Joo Myung Lee1, Ki Hong Choi1, Doyeon Hwang2, Jonghanne Park3, Ji-Hyun Jung4, Hyung Yoon Kim5, Hae Won Jung6, Yun-Kyeong Cho7, Hyuck-Jun Yoon7, Young Bin Song1, Joo-Yong Hahn1, Joon-Hyung Doh8, Chang-Wook Nam7, Eun-Seok Shin9, Seung-Ho Hur7, Bon-Kwon Koo10. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. 3. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Naju National Hospital, Ministry of Health and Welfare, Naju, Republic of Korea. 4. Sejong Heart Institute, Sejong General Hospital, Bucheon, Republic of Korea. 5. Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea. 6. Department of Cardiology, Daegu Catholic University Medical Center, Daegu, Republic of Korea. 7. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 8. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea. 9. Division of Cardiology, Dietrich Bonhoeffer Hospital, Academic Teaching Hospital of University of Greifswald, Greifswald, Germany; Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea. 10. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea; Institute on Aging, Seoul National University, Seoul, Republic of Korea. Electronic address: bkkoo@snu.ac.kr.
Abstract
OBJECTIVES: This study investigated the prognostic implication of coronary flow reserve (CFR) in patients who underwent fractional flow reserve (FFR) measurement. BACKGROUND: Limited data are available regarding the long-term prognosis associated with thermodilution CFR in patients with coronary artery disease. METHODS: A total of 519 patients (737 vessels) who did not undergo revascularization were classified according to FFR and CFR values. Low FFR and low CFR were defined with upper thresholds of 0.8 and 2.0, respectively. FFR and CFR were measured by a pressure-temperature sensor-tipped wire. Clinical outcomes were assessed by the vessel-oriented composite outcome (VOCO) (a composite of cardiac death, vessel-specific myocardial infarction, and vessel-specific revascularization) during 5 years of follow-up. RESULTS: The categorical agreement (kappa = 0.080; p = 0.024) between FFR and CFR were modest, and 30.6% of the population showed discordant results between FFR and CFR. During 5 years of follow-up, patients with low CFR had a significantly higher risk of VOCO than did those with high CFR (hazard ratio [HR]: 3.171; 95% CI: 1.664 to 6.042; p < 0.001). Among patients with high FFR, there were no differences in clinical risk factor profiles, FFR, or stenosis severity between the high-CFR and low-CFR groups, and low CFR was an independent predictor for VOCO (HR: 4.999; 95% CI: 2.104 to 11.879; p < 0.001). In a 4-group classification according to both FFR and CFR, patients with low FFR and low CFR had the highest risk of VOCO (17.9%; overall p < 0.001). CONCLUSIONS: Patients with low CFR had a significantly higher risk of clinical events during 5 years of follow-up. Low CFR was an independent predictor for patient-oriented composite outcome among patients with high FFR. These results support the value of CFR in patients who undergo FFR measurement. (Clinical, Physical and Prognostic Implication of Microvascular Status; NCT02186093).
OBJECTIVES: This study investigated the prognostic implication of coronary flow reserve (CFR) in patients who underwent fractional flow reserve (FFR) measurement. BACKGROUND: Limited data are available regarding the long-term prognosis associated with thermodilution CFR in patients with coronary artery disease. METHODS: A total of 519 patients (737 vessels) who did not undergo revascularization were classified according to FFR and CFR values. Low FFR and low CFR were defined with upper thresholds of 0.8 and 2.0, respectively. FFR and CFR were measured by a pressure-temperature sensor-tipped wire. Clinical outcomes were assessed by the vessel-oriented composite outcome (VOCO) (a composite of cardiac death, vessel-specific myocardial infarction, and vessel-specific revascularization) during 5 years of follow-up. RESULTS: The categorical agreement (kappa = 0.080; p = 0.024) between FFR and CFR were modest, and 30.6% of the population showed discordant results between FFR and CFR. During 5 years of follow-up, patients with low CFR had a significantly higher risk of VOCO than did those with high CFR (hazard ratio [HR]: 3.171; 95% CI: 1.664 to 6.042; p < 0.001). Among patients with high FFR, there were no differences in clinical risk factor profiles, FFR, or stenosis severity between the high-CFR and low-CFR groups, and low CFR was an independent predictor for VOCO (HR: 4.999; 95% CI: 2.104 to 11.879; p < 0.001). In a 4-group classification according to both FFR and CFR, patients with low FFR and low CFR had the highest risk of VOCO (17.9%; overall p < 0.001). CONCLUSIONS:Patients with low CFR had a significantly higher risk of clinical events during 5 years of follow-up. Low CFR was an independent predictor for patient-oriented composite outcome among patients with high FFR. These results support the value of CFR in patients who undergo FFR measurement. (Clinical, Physical and Prognostic Implication of Microvascular Status; NCT02186093).
Authors: Tim P van de Hoef; Joo Myung Lee; Mauro Echavarria-Pinto; Bon-Kwon Koo; Hitoshi Matsuo; Manesh R Patel; Justin E Davies; Javier Escaned; Jan J Piek Journal: Nat Rev Cardiol Date: 2020-05-14 Impact factor: 32.419
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Authors: Mark A Gdowski; Venkatesh L Murthy; Michelle Doering; Andrea G Monroy-Gonzalez; Riemer Slart; David L Brown Journal: J Am Heart Assoc Date: 2020-04-29 Impact factor: 5.501
Authors: Sayan Sen; Yousif Ahmad; Hakim-Moulay Dehbi; James P Howard; Juan F Iglesias; Rasha Al-Lamee; Ricardo Petraco; Sukhjinder Nijjer; Ravinay Bhindi; Sam Lehman; Darren Walters; James Sapontis; Luc Janssens; Christiaan J Vrints; Ahmed Khashaba; Mika Laine; Eric Van Belle; Florian Krackhardt; Waldemar Bojara; Olaf Going; Tobias Härle; Ciro Indolfi; Giampaolo Niccoli; Flavio Ribichini; Nobuhiro Tanaka; Hiroyoshi Yokoi; Hiroaki Takashima; Yuetsu Kikuta; Andrejs Erglis; Hugo Vinhas; Pedro Canas Silva; Sérgio B Baptista; Ali Alghamdi; Farrel Hellig; Bon-Kwon Koo; Chang-Wook Nam; Eun-Seok Shin; Joon-Hyung Doh; Salvatore Brugaletta; Eduardo Alegria-Barrero; Martijin Meuwissen; Jan J Piek; Niels van Royen; Murat Sezer; Carlo Di Mario; Robert T Gerber; Iqbal S Malik; Andrew S P Sharp; Suneel Talwar; Kare Tang; Habib Samady; John Altman; Arnold H Seto; Jasvindar Singh; Allen Jeremias; Hitoshi Matsuo; Rajesh K Kharbanda; Manesh R Patel; Patrick Serruys; Javier Escaned; Justin E Davies Journal: J Am Coll Cardiol Date: 2019-02-05 Impact factor: 24.094