Division of Cardiology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
Sci Rep. 2022 Sep 2;12(1):14962. doi: 10.1038/s41598-022-19330-1.
Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical-functional mismatch) and its influence on reclassification of functional significance. Distal-to-aortic pressure ratio (Pd/Pa) was measured using adenosine (Pd/Pa) and papaverine (Pd/Pa) in 326 patients (326 vessels). The overestimation of FFR was calculated as Pd/Pa-Pd/Pa. The anatomical-functional mismatch was defined as diameter stenosis > 50% and Pd/Pa > 0.80. Reclassification was indicated by Pd/Pa > 0.80 and Pd/Pa ≤ 0.80. The mismatch (n = 72) had a greater overestimation of FFR than the non-mismatch (n = 99): median 0.02 (interquartile range 0.01-0.05) versus 0.01 (0.00-0.04), p = 0.014. Multivariable analysis identified the overestimation of FFR (p = 0.003), minimal luminal diameter (p = 0.001), and non-left anterior descending artery (LAD) location (p < 0.001) as determinants of the mismatch. Reclassification was indicated in 29% of the mismatch and was more frequent in the LAD than in the non-LAD (52% vs. 20%, p = 0.005). The overestimation of FFR is an independent determinant of anatomical-functional mismatch. Anatomical-functional mismatch, specifically in the LAD, may suggest a false-negative result.
腺苷偶尔会导致与其他充血刺激相比，分数流量储备（FFR）值的高估。我们旨在阐明腺苷引起的 FFR 高估与解剖学上显著但功能上无意义的病变（解剖学-功能不匹配）的关系及其对功能意义再分类的影响。在 326 例患者（326 支血管）中使用腺苷（Pd/Pa）和罂粟碱（Pd/Pa）测量远端至主动脉压力比（Pd/Pa）。FFR 的高估计算为 Pd/Pa-Pd/Pa。解剖学-功能不匹配定义为直径狭窄> 50%，Pd/Pa> 0.80。Pd/Pa> 0.80 和 Pd/Pa≤ 0.80 表示再分类。不匹配（n = 72）的 FFR 高估大于无不匹配（n = 99）：中位数 0.02（四分位距 0.01-0.05）与 0.01（0.00-0.04），p = 0.014。多变量分析确定 FFR 高估（p = 0.003）、最小管腔直径（p = 0.001）和非前降支（LAD）位置（p < 0.001）是不匹配的决定因素。不匹配的 29%提示再分类，LAD 比非 LAD 更常见（52% vs. 20%，p = 0.005）。FFR 的高估是解剖学-功能不匹配的独立决定因素。特别是在 LAD 中的解剖学-功能不匹配可能提示假阴性结果。
