hypertens 2022. [DOI: 10.1097/01.hjh.0000838112.55341.b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
3
|
Eftekhari A, Westra J, Stegehuis V, Holm NR, van de Hoef TP, Kirkeeide RL, Piek JJ, Lance Gould K, Johnson NP, Christiansen EH. Prognostic value of microvascular resistance and its association to fractional flow reserve: a DEFINE-FLOW substudy. Open Heart 2022; 9:openhrt-2022-001981. [PMID: 35410913 PMCID: PMC9003618 DOI: 10.1136/openhrt-2022-001981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to evaluate the prognostic value of hyperemic microvascular resistance (HMR) and its relationship with hyperemic stenosis resistance (HSR) index and fractional flow reserve (FFR) in stable coronary artery disease. Methods This is a substudy of the DEFINE-FLOW cohort (NCT02328820), which evaluated the prognosis of lesions (n=456) after combined FFR and coronary flow reserve (CFR) assessment in a prospective, non-blinded, non-randomised, multicentre study in 12 centres in Europe and Japan. Participants (n=430) were evaluated by wire-based measurement of coronary pressure, flow and vascular resistance (ComboWire XT, Phillips Volcano, San Diego, California, USA). Results Mean FFR and CFR were 0.82±0.10 and 2.2±0.6, respectively. When divided according to FFR and CFR thresholds (above and below 0.80 and 2.0, respectively), HMR was highest in lesions with FFR>0.80 and CFR<2.0 (n=99) compared with lesions with FFR≤0.80 and CFR≥2.0 (n=68) (2.92±1.2 vs 1.91±0.64 mm Hg/cm/s, p<0.001). The FFR value was proportional to the ratio between HMR and the HMR+HSR (total resistance), 95% limits of agreement (−0.032; 0.019), bias (−0.003±0.02) and correlation (r2=0.98, p<0.0001). Cox regression model using HMR as continuous parameter for target vessel failure showed an HR of 1.51, 95% CI (0.9 to 2.4), p=0.10. Conclusions Increased HMR was not associated with a higher rate of adverse clinical events, in this population of mainly stable patients. FFR can be equally well expressed as HMR/HMR+HSR, thereby providing an alternative conceptual formulation linking epicardial severity with microvascular resistance. Trial registration number NCT02328820.
Collapse
Affiliation(s)
- Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
- Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Valérie Stegehuis
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Niels Ramsing Holm
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Tim P van de Hoef
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Richard L Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | | |
Collapse
|
4
|
Westra J, Eftekhari A, Renkens M, Mejía-Rentería H, Sejr-Hansen M, Stegehuis V, Holm NR, de Winter RJ, Piek JJ, Escaned J, Wykrzykowska JJ, Christiansen EH. Characterization of quantitative flow ratio and fractional flow reserve discordance using doppler flow and clinical follow-up. Int J Cardiovasc Imaging 2022; 38:10.1007/s10554-022-02522-1. [PMID: 35041147 DOI: 10.1007/s10554-022-02522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
The physiological mechanisms of quantitative flow ratio and fractional flow reserve disagreement are not fully understood. We aimed to characterize the coronary flow and resistance profile of intermediate stenosed epicardial coronary arteries with concordant and discordant FFR and QFR. Post-hoc analysis of the DEFINE-FLOW study. Anatomical and Doppler-derived physiological parameters were compared for lesions with FFR+QFR- (n = 18) vs. FFR+QFR+ (n = 43) and for FFR-QFR+ (n = 34) vs. FFR-QFR- (n = 139). The association of QFR results with the two-year rate of target vessel failure was assessed in the proportion of vessels (n = 195) that did not undergo revascularization. Coronary flow reserve was higher [2.3 (IQR: 2.1-2.7) vs. 1.9 (IQR: 1.5-2.4)], hyperemic microvascular resistance lower [1.72 (IQR: 1.48-2.31) vs. 2.26 (IQR: 1.79-2.87)] and anatomical lesion severity less severe [% diameter stenosis 45.5 (IQR: 41.5-52.5) vs. 58.5 (IQR: 53.1-64.0)] for FFR+QFR- lesions compared with FFR+QFR+ lesions. In comparison of FFR-QFR+ vs. FFR-QFR- lesions, lesion severity was more severe [% diameter stenosis 55.2 (IQR: 51.7-61.3) vs. 43.4 (IQR: 35.0-50.6)] while coronary flow reserve [2.2 (IQR: 1.9-2.9) vs. 2.2 (IQR: 1.9-2.6)] and hyperemic microvascular resistance [2.34 (IQR: 1.85-2.81) vs. 2.57 (IQR: 2.01-3.22)] did not differ. The agreement and diagnostic performance of FFR using hyperemic stenosis resistance (> 0.80) as reference standard was higher compared with QFR and coronary flow reserve. Disagreement between FFR and QFR is partly explained by physiological and anatomical factors. Clinical Trials Registration https://www.clinicaltrials.gov ; Unique identifier: NCT01813435. Changes in central physiological and anatomical parameters according to FFR and QFR match/mismatch quadrants.
Collapse
Affiliation(s)
- Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mick Renkens
- Department of Cardiology, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
| | | | - Martin Sejr-Hansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Valérie Stegehuis
- Department of Cardiology, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
| | - Niels Ramsing Holm
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Robert-Jan de Winter
- Department of Cardiology, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC (Location AMC), Amsterdam, The Netherlands
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - J J Wykrzykowska
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Cardiology, Groningen UMC, Groningen, The Netherlands
| | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| |
Collapse
|
5
|
Wijntjens G, van Lavieren M, van de Hoef T, Pinto ME, Meuwissen M, Stegehuis V, Koch K, Chamuleau S, Voskuil M, de Winter R, Tijssen J, Escaned J, Piek J. TCT-412 Prognostic implications of pressure-bounded coronary flow reserve versus flow-derived coronary flow reserve. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
6
|
Wijntjens G, van de Hoef T, Stegehuis V, Meuwissen M, Pinto ME, Chamuleau S, Voskuil M, Koch K, de Winter R, Piek J. TCT-373 Diagnostic accuracy of combined pressure and flow-derived indices versus pressure only indices for myocardial ischemia. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
7
|
Wijntjens G, Kikuta Y, van de Hoef T, Petraco R, Nijjer S, de Waard G, Sen S, Pinto ME, Stegehuis V, Mejia-Renteria H, Meuwissen M, Danad I, Knaapen P, Escaned J, Davies J, Van Royen N, Piek J. TCT-337 Hemodynamic changes after percutaneous coronary interventions of stenoses with discordant fractional flow reserve and coronary flow reserve. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|