Importance of guiding catheter disengagement during measurement of fractional flow reserve in patients with an isolated proximal left anterior descending artery stenosis. Issue 4 (25th June 2014)

• Record Type: Journal Article
• Authors: Aminian, Adel; Dolatabadi, Dariouch; Lefebvre, Pascal; Khalil, Georges; Zimmerman, Robert; Michalakis, Georges; Lalmand, Jacques
• Is Part Of: Catheterization and cardiovascular interventions. Volume 85:Issue 4(2015:Mar. 01)
• Page Start: 595
• Page End: 601
• Publication Date: 2014-06-25
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25568
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25568-sec-0001" sec-type="section"> <title>Objective</title> <p>To determine the impact of ostial guiding catheter disengagement during measurement of fractional flow reserve (FFR) in patients with an isolated proximal left anterior descending artery (LAD) stenosis.</p> </sec> <sec id="ccd25568-sec-0002" sec-type="section"> <title>Methods</title> <p>Measurements of FFR were performed in 21 patients with an isolated intermediate lesion of the proximal LAD. Proximal aortic pressure (Pa), distal post stenotic pressure (Pd), and Pd/Pa were recorded at baseline, after at least 90 sec of intravenous (IV) adenosine infusion with the guiding catheter still engaged in the coronary ostium (Pa<sub>1</sub>, Pd<sub>1</sub>, FFR<sub>eng</sub>), and after at least 30 sec of guiding catheter disengagement back to the aorta (Pa<sub>2</sub>, Pd<sub>2</sub>, FFR<sub>dis</sub>).</p> </sec> <sec id="ccd25568-sec-0003" sec-type="section"> <title>Results</title> <p>The average value of Pd/Pa at baseline was 0.92 ± 0.04. After 110 ± 8 sec of IV adenosine infusion, FFR<sub>eng</sub> was 0.81 ± 0.07, which decreased to 0.77 ± 0.08 (FFR<sub>dis</sub>) after 38 ± 6 sec of guiding catheter disengagement. The mean Δ<sub>FFR</sub> (FFR<sub>eng</sub> − FFR<sub>dis</sub>) was 0.05 ± 0.04. As compared to baseline values, the mean change in FFR values was significantly increased after disengagement of the guiding catheter (Pd/Pa<sub>baseline</sub> − FFR<sub>dis</sub> vs. Pd/Pa<sub>baseline</sub> − FFR<sub>eng</sub>, 0.15 ± 0.05 vs. 0.10 ± 0.04, <italic>P</italic> < 0.0001). Before guiding catheter disengagement, eight patients (38%) had an FFR value ≤ 0.8. Following disengagement of the guiding catheter, the new FFR values decreased below 0.8 in six additional patients (28%), with subsequent change in treatment strategy.</p> </sec> <sec id="ccd25568-sec-0004" sec-type="section"> <title>Conclusions</title> <p>During FFR assessment of isolated intermediate proximal LAD lesions, guiding catheter disengagement is associated with a decrease in mean FFR values. In patients with FFR values lying close to the treatment threshold, this can have an impact on treatment strategy. © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>