オオツキ ヒサオ   OOTSUKI Hisao
  大槻 尚男
   所属   医学部 医学科(東京女子医科大学病院)
   職種   特任助教
言語種別 英語
発表タイトル Predictors of "Visual-functional Mismatch" in Contemporary Practice -the Characteristics Associating With Mismatch Between Angiographic Stenosis and Hybrid IFR-FFR Strategy
会議名 AHA2016 (American Heart Associations Scientific Sessions 2016)
主催者 American Heart Associations
学会区分 国際学会及び海外の学会
発表形式 ポスター掲示
講演区分 一般
発表者・共同発表者◎MORIOKA Yuta, ARASHI Hiroyuki, YAMAGUCHI Junichi, KADOWAKI Hiromu, TANAKA Kazuki, ITANI Ryosuke, OOTSUKI Hisao, SHIMAZAKI Kensuke, HARUKI Shintaro, NAKAO Masashi, KAMISHIMA Kazuho, JUJO Kentaro, MINAMI Yuichiro, OGAWA Hiroshi, HAGIWARA Nobuhisa
発表年月日 2016/11/14
開催地
(都市, 国名)
New Orleans, USA
概要 Abstract

Background: A "hybrid Instantaneous wave-free ratio (IFR) and fractional flow reserve (FFR) strategy" are increasing to evaluate functional severity of coronary intermediate stenosis in clinical setting. Previous studies reported 35-40% of visual-functional mismatches were observed between coronary angiography (CAG) and FFR. We aimed to clarify the relation between angiographic severity and functional severity under hybrid IFR-FFR strategy.

Method and Results: We analyzed 252 patients (340 lesions) undergoing CAG and hybrid IFR-FFR evaluation. First, IFR was measured under resting flow. Relation between IFR and % diameter stenosis (DS) were shown in Figure 1. Additional FFR was examined under hyperemia in 105 lesions with IFR values between 0.86 to 0.93 that is called "adenosine zone". Figure 2 shows relation between additional FFR and %DS. After hybrid strategy, mismatches were observed in 148 lesions (43.5%, Table.1). Among total lesions, regular-mismatch was observed in 97 lesions (28.5%), whereas reverse-mismatch was seen in 51 lesions (15.0%). Angiographic significant stenosis seemed to be more reliable in patients with diabetes mellitus and lower glomerular filtration rate. Even when CAG indicated %DS ≤ 50%, younger age was associated with functional positive. Non-left anterior descending artery (LAD) lesions had a higher frequency of regular-mismatch (75.3%) than did LAD lesions (23.7%). Reverse-mismatches were identified in 48 (94.1%) LAD lesions but were scarce among non-LAD lesions (3 lesions, 5.9%).

Conclusion: Visual-functional mismatch was observed in hybrid IFR-FFR strategy too. Frequency of mismatch in hybrid strategy tended to be higher compared to previous studies between FFR and % DS. LAD and non-LAD with intermediate coronary artery stenosis had differing features between angiographic characteristics and hybrid IFR - FFR evaluation.