Fractional flow reserve in patients with prior myocardial infarction

Bernard de Bruyne, Nico H.J. Pijls, Jozef Bartunek, Kemal Kulecki, Jan Willem Bech, Hugo de Winter, Paul van Crombrugge, Guy R. Heyndrickx, William Wijns

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    273 Citations (Scopus)

    Abstract

    Background - Fractional flow reserve (FFR), an index of coronary stenosis severity, can be calculated from the ratio of hyperemic distal to proximal coronary pressure. An FFR value of 0.75 can distinguish patients with normal and abnormal noninvasive stress testing in case of normal left ventricular function. The present study aimed at investigating the value of FFR in patients with a prior myocardial infarction. Methods and Results - In 57 patients who had sustained a myocardial infarction ≥6 days earlier, myocardial perfusion single photon emission scintigraphy (SPECT) imaging and FFR were obtained before and after angioplasty. The sensitivity and specificity of the 0.75 value of FFR to detect flow maldistribution at SPECT imaging were 82% and 87%. The concordance between the FFR and SPECT imaging was 85% (P<0.001). When only truly positive and truly negative SPECT imaging were considered, the corresponding values were 87%, 100%, and 94% (P<0.001). Patients with positive SPECT imaging before angioplasty had a significantly lower FFR than patients with negative SPECT imaging (0.52±0.18 versus 0.67±0.16, P=0.0079) but a significantly higher left ventricular ejection fraction (63±10% versus 52±10%, P=0.0009) despite a similar degree of diameter stenosis (67±13% versus 68±16%, P=NS). A significant inverse correlation was found between LVEF and FFR (R=0.297, P=0.049). Conclusions - The present data indicate (1) that the 0.75 cutoff value of FFR to distinguish patients with positive from patients with negative SPECT imaging is valid after a myocardial infarction and (2) that for a similar degree of stenosis, the value of FFR depends on the mass of viable myocardium.

    Original languageEnglish
    Pages (from-to)157-162
    Number of pages6
    JournalCirculation
    Volume104
    Issue number2
    DOIs
    Publication statusPublished - 10 Jul 2001

    Keywords

    • Coronary disease
    • Infarction
    • Ischemia
    • Pressure
    • Scintigraphy

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