title: Myocardial Fractional Flow Reserve Measurement Using Contrast Media as a First-Line Assessment of Coronary Lesions in Current Practice.
abstract: Fractional flow reserve (FFR) measurement requires adenosine injection. However, adenosine can induce conductive and rhythmic complications, or be contraindicated in some patients. Contrast-induced hyperemia could provide a simple first-line method (contrast-enhanced FFR; cFFR) to assess coronary lesions. In this study we evaluated the accuracy of cFFR to predict lesion significance.
  
  
  
  This prospective study included 104 patients with 138 coronary lesions. Each stenosis was evaluated using resting distal coronary pressure to aortic pressure ratio (Pd/Pa) measurements using intracoronary iodixanol (cFFR) and adenosine (FFR) injection. An FFR value ≤ 0.8 defined a significant lesion.
  
  
  
  Dose-ranging analysis (n = 12 lesions) showed that 10 mL iodixanol was required to obtain the lowest cFFR value. Intermeasurement reproducibility of cFFR (n = 18 lesions) showed limited variability and small mean estimated bias (0.001 ± 0.014). Values of cFFR and FFR were highly correlated in a first series of n = 36 lesions (r = 0.9; P < 0.001). Receiver-operating characteristic curve analysis showed an excellent accuracy of cFFR cutoff value of ≤ 0.85 in predicting FFR value ≤ 0.80 (area under the curve, 0.94; 95% confidence interval, 0.90-0.98; sensitivity, 95%; specificity, 73%). This threshold was then tested prospectively in an independent cohort of n = 72 lesions. A cFFR value ≤ 0.85 correctly identified hemodynamically significant lesions with a sensitivity of 100%, specificity of 78%, positive predictive value of 78%, and negative predictive value of 100%.
  
  
  
  cFFR is reproducible and can be achieved with usual volumes of contrast. A cFFR threshold value of 0.85 provides excellent sensitivity and negative predictive value in coronary artery stenosis.
authors.affiliation: Cardiology Department, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Spagnoli
authors.affiliation: Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
authors.affiliation: Cardiology Department, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France.
authors.forename: Jean Guillaume
authors.initials: JG
authors.lastname: Dillinger
authors.affiliation: Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Veugeois
authors.affiliation: Cardiology Department, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.affiliation: Cardiology Department, Lariboisière Hospital, Assistance Publique Hôpitaux de Paris, Université Paris VII Denis Diderot, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.affiliation: Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.affiliation: Cardiology Department, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris, Université Paris XI Paris Sud, Clamart, France. Electronic address: prmslama@gmail.com.
authors.forename: Michel S
authors.initials: MS
authors.lastname: Slama
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D015992:Body Mass Index; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014283:Triiodobenzoic Acids / Q000008:administration & dosage
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C044834:iodixanol; D000241:Adenosine