Key result
Intracoronary ST shift during adenosine predicts abnormal FFR with ~86% specificity.
Why the study?
Intracoronary electrocardiogram ST segment recording during maximal pharmacologic vasodilation may provide an indirect estimation of fractional flow reserve results for assessing vessel stenosis significance.
Does intracoronary ECG ST segment shift during adenosine infusion accurately predict abnormal fractional flow reserve in clinically stable patients with intermediate coronary stenosis?
Observational (n=48)
Does intracoronary ECG ST segment shift during adenosine infusion accurately predict abnormal fractional flow reserve in clinically stable patients with intermediate coronary stenosis?
Absolute Event Rate: 81% vs 13.6%
p-value: p=< 0.001
Intracoronary ST segment shift during adenosine infusion shows good diagnostic accuracy for predicting abnormal FFR and may serve as an alternative to assess the functional significance of borderline stenoses.
Intracoronary ST shift during adenosine may indicate abnormal FFR in intermediate stenoses; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: By measuring the pressure decline caused by coronary narrowing, fractional flow reserve (FFR) is an index of the physiological significance of a vessel stenosis. Intracoronary electrocardiogram (IC-ECG) recording from an angioplasty guidewire is more sensitive than standard ECG in detecting regional myocardial ischemia. The aim of the study was to assess if unipolar IC-ECG ST segment recording from angioplasty guidewire during maximal pharmacologic vasodilation could be used as an indirect estimation of FFR results. METHODS: Forty-eight clinically stable patients with intermediate stenosis underwent FFR evaluation and IC-ECG recording during intravenous adenosine infusion. RESULTS: FFR values were ≤ 0.80 in 26 (54%) patients and > 0.80 in 22 (46%). After adenosine, standard ECG was abnormal in only nine (19%) patients, while IC-ECG showed a significant ST segment shift (IST) in 24 (50%) patients: ST elevation in 19 patients and depression in five). IST was documented in 21/26 patients with FFR ≤ 0.80 (81%) and in 3/22 with FFR > 0.80 (p < 0.001). Sensitivity of IST for predicting an abnormal FFR value was 81%, specificity 86%, positive and negative predictive accuracies were 88% and 79%, respectively. CONCLUSIONS: Intracoronary ST segment shift evaluation during adenosine infusion may be of value in assessing the functional significance of a borderline stenosis. The presence of IST during adenosine infusion could obviate the need for additional FFR evaluation.
No takes yet. Share an insight, caveat, or question.
Balian et al. (2011) conducted an observational in intermediate coronary stenosis (n=48). Intracoronary electrocardiogram (IC-ECG) ST segment shift vs. Fractional flow reserve (FFR) was evaluated on Significant ST segment shift (IST) predicting FFR ≤ 0.80 (p=< 0.001). Intracoronary ST segment shift during adenosine infusion predicted an abnormal FFR (≤0.80) with 81% sensitivity and 86% specificity (P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: