title: Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio, and non-invasive coronary flow reserve.
abstract: To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50-70 % diameter stenosis), were prospectively studied. IFR was calculated as a trans-lesion pressure ratio during the wave-free period in diastole; FFR as distal pressure divided by mean aortic pressure during maximal hyperemia (using 180 μg intracoronary adenosine); and CFR as hyperemic peak LAD flow velocity divided by baseline flow velocity using intravenous adenosine (140 μg/kg/min over 2 min). The mean values of IFR, FFR, and CFR were 0.88 ± 0.07, 0.81 ± 0.09, and 2.4 ± 0.6 respectively. A significant correlation was found between CFR and FFR (r = 0. 68), FFR and IFR (r = 0.6), and between CFR and IFR (r = 0.5) (all, p < 0.01). Using a ROC curve analysis, the best cut-off to detect a significant lesion based on FFR assessment (FFR ≤ 0.8, n = 31) was IFR ≤ 0.88 with a sensitivity (Se) of 74 %, specificity (Sp) of 73 %, AUC 0.81 ± 0.04, accuracy 72 %; and CFR ≤ 2 with a Se = 77 %, Sp = 89 %, AUC 0.88 ± 0.04, accuracy 85 % (all, p < 0.001). In stable patients with LAD stenosis of IS, non-invasive CFR is a useful tool to detect a significant lesion based on FFR. Furthermore, there was a better correlation between CFR and FFR than between CFR and IFR, and a trend to a better diagnostic performance for CFR versus IFR.
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France. patrickmeimoun.md@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Meimoun
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: J
authors.initials: J
authors.lastname: Clerc
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: D
authors.initials: D
authors.lastname: Ardourel
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: U
authors.initials: U
authors.lastname: Djou
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: S
authors.initials: S
authors.lastname: Martis
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: T
authors.initials: T
authors.lastname: Botoro
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: F
authors.initials: F
authors.lastname: Elmkies
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: H
authors.initials: H
authors.lastname: Zemir
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: A
authors.initials: A
authors.lastname: Luycx-Bore
authors.affiliation: Department of Cardiology, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France.
authors.forename: J
authors.initials: J
authors.lastname: Boulanger
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015150:Echocardiography, Doppler; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted
keywords: Coronary flow reserve; Fractional flow reserve; Instantaneous wave-free ratio; Intermediate coronary stenosis