title: Variability of fractional flow reserve according to the methods of hyperemia induction.
abstract: OBJECTIVE
  We performed this study to evaluate the variability of fractional flow reserve (FFR) values which were measured from various methods of hyperemia induction.
  
  
  BACKGROUND
  Concerns have been raised regarding the variability of FFR due to different routes for hyperemic agent administration and different hyperemic agents targeting different receptors to induce maximal hyperemia.
  
  
  METHODS
  A total of 656 intermediate coronary lesions from 628 patients with coronary artery disease were analyzed. Among them, 238 lesions underwent FFR measurement with hyperemia induced by both intravenous (IV) and intracoronary (IC) adenosine administration, 318 by IV adenosine/adenosine triphosphate (ATP) and IC nicorandil injection, and 100 by IV adenosine and regadenoson infusion.
  
  
  RESULTS
  Excellent correlation and close classification agreement (FFR ≤ 0.80) were observed between IV vs. IC adenosine (r = 0.980, CA = 92.9%, Cohen's Kappa = 0.887, P < 0.001), between IV adenosine/ATP vs. IC nicorandil (r = 0.962, CA = 91.2%, Cohen's Kappa = 0.817, P < 0.001), and between IV adenosine vs. regadenoson (r = 0.990, CA = 100%, Cohen's Kappa = 1.000, P < 0.001). When changes in blood pressure (ΔBP) or heart rate (ΔHR) were compared with changes in FFR (ΔFFR) between IV adenosine/ATP and IC nicorandil administration, there were no significant correlations between ΔBP and ΔFFR nor between ΔHR and ΔFFR (r = -0.122, P = 0.076; r = 0.036, P = 0.605, respectively).
  
  
  CONCLUSIONS
  This study suggests that the measurement of FFR is reproducible regardless of the hemodynamic changes, hyperemic agents used, or the route of administration.
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Woo-Hyun
authors.initials: WH
authors.lastname: Lim
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.forename: Chang-Wook
authors.initials: CW
authors.lastname: Nam
authors.forename: Joon-Hyung
authors.initials: JH
authors.lastname: Doh
authors.forename: Jin Joo
authors.initials: JJ
authors.lastname: Park
authors.forename: Han-Mo
authors.initials: HM
authors.lastname: Yang
authors.forename: Kyung Woo
authors.initials: KW
authors.lastname: Park
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takashima
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Waseda
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
authors.forename: Daiki
authors.initials: D
authors.lastname: Kato
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Kurita
authors.forename: Maki
authors.initials: M
authors.lastname: Oi
authors.forename: Mamoru
authors.initials: M
authors.lastname: Toyofuku
authors.forename: Lokien
authors.initials: L
authors.lastname: van Nunen
authors.forename: Nico H J
authors.initials: NH
authors.lastname: Pijls
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006940:Hyperemia / Q000139:chemically induced* / Q000503:physiopathology*; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D020108:Nicorandil / Q000008:administration & dosage; D011687:Purines / Q000008:administration & dosage; D011720:Pyrazoles / Q000008:administration & dosage; D011859:Radiography; D015203:Reproducibility of Results; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D011687:Purines; D011720:Pyrazoles; D014665:Vasodilator Agents; D020108:Nicorandil; C430916:regadenoson; D000241:Adenosine
keywords: fractional flow reserve; hyperemia; variability