Prevalence of myocardial perfusion scintigraphy derived ischemia in coronary lesions with discordant fractional flow reserve and non-hyperemic pressure ratios. (15th June 2022)

• Record Type: Journal Article
• Authors: Higashioka, Daisuke; Shiono, Yasutsugu; Emori, Hiroki; Khalifa, Amir Kh.M.; Takahata, Masahiro; Wada, Teruaki; Fujita, Suwako; Kashiwagi, Manabu; Shimamura, Kunihiro; Kuroi, Akio; Tanimoto, Takashi; Kubo, Takashi; Akasaka, Takashi; Tanaka, Atsushi
• Is Part Of: International journal of cardiology. Volume 357(2022)
• Page Start: 20
• Page End: 25
• Publication Date: 2022-06-15
• Subjects: Myocardial perfusion scintigraphy -- Fractional flow reserve -- Non-hyperemic pressure ratio -- Instantaneous wave-free ratio; dPR diastolic pressure ratio -- FFR fractional flow reserve -- iFR instantaneous wave-free ratio -- MPS myocardial perfusion scintigraphy -- NHPR non-hyperemic pressure ratio -- RFR resting full-cycle ratio -- SDS summed difference score -- SSS summed stress score -- SRS summed rest score -- 201Tl thallium-201; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.02.031
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Whether a coronary lesion with discordant fractional flow reserve (FFR) and non-hyperemic pressure ratios (NHPRs) causes myocardial ischemia remains unclear. This study investigates the prevalence of myocardial ischemia as assessed by myocardial perfusion scintigraphy (MPS) in coronary lesions with discordant FFR and instantaneous wave-free ratio (iFR), and, additionally, other NHPRs: resting full-cycle ratio (RFR), diastolic pressure ratio (dPR), and resting Pd/Pa. Methods: A total of 484 coronary arteries in 295 patients with stable coronary artery disease that underwent MPS and invasive physiological pressure measurements were categorized into four groups (FFR+/NHPR+, FFR+/NHPR-, FFR-/NHPR+, and FFR-/NHPR-) using the respective cut-off values of FFR ≤ 0.80, iFR ≤ 0.89, RFR ≤ 0.89, dPR < 0.89, and Pd/Pa ≤ 0.92. The proportions of MPS-derived myocardial ischemia in a relevant myocardial territory were compared between the four groups. Results: In total, 175 (36%), 61(13%), 35(7%) and 213(44%) vessels were classified into FFR+/iFR+, FFR+/iFR-, FFR-/iFR+ and FFR-/iFR- groups, respectively. The FFR+/iFR+ group had the highest proportion of MPS-derived ischemia (70%), followed by the FFR+/iFR- group (38%), the FFR-/iFR+ group (23%), and the FFR-/iFR- group (10%) ( P < 0.001). Similar proportions of MPS-derived ischemia were found when RFR. (70%, 34%, 24%, and 10%, P < 0.001), dPR (70%, 38%, 26%, and 10%, P < 0.001), and Pd/Pa (70%, 31%, 22%, and 10%, P < 0.001) were used in place of iFR. Conclusions: The prevalence of MPS-derived myocardial ischemia in coronary lesions with discordance between FFR and NHPRs is lower than those with concordantly positive FFR and NHPRs, but higher than those with concordantly negative FFR and NHPRs. Highlights: FFR and NHPR individually agree well with ischemia on myocardial perfusion imaging. Highest prevalence of ischemia was found when FFR and NHPR were concordantly positive. Prevalence of ischemia was the lowest when FFR and NHPR were concordantly negative. Discordant FFR and NHPR were associated with intermediate prevalence of ischemia. Similar trends were seen in the prevalence of myocardial ischemia whether MVD or SVD.