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.
Journal: Journal of the American Heart Association
Issue Date: 1-Jan-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: 85110263304
Appears in Collections:Faculty of Medical Sciences, Kragujevac
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