Handgrip-enhanced myocardial fractional flow reserve for assessment of coronary artery stenoses - 17/08/11
, Socrates Korovesis, MD a, Evangelia Karvouni, MD a, Eleftherios Giazitzoglou, MD a, Ilias Karabinos, MD a, Efthalia Tzanalaridou, MSc a, Demosthenes Panagiotakos, PhD a, Michael M. Webb-Peploe, MD, FRCP bRiassunto |
Background |
Fractional flow reserve (FFR) may yield false-negative results in up to 12% of lesions tested, and there is a zone of uncertainty at borderline values.
Methods |
Forty-eight patients were investigated by means of dobutamine stress echocardiography (DSE), coronary angiography, and FFR assessment of 48 coronary lesions before, during, and immediately after handgrip exercise.
Results |
Mean FFR values were lower during and immediately after handgrip exercise as compared with baseline (0.86 ± 0.09 vs 0.87 ± 0.08 vs 0.88 ± 0.08, P < .05, respectively). The sensitivity of FFR ≤0.75 for predicting myocardial ischemia on DSE was 17.6% before handgrip exercise, 52.9% during, and 35.5% immediately after exercise. The specificity of FFR ≤0.75 before, during, and immediate after exercise was 100%, 93.5%, and 96.8%, respectively. In 10 patients, FFR values >0.75 before handgrip became ≤0.75 during or immediately after handgrip exercise (P = .01). All these patients had angina and/or DSE indicating ischemia in the territory of the vessel studied, and underwent coronary intervention. At 6 months follow-up, all patients were asymptomatic with negative DSE tests.
Conclusions |
The addition of handgrip exercise can significantly lower the FFR and potentially improve its ability to detect physiologically significant stenoses.
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Vol 151 - N° 5
P. 1107.e1-1107.e7 - Maggio 2006 Ritorno al numero
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