Measurement of fractional flow reserve to assess moderately severe coronary lesions: correlation with dobutamine stress echocardiography.
BACKGROUND
New techniques to evaluate coronary artery disease, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to determine the correlation between FFR and dobutamine stress echocardiography in patients with moderately severe coronary stenosis in order to judge the usefulness of FFR for commonly encountered clinical problems.


RESULTS
We studied 21 patients with 23 moderately severe coronary artery stenoses on angiography. The FFR was calculated and dobutamine stress echocardiography was performed to detect ischemia. Of the 16 stenoses with a negative FFR (> or = 0.75), dobutamine echocardiography also was negative. In the seven stenoses with a positive FFR (< 0.75), dobutamine echocardiography was positive in three. The efficacy of FFR in detecting ischemia that was confirmed with stress echocardiography was sensitivity 100%, specificity 80%, positive and negative predictive value 42.8%, and 100%, respectively, with a global predictive value 82.6%. A moderate degree of correlation was found between the two diagnostic tests (kappa [kappa] = 0.51).


CONCLUSIONS
FFR correlates moderately well with dobutamine stress echocardiography in the assessment of moderately severe lesions in patients for whom coronary arteriography is usually indicated. However, its high negative predictive value makes FFR a useful aid in reaching clinical decisions promptly in the hemodynamics laboratory.
Jiménez-Navarro
M
M
Servicio de Cardiología, Unidad de Hemodinámica, Hospital Clinico Universitario Virge de la Victoria, Campus de Teatinos s/n, E-29019, Málaga, Spain.
Alonso-Briales
J H
JH
Hernández García
M J
MJ
Rodríguez Bailón
I
I
Gómez-Doblas
J J
JJ
de Teresa Galván
E
E
D000328:Adult; D000368:Aged; D001810:Blood Volume / Q000502:physiology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index