Respiration‐related variations in Pd/Pa ratio and fractional flow reserve in resting conditions and during intravenous adenosine administration. Issue 3 (12th November 2021)

• Record Type: Journal Article
• Authors: Feenstra, Rutger G. T.; van Lavieren, Martijn A.; Echavarria‐Pinto, Mauro; Wijntjens, Gilbert W.; Stegehuis, Valerie E.; Meuwissen, Martijn; de Winter, Robbert J.; Beijk, Marcel A.M.; Lerman, Amir; Escaned, Javier; Piek, Jan J.; van de Hoef, Tim P.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 99:Issue 3(2022)
• Page Start: 844
• Page End: 852
• Publication Date: 2021-11-12
• Subjects: clinical research -- fractional flow reserve -- stable angina; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.30012
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: 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 (R 2 = 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.