CLINICAL STUDY
Fractional flow reserve, absolute and relative coronary blood flow velocity reserve in relation to the results of technetium-99m sestambi single-photon emission computed tomography in patients with two-vessel coronary artery disease
Steven A. J. Chamuleau, MD*,
Martijn Meuwissen, MD*,
Berthe L. F. van Eck-Smit, MD ,
Karel T. Koch, MD*,
Angelina de Jong, MSc*,
Robbert J. de Winter, MD*,
Carl E. Schotborgh, MD*,
Matthijs Bax, MD*,
Hein J. Verberne, MD,
Jan G. P. Tijssen, PhD* and
Jan J. Piek, MD*,1
* Department of Cardiology, Academic Medical Center of Amsterdam, Amsterdam, The Netherlands
Department of Nuclear Medicine, Academic Medical Center of Amsterdam, Amsterdam, The Netherlands
Manuscript received March 9, 2000;
revised manuscript received December 7, 2000,
accepted December 27, 2000.
Reprint requests and correspondence: Dr. J. J. Piek, Department of Cardiology, Room B2-108, Academic Medical Center Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
s.a.chamuleau{at}amc.uva.nl
OBJECTIVES
We sought to perform a direct comparison between perfusion scintigraphic results and intracoronary-derived hemodynamic variables (fractional flow reserve [FFR]; absolute and relative coronary flow velocity reserve [CFVR and rCFVR, respectively]) in patients with two-vessel disease.
BACKGROUND
There is limited information on the diagnostic accuracy of intracoronary-derived variables (CFVR, FFR and rCFVR) in patients with multivessel disease.
METHODS
Dipyridamole technetium-99m sestambi (MIBI) single-photon emission computed tomography (SPECT) was performed in 127 patients. The presence of reversible perfusion defects in the region of interest was determined. Within one week, angiography was performed; CFVR, rCFVR and FFR were determined in 161 coronary lesions after intracoronary administration of adenosine. The predictive value for the presence of reversible perfusion defects on MIBI SPECT of CFVR, rCFVR and FFR was evaluated by the area under the curve (AUC) of the receiver operating characteristics curves.
RESULTS
The mean percentage diameter stenosis was 57% (range 35% to 85%), as measured by quantitative coronary angiography. Using per-patient analysis, the AUCs for CFVR (0.70 ± 0.052), rCFVR (0.72 ± 0.051) and FFR (0.76 ± 0.050) were not significantly different (p = NS). The percentages of agreement with the results of MIBI SPECT were 76%, 78% and 77% for CFVR, rCFVR and FFR, respectively. Per-lesion analysis, using all 161 measured lesions, yielded similar results.
CONCLUSIONS
The diagnostic accuracy of three intracoronary-derived hemodynamic variables, as compared with the results of perfusion scintigraphy, is similar in patients with two-vessel coronary artery disease. Cut-off values of 2.0 for CFVR, 0.65 for rCFVR and 0.75 for FFR can be used for clinical decision-making in this patient cohort. Discordant results were obtained in 23% of the cases that require prospective evaluation for appropriate patient management.
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Abbreviations and Acronyms
| | AUC | = area under the curve | | CFVR and rCFVR | = coronary flow velocity reserve and relative coronary flow velocity reserve, respectively | | FFR | = fractional flow reserve | | LAD | = left anterior descending coronary artery | | LCx | = left circumflex coronary artery | | MIBI | = technetium-99m labeled sestambi | | RCA | = right coronary artery | | ROC | = receiver operating characteristics | | SPECT | = single-photon emission computed tomography |
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