BACKGROUND: By measuring the pressure decline caused by coronary narrowing, fractional flow reserve (FFR) is an index of the physiological significance of a vessel stenosis. Intracoronary electrocardiogram (IC-ECG) recording from an angioplasty guidewire is more sensitive than standard ECG in detecting regional myocardial ischemia. The aim of the study was to assess if unipolar IC-ECG ST segment recording from angioplasty guidewire during maximal pharmacologic vasodilation could be used as an indirect estimation of FFR results. METHODS: Forty-eight clinically stable patients with intermediate stenosis underwent FFR evaluation and IC-ECG recording during intravenous adenosine infusion. RESULTS: FFR values were ≤ 0.80 in 26 (54%) patients and > 0.80 in 22 (46%). After adenosine, standard ECG was abnormal in only nine (19%) patients, while IC-ECG showed a significant ST segment shift (IST) in 24 (50%) patients: ST elevation in 19 patients and depression in five). IST was documented in 21/26 patients with FFR ≤ 0.80 (81%) and in 3/22 with FFR > 0.80 (p < 0.001). Sensitivity of IST for predicting an abnormal FFR value was 81%, specificity 86%, positive and negative predictive accuracies were 88% and 79%, respectively. CONCLUSIONS: Intracoronary ST segment shift evaluation during adenosine infusion may be of value in assessing the functional significance of a borderline stenosis. The presence of IST during adenosine infusion could obviate the need for additional FFR evaluation.
BACKGROUND: By measuring the pressure decline caused by coronary narrowing, fractional flow reserve (FFR) is an index of the physiological significance of a vessel stenosis. Intracoronary electrocardiogram (IC-ECG) recording from an angioplasty guidewire is more sensitive than standard ECG in detecting regional myocardial ischemia. The aim of the study was to assess if unipolar IC-ECG ST segment recording from angioplasty guidewire during maximal pharmacologic vasodilation could be used as an indirect estimation of FFR results. METHODS: Forty-eight clinically stable patients with intermediate stenosis underwent FFR evaluation and IC-ECG recording during intravenous adenosine infusion. RESULTS: FFR values were ≤ 0.80 in 26 (54%) patients and > 0.80 in 22 (46%). After adenosine, standard ECG was abnormal in only nine (19%) patients, while IC-ECG showed a significant ST segment shift (IST) in 24 (50%) patients: ST elevation in 19 patients and depression in five). IST was documented in 21/26 patients with FFR ≤ 0.80 (81%) and in 3/22 with FFR > 0.80 (p < 0.001). Sensitivity of IST for predicting an abnormal FFR value was 81%, specificity 86%, positive and negative predictive accuracies were 88% and 79%, respectively. CONCLUSIONS: Intracoronary ST segment shift evaluation during adenosine infusion may be of value in assessing the functional significance of a borderline stenosis. The presence of IST during adenosine infusion could obviate the need for additional FFR evaluation.
Authors: Marius Reto Bigler; Michael Stoller; Fabien Praz; George C M Siontis; Raphael Grossenbacher; Christine Tschannen; Christian Seiler Journal: Open Heart Date: 2021-01
Authors: Marius Reto Bigler; Andrea Kieninger-Gräfitsch; Frédéric Waldmann; Christian Seiler; Reto Wildhaber Journal: Front Cardiovasc Med Date: 2022-09-07