TY - JOUR
T1 - Respiration-related variations in Pd/Pa ratio and fractional flow reserve in resting conditions and during intravenous adenosine administration
AU - Feenstra, Rutger G. T.
AU - van Lavieren, Martijn A.
AU - Echavarria-Pinto, Mauro
AU - Wijntjens, Gilbert W.
AU - Stegehuis, Valerie E.
AU - Meuwissen, Martijn
AU - de Winter, Robbert J.
AU - Beijk, Marcel A. M.
AU - Lerman, Amir
AU - Escaned, Javier
AU - Piek, Jan J.
AU - van de Hoef, Tim P.
N1 - Funding Information: The ADVISE II study was funded by Volcano Corporation. The sponsor of the study had no role in the study design, data acquisition, data analysis or writing of the manuscript. All original data analyses were independently performed by the core laboratory (Cardialysis), and the currently data analyses were performed by the authors. Publisher Copyright: © 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.
PY - 2022/2/15
Y1 - 2022/2/15
N2 - Aims: We evaluated the occurrence and physiology of respiration-related beat-to-beat variations in resting Pd/Pa and FFR during intravenous adenosine administration, and its impact on clinical decision-making. Methods and Results: Coronary pressure tracings in rest and at plateau hyperemia were analyzed in a total of 39 stenosis from 37 patients, and respiratory rate was calculated with ECG-derived respiration (EDR) in 26 stenoses from 26 patients. Beat-to-beat variations in FFR occurred in a cyclical fashion and were strongly correlated with respiratory rate (R2 = 0.757, p < 0.001). There was no correlation between respiratory rate and variations in resting Pd/Pa. When single-beat averages were used to calculate FFR, mean ΔFFR was 0.04 ± 0.02. With averaging of FFR over three or five cardiac cycles, mean ΔFFR decreased to 0.02 ± 0.02, and 0.01 ± 0.01, respectively. Using a FFR ≤ 0.80 threshold, stenosis classification changed in 20.5% (8/39), 12.8% (5/39) and 5.1% (2/39) for single-beat, three-beat and five-beat averaged FFR. The impact of respiration was more pronounced in patients with pulmonary disease (ΔFFR 0.05 ± 0.02 vs 0.03 ± 0.02, p = 0.021). Conclusion: Beat-to-beat variations in FFR during plateau hyperemia related to respiration are common, of clinically relevant magnitude, and frequently lead FFR to cross treatment thresholds. A five-beat averaged FFR, overcomes clinically relevant impact of FFR variation.
AB - Aims: We evaluated the occurrence and physiology of respiration-related beat-to-beat variations in resting Pd/Pa and FFR during intravenous adenosine administration, and its impact on clinical decision-making. Methods and Results: Coronary pressure tracings in rest and at plateau hyperemia were analyzed in a total of 39 stenosis from 37 patients, and respiratory rate was calculated with ECG-derived respiration (EDR) in 26 stenoses from 26 patients. Beat-to-beat variations in FFR occurred in a cyclical fashion and were strongly correlated with respiratory rate (R2 = 0.757, p < 0.001). There was no correlation between respiratory rate and variations in resting Pd/Pa. When single-beat averages were used to calculate FFR, mean ΔFFR was 0.04 ± 0.02. With averaging of FFR over three or five cardiac cycles, mean ΔFFR decreased to 0.02 ± 0.02, and 0.01 ± 0.01, respectively. Using a FFR ≤ 0.80 threshold, stenosis classification changed in 20.5% (8/39), 12.8% (5/39) and 5.1% (2/39) for single-beat, three-beat and five-beat averaged FFR. The impact of respiration was more pronounced in patients with pulmonary disease (ΔFFR 0.05 ± 0.02 vs 0.03 ± 0.02, p = 0.021). Conclusion: Beat-to-beat variations in FFR during plateau hyperemia related to respiration are common, of clinically relevant magnitude, and frequently lead FFR to cross treatment thresholds. A five-beat averaged FFR, overcomes clinically relevant impact of FFR variation.
KW - clinical research
KW - fractional flow reserve
KW - stable angina
UR - http://www.scopus.com/inward/record.url?scp=85119134641&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ccd.30012
DO - https://doi.org/10.1002/ccd.30012
M3 - Article
C2 - 34766734
SN - 1522-1946
VL - 99
SP - 844
EP - 852
JO - Catheterization and cardiovascular interventions
JF - Catheterization and cardiovascular interventions
IS - 3
ER -