Jamie Layland1, Samuli Rauhalammi1, Stuart Watkins1, Nadeem Ahmed1, John McClure1, Matthew M Y Lee1, David Carrick1, Anna O'Donnell1, Arvind Sood1, Mark C Petrie1, Vannesa Teng Yue May1, Hany Eteiba1, Mitchell Lindsay1, Margaret McEntegart1, Keith G Oldroyd1, Aleksandra Radjenovic1, Colin Berry2. 1. From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.). 2. From the West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, United Kingdom (J.L., S.W., N.A., M.M.Y.L., D.C., A.O., M.C.P., H.E., M.L., M.M., K.G.O., C.B.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (J.L., S.R., N.A., J.M., D.C., V.T.Y.M., A.R., C.B.); and Hairmyres Hospital, Hairmyres, East Kilbride, United Kingdom (A.S.). colin.berry@glasgow.ac.uk.
Abstract
BACKGROUND: The use of fractional flow reserve (FFR) in acute coronary syndromes is controversial. The British Heart Foundation Fractional Flow Reserve Versus Angiography in Guiding Management to Optimize Outcomes in Non-ST-Elevation Myocardial Infarction (FAMOUS-NSTEMI) study (NCT01764334) has recently demonstrated the safety and feasibility of FFR measurement in patients with non-ST-segment-elevation myocardial infarction. We report the findings of the cardiac magnetic resonance (CMR) substudy to assess the diagnostic accuracy of FFR compared with 3.0-T stress CMR perfusion. METHODS AND RESULTS: One hundred six patients with non-ST-segment-elevation myocardial infarction who had been referred for early invasive management were included from 2 centers. FFR was measured in all major patent epicardial coronary arteries with a visual stenosis estimated at ≥30%, and if percutaneous coronary intervention was performed, an FFR assessment was repeated. Myocardial perfusion was assessed with stress perfusion CMR at 3 T. The mean age was 56.7±9.8 years; 82.6% were men. Mean time from FFR evaluation to CMR was 6.1±3.1 days. The mean±SD left ventricular ejection fraction was 58.2±9.1%. Mean infarct size was 5.4±7.1%, and mean troponin concentration was 5.2±9.2 μg/L. There were 34 fixed and 160 inducible perfusion defects. There was a negative correlation between the number of segments with a perfusion abnormality and FFR (r=-0.77; P<0.0001). The overall sensitivity, specificity, positive predictive value, and negative predictive value for an FFR of ≤0.8 were 91.4%, 92.2%, 76%, and 97%, respectively. Diagnostic accuracy was 92%. The positive and negative predictive values of FFR for flow-limiting coronary artery disease (FFR≤0.8) in patients with non-ST-segment-elevation myocardial infarction (n=21) who underwent perfusion CMR before invasive angiography were 92% and 93%, respectively. Receiver operating characteristic analysis indicated that the optimal cutoff value of FFR for demonstrating reversible ischemia on CMR was ≤0.805 (area under the receiver operating characteristic curve, 0.94 [0.9-0.99]; P<0.0001). CONCLUSIONS: FFR in patients with recent non-ST-segment-elevation myocardial infarction showed high concordance with myocardial perfusion in matched territories as revealed by 3.0-T stress perfusion CMR. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422.
BACKGROUND: The use of fractional flow reserve (FFR) in acute coronary syndromes is controversial. The British Heart Foundation Fractional Flow Reserve Versus Angiography in Guiding Management to Optimize Outcomes in Non-ST-Elevation Myocardial Infarction (FAMOUS-NSTEMI) study (NCT01764334) has recently demonstrated the safety and feasibility of FFR measurement in patients with non-ST-segment-elevation myocardial infarction. We report the findings of the cardiac magnetic resonance (CMR) substudy to assess the diagnostic accuracy of FFR compared with 3.0-T stress CMR perfusion. METHODS AND RESULTS: One hundred six patients with non-ST-segment-elevation myocardial infarction who had been referred for early invasive management were included from 2 centers. FFR was measured in all major patent epicardial coronary arteries with a visual stenosis estimated at ≥30%, and if percutaneous coronary intervention was performed, an FFR assessment was repeated. Myocardial perfusion was assessed with stress perfusion CMR at 3 T. The mean age was 56.7±9.8 years; 82.6% were men. Mean time from FFR evaluation to CMR was 6.1±3.1 days. The mean±SD left ventricular ejection fraction was 58.2±9.1%. Mean infarct size was 5.4±7.1%, and mean troponin concentration was 5.2±9.2 μg/L. There were 34 fixed and 160 inducible perfusion defects. There was a negative correlation between the number of segments with a perfusion abnormality and FFR (r=-0.77; P<0.0001). The overall sensitivity, specificity, positive predictive value, and negative predictive value for an FFR of ≤0.8 were 91.4%, 92.2%, 76%, and 97%, respectively. Diagnostic accuracy was 92%. The positive and negative predictive values of FFR for flow-limiting coronary artery disease (FFR≤0.8) in patients with non-ST-segment-elevation myocardial infarction (n=21) who underwent perfusion CMR before invasive angiography were 92% and 93%, respectively. Receiver operating characteristic analysis indicated that the optimal cutoff value of FFR for demonstrating reversible ischemia on CMR was ≤0.805 (area under the receiver operating characteristic curve, 0.94 [0.9-0.99]; P<0.0001). CONCLUSIONS: FFR in patients with recent non-ST-segment-elevation myocardial infarction showed high concordance with myocardial perfusion in matched territories as revealed by 3.0-T stress perfusion CMR. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02073422.
Authors: Colin Berry; David Corcoran; Barry Hennigan; Stuart Watkins; Jamie Layland; Keith G Oldroyd Journal: Eur Heart J Date: 2015-06-02 Impact factor: 29.983
Authors: Roberto Scarsini; Dimitrios Terentes-Printzios; Giovanni Luigi De Maria; Flavio Ribichini; Adrian Banning Journal: Interv Cardiol Date: 2020-06-04
Authors: Mina Ghobrial; Hazel Arfah Haley; Rebecca Gosling; Vignesh Rammohan; Patricia V Lawford; D Rod Hose; Julian P Gunn; Paul D Morris Journal: Heart Date: 2021-01-08 Impact factor: 5.994