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Updated: Jun 30, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Hemodynamic evaluation of coronary artery bypass graft lesions using fractional flow reserve
Raed Aqel1, Gilbert J Zoghbi, Fadi Hage
1Birmingham VA Medical Center, Birmingham, AL, USA. raed.aqel@va.gov
Insights
Fractional flow reserve (FFR) assessment of saphenous vein graft (SVG) lesions is feasible. FFR offers acceptable specificity and negative predictive value for detecting ischemia compared to stress myocardial perfusion imaging (MPI).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Coronary angiography cannot determine the hemodynamic significance of coronary artery stenosis.
- Assessing the physiological significance of saphenous vein graft (SVG) lesions using fractional flow reserve (FFR) with a pressure wire is not well-established.
Purpose of the Study:
- To evaluate the feasibility of using FFR to assess the physiological significance of SVG lesions.
- To compare FFR measurements with stress myocardial perfusion imaging (MPI) for detecting ischemia in SVG territories.
Main Methods:
- FFR was measured in 10 SVG lesions from 10 male patients referred for percutaneous coronary intervention.
- Patients underwent stress MPI prior to the procedure.
- Angiographic diameter stenosis (DS) and FFR values were recorded.
Main Results:
- All SVGs had DS > 50%, with 30% having DS >= 70%.
- Significant FFR (<0.75) was found in 30% of patients, and ischemia on MPI was present in 20%.
- FFR showed 50% sensitivity and 75% specificity for detecting ischemia on MPI, with no significant correlation between FFR and DS (R²=0.1, P=0.35).
Conclusions:
- FFR assessment of SVG lesions is feasible.
- FFR provides acceptable specificity and negative predictive value compared to stress MPI for evaluating SVG lesion significance.
Background:
Coronary angiography is limited by its inability to assess the hemodynamic significance of a coronary artery stenosis. The assessment of the physiological significance of saphenous vein graft (SVG) lesions with a pressure wire to determine the fractional flow reserve (FFR) is lacking.
Methods:
FFR was determined in 10 SVG lesions of 10 males who had stress myocardial perfusion imaging (MPI) prior to referral for percutaneous coronary intervention for clinical indications.
Results:
All SVGs had a diameter stenosis (DS) > 50% and 30% had a DS > or = 70%. A significant FFR was present in 30% of patients. Ischemia along the territory of the SVG was present in 20% of patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FFR < 0.75 for the detection of ischemia on stress MPI were 50, 75, 33, 85, and 70%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FFR < 0.75 for detecting > or = 70% DS on angiography were 33, 71, 33, 71, and 60%, respectively. There was no significant correlation between FFR and % DS (R(2) = 0.1, P = 0.35).
Conclusion:
The use of FFR to assess the physiological significance of SVG lesions is feasible and provides an acceptable specificity and negative predictive value compared to stress MPI.
