Hemodynamic evaluation of coronary artery bypass graft lesions using fractional flow reserve

• Published in: Catheterization and cardiovascular interventions Vol. 72; no. 4; pp. 479 - 485
• Main Authors: Aqel, Raed, Zoghbi, Gilbert J., Hage, Fadi, Dell'Italia, Louis, Iskandrian, Ami E.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.10.2008
• Subjects: Aged; bypass grafts; Constriction, Pathologic; coronary; Coronary Angiography; Coronary Artery Bypass; coronary flow; Coronary Stenosis - pathology; Coronary Stenosis - physiopathology; Coronary Stenosis - surgery; Feasibility Studies; Fractional Flow Reserve, Myocardial; Hemodynamics; Humans; Male; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - pathology; Myocardial Ischemia - physiopathology; Myocardial Perfusion Imaging; Predictive Value of Tests; quantitative coronary angiography; Saphenous Vein - pathology; Saphenous Vein - physiopathology; Saphenous Vein - transplantation; Sensitivity and Specificity; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.21675

Background: Coronary angiography is limited by its inability to assess the hemodynamic significance of a coronary artery stenosis. The assessment of the physiological significance of saphenous vein graft (SVG) lesions with a pressure wire to determine the fractional flow reserve (FFR) is lacking. Methods: FFR was determined in 10 SVG lesions of 10 males who had stress myocardial perfusion imaging (MPI) prior to referral for percutaneous coronary intervention for clinical indications. Results: All SVGs had a diameter stenosis (DS) >50% and 30% had a DS ≥70%. A significant FFR was present in 30% of patients. Ischemia along the territory of the SVG was present in 20% of patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FFR <0.75 for the detection of ischemia on stress MPI were 50, 75, 33, 85, and 70%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FFR <0.75 for detecting ≥70% DS on angiography were 33, 71, 33, 71, and 60%, respectively. There was no significant correlation between FFR and % DS (R2 = 0.1, P = 0.35). Conclusion: The use of FFR to assess the physiological significance of SVG lesions is feasible and provides an acceptable specificity and negative predictive value compared to stress MPI. © 2008 Wiley‐Liss, Inc.