Impact of Right Atrial Pressure on Fractional Flow Reserve Measurements: Comparison of Fractional Flow Reserve and Myocardial Fractional Flow Reserve in 1,600 Coronary Stenoses

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• 作者：Gabor G. Toth ; MD^a ; ^b ; Bernard De Bruyne ; MD ; PhD^a ; Dan Rusinaru ; MD^a ; ^c ; Giuseppe Di Gioia ; MD^a ; ^d ; Jozef Bartunek ; MD ; PhD^a ; Mariano Pellicano ; MD^a ; Marc Vanderheyden ; MD^a ; Julien Adjedj ; MD^a ; William Wijns ; MD ; PhD^a ; Nico H.J. Pijls ; MD ; PhD^e ; ^f ; Emanuele Barbato ; MD ; PhD^a ; ^d ; ^{emanuele.barbato@olvz-aalst.be" class="auth_mail" title="E-mail the corresponding author}
• 关键词：fractional flow reserve ; heart failure ; myocardial fractional flow reserve ; right atrial pressure
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：14 March 2016
• 年：2016
• 卷：9
• 期：5
• 页码：453-459
• 全文大小：894 K

文摘

This study sought to assess the impact of a wide range of mean right atrial pressure (P_ra) on fractional flow reserve (FFR) measurements.

Background

FFR invasively assesses the ischemic potential of coronary stenoses. FFR is calculated as the ratio of mean distal coronary pressure (P_d) to mean aortic pressure (P_a) during maximal hyperemia. The P_ra is considered to have little impact if it is within normal range, so it is neglected in the formula.

Methods

In 1,676 stenoses of 1,235 patients undergoing left-right heart catheterization for ischemic (642 [52%]) or valvular heart disease (593 [48%]), the authors compared the FFR values calculated without accounting for P_ra (FFR= P_d/P_a) to the corresponding myocardial fractional flow reserve (FFR_myo) values accounting for P_ra (FFR_myo = P_d − P_ra/P_a − P_ra).

Results

The median P_ra was 7 (interquartile range [IQR]: 5 to 10) mm Hg with a maximum of 27 mm Hg. The correlation and agreement between FFR and FFR_myo was excellent (R² = 0.987; slope 1.096 ± 0.003). The median FFR (0.85; IQR: 0.78 to 0.91) was slightly but statistically significantly higher than the median FFR_myo (0.83; IQR: 0.76 to 0.90; p < 0.001) with a median difference of 0.01 (IQR: 0.01 to 0.02). Values of FFR above the cutoff of 0.80 provided an FFR_myo ≤0.80 in 110 (9%) stenoses. No FFR value above 0.80 provided an FFR_myo ≤0.75.

Conclusions

The difference between FFR and FFR_myo was minimal even in patients with markedly increased P_ra. FFR values above the gray zone (i.e., >0.80) did not yield values below the gray zone (i.e., ≤0.75) in any case, which suggests that the impact of right atrial pressure on FFR measurement is indeed negligible.