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The validation of fractional flow reserve in patients with coronary multivessel disease: a comparison with SPECT and contrast-enhanced dobutamine stress echocardiography

Die Validierung der Fraktionalen Flussreserve bei Patienten mit koronarer Mehrgefäßerkrankung: ein Vergleich mit SPECT und Dobutamin-Stressechokardiographie

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Zusammenfassung

Die Fraktionale Flussreserve (FFR) ist ein gut etablierter Parameter, um die hämodynamische Wertigkeit von Koronarstenosen einzuschätzen. Eine FFR unter 0,75 identifiziert bei koronarer Ein- und Zweigefäßerkrankung eine Läsion als funktionell relevant. Diese prospektive Studie wurde durchgeführt, um den besten Schwellenwert (BCV) der FFR bei Patienten mit einer Mehrgefäßerkrankung mit zwei nichtinvasiven Untersuchungsmethoden, der Myokardszintigraphie (SPECT) und der Dobutamin-Stressechokardiographie (DSE) als Referenzmethoden, zu ermitteln.

Methoden

47 symptomatische Patienten (29 männlich, mittleres Alter 64±10 Jahre) mit angiographisch mittelgradigen Koronarstenosen (50–75% Stenosediameter) wurden in die Studie eingeschlossen. DSE (5–40 μg/min/kg Dobutamin) wurde nach der intravenösen Injektion eines transpulmonalen Kontrastmittels durchgeführt (Optison, Amersham Health, Princeton, NJ, USA; Sonovue, Bracco Diagnostics Inc., Princeton, NJ, USA). SPECT (Tc-99m-MIBI) erfolgte unter maximaler Belastung. Alle Untersuchungen (DSE, SPECT und FFR) wurden innerhalb von 4 Wochen durchgeführt.

Ergebnisse

15 Patienten hatten positive Ergebnisse in der SPECT und entsprechend 16 Patienten in der DSE. Die mittlere FFR, gemessen im Zielgefäß (RCA n=10; LAD n=22, RCX n=15) war 0,80±0,13. Die FFR war <0,75 bei 15 Patienten. Eine ROC-Analyse ergab den BCV (größte Summe von Sensitivität und Spezifität) bei 0,75. Bei diesem Schwellenwert lagen Sensitivität und Spezifität mit beiden nicht invasiven Untersuchungen als Referenzmethode bei 83 und 77%.

Zusammenfassung

Auch bei Patienten mit Mehrgefäßerkrankung identifiziert eine FFR <0,75 im Vergleich mit der DSE und der SPECT eine hämodynamisch relevante Läsion. Diese Studie konnte zeigen, dass die vorbeschriebenen FFR-Kriterien auch bei Patienten mit komplexer koronarer Herzerkrankung anwendbar sind.

Summary

Fractional flow reserve (FFR) is a new but well established parameter for the hemodynamic evaluation of coronary stenoses. A FFR below 0.75 was validated as functionally significant in coronary one or two vessel disease. This study was designed to prospectively define the best FFR cut off value (BCV) in patients with multivessel disease using two noninvasive tests, myocardial perfusion scintigraphy (SPECT) and contrast-enhanced dobutamine stress echocardiography (DSE) as reference methods.

Methods

47 symptomatic patients (29 male, mean age 64±10 yrs) with angiographically intermediate coronary lesions (50–75% diameter stenosis) entered the study. DSE (5–40 μg/min/kg dobutamine) was performed after intravenous injection of a second generation transpulmonary contrast agent. SPECT (Tc-99m-MIBI) was done at peak stress. All tests (DSE, SPECT and FFR) were performed within 4 weeks.

Results

SPECT yielded positive results in 15 and DSE in 16 patients, respectively. Mean FFR measured in the target lesion (RCA n=10; LAD n=22, RCX n=15) was 0.80±0.13. FFR was <0.75 in 15 patients. By performing a ROC analysis the BCV (highest sum of sensitivity and specificity) was found at 0.75. At this cut off value using both non-invasive tests as reference method, sensitivity and specificity were 83 and 77%.

Conclusion

In patients with multivessel disease, a FFR <0.75 identifies a hemodynamically relevant lesion as compared to DSE and SPECT. This study underlines that FFR criteria are also applicable in patients with complex coronary artery disease.

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Authors and Affiliations

  1. Dept. of Cardiology, Medizinische Poliklinik—Innenstadt, University of Munich, Ziemssenstr. 1, 80336, Munich, Germany

    I. Erhard,  J. Rieber,  P. Jung,  T. Schiele,  H.-U. Stempfle,  A. König,  M. Baylacher,  K. Theisen &  V. Klauss

  2. Dept. of Nuclear Medicine, Medizinische Klinik, University of, Munich

    M. Hacker

  3. Harvard Center for Risk Analysis, Harvard School of Public Health Boston, MA Institute for Medical Informatics Biometry and Epidemiology, University of, Munich

    U. Siebert

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  1. I. Erhard
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  2. J. Rieber
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  5. T. Schiele
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  6. H.-U. Stempfle
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  7. A. König
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Correspondence to V. Klauss.

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Erhard, I., Rieber, J., Jung, P. et al. The validation of fractional flow reserve in patients with coronary multivessel disease: a comparison with SPECT and contrast-enhanced dobutamine stress echocardiography. ZS Kardiologie 94, 321–327 (2005). https://doi.org/10.1007/s00392-005-0213-6

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  • DOI: https://doi.org/10.1007/s00392-005-0213-6

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