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Respiration-related variations in Pd/Pa ratio and fractional flow reserve in resting conditions and during intravenous adenosine administration. / Feenstra, Rutger G. T.; van Lavieren, Martijn A.; Echavarria-Pinto, Mauro et al.

In: Catheterization and cardiovascular interventions, 2021.

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@article{3ebcb15738544b19a721eac6bccd85de,
title = "Respiration-related variations in Pd/Pa ratio and fractional flow reserve in resting conditions and during intravenous adenosine administration",
abstract = "Aims: We evaluated the occurrence and physiology of respiration-related beat-to-beat variations in resting Pd/Pa and FFR during intravenous adenosine administration, and its impact on clinical decision-making. Methods and Results: Coronary pressure tracings in rest and at plateau hyperemia were analyzed in a total of 39 stenosis from 37 patients, and respiratory rate was calculated with ECG-derived respiration (EDR) in 26 stenoses from 26 patients. Beat-to-beat variations in FFR occurred in a cyclical fashion and were strongly correlated with respiratory rate (R2 = 0.757, p < 0.001). There was no correlation between respiratory rate and variations in resting Pd/Pa. When single-beat averages were used to calculate FFR, mean ΔFFR was 0.04 ± 0.02. With averaging of FFR over three or five cardiac cycles, mean ΔFFR decreased to 0.02 ± 0.02, and 0.01 ± 0.01, respectively. Using a FFR ≤ 0.80 threshold, stenosis classification changed in 20.5% (8/39), 12.8% (5/39) and 5.1% (2/39) for single-beat, three-beat and five-beat averaged FFR. The impact of respiration was more pronounced in patients with pulmonary disease (ΔFFR 0.05 ± 0.02 vs 0.03 ± 0.02, p = 0.021). Conclusion: Beat-to-beat variations in FFR during plateau hyperemia related to respiration are common, of clinically relevant magnitude, and frequently lead FFR to cross treatment thresholds. A five-beat averaged FFR, overcomes clinically relevant impact of FFR variation.",
keywords = "clinical research, fractional flow reserve, stable angina",
author = "Feenstra, {Rutger G. T.} and {van Lavieren}, {Martijn A.} and Mauro Echavarria-Pinto and Wijntjens, {Gilbert W.} and Stegehuis, {Valerie E.} and Martijn Meuwissen and {de Winter}, {Robbert J.} and Beijk, {Marcel A. M.} and Amir Lerman and Javier Escaned and Piek, {Jan J.} and {van de Hoef}, {Tim P.}",
note = "Funding Information: The ADVISE II study was funded by Volcano Corporation. The sponsor of the study had no role in the study design, data acquisition, data analysis or writing of the manuscript. All original data analyses were independently performed by the core laboratory (Cardialysis), and the currently data analyses were performed by the authors. Publisher Copyright: {\textcopyright} 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.",
year = "2021",
doi = "10.1002/ccd.30012",
language = "English",
journal = "Catheterization and cardiovascular interventions",
issn = "1522-1946",
publisher = "Wiley-Liss Inc.",

}

RIS

TY - JOUR

T1 - Respiration-related variations in Pd/Pa ratio and fractional flow reserve in resting conditions and during intravenous adenosine administration

AU - Feenstra, Rutger G. T.

AU - van Lavieren, Martijn A.

AU - Echavarria-Pinto, Mauro

AU - Wijntjens, Gilbert W.

AU - Stegehuis, Valerie E.

AU - Meuwissen, Martijn

AU - de Winter, Robbert J.

AU - Beijk, Marcel A. M.

AU - Lerman, Amir

AU - Escaned, Javier

AU - Piek, Jan J.

AU - van de Hoef, Tim P.

N1 - Funding Information: The ADVISE II study was funded by Volcano Corporation. The sponsor of the study had no role in the study design, data acquisition, data analysis or writing of the manuscript. All original data analyses were independently performed by the core laboratory (Cardialysis), and the currently data analyses were performed by the authors. Publisher Copyright: © 2021 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

PY - 2021

Y1 - 2021

N2 - Aims: We evaluated the occurrence and physiology of respiration-related beat-to-beat variations in resting Pd/Pa and FFR during intravenous adenosine administration, and its impact on clinical decision-making. Methods and Results: Coronary pressure tracings in rest and at plateau hyperemia were analyzed in a total of 39 stenosis from 37 patients, and respiratory rate was calculated with ECG-derived respiration (EDR) in 26 stenoses from 26 patients. Beat-to-beat variations in FFR occurred in a cyclical fashion and were strongly correlated with respiratory rate (R2 = 0.757, p < 0.001). There was no correlation between respiratory rate and variations in resting Pd/Pa. When single-beat averages were used to calculate FFR, mean ΔFFR was 0.04 ± 0.02. With averaging of FFR over three or five cardiac cycles, mean ΔFFR decreased to 0.02 ± 0.02, and 0.01 ± 0.01, respectively. Using a FFR ≤ 0.80 threshold, stenosis classification changed in 20.5% (8/39), 12.8% (5/39) and 5.1% (2/39) for single-beat, three-beat and five-beat averaged FFR. The impact of respiration was more pronounced in patients with pulmonary disease (ΔFFR 0.05 ± 0.02 vs 0.03 ± 0.02, p = 0.021). Conclusion: Beat-to-beat variations in FFR during plateau hyperemia related to respiration are common, of clinically relevant magnitude, and frequently lead FFR to cross treatment thresholds. A five-beat averaged FFR, overcomes clinically relevant impact of FFR variation.

AB - Aims: We evaluated the occurrence and physiology of respiration-related beat-to-beat variations in resting Pd/Pa and FFR during intravenous adenosine administration, and its impact on clinical decision-making. Methods and Results: Coronary pressure tracings in rest and at plateau hyperemia were analyzed in a total of 39 stenosis from 37 patients, and respiratory rate was calculated with ECG-derived respiration (EDR) in 26 stenoses from 26 patients. Beat-to-beat variations in FFR occurred in a cyclical fashion and were strongly correlated with respiratory rate (R2 = 0.757, p < 0.001). There was no correlation between respiratory rate and variations in resting Pd/Pa. When single-beat averages were used to calculate FFR, mean ΔFFR was 0.04 ± 0.02. With averaging of FFR over three or five cardiac cycles, mean ΔFFR decreased to 0.02 ± 0.02, and 0.01 ± 0.01, respectively. Using a FFR ≤ 0.80 threshold, stenosis classification changed in 20.5% (8/39), 12.8% (5/39) and 5.1% (2/39) for single-beat, three-beat and five-beat averaged FFR. The impact of respiration was more pronounced in patients with pulmonary disease (ΔFFR 0.05 ± 0.02 vs 0.03 ± 0.02, p = 0.021). Conclusion: Beat-to-beat variations in FFR during plateau hyperemia related to respiration are common, of clinically relevant magnitude, and frequently lead FFR to cross treatment thresholds. A five-beat averaged FFR, overcomes clinically relevant impact of FFR variation.

KW - clinical research

KW - fractional flow reserve

KW - stable angina

UR - http://www.scopus.com/inward/record.url?scp=85119134641&partnerID=8YFLogxK

U2 - 10.1002/ccd.30012

DO - 10.1002/ccd.30012

M3 - Article

C2 - 34766734

JO - Catheterization and cardiovascular interventions

JF - Catheterization and cardiovascular interventions

SN - 1522-1946

ER -

ID: 20468101