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Published on: June 28, 2019
Angiographic severity does not correlate with fractional flow reserve in heavily calcified coronary arteries
Paul M Johnson1, Chaitanya Madamanchi1, Zarina M Sharalaya1
1Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina.
Insights
In heavily calcified coronary arteries, angiographic stenosis severity does not correlate with hemodynamic significance. Fractional flow reserve (FFR) testing is crucial for assessing intermediate lesions in these patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Angiographic stenosis severity is a key factor in revascularization decisions.
- The impact of coronary lesion calcification on hemodynamic significance remains unclear.
Purpose of the Study:
- To investigate the relationship between coronary artery stenosis severity and its hemodynamic significance in calcified lesions.
- To assess the utility of fractional flow reserve (FFR) in evaluating intermediate coronary lesions with varying degrees of calcification.
Main Methods:
- Fractional flow reserve (FFR) testing was performed on 200 patients with intermediate coronary lesions using a pressure wire and adenosine.
- Coronary calcification was quantified using cineangiography, categorized into none/mild (0), moderate (1), and severe (2) based on radiopacity.
- Correlation between angiographic stenosis and FFR was analyzed across different calcium scores.
Main Results:
- A significant decrease in the correlation between angiographic stenosis and FFR was observed as lesion calcification increased.
- For severe calcification (Calcium Score 2), the correlation was non-significant (R² = 0.02, P = 0.35).
- Patients with severe calcification were older and had higher rates of chronic kidney and pulmonary disease.
Conclusions:
- In heavily calcified coronary lesions, angiographic appearance does not reliably predict hemodynamic significance.
- Fractional flow reserve (FFR) is essential for accurately determining the hemodynamic significance of intermediate coronary lesions, especially in the presence of heavy calcification.
Objectives:
To determine the relationship between severity of stenosis and hemodynamic significance in calcified coronary arteries.
Background:
Severity of stenosis is widely used to determine the need for revascularization but the effect of lesion calcification on hemodynamic significance is not well understood.
Methods:
Two hundred consecutive patients undergoing fractional flow reserve (FFR) testing of an intermediate coronary lesion with a pressure wire and intravenous infusion of adenosine were studied. Coronary calcium was quantified based upon radiopacities at the site of the stenosis on cineangiography using the method of Mintz et al. (0 = none or mild calcium, 1 = moderate calcium, 2 = severe calcium).
Results:
Mean age was 61 ± 11 years, 66% were males, 87.5% had hypertension, 44.5% had diabetes, and 20.5% were current smokers. The mean coronary stenosis by quantitative coronary angiography was 60 ± 12% and the mean FFR was 0.83 ± 0.08. There were 109, 45, and 46 patients classified as Calcium Score of 0, 1, or 2, respectively. Compared to those with no/mild or moderate calcification, patients with severe coronary calcium were older and more likely to have chronic kidney disease and pulmonary disease. The correlation between angiographic severity and FFR decreased as lesion calcification increased [calcium score = 0 (R2 = 0.25, P < 0.005); calcium score = 1 (R2 = 0.11, P < 0.005); calcium score = 2 (R2 = 0.02, P = 0.35)].
Conclusions:
In patients with heavily calcified coronary lesions, there was no association between angiographic stenosis and hemodynamic significance and FFR is needed to determine hemodynamic significance of intermediate lesions. © 2016 Wiley Periodicals, Inc.
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