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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group UK
2022
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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. |
format | Online Article Text |
id | pubmed-9440099 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
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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