Effective Radiation Dose, Time, and Contrast Medium to Measure Fractional Flow Reserve

• Published in: JACC. Cardiovascular interventions Vol. 3; no. 8; pp. 821 - 827
• Main Authors: Ntalianis, Argyrios, MD, PhD, Trana, Catalina, MD, Muller, Olivier, MD, PhD, Mangiacapra, Fabio, MD, Peace, Aaron, MD, PhD, De Backer, Carina, RN, De Block, Liesbeth, RN, Wyffels, Eric, MD, Bartunek, Jozef, MD, PhD, Vanderheyden, Marc, MD, Heyse, Alex, MD, Van Durme, Frederic, MD, Van Driessche, Luc, MD, De Jans, Jo, RN, Heyndrickx, Guy R., MD, PhD, Wijns, William, MD, PhD, Barbato, Emanuele, MD, PhD, De Bruyne, Bernard, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2010
• Subjects: Adenosine; Aged; Belgium; Cardiovascular; Contrast Media; contrast medium; Coronary Angiography; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Female; fractional flow reserve; Fractional Flow Reserve, Myocardial; Humans; Hyperemia - diagnostic imaging; Hyperemia - physiopathology; Male; Middle Aged; Predictive Value of Tests; radiation; Radiation Dosage; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Vasodilator Agents; percutaneous coronary intervention; FFR; contrast medium; radiation; PCI; coronary angiography; fractional flow reserve
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2010.06.006

Objectives This study sought to define the additional effective radiation dose, procedural time, and contrast medium needed to obtain fractional flow reserve (FFR) measurements after a diagnostic coronary angiogram. Background The FFR measurements performed at the end of a diagnostic angiogram allow the obtaining of functional information that complements the anatomic findings. Methods In 200 patients (mean age 66 ± 10 years) undergoing diagnostic coronary angiography, FFR was measured in at least 1 intermediate coronary artery stenosis. Hyperemia was achieved by intracoronary (n = 180) or intravenous (n = 20) adenosine. The radiation dose (mSv), procedural time (min), and contrast medium (ml) needed for diagnostic angiography and FFR were recorded. Results A total of 296 stenoses (1.5 ± 0.7 stenoses per patient) were assessed. The additional mean radiation dose, procedural time, and contrast medium needed to obtain FFR expressed as a percentage of the entire procedure were 30 ± 16% (median 4 mSv, range 2.4 to 6.7 mSv), 26 ± 13% (median 9 min, range 7 to 13 min), and 31 ± 16% (median 50 ml, range 30 to 90 ml), respectively. The radiation dose and contrast medium during FFR were similar after intravenous and intracoronary adenosine, though the procedural time was slightly longer with intravenous adenosine (median 11 min, range 10 to 17 min, p = 0.04) than with intracoronary adenosine (median 9 min, range 7 to 13 min). When FFR was measured in 3 or more lesions, radiation dose, procedural time, and contrast medium increased. Conclusions The additional radiation dose, procedural time, and contrast medium to obtain FFR measurement are low as compared to other cardiovascular imaging modalities. Therefore, the combination of diagnostic angiography and FFR measurements is warranted to provide simultaneously anatomic and functional information in patients with coronary artery disease.