Department of Cardiology, Bursa City Hospital, Health Sciences University, Bursa, Turkey. Email:
Department of Cardiology, Bursa Yüksek Ihtisas Training and Research Hospital, Health Sciences University, Bursa, Turkey.
Cardiovasc J Afr. 2023;34(4):248-254. doi: 10.5830/CVJA-2023-045. Epub 2023 Sep 21.
Fractional flow reserve (FFR) assessment compares the blood flow on either side of a blockage in the coronary artery and indicates how severe the stenosis is in the artery. Intravenous adenosine is widely used to achieve conditions of stable hyperaemia for the measurement of FR. However, intravenous adenosine affects both systemic and coronary vascular beds differentially. Therefore, FFR has some limitations, such as the side effects of adenosine and the long procedure time. In addition, there are not enough studies on the evaluation of the baseline ratio of distal coronary pressure to aortic pressure (Pd/Pa) according to standard cut-off values in coronary stenosis under special clinical conditions. This study aimed to assess the diagnostic power of the baseline FFR value for critical coronary stenosis and to determine its predictive value in special patient groups.
This retrospective study included 158 patients, who were stratified as Q1 (< 0.89), Q2 (0.89-0.92), Q3 (0.93-0.95) and Q4 (> 0.95) based on baseline FFR values. The baseline Pd/Pa value, the change in adenosine FFR and the raw FFR change were recorded. Its predictive value was also calculated for specific patient groups.
The threshold value of baseline FFR level for predicting critical stenosis was ≤ 0.92 with a sensitivity of 92.8% and a specificity of 82% (upper limit of Q2 cartilage). Patients with a baseline FFR value ≤ 0.92 had a 58.4-fold greater likelihood of a critical outcome compared with patients with a baseline FFR value > 0.92 (OR: 58.4; 95% CI: 20.3-124.6). In patients with a baseline FFR ≤ 0.92, the Q1 group had a 10.23-fold higher odds of critical stenosis compared with the Q2 group (OR: 10.23; 95% CI: 2.14-48.84). The same values had similar diagnostic power for all specific patient groups.
The baseline FFR value could be used to predict critical coronary stenosis in our patients and had similar value for predicting lesion severity in all the subgroups.
分流量比值（FFR）评估比较了冠状动脉阻塞两侧的血流，并表明动脉狭窄的严重程度。静脉内腺苷广泛用于实现 FR 测量的稳定充血条件。然而，静脉内腺苷对全身和冠状动脉血管床的影响不同。因此，FFR 有一些局限性，例如腺苷的副作用和较长的操作时间。此外，在特殊临床情况下，根据标准截止值，对于冠状动脉狭窄，远端冠状动脉压力与主动脉压力的基础比值（Pd/Pa）的评估研究还不够充分。本研究旨在评估基础 FFR 值对临界冠状动脉狭窄的诊断能力，并确定其在特殊患者群体中的预测价值。
这项回顾性研究包括 158 名患者，根据基础 FFR 值分为 Q1（<0.89）、Q2（0.89-0.92）、Q3（0.93-0.95）和 Q4（>0.95）。记录了基础 Pd/Pa 值、腺苷 FFR 变化和原始 FFR 变化。还计算了其在特定患者群体中的预测价值。
预测临界狭窄的基础 FFR 水平的阈值值为≤0.92，灵敏度为 92.8%，特异性为 82%（Q2 软骨上限）。与基础 FFR 值>0.92 的患者相比，基础 FFR 值≤0.92 的患者发生临界结果的可能性高 58.4 倍（OR：58.4；95%CI：20.3-124.6）。在基础 FFR≤0.92 的患者中，Q1 组发生临界狭窄的几率比 Q2 组高 10.23 倍（OR：10.23；95%CI：2.14-48.84）。所有特定患者群体的相同值均具有相似的诊断能力。
基础 FFR 值可用于预测我们患者的临界冠状动脉狭窄，并且对于预测所有亚组的病变严重程度具有相似的价值。
