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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Relationship between reversibility score on corresponding left ventricular segments and fractional flow reserve in
Bertalan Kracskó1, Ildikó Garai, Sándor Barna
1Institute of Cardiology, University of Debrecen Clinical Center; Debrecen-Hungary. kracskobertalan@gmail.com.
Insights
A new index combining fractional flow reserve (FFR) and left ventricular segments (LVIi) better predicts myocardial ischemia on scintigraphy than FFR alone. This LVIi offers improved sensitivity and specificity for identifying significant coronary lesions.
Area of Science:
- Cardiology
- Nuclear Medicine
- Medical Imaging
Background:
- Fractional flow reserve (FFR) is an invasive measure of coronary stenosis severity.
- Myocardial perfusion scintigraphy assesses blood flow to the heart muscle.
- Current methods may have limitations in correlating functional significance with anatomical lesions.
Purpose of the Study:
- To evaluate the correlation between scintigraphy-detected perfusion abnormalities and FFR values.
- To assess the utility of a novel combined index (LVIi) for predicting myocardial ischemia.
- To compare the diagnostic performance of LVIi versus FFR in identifying significant coronary lesions.
Main Methods:
- Retrospective analysis of 28 patients with intermediate coronary stenosis undergoing FFR and myocardial perfusion SPECT.
- Calculation of the left ventricular ischemic index (LVIi = N x (1-FFR)), incorporating FFR and number of affected left ventricular segments.
- Comparison of LVIi and FFR with scintigraphic findings (regional difference score, rDSc) using linear regression and ROC analysis.
Main Results:
- A strong linear correlation was observed between LVIi and rDSc (p<0.001).
- LVIi demonstrated higher sensitivity (78%) and specificity (94%) for predicting ischemia compared to FFR alone (72% sensitivity, 94% specificity).
- The area under the ROC curve was significantly greater for LVIi (0.94) than for FFR (0.87).
Conclusions:
- The LVIi is a valuable index for assessing myocardial ischemia, outperforming FFR alone.
- An LVIi >0.96 suggests a clinically relevant coronary stenosis.
- Integrating FFR with left ventricular segment information improves clinical decision-making for coronary artery disease.
Objective:
The objective of this study was to find the correlation between the severity of perfusion abnormality detected by scintigraphy and the FFR value, as well as the localization of a particular coronary lesion. On the basis of FFR values and the corresponding left ventricular segments, we proposed a combined index to aim for better correlation with myocardial ischemia than the FFR parameter alone.
Methods:
Twenty-eight patients (male: 22, female: 6, age 62±7.62) having FFR measurements and myocardial perfusion SPECT studies were enrolled in our retrospective analysis. FFR measurements on 36 vessels (20 LAD, 6 LCx, 10 RCA) with intermediate stenosis (40%-60%) were compared to the Tc-99m SestaMIBI myocardial perfusion SPECT studies. SPECT studies were performed before the invasive procedure in all cases. We introduced a new ischemic index, the left ventricular ischemic index (LVIi), by combining FFR values with the number of corresponding myocardial segments (N) [LVIi=N x (1-FFR)]. This index correlated with the regional myocardial perfusion defects identified on the scintigrams. A perfusion reversibility score of 2 or above was considered indicative of active ischemia (regional difference score: rDSc). For the statistical analysis, we used linear regression analysis and receiver operating characteristic (ROC) curve analysis to compare the different parameters.
Results:
A close linear relationship was found between the LVIi and rDSc values (p<0.001) with linear regression analysis. When analyzing all FFR values independently of the localization of the lesions, they also correlated significantly to the rDSc, but this relation was not as close. LVIi predicted active ischemia (≥2 rDSc) on myocardial scintigraphy with 78% sensitivity and 94% specificity when the cutoff value was set to 0.96. FFR alone predicted ischemia on scintigraphy with 72% sensitivity and 94% specificity at the best 0.8 cut-off value. The area under the ROC curve was significantly higher for LVIi than FFR (0.94 vs. 0.87; p<0.05).
Conclusion:
The scintigraphic data indicate that an LVIi >0.96 implies a clinically relevant stenotic lesion. In our opinion, FFR values, weighted with the corresponding left ventricular segments, should be taken into consideration for the best clinical decision-making.
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