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Fractional flow reserve in patients with reduced ejection fraction

Giuseppe Di Gioia1,2, Bernard De Bruyne1, Mariano Pellicano1,2

  • 1Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.

European Heart Journal
|August 17, 2019
PubMed

Insights

Fractional flow reserve (FFR) guided treatment in patients with reduced ejection fraction and coronary artery disease (CAD) significantly lowered death and major adverse cardiovascular events. This approach led to reduced revascularization rates compared to angiography-guided management.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Fractional flow reserve (FFR) has not been previously studied in patients with reduced ejection fraction (LVEF ≤50%) and coronary artery disease (CAD).
  • Evaluating FFR's impact on management strategies and outcomes in this specific patient population is crucial.

Purpose of the Study:

  • To investigate the effect of FFR-guided revascularization versus angiography-guided management on clinical outcomes in patients with reduced LVEF and CAD.
  • To assess the impact of FFR on revascularization rates and subsequent major adverse cardiovascular and cerebrovascular events (MACCE).

Main Methods:

  • A retrospective study included patients with LVEF ≤50% undergoing coronary angiography between 2002 and 2010.
  • Patients were divided into an FFR-guided group and an Angiography-guided group, with propensity score matching used for comparison.
  • Outcomes, including all-cause death and MACCE, were compared between groups over a 5-year follow-up period.

Main Results:

  • FFR guidance resulted in a significant downgrade of stenotic vessels compared to angiography alone (1.43 vs. 1.97 vessels; P < 0.001).
  • The FFR-guided group showed lower revascularization rates (52% vs. 62%; P < 0.001).
  • At 5 years, FFR-guided management was associated with significantly lower all-cause death (22% vs. 31%; P < 0.001) and MACCE (40% vs. 46%; P = 0.019) compared to the Angiography-guided group.

Conclusions:

  • In patients with reduced LVEF and CAD, FFR-guided revascularization improves outcomes, leading to reduced death and MACCE rates at 5 years.
  • FFR guidance facilitates conservative management, including less coronary artery bypass grafting and more percutaneous coronary intervention or medical therapy.
  • The findings support the use of FFR to optimize treatment strategies in heart failure patients with concomitant coronary artery disease.
Abstract

Keywords:
Clinical outcomeCoronary physiologyFractional flow reserveHeart failure

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