Handgrip-enhanced myocardial fractional flow reserve for assessment of coronary artery stenoses

American Heart Journal
Demosthenes G KatritsisMichael M Webb-Peploe

Abstract

Fractional flow reserve (FFR) may yield false-negative results in up to 12% of lesions tested, and there is a zone of uncertainty at borderline values. Forty-eight patients were investigated by means of dobutamine stress echocardiography (DSE), coronary angiography, and FFR assessment of 48 coronary lesions before, during, and immediately after handgrip exercise. Mean FFR values were lower during and immediately after handgrip exercise as compared with baseline (0.86 +/- 0.09 vs 0.87 +/- 0.08 vs 0.88 +/- 0.08, P < .05, respectively). The sensitivity of FFR < or = 0.75 for predicting myocardial ischemia on DSE was 17.6% before handgrip exercise, 52.9% during, and 35.5% immediately after exercise. The specificity of FFR < or = 0.75 before, during, and immediate after exercise was 100%, 93.5%, and 96.8%, respectively. In 10 patients, FFR values > 0.75 before handgrip became < or = 0.75 during or immediately after handgrip exercise (P = .01). All these patients had angina and/or DSE indicating ischemia in the territory of the vessel studied, and underwent coronary intervention. At 6 months follow-up, all patients were asymptomatic with negative DSE tests. The addition of handgrip exercise can significantly lower the FFR and potenti...Continue Reading

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Citations

May 1, 2009·International Journal of Cardiology·Giuseppe DattiloSalvatore Patanè
Apr 2, 2009·International Journal of Cardiology·Giuseppe DattiloScipione Carerj
Sep 25, 2008·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Raed AqelAmi E Iskandrian
Sep 6, 2008·Journal of the American College of Cardiology·Demosthenes G Katritsis, Bernhard Meier

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