Impact of hyperaemic microvascular resistance on fractional flow reserve measurements in patients with stable coronary artery disease: insights from combined stenosis and microvascular resistance assessment

Tim P. van de Hoef, Froukje Nolte, Mauro Echavarría-Pinto, Martijn A. van Lavieren, Peter Damman, Steven A. J. Chamuleau, Michiel Voskuil, Hein J. Verberne, José P. S. Henriques, Berthe L. F. van Eck-Smit, Karel T. Koch, Robbert J. de Winter, Jos A. E. Spaan, Maria Siebes, Jan G. P. Tijssen, Martijn Meuwissen, Jan J. Piek

Research output: Contribution to journalArticleAcademicpeer-review

91 Citations (Scopus)

Abstract

Fractional flow reserve (FFR) aims to identify the extent of epicardial disease, but may be obscured by involvement of the coronary microvasculature. We documented the impact of hyperaemic stenosis resistance (HSR) and hyperaemic microvascular resistance (HMR) on FFR, and its relationship with myocardial ischaemia in patients with stable coronary artery disease. We evaluated 255 coronary arteries with stenoses of intermediate severity by means of intracoronary pressure and flow measurements to determine FFR, HSR and HMR. Myocardial perfusion scintigraphy (MPS) was performed to identify inducible myocardial ischaemia. In 178 patients, HMR was additionally determined in a reference coronary artery. Target vessel HMR was stratified according to reference vessel HMR tertiles. The diagnostic OR for inducible ischaemia on MPS of a positive compared with a negative FFR was significantly higher only in the presence of a high HMR (at the 0.75 and 0.80 FFR cut-off). Among stenoses with a positive FFR, the prevalence of ischaemia was significantly higher when HMR was high despite equivalent FFR across the HMR groups. This was paralleled by a concomitant significant increase in HSR with increasing HMR across groups. The relation between FFR and HSR (r(2)=0.54, p <0.001) was modulated by the magnitude of HMR, and improved substantially after adjustment for HMR (adjusted-r(2)=0.73, p <0.001), where, for epicardial disease of equivalent severity, FFR increased with increasing HMR. Identification of epicardial disease severity by FFR is partly obscured by the microvascular resistance, which illustrates the necessity of combined pressure and flow measurements in daily practice
Original languageEnglish
Pages (from-to)951-959
JournalHeart (British Cardiac Society)
Volume100
Issue number12
DOIs
Publication statusPublished - 2014

Cite this