Przemysław J Kwasiborski1, Wojciech Czerwiński2, Paweł Kowalczyk3, Małgorzata Buksińska-Lisik4, Grzegorz Horszczaruk5, Michael S Aboodi6, Kamil Derbisz2, Mariusz Hochul2, Adam Janas2, Andrzej Cwetsch7, Wojciech Wąsek8, Piotr P Buszman2, Jozef Bartunek9, Paweł E Buszman10, Patrick W Serruys11, Krzysztof Milewski12. 1. Third Department of Internal Medicine and Cardiology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland. Electronic address: pkwasiborski77@gmail.com. 2. Center for Cardiovascular Research and Development, American Heart of Poland S.A., Poland. 3. Medical University of Warsaw, Biophysics Department, Warsaw, Poland. 4. Third Department of Internal Medicine and Cardiology, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland. 5. Angiology and Hemodynamics Laboratory, MSSW, Warsaw, Poland. 6. Department of Medicine, Montefiore Medical Center, NY, USA. 7. Department of Cardiology, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw 44, Poland. 8. Faculty of Medicine, University of Rzeszów, Poland. 9. Cardiology Department, Andrzej-Frycz Modrzewski Kraków University, Kraków, Poland. 10. Cardiovascular Center, OLV Hospital Aalst, Belgium. 11. Imperial College London, Kensington, London, UK. 12. The Jerzy Kukuczka Academy of Physical Education, Faculty of Physiotherapy, Poland.
Abstract
BACKGROUND: Functional lesion assessment in stable coronary disease is considered the gold standard. The result of fractional flow reserve (FFR) in stable coronary disease is often a decision-maker for patient qualification. Taking into account the paramount position of FFR, it is crucial to acknowledge and reduce all potential bias. AIMS: In the present study, we quantified the influence of elevated HR on FFR results using a preclinical model and then validated the results in a clinical setting. METHODS AND RESULTS: The relationship between FFR and HR was first explored experimentally in a porcine model. A clinical validation study was conducted in patients with isolated moderate lesions in the left anterior descending artery (LAD) or right coronary artery (RCA). In both the experimental and clinical arms, FFR was measured at resting HR and with pacing at 100, 130, 160, and 180 (for pigs) beats per minute. In the porcine model and in the clinical settings, a significant correlation between FFR and HR was confirmed in the LAD (r = 0.89, p < .0001; r = 0.53, p = .00002), but not in the RCA (r = -0.19, p = .5; r = 0.14, p = .3). Post hoc analyses revealed that the FFR values in the LAD at 130/min and above tended to be significantly different from the baseline HR. CONCLUSIONS: The results of this study indicate that in an experimental setting, tachycardia might be responsible for an overestimation of FFR results in LAD lesions.
BACKGROUND: Functional lesion assessment in stable coronary disease is considered the gold standard. The result of fractional flow reserve (FFR) in stable coronary disease is often a decision-maker for patient qualification. Taking into account the paramount position of FFR, it is crucial to acknowledge and reduce all potential bias. AIMS: In the present study, we quantified the influence of elevated HR on FFR results using a preclinical model and then validated the results in a clinical setting. METHODS AND RESULTS: The relationship between FFR and HR was first explored experimentally in a porcine model. A clinical validation study was conducted in patients with isolated moderate lesions in the left anterior descending artery (LAD) or right coronary artery (RCA). In both the experimental and clinical arms, FFR was measured at resting HR and with pacing at 100, 130, 160, and 180 (for pigs) beats per minute. In the porcine model and in the clinical settings, a significant correlation between FFR and HR was confirmed in the LAD (r = 0.89, p < .0001; r = 0.53, p = .00002), but not in the RCA (r = -0.19, p = .5; r = 0.14, p = .3). Post hoc analyses revealed that the FFR values in the LAD at 130/min and above tended to be significantly different from the baseline HR. CONCLUSIONS: The results of this study indicate that in an experimental setting, tachycardia might be responsible for an overestimation of FFR results in LAD lesions.