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Minerva Cardiology and Angiology 2021 August;69(4):449-57

DOI: 10.23736/S2724-5683.20.05354-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Contrast FFR plus intracoronary injection of nitro-glycerine accurately predicts FFR for coronary stenosis functional assessment

Alejandro GUTIÉRREZ-BARRIOS 1, 2 , Inmaculada NOVAL-MORILLAS 1, 2, Santiago CAMACHO-FREIRE 3, Juan E. PUCHE 1, Livia GHEORGHE 1, 2, Etelvino SILVA 3, Inara ALARCON-LASTRA 1, Dolores CAÑADAS-PRUAÑO 1, 2, Antonio GÓMEZ-MENCHERO 3, Germán CALLE-PÉREZ 1, 2, Jose F. DIAZ-FERNANDEZ 3, Rafael VÁZQUEZ-GARCÍA 1, 2

1 Department of Cardiology, Puerta del Mar University Hospital, Cádiz, Spain; 2 Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), Cádiz, Spain; 3 Department of Cardiology, Juan Ramón Jiménez Hospital, Huelva, Spain



BACKGROUND: Fractional flow reserve (FFR) is the “gold standard” for assessing the physiological significance of coronary disease. In the last decade, several alternative adenosine-free indexes have been proposed in order to facilitate the dissemination of the functional evaluation of coronary stenosis. Our aim was to investigate whether radiographic contrast plus intracoronary nitroglycerin (cFFR-NTG) can predict functional assessment of coronary stenosis offering superior diagnostic agreement with FFR compared to non-hyperemic indexes and contrast mediated FFR (cFFR).
METHODS: Three hundred twenty-nine lesions evaluated with pressure wire in 266 patients were prospectively included in this multicenter study.
RESULTS: The ROC curves for cFFR-NTG using an FFR≤0.80 showed a higher accuracy in predicting FFR (AUC=0.97) than resting Pd/Pa (AUC=0.90, P<0.01) and cFFR (AUC=0.93.5, P<0.01). A significant (P<0.01) strong correlation was found between FFR and the four analyzed indexes: Pd/Pa (r=0.78); iFR/RFR (r=0.73); cFFR(r=0.89) and cFFR-NTG (r=0.93). cFFR-NTG showed the closest agreement at Bland-Altman analysis. The cFFR-NTG cut off value >0.84 showed the highest negative predictive value (88%), specificity (91%), sensitivity (94%) and accuracy (92%) of the studied indexes.
CONCLUSIONS: Submaximal hyperemic adenosine-free indexes are an efficient alternative to adenosine for the physiological assessment of epicardial coronary disease. The most accurate index in predicting the functional significance of coronary stenosis using FFR as reference was cFFR-NTG.


KEY WORDS: Coronary artery disease; Fractional flow reserve, myocardial; Percutaneous coronary intervention

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