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Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch

Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical–functional m...

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Autores principales: Matsumoto, Hidenari, Masaki, Ryota, Higuchi, Satoshi, Tanaka, Hideaki, Kondo, Seita, Tsujita, Hiroaki, Shinke, Toshiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440099/
https://www.ncbi.nlm.nih.gov/pubmed/36056128
http://dx.doi.org/10.1038/s41598-022-19330-1
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author Matsumoto, Hidenari
Masaki, Ryota
Higuchi, Satoshi
Tanaka, Hideaki
Kondo, Seita
Tsujita, Hiroaki
Shinke, Toshiro
author_facet Matsumoto, Hidenari
Masaki, Ryota
Higuchi, Satoshi
Tanaka, Hideaki
Kondo, Seita
Tsujita, Hiroaki
Shinke, Toshiro
author_sort Matsumoto, Hidenari
collection PubMed
description Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical–functional mismatch) and its influence on reclassification of functional significance. Distal-to-aortic pressure ratio (Pd/Pa) was measured using adenosine (Pd/Pa(ADN)) and papaverine (Pd/Pa(PAP)) in 326 patients (326 vessels). The overestimation of FFR was calculated as Pd/Pa(ADN)–Pd/Pa(PAP). The anatomical–functional mismatch was defined as diameter stenosis > 50% and Pd/Pa(ADN) > 0.80. Reclassification was indicated by Pd/Pa(ADN) > 0.80 and Pd/Pa(PAP) ≤ 0.80. The mismatch (n = 72) had a greater overestimation of FFR than the non-mismatch (n = 99): median 0.02 (interquartile range 0.01–0.05) versus 0.01 (0.00–0.04), p = 0.014. Multivariable analysis identified the overestimation of FFR (p = 0.003), minimal luminal diameter (p = 0.001), and non-left anterior descending artery (LAD) location (p < 0.001) as determinants of the mismatch. Reclassification was indicated in 29% of the mismatch and was more frequent in the LAD than in the non-LAD (52% vs. 20%, p = 0.005). The overestimation of FFR is an independent determinant of anatomical−functional mismatch. Anatomical−functional mismatch, specifically in the LAD, may suggest a false-negative result.
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spelling pubmed-94400992022-09-04 Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch Matsumoto, Hidenari Masaki, Ryota Higuchi, Satoshi Tanaka, Hideaki Kondo, Seita Tsujita, Hiroaki Shinke, Toshiro Sci Rep Article Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical–functional mismatch) and its influence on reclassification of functional significance. Distal-to-aortic pressure ratio (Pd/Pa) was measured using adenosine (Pd/Pa(ADN)) and papaverine (Pd/Pa(PAP)) in 326 patients (326 vessels). The overestimation of FFR was calculated as Pd/Pa(ADN)–Pd/Pa(PAP). The anatomical–functional mismatch was defined as diameter stenosis > 50% and Pd/Pa(ADN) > 0.80. Reclassification was indicated by Pd/Pa(ADN) > 0.80 and Pd/Pa(PAP) ≤ 0.80. The mismatch (n = 72) had a greater overestimation of FFR than the non-mismatch (n = 99): median 0.02 (interquartile range 0.01–0.05) versus 0.01 (0.00–0.04), p = 0.014. Multivariable analysis identified the overestimation of FFR (p = 0.003), minimal luminal diameter (p = 0.001), and non-left anterior descending artery (LAD) location (p < 0.001) as determinants of the mismatch. Reclassification was indicated in 29% of the mismatch and was more frequent in the LAD than in the non-LAD (52% vs. 20%, p = 0.005). The overestimation of FFR is an independent determinant of anatomical−functional mismatch. Anatomical−functional mismatch, specifically in the LAD, may suggest a false-negative result. Nature Publishing Group UK 2022-09-02 /pmc/articles/PMC9440099/ /pubmed/36056128 http://dx.doi.org/10.1038/s41598-022-19330-1 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Matsumoto, Hidenari
Masaki, Ryota
Higuchi, Satoshi
Tanaka, Hideaki
Kondo, Seita
Tsujita, Hiroaki
Shinke, Toshiro
Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch
title Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch
title_full Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch
title_fullStr Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch
title_full_unstemmed Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch
title_short Impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch
title_sort impact of overestimation of fractional flow reserve by adenosine on anatomical–functional mismatch
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440099/
https://www.ncbi.nlm.nih.gov/pubmed/36056128
http://dx.doi.org/10.1038/s41598-022-19330-1
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