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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Future culprit detection based on angiography-derived FFR
Mattia Pagnoni1, David Meier1, Alessandro Candreva2
1Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
Insights
Mild coronary artery disease lesions that later cause myocardial infarction show lower quantitative flow ratio (QFR) and higher diameter stenosis years before the event. Lower baseline QFR in these future culprit lesions may predict earlier myocardial infarction.
Area of Science:
- Cardiology
- Medical Imaging
- Vascular Biology
Background:
- The diagnostic accuracy of fractional flow reserve (FFR) in identifying significant coronary artery disease (CAD) in mild cases can be limited.
- Quantitative flow ratio (QFR) offers an alternative, angiography-derived method to assess hemodynamic significance.
Purpose of the Study:
- To investigate the hemodynamic characteristics of mild coronary stenoses that subsequently lead to myocardial infarction (MI).
- To evaluate the utility of quantitative flow ratio (QFR) in predicting future adverse events in patients with non-significant CAD at baseline.
Main Methods:
- Retrospective analysis of patients who experienced MI and had prior coronary angiography within 5 years.
- Quantitative coronary angiography, QFR, and lesion length analysis were performed on both future culprit lesions (FCL) and non-culprit lesions (NCL).
Main Results:
- Future culprit lesions (FCL) demonstrated greater diameter stenosis (%DS) and lower QFR compared to non-culprit lesions (NCL).
- The difference in QFR between FCL and NCL was more pronounced when the interval between angiograms was less than 2 years.
- Lesions with lower baseline QFR were associated with an earlier occurrence of MI.
Conclusions:
- Mild coronary stenoses that eventually cause MI exhibit distinct hemodynamic profiles (lower QFR, higher %DS) years prior to the event.
- Baseline QFR may serve as a predictor for the timing of MI in patients with mild CAD.
Objectives:
We sought to characterize the hemodynamic impact of mild coronary artery disease (CAD) using quantitative flow ratio (QFR, an angiography-derived fractional flow reserve [FFR]) in a population of patients with only non-significant CAD at baseline that subsequently experienced a myocardial infarction (MI).
Background:
The discriminatory value of FFR in patients with mild CAD remains imperfect.
Methods:
We retrospectively included patients who underwent invasive coronary angiography for an MI, in whom another angiogram had been performed within the previous 5 years. Three-dimensional quantitative coronary angiography, QFR, and lesion length analysis were conducted on lesions responsible for the MI (future culprit lesions, [FCL]) as well as on control lesions (non-culprit lesions, [NCL]).
Results:
Eighty-three FCL and 117 NCL were analyzed in 83 patients: FCL were more severe (median % diameter of stenosis [DS] 39.1% [29.8; 45.7] vs. 29.8% [25.0; 37.2], p < .001), had lower QFR values (0.94 [0.86; 0.98] vs. 0.98 [0.96; 1.00], p < .001) and tended to be longer (15.2 mm [10.0; 27.3] vs. 12.7 mm [9.3; 22.4], p = .070) than NCL. In lesions with an interval < 2 years between baseline angiography and MI, the difference in QFR was more pronounced compared to the lesions with a longer interval (FCL: 0.92 [0.85; 0.97] vs. NCL: 0.98 [0.94; 1.00], p < .001 and FCL: 0.96 [0.88; 1.00] vs. NCL: 0.98 [0.96;1.00], p = .006 respectively) CONCLUSION: Mild coronary stenoses that are subsequently responsible for an MI (FCL) exhibit a higher DS and lower QFR years before the event. Furthermore, FCL with a lower QFR at baseline appear to lead earlier to MI.
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