Post-occlusional hyperemia for fractional flow reserve assessment and pull-back curve analysis

Cardiovasc Interv Ther. 2020 Apr;35(2):142-149. doi: 10.1007/s12928-019-00579-9. Epub 2019 Feb 20.

Abstract

Balloon occlusion is a potential method for inducing hyperemia to measure post-percutaneous coronary intervention (PCI) fractional flow reserve (FFR). The objective of this study was to determine the clinical usefulness of post-occlusional hyperemia. FFRs measured using post-occlusional hyperemia caused by 30 (FFRoccl30) and 60 s (FFRoccl60) of balloon occlusion after PCI were compared in 60 lesions from 60 patients. The duration of hyperemia was also measured. There was a strong correlation between FFRoccl30 and FFRoccl60 (r = 0.969, p < 0.01). The duration of hyperemia was significantly longer with FFRoccl60 than with FFRoccl30 (68 ± 23 vs. 37 ± 15 s, p < 0.01). The time required for pullback curve analysis was around 45 s. However, in 7 (12%) cases, the duration of hyperemia with FFRoccl60 was < 45 s, which was not enough for pull-back curve analysis. To predict the duration of hyperemia with FFRoccl60 ≥ 45 s, the receiver operating characteristic curve analysis revealed a cut-off value of 25 s of hyperemia with FFRoccl30. FFRoccl30 is sufficient for diagnostic purposes. FFRoccl60 is suitable for pull-back curve analysis in select cases based on predictions made using the duration of hyperemia with FFRoccl30.

Keywords: Fractional flow reserve; Hyperemia; Percutaneous coronary intervention.

MeSH terms

  • Adenosine Triphosphate
  • Aged
  • Balloon Occlusion* / methods
  • Cardiac Catheterization
  • Coronary Stenosis / therapy*
  • Female
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Hyperemia*
  • Male
  • Percutaneous Coronary Intervention*
  • Prospective Studies
  • Time Factors

Substances

  • Adenosine Triphosphate