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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Fractional Flow Reserve of Infarct-Related Arteries Identifies Reversible Defects on Noninvasive Myocardial Perfusion Imaging Early After Myocardial Infarction

Habib Samady, MD, FACC ^{_* , _*} , Wolfgang Lepper, MD, Eric R. Powers, MD, FACC, Kevin Wei, MD, FACC^{||, 1} , Michael Ragosta, MD, FACC _^* , Gregory G. Bishop, MD, Ian J. Sarembock, MD, FACC, Lawrence Gimple, MD, FACC, Denny D. Watson, PhD, George A. Beller, MD, MACC and Kurt G. Barringhaus, MD^¶

^_* Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
University Hospital RWTH Aachen, Aachen, Germany
Cardiovascular Division, University of Virginia School of Medicine, Charlottesville, Virginia
Department of Radiology, University of Virginia School of Medicine, Charlottesville, Virginia
^|| Oregon Health and Science University, Portland, Oregon
^¶ Cardiovascular Division, University of Massachusetts Medical School, Worcester, Massachusetts

Manuscript received October 18, 2005; revised manuscript received January 5, 2006, accepted January 9, 2006.

^_* Reprint requests and correspondence: Dr. Habib Samady, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, Georgia 30322. (Email: hsamady{at}emory.edu).

OBJECTIVES: We hypothesized that fractional flow reserve (FFR) of an infarct-related artery (IRA) early after myocardial infarction (MI) identifies inducible ischemia on noninvasive imaging.

BACKGROUND: Early after MI, IRAs frequently have angiographically indeterminant lesions. Whether FFR can detect reversible perfusion defects early after MI when dynamic microvascular abnormalities are present is not known.

METHODS: Rest and dipyridamole (DP)-stress ^99mTc sestamibi single-photon emission computed tomography (SPECT) were performed in 48 patients 3.7 ± 1.3 days after MI, with 23 patients undergoing concurrent myocardial contrast echocardiography (MCE). Angiography, FFR, and percutaneous coronary intervention (PCI) of the IRA (as necessary) were subsequently performed. Follow-up SPECT was performed 11 weeks after PCI to identify true reversibility on baseline SPECT.

RESULTS: The sensitivity, specificity, positive and negative predictive value, and concordance of FFR 0.75 for detecting reversibility on SPECT were 88%, 50%, 68%, 89%, and 71% (chi-square <0.001), respectively; which improved to 88%, 93%, 88%, 93%, and 91% (chi-square <0.001), respectively, for the detection of true reversibility. The corresponding values of FFR 0.75 for detecting reversibility on DP-MCE were 90%, 100%, 100%, 75%, and 93% (chi-square <0.001), respectively, and on either SPECT or MCE were 88%, 93%, 91%, 91%, and 91% (chi-square <0.001), respectively. The optimal FFR value for discriminating inducible ischemia on noninvasive imaging was 0.78.

CONCLUSIONS: Fractional flow reserve of the IRA accurately identifies reversibility on noninvasive imaging early after MI. These findings support the utility of FFR early after MI.

Abbreviations and Acronyms   DP = dipyridamole   DS = diameter stenosis   FFR = fractional flow reserve   IRA = infarct-related artery   MCE = myocardial contrast echocardiography   MI = myocardial infarction   NPV = negative predictive value   NS = not specified   PCI = percutaneous coronary intervention   PI = pulsing intervals   PPV = positive predictive value   QCA = quantitative coronary angiography   SDS = segmental difference score   SPECT = single-photon emission computed tomography   SRS = segmental rest score   SSS = segmental stress score   STEMI = ST-segment elevation myocardial infarction   TnI = troponin I

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