期刊
JOURNAL OF THE AMERICAN HEART ASSOCIATION
卷 10, 期 13, 页码 -出版社
WILEY
DOI: 10.1161/JAHA.120.020597
关键词
adenosine; dobutamine; fractional flow reserve; myocardial bridging; myocardial ischemia; stress-echocardiography
资金
- Ministry of Education, Sciences and Technological Development of Republic of Serbia [III41022]
The study found that the use of diastolic-FFR during dobutamine provocation is more reliable for assessing myocardial bridging compared to conventional FFR, providing better functional significance of MB in relation to stress-induced myocardial ischemia.
Background Functional assessment of myocardial bridging (MB) remains clinically challenging because of the dynamic nature of the extravascular coronary compression with a certain degree of intraluminal coronary reduction. The aim of our study was to assess performance and diagnostic value of diastolic-fractional flow reserve (d-FFR) during dobutamine provocation versus conventional-FFR during adenosine provocation with exercise-induced myocardial ischemia as reference. Methods and Results This prospective study includes 60 symptomatic patients (45 men, mean age 57 +/- 9 years) with MB on the left anterior descending artery and systolic compression >= 50% diameter stenosis. Patients were evaluated by exercise stress-echocardiography test, and both conventional-FFR and d-FFR in the distal segment of left anterior descending artery during intravenous infusion of adenosine (140 mu g/kg per minute) and dobutamine (10-50 mu g/kg per minute), separately. Exercise-stress-echocardiography test was positive for myocardial ischemia in 19/60 patients (32%). Conventional-FFR during adenosine and peak dobutamine had similar values (0.84 +/- 0.04 versus 0.84 +/- 0.06, P=0.852), but d-FFR during peak dobutamine was significantly lower than d-FFR during adenosine (0.76 +/- 0.08 versus 0.79 +/- 0.08, P=0.018). Diastolic-FFR during peak dobutamine was significantly lower in the exercise-stress-echocardiography test -positive group compared with the exercise- stress-echocardiography test -negative group (0.70 +/- 0.07 versus 0.79 +/- 0.06, P<0.001), but not during adenosine (0.79 +/- 0.07 versus 0.78 +/- 0.09, P=0.613). Among physiological indices, d-FFR during peak dobutamine was the only independent predictor of functionally significant MB (odds ratio, 0.870; 95% CI, 0.767-0.986, P=0.03). Receiver-operating characteristics curve analysis identifies the optimal d-FFR during peak dobutamine cut-off <= 0.76 (area under curve, 0.927; 95% CI, 0.833-1.000; P<0.001) with a sensitivity, specificity, and positive and negative predictive value of 95%, 95%, 90%, and 98%, respectively, for identifying MB associated with stress-induced ischemia. Conclusions Diastolic-FFR, but not conventional-FFR, during inotropic stimulation with high-dose dobutamine, in comparison to vasodilatation with adenosine, provides more reliable functional significance of MB in relation to stress-induced myocardial ischemia.
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