Please use this identifier to cite or link to this item:
https://scidar.kg.ac.rs/handle/123456789/13562
Title: | Functional assessment of myocardial bridging with conventional and diastolic fractional flow reserve: Vasodilator versus inotropic provocation |
Authors: | Aleksandrić B. Djordjevic-Ðikic A. Dobric M. Giga V. Soldatovic, Ivan ![]() Vukcevic V. Tomasevic, Miloje ![]() ![]() Stojković A. Orlic D. Saponjski J. Tesic, Milorad ![]() Banovic M. Petrovic M. Juricic S. Nedeljkovic M. Stankovic, Goran ![]() Ostojic M. Beleslin B. |
Issue Date: | 2021 |
Abstract: | BACKGROUND: Functional assessment of myocardial bridging (MB) remains clinically challenging because of the dynamic nature of the extravascular coronary compression with a certain degree of intraluminal coronary reduction. The aim of our study was to assess performance and diagnostic value of diastolic-fractional flow reserve (d-FFR) during dobutamine provocation versus conventional-FFR during adenosine provocation with exercise-induced myocardial ischemia as reference. ETHODS AND RESULTS: This prospective study includes 60 symptomatic patients (45 men, mean age 57±9 years) with MB on the left anterior descending artery and systolic compression≥50% diameter stenosis. Patients were evaluated by exercise stress-echocardiography test, and both conventional-FFR and d-FFR in the distal segment of left anterior descending artery during intravenous infusion of adenosine (140 μg/kg per minute) and dobutamine (10-50 μg/kg per minute), separately. Exercise-stress-echocardiography test was positive for myocardial ischemia in 19/60 patients (32%). Conventional-FFR during adenosine and peak dobutamine had similar values (0.84±0.04 versus 0.84±0.06, P=0.852), but d-FFR during peak dobutamine was significantly lower than d-FFR during adenosine (0.76±0.08 versus 0.79±0.08, P=0.018). Diastolic-FFR during peak dobutamine was significantly lower in the exercise-stress-echocardiography test -positive group compared with the exercise-stress-echocardiography test -negative group (0.70±0.07 versus 0.79±0.06, P<0.001), but not during adenosine (0.79±0.07 versus 0.78±0.09, P=0.613). Among physiological indices, d-FFR during peak dobutamine was the only independent predictor of functionally significant MB (odds ratio, 0.870; 95% CI, 0.767-0.986, P=0.03). Receiver-operating characteristics curve analysis identifies the optimal d-FFR during peak dobutamine cut-off≤0.76 (area under curve, 0.927; 95% CI, 0.833-1.000;P<0.001) with a sensitivity, specificity, and positive and negative predictive value of 95%, 95%, 90%, and 98%, respectively, for identifying MB associated with stress-induced ischemia. CONCLUSIONS: Diastolic-FFR, but not conventional-FFR, during inotropic stimulation with high-dose dobutamine, in comparison to vasodilatation with adenosine, provides more reliable functional significance of MB in relation to stress-induced myocardial ischemia. |
URI: | https://scidar.kg.ac.rs/handle/123456789/13562 |
Type: | article |
DOI: | 10.1161/JAHA.120.020597 |
SCOPUS: | 2-s2.0-85110263304 |
Appears in Collections: | Faculty of Medical Sciences, Kragujevac |
Files in This Item:
File | Description | Size | Format | |
---|---|---|---|---|
10.1161-JAHA.120.020597.pdf | 2.27 MB | Adobe PDF | ![]() View/Open |
This item is licensed under a Creative Commons License