title: High left ventricular mass index does not limit the utility of fractional flow reserve for the physiologic assessment of lesion severity.
abstract: OBJECTIVE
  To demonstrate that fractional flow reserve (FFR) of vessels in patients with high left ventricular mass index (LVMI) should be similar to that of matched vessels in patients with normal LVMI.
  
  
  BACKGROUND
  FFR is a physiologic index of coronary lesion severity. It is not known whether FFR remains useful in the setting of increased LVMI, when microvascular abnormalities may be present.
  
  
  METHODS
  LVMI was calculated in 84 patients using contrast left ventriculography after validation with cardiac magnetic resonance imaging. Cardiac risk factors, LV ejection fraction (LVEF), minimal lumen diameter (MLD), percent diameter stenosis (%DS), lesion length and FFR were compared in 22 patients with high LVMI to 62 patients with normal LVMI and angiographically-matched vessels.
  
  
  RESULTS
  LVMI was 126 +/- 21 g/m2 in the high LVMI group and 84 +/- 21 g/m2 in the normal LVMI group. There were no differences in age, LVEF, diabetes, hypertension or dyslipidemia between groups. Angiographic lesion characteristics were well matched in patients with high versus normal LVMI (MLD 1.3 +/- 0.6 mm vs. 1.3 +/- 0.6 mm, %DS 61 +/- 13% vs. 62 +/- 13%, and lesion length 14.2 +/- 7.0 mm vs. 14.3 +/- 7.0 mm; p = NS for all). Importantly, no difference in FFR was observed (0.79 +/- 0.12 vs. 0.78 +/- 0.16; p = NS) between the groups, and LVMI did not correlate with FFR in a multivariate analysis.
  
  
  CONCLUSIONS
  FFR of coronary lesions in patients with high LVMI is no different than FFR of angiographically-matched lesions in patients with normal LVMI, suggesting that high LV mass should not limit the utility of FFR as an index of coronary lesion severity.
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Virginia Health Systems, Charlottesville, Virginia, USA.
authors.forename: Adnan K
authors.initials: AK
authors.lastname: Chhatriwalla
authors.forename: Michael
authors.initials: M
authors.lastname: Ragosta
authors.forename: Eric R
authors.initials: ER
authors.lastname: Powers
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Sarembock
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Gimple
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Fischer
authors.forename: Kurt G
authors.initials: KG
authors.lastname: Barringhaus
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Kramer
authors.forename: Habib
authors.initials: H
authors.lastname: Samady
mesh_terms: D001783:Blood Flow Velocity; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D015635:Radionuclide Ventriculography / Q000379:methods; D012016:Reference Values; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013318:Stroke Volume / Q000502:physiology