Combined Assessment of Fractional Flow Reserve and Coronary Flow Velocity Reserve after Drug-Eluting Stent Implantation - 02/04/24
Abstract |
Background |
Coronary flow velocity reserve (CFVR) can be measured noninvasively using stress transthoracic Doppler echocardiography (S-TDE). The prognostic significance of S-TDE-derived CFVR after percutaneous coronary intervention (PCI) remains unknown. The aim of this study was to investigate the prognostic value of post-PCI CFVR and its additional efficacy to fractional flow reserve (FFR) in patients undergoing elective PCI.
Methods |
A retrospective study was conducted involving 187 consecutive patients with chronic coronary syndrome who underwent elective PCI guided by FFR for the left anterior descending coronary artery. Pre- and post-PCI wire-based FFR and CFVR assessments of the left anterior descending coronary artery using S-TDE were performed in all patients. The association between post-PCI clinical and physiologic parameters and major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, heart failure, and unplanned remote target vessel revascularization, was evaluated.
Results |
Three-quarters of patients exhibited CFVR increase after PCI, while all patients showed FFR improvement. During a median follow-up period of 1.5 years, MACE occurred in 21 patients (11.2%). Among clinical demographics, patients with MACE had higher levels of N-terminal pro–brain natriuretic peptide compared with those without MACE (median, 615 pg/mL [interquartile range, 245-1,500 pg/mL] vs 180 pg/mL [interquartile range, 70-559 pg/mL]; P = .010). Post-PCI S-TDE-derived CFVR was lower in patients with MACE, while post-PCI FFR showed a nonsignificant tendency to be lower in patients with MACE. In a multivariable analysis, higher NT-proBNP (adjusted hazard ratio, 1.33; 95% CI, 1.02-1.74; P = .038), post-PCI CFVR ≤ 2.0 (adjusted hazard ratio, 2.93; 95% CI, 1.16-7.40; P = .023), and post-PCI FFR ≤ 0.82 (adjusted hazard ratio, 3.93; 95% CI, 1.52-10.18; P = .005) were independently associated with MACE.
Conclusions |
In patients with chronic coronary syndrome who underwent successful elective PCI for left anterior descending coronary artery, the combined assessment of S-TDE-derived post-PCI CFVR and post-PCI FFR provided a significant association with the occurrence of MACE.
Le texte complet de cet article est disponible en PDF.Central Illustration |
Kaplan-Meier curves showing MACE-free survival in two groups classified according to FFR and CFVR values. Kaplan-Meier curves showing survival from MACE comparing patients classified according to a post-PCI FFR value of 0.82 and a CFVR value of 2.0. ∗Significant difference exists between the two groups.
Le texte complet de cet article est disponible en PDF.Highlights |
• | CFVR increased in 75% of patients after PCI, while FFR increased in all patients. |
• | Post-PCI FFR and CFVR were both associated with patient outcomes. |
• | Post-PCI CFVR combined with post-PCI FFR may heighten MACE prediction relevance. |
Keywords : Chronic coronary syndrome, Percutaneous coronary intervention, Fractional flow reserve, Coronary flow velocity reserve, MACE
Abbreviations : CFR, CFVR, DES, FFR, LAD, MACE, NT-proBNP, PCI, S-TDE, TVF
Plan
Vol 37 - N° 4
P. 428-438 - avril 2024 Retour au numéro
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