title: The Multi-center Evaluation of the Accuracy of the Contrast MEdium INduced Pd/Pa RaTiO in Predicting FFR (MEMENTO-FFR) Study.
abstract: OBJECTIVE
  Adenosine administration is needed for the achievement of maximal hyperaemia fractional flow reserve (FFR) assessment. The objective was to test the accuracy of Pd/Pa ratio registered during submaximal hyperaemia induced by non-ionic contrast medium (contrast FFR [cFFR]) in predicting FFR and comparing it to the performance of resting Pd/Pa in a collaborative registry of 926 patients enrolled in 10 hospitals from four European countries (Italy, Spain, France and Portugal).
  
  
  RESULTS
  Resting Pd/Pa, cFFR and FFR were measured in 1,026 coronary stenoses functionally evaluated using commercially available pressure wires. cFFR was obtained after intracoronary injection of contrast medium, while FFR was measured after administration of adenosine. Resting Pd/Pa and cFFR were significantly higher than FFR (0.93±0.05 vs. 0.87±0.08 vs. 0.84±0.08, p<0.001). A strong correlation and a close agreement at Bland-Altman analysis between cFFR and FFR were observed (r=0.90, p<0.001 and 95% CI of disagreement: from -0.042 to 0.11). ROC curve analysis showed an excellent accuracy (89%) of the cFFR cut-off of ≤0.85 in predicting an FFR value ≤0.80 (AUC 0.95 [95% CI: 0.94-0.96]), significantly better than that observed using resting Pd/Pa (AUC: 0.90, 95% CI: 0.88-0.91; p<0.001). A cFFR/FFR hybrid approach showed a significantly lower number of lesions requiring adenosine than a resting Pd/Pa/FFR hybrid approach (22% vs. 44%, p<0.0001).
  
  
  CONCLUSIONS
  cFFR is accurate in predicting the functional significance of coronary stenosis. This could allow limiting the use of adenosine to obtain FFR to a minority of stenoses with considerable savings of time and costs.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Roberto
authors.initials: R
authors.lastname: Martin-Reyes
authors.forename: Sergio B
authors.initials: SB
authors.lastname: Baptista
authors.forename: Nicolas
authors.initials: N
authors.lastname: Amabile
authors.forename: Luis
authors.initials: L
authors.lastname: Raposo
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Franco Pelaez
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Pio
authors.initials: P
authors.lastname: Cialdella
authors.forename: Eloisa
authors.initials: E
authors.lastname: Basile
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zimbardo
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Cristina
authors.initials: C
authors.lastname: Aurigemma
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Rebuzzi
authors.forename: Mariana
authors.initials: M
authors.lastname: Faustino
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Pedro F
authors.initials: PF
authors.lastname: Abreu
authors.forename: Michel S
authors.initials: MS
authors.lastname: Slama
authors.forename: Vincent
authors.initials: V
authors.lastname: Spagnoli
authors.forename: Miren
authors.initials: M
authors.lastname: Telleria Arrieta
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat Santos
authors.forename: Jose M
authors.initials: JM
authors.lastname: de la Torre Hernandez
authors.forename: Ramon
authors.initials: R
authors.lastname: Lopez Palop
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D003287:Contrast Media; D023921:Coronary Stenosis / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media