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DISENGAGE Registry
Mariano Pellicano1,2, Giovanni Ciccarelli2, Panagiotis Xaplanteris1
1Cardiovascular Research Center Aalst, OLV Clinic, Moorselbaan, Belgium (M.P., G.C., P.X., G.D.G., A.M., I.C., A.H., F.V.D., M.V., J.B., B.D.B.).
Insights
Guiding catheter engagement can artificially lower fractional flow reserve (FFR) measurements, potentially altering treatment decisions for coronary stenosis. Disengaging the catheter often improves FFR values, especially for proximal lesions near the cutoff.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Fractional flow reserve (FFR) measurements can be affected by guiding catheter (GC) placement in the coronary ostium.
- Artificial ostial stenosis from GC engagement may impede hyperemic flow, impacting FFR accuracy.
Purpose of the Study:
- To investigate if selective GC engagement affects hyperemic flow and FFR measurements.
- To determine the impact of GC disengagement on clinical decision-making for coronary stenosis.
Main Methods:
- Prospective measurement of FFR with GC engaged (FFReng) and disengaged (FFRdis) in 202 intermediate coronary stenoses.
- Assessed the significance of ΔFFReng-FFRdis compared to test-retest repeatability.
- Analyzed the clinical significance and impact on treatment strategy and stenosis location.
Main Results:
- FFR significantly changed after GC disengagement (FFReng 0.84±0.08 vs. FFRdis 0.80±0.09, P<0.001).
- In 19% of cases with FFReng 0.81-0.85, disengagement shifted the FFR below the 0.80 cutoff, changing treatment from medical therapy to PCI.
- GC disengagement impact was more pronounced in proximal/middle segments (0.04±0.03) than distal segments (0.03±0.03, P=0.042).
Conclusions:
- Guiding catheter disengagement shifts FFR values across the 0.80 clinical cutoff in 19% of measurements.
- This shift predominantly occurs in proximal/middle coronary segments with FFR values near the cutoff.
- Accurate FFR assessment may require consideration of GC influence, particularly in specific anatomical locations and FFR ranges.
Background:
During fractional flow reserve (FFR) measurement, the simple presence of the guiding catheter (GC) within the coronary ostium might create artificial ostial stenosis, affecting the hyperemic flow. We aimed to investigate whether selective GC engagement of the coronary ostium might impede hyperemic flow, and therefore impact FFR measurements and related clinical decision-making.
Methods:
In the DISENGAGE (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, FFR was prospectively measured twice (with GC engaged [FFReng] and disengaged [FFRdis]) in 202 intermediate stenoses of 173 patients. We assessed (1) whether ΔFFReng-FFRdis was significantly different from the intrinsic variability of repeated FFR measurements (test-retest repeatability); (2) whether the extent of ΔFFReng-FFRdis could be clinically significant and therefore able to impact clinical decision-making; and (3) whether ΔFFReng-FFRdis related to the stenosis location, that is, proximal and middle versus distal coronary segments.
Results:
Overall, FFR significantly changed after GC disengagement: FFReng 0.84±0.08 versus FFRdis 0.80±0.09, P<0.001. Particularly, in 38 stenoses (19%) with FFR values in the 0.81 to 0.85 range, GC disengagement was associated with a shift from above to below the 0.80 clinical cutoff, resulting into a change of the treatment strategy from medical therapy to percutaneous coronary intervention. The impact of GC disengagement was significantly more pronounced with stenoses located in proximal and middle as compared with distal coronary segments (ΔFFReng-FFRdis, proximal and middle 0.04±0.03 versus distal segments 0.03±0.03; P=0.042).
Conclusions:
GC disengagement results in a shift of FFR values from above to below the clinical cutoff FFR value of 0.80 in 1 out of 5 measurements. This occurs mostly when the stenosis is located in proximal and middle coronary segments and the FFR value is close to the cutoff value.
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