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Long-term prognostic value of CFVR and FFR versus perfusion scintigraphy in patients with multivessel disease
S A J Chamuleau1, B L F van Eck-Smit, M Meuwissen
1Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
Insights
Intracoronary hemodynamic parameters like coronary flow velocity reserve (CFVR) and fractional flow reserve (FFR) offer superior long-term risk stratification for intermediate coronary lesions compared to myocardial perfusion scintigraphy (MPS). Negative CFVR or FFR values significantly predict future cardiac events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Assessing intermediate coronary artery lesions is crucial for managing multivessel disease.
- Myocardial perfusion scintigraphy (MPS) is a common diagnostic tool, but its prognostic value for intermediate lesions needs comparison.
- Intracoronary hemodynamic parameters offer a physiological assessment of lesion severity.
Purpose of the Study:
- To compare the long-term prognostic value of intracoronary hemodynamic parameters (CFVR and FFR) with MPS in patients with intermediate coronary lesions.
- To determine if hemodynamic assessment provides more accurate risk stratification than MPS.
Main Methods:
- A multicentre study included 191 patients with severe and intermediate coronary lesions.
- Myocardial perfusion scintigraphy (MPS) was performed to detect reversible perfusion defects.
- Coronary flow velocity reserve (CFVR) and fractional flow reserve (FFR) were measured distal to the intermediate lesion.
Main Results:
- During a mean follow-up of 793 days, 67 cardiac events occurred.
- Event-free survival was higher for negative CFVR (79%) and FFR (79%) compared to MPS (63%).
- CFVR and FFR showed a significantly higher relative risk for cardiac events (2.2 and 2.4, respectively) compared to MPS (1.2).
Conclusions:
- Selective evaluation of intermediate lesions using CFVR or FFR provides more adequate risk stratification in multivessel disease than MPS.
- A CFVR <2.0 or FFR <0.75 is associated with a significant increase in cardiac events, mainly revascularization procedures.
- Hemodynamic assessment offers superior prognostic value for intermediate coronary lesions.
Objective:
In this multicentre study, we investigated the long-term prognostic value of intracoronary derived haemodynamic parameters compared with the results of myocardial perfusion scintigraphy (MPS).
Methods:
Patients (n=191) who were referred for angioplasty of a severe lesion in the presence of an intermediate lesion in another coronary artery were included. MPS was performed to determine the presence of reversible perfusion defects in the area of the intermediate lesion. Coronary flow velocity reserve (CFVR), and additionally fractional flow reserve (FFR; n=129), were determined distal to the intermediate lesion; CFVR >/=2.0 and FFR >/=0.75 were considered negative.
Results:
In total 67 events occurred in 49 patients (3 deaths, 9 MI, 9 CABG, 46 PTCA) during a mean of 793 days follow-up. Event-free survival was 63% for MPS, 79% for CFVR, and 79% for FFR if a negative test result was obtained. The relative risk was 1.2 (not significant) for MPS, 2.2 (p=0.001) for CFVR, and 2.4 (p=0.004) for FFR.
Conclusion:
Selective evaluation of an intermediate lesion using CFVR or FFR allows more adequate risk stratification in patients with multivessel disease than MPS. A CFVR <2.0 or a FFR <0.75 was associated with a significant increase of the occurrence of cardiac events during long-term follow-up, predominantly associated with revascularisation. (Neth Heart J 2007;15:369-74.).
