Comparison between angiography and fractional flow reserve versus single-photon emission computed tomographic myocardial perfusion imaging for determining lesion significance in patients with multivessel coronary disease.

We hypothesized that myocardial perfusion imaging (MPI) would fail to identify all vascular zones with the potential for myocardial ischemia in patients with multivessel coronary disease (MVD). MPI is based on the concept of relative flow reserve. The ability of these techniques to determine the significance of a particular stenosis in the setting of MVD is questionable. Fractional flow reserve (FFR) can determine the significance of individual stenoses. Thirty-six patients with disease involving 88 arteries underwent angiography, FFR, and MPI. FFR was performed using a pressure wire with hyperemia from intracoronary adenosine. Myocardial perfusion images were analyzed quantitatively and segments assigned to a specific coronary artery. The relation between FFR and perfusion was determined for each vascular zone. Of the 88 vessels, the artery was occluded (n=20) or had an abnormal FFR

Fractional flow reserve: critical review of an important physiologic adjunct to angiography.

With growing numbers of patients with acute coronary syndromes undergoing catheterization without prior non-invasive imaging and the increasing numbers of patients with angiographic multivessel coronary artery disease, complementary physiologic lesion assessment for directing revascularization is of increasing value. Fractional flow reserve (FFR) has emerged as a simple, reliable, and reproducible physiologic index of lesion severity. In concert with coronary flow reserve, FFR yields significant information about the epicardial artery and the microvascular bed it subtends. This review will critically consider the theory of FFR measurements in the context of recent insights into coronary hemodynamics and how FFR measurements are significantly affected by microvascular disease states such as myocardial infarction, left ventricular hypertrophy, or diabetes mellitus. Clinical studies have demonstrated the usefulness of FFR for the assessment of intermediate lesions in single-vessel, multivessel, and possibly left main disease. In addition, measurement of fractional collateral flow reserve during angioplasty and FFR after stent deployment have prognostic value for major adverse cardiac events after percutaneous intervention. Furthermore, with economic concerns about the appropriate use of drug-eluting stents, FFR assessment can be used to direct percutaneous coronary intervention only to flow-limiting lesions and to achieve optimal stent deployment. Therefore, FFR represents a powerful new tool in the cardiologists' arsenal in the cardiac catheterization laboratory.