Key result
FFR overestimation by adenosine vs papaverine is linked to ~16% higher anatomical-functional mismatch per 0.01 increase.
Why the study?
Adenosine occasionally overestimates FFR compared with other hyperemic stimuli, but its association with anatomical-functional mismatch and impact on reclassification remained unclear.
Does overestimation of FFR by adenosine cause anatomical-functional mismatch and reclassification of functional significance compared to papaverine in patients with chronic coronary syndrome?
Observational (n=326)
No
Does overestimation of FFR by adenosine cause anatomical-functional mismatch and reclassification of functional significance compared to papaverine in patients with chronic coronary syndrome?
Overestimation of FFR by adenosine is an independent determinant of anatomical-functional mismatch, and using papaverine reclassifies functional significance in nearly 30% of these mismatched lesions, particularly in the LAD.
Answers are grounded in this paper and cite their sources.
Adenosine FFR overestimation was associated with mismatch; leaves open whether papaverine improves reclassification accuracy in chronic coronary syndrome.
Adenosine occasionally results in overestimation of fractional flow reserve (FFR) values, compared with other hyperemic stimuli. We aimed to elucidate the association of overestimation of FFR by adenosine with anatomically significant but functionally non-significant lesions (anatomical–functional mismatch) and its influence on reclassification of functional significance. Distal-to-aortic pressure ratio (Pd/Pa) was measured using adenosine (Pd/Pa ADN ) and papaverine (Pd/Pa PAP ) in 326 patients (326 vessels). The overestimation of FFR was calculated as Pd/Pa ADN –Pd/Pa PAP . The anatomical–functional mismatch was defined as diameter stenosis > 50% and Pd/Pa ADN > 0.80. Reclassification was indicated by Pd/Pa ADN > 0.80 and Pd/Pa PAP ≤ 0.80. The mismatch (n = 72) had a greater overestimation of FFR than the non-mismatch (n = 99): median 0.02 (interquartile range 0.01–0.05) versus 0.01 (0.00–0.04), p = 0.014. Multivariable analysis identified the overestimation of FFR ( p = 0.003), minimal luminal diameter ( p = 0.001), and non-left anterior descending artery (LAD) location ( p < 0.001) as determinants of the mismatch. Reclassification was indicated in 29% of the mismatch and was more frequent in the LAD than in the non-LAD (52% vs. 20%, p = 0.005). The overestimation of FFR is an independent determinant of anatomical−functional mismatch. Anatomical−functional mismatch, specifically in the LAD, may suggest a false-negative result.
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Matsumoto et al. (2022) conducted an observational in Chronic coronary syndrome with coronary stenosis of 30-90% (n=326). Adenosine vs. Papaverine was evaluated on Anatomical-functional mismatch (diameter stenosis > 50% and Pd/PaADN > 0.80) (OR 1.16, 95% CI 1.05-1.28, p=0.003). Overestimation of fractional flow reserve by adenosine compared to papaverine was an independent determinant of anatomical-functional mismatch (OR 1.16 per 0.01 increase).
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