(Circulation. 1995;92:39-46.)
© 1995 American Heart Association, Inc.
Articles |
Relation Between Myocardial Fractional Flow Reserve Calculated From Coronary Pressure Measurements and Exercise-Induced Myocardial Ischemia
Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 14-17, 1994.
From the Cardiovascular Center, Aalst, Belgium.
Correspondence to Bernard De Bruyne, MD, Cardiovascular Center, Aalst, O.L.V. Hospital, Moorselbaan, 164, B-9300 Aalst, Belgium.
Background Myocardial fractional flow reserve
(FFRmyo) is a functional index of stenosis severity
that can be derived from intracoronary pressure measurements performed
during maximal vasodilatation. It is defined as the maximal myocardial
perfusion during hyperemia in the presence of a stenosis in the
epicardial artery expressed as a fraction of its normal maximal
expected value. To determine threshold values of
FFRmyo, of hyperemic translesional pressure gradient
(
Pmax), and of resting translesional pressure
gradient (Prest) that are uniformly associated with
exercise-induced ischemia, we studied the relation between these
pressure-derived indexes and the results of exercise ECG.
Methods and Results We studied 60 patients with an isolated
lesion in one major epicardial coronary artery, normal left ventricular
function, and no left ventricular hypertrophy. Maximal exercise ECG
(off anti-ischemic medication) was performed within 6 hours before
catheterization. Intracoronary pressure measurements were taken at rest
and during hyperemia with a pressure monitoring guide wire.
ST-segment depressions at peak exercise (considered abnormal when 
0.1
mV) were compared with FFRmyo,
Pmax, and Prest. Thirty-seven
patients had an abnormal and 23 patients a normal exercise ECG. A
significant linear correlation was found between the magnitude of
ST-segment depressions and both FFRmyo and
Pmax (r=-.75, SEE=0.53;
r=.71,
SEE=0.56). A weaker correlation was noted between ST-segment
depressions and Prest (r=.53,
SEE=0.67).
Sensitivity and specificity curves were constructed for the prediction
of an abnormal exercise ECG for the three pressure-derived indexes. The
values that most accurately predicted an abnormal exercise ECG were
66% for FFRmyo, 31 mm Hg for
Pmax, and 12 mm Hg for Prest. No
patient with a FFRmyo value >72% showed an abnormal
exercise ECG. In addition, receiver operating characteristic curves
demonstrated a greater accuracy of FFRmyo and of
Pmax than of Prest for predicting the
results of the exercise ECG.
Conclusions In the present study, cutoff values of FFRmyo and translesional pressure gradients are established from the relation between intracoronary pressure–derived indexes and ECG signs of myocardial ischemia during maximal exercise. These values can be helpful for clinical decision making in cases with dubious angiographic results. Furthermore, our data support the concept that stenosis physiology is better reflected by hyperemic than by basal measurements.
Key Words: perfusion • electrocardiography • stenosis • blood flow
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