Feature | March 27, 2012

Study Shows Significant Mismatch Between Angiography, FFR Evaluation

The hemodynamic flow effect of a plaque rupture, as detected by FFR.

March 24, 2012 Coronary angiography is unable to accurately predict the severity of vessel narrowing, suggesting fractional flow reserve (FFR) functional tests should be added to help determine if a patient needs revascularization. This was according to research presented from the IRIS FFR-DEFER trial at the American College of Cardiology's (ACC) 61st Annual Scientific Session this week in Chicago. 

Seeking to improve physicians’ decision-making process when determining if a patient needs revascularization, a South Korean research team compared two different methods of evaluating arterial narrowing: coronary angiography and FFR. Currently, coronary angiography is commonly used to determine the need for revascularization, while FFR is included in practice guidelines but less frequently utilized. FFR uses an catheter probe to measure the level of blood flow before and after a stenotic lesion to determine how much the narrowing is affecting arterial function.

Specifically, the team wanted to determine why there is often a discrepancy, called a “visual-functional mismatch,” between the findings of these tests when performed on the same vessel.

“There are often notable discrepancies between the angiographic diameter stenosis and the physiologic significance of the lesion,” said lead investigator Seung-Jung Park, M.D., Ph.D., professor of medicine at Asan Medical Center in Seoul, South Korea. 

“We conducted the study to provide a comprehensive understanding of the factors responsible for this ‘visual-functional mismatch,’ which we believed would be helpful to overcome interventionalists’ excessive preoccupation with using angiography to decide whether to treat or not to treat,” he said. 

The researchers enrolled 1,000 patients with 1,129 lesions between November 2009 and June 2011 at a single center in Seoul, South Korea. Sixty-three patients had left main coronary artery (LMCA) lesions (a more complex type of narrowing; number of lesions=63), while 937 patients had non-LMCA lesions (number of lesions=1,066). The researchers completed three tests on each lesion: coronary angiography, FFR and intravascular ultrasound. They then examined the occurrence of visual-functional mismatch and analyzed the factors that led to the discrepancies between coronary angiography and FFR. 

They found that among patients with non-LMCA (less complex) lesions, there were 605 lesions in which coronary angiography showed that the vessel had narrowed by more than 50 percent (suggesting that the heart may not be getting enough oxygen, a condition called “myocardial ischemia”). Of these lesions, 343 (57 percent) showed a FFR of greater than or equal to 0.80 (no more than a 20 percent reduction in blood flow, suggesting that ischemia was unlikely), resulting in a visual-functional mismatch. 

Conversely, among the 461 non-LMCA lesions with less than or equal to 50 percent vessel narrowing (suggesting that ischemia was unlikely), 75 (16 percent) had an FFR of less than 0.80 (more than a 20 percent reduction in blood flow, suggesting that ischemia was likely), resulting in a “reverse” visual-functional mismatch. 

In the LMCA group, mismatch was seen in 8 lesions (35 percent). Reverse mismatch was seen in 16 lesions (40 percent).  

Using statistical analysis and intravascular ultrasound (IVUS), the researchers determined several factors that were predictors of mismatch, including: older patient age (adjusted odds ratio [AOR] 1.04, p<0.001), non-left anterior descending artery location (AOR 3, p<0.001), the absence of plaque rupture (AOR 2.6, p=0.004), short lesion length (AOR 1.03, p<0.001), a large minimal lumen cross-sectional area (AOR 2, p=0.001), a smaller plaque burden (AOR 1.05, p<0.001) and a greater minimal lumen diameter (AOR 1.09, p=0.040). 

The predictors of reverse mismatch included younger age (AOR 1.04, p=0.003), left anterior descending artery location (AOR 5.4, p<0.001), the presence of plaque rupture (AOR 3.2, p=0.011), smaller minimal lumen cross-sectional area (AOR 2.9, p<0.001) and larger plaque burden (AOR 1.03, p=0.027). 

According to the researchers, the results showed that discrepancies between the two tests were caused by clinical and lesion-specific factors that are often unable to be identified from coronary angiography alone. They concluded that coronary angiography could not accurately predict the functional results of FFR and that FFR should be included in the assessment process before cardiac specialists make decisions about revascularization.

For more information: www.acc.org

Related Content

A patient-specific airway stents developed by Cleveland Clinic physician Tom Gildea, M.D. 

A patient-specific airway stents developed by Cleveland Clinic physician Tom Gildea, M.D. 

News | Computed Tomography (CT) | February 10, 2020
February 10, 2020 — The U.S.
This is a lung X-ray reviewed automatically by artificial intelligence (AI) to identify a collapsed lung (pneumothorax) in the color coded area. This AI app from Lunit is awaiting final FDA review and in planned to be integrated into several vendors' mobile digital radiography (DR) systems. Fujifilm showed this software integrated as a work-in-progress into its mobile X-ray system at RSNA 2019. GE Healthcare has its own version of this software for its mobile r=ray systems that gained FDA in 2019.   #RSNA #

This is a lung X-ray reviewed automatically by artificial intelligence (AI) to identify a collapsed lung (pneumothorax) in the color coded area. This AI app from Lunit is awaiting final FDA review and in planned to be integrated into several vendors' mobile digital radiography (DR) systems. Fujifilm showed this software integrated as a work-in-progress into its mobile X-ray system at RSNA 2019. GE Healthcare has its own version of this software for its mobile r=ray systems that gained FDA in 2019.

Feature | RSNA | January 20, 2020 | Dave Fornell, Editor
Here are images of some of the newest new medical imaging technologies displayed on the expo floor at the ...
The Alphenix Aero Package from Canon Medical Systems USA, Inc. enables OBLs and ASCs to attain premium technology at a flexible price point by tailoring Canon Medical’s Alphenix systems to fit their facilities’ needs.

The Alphenix Aero Package from Canon Medical Systems USA, Inc. enables OBLs and ASCs to attain premium technology at a flexible price point by tailoring Canon Medical’s Alphenix systems to fit their facilities’ needs.

Technology | Interventional Radiology | October 28, 2019
October 28, 2019 — Office based labs (OBLs) and ambulatory surgery centers (ASCs) require a fresh perspective from im
FDA Clears Turner Imaging Systems' Smart-C Mini C-arm
Technology | Mobile C-Arms | October 23, 2019
Advanced X-ray imaging systems developer Turner Imaging Systems announced the company has received U.S. Food and Drug...
Canon Medical Launches Alphenix Encore Plus Program
News | Angiography | October 09, 2019
In the complex and fast-paced world of healthcare, customers face the challenge of staying up-to-date with the most...
New ESC Guideline Provides Class 1 Recommendation for Coronary CTA
News | CT Angiography (CTA) | September 17, 2019
The European Society of Cardiology (ESC) published new guidelines on the diagnosis and management of chronic coronary...
The Artis icono biplane angiography system is designed for use in neurointerventions and interventional radiology

The Artis icono biplane angiography system is designed for use in neurointerventions and interventional radiology. Image courtesy of Siemens Healthineers.

Technology | Angiography | September 17, 2019
The U.S. Food and Drug Administration (FDA) has cleared the Artis icono, a high-precision family of angiography systems...
Jackson Memorial Hospital Holds Ribbon-cutting for New Cardiac Catheterization Labs
News | Angiography | August 21, 2019
Jackson Memorial Hospital in Miami celebrated the opening of two newly renovated cardiac catheterization suites during...
WVU Medicine Installs First Alphenix 4D CT in the U.S.
News | CT Angiography (CTA) | July 24, 2019
The West Virginia University (WVU) Heart and Vascular Institute is the first hospital in the country to acquire the...