Fractional flow reserve in patients with reduced ejection fraction

Giuseppe Di Gioia; Bernard De Bruyne; Mariano Pellicano; Jozef Bartunek; Iginio Colaiori; Antonella Fiordelisi; Grazia Canciello; Panagiotis Xaplanteris; Stephane Fournier; Asim Katbeh; Danilo Franco; Monika Kodeboina; Carmine Morisco; Frank Van Praet; Filip Casselman; Ivan Degrieck; Bernard Stockman; Marc Vanderheyden; Emanuele Barbato

doi:10.1093/eurheartj/ehz571

Fractional flow reserve in patients with reduced ejection fraction

Eur Heart J. 2020 May 1;41(17):1665-1672. doi: 10.1093/eurheartj/ehz571.

Authors

Giuseppe Di Gioia^{1

2}, Bernard De Bruyne¹, Mariano Pellicano^{1

2}, Jozef Bartunek¹, Iginio Colaiori¹, Antonella Fiordelisi², Grazia Canciello², Panagiotis Xaplanteris¹, Stephane Fournier^{1

2}, Asim Katbeh^{1

2}, Danilo Franco¹, Monika Kodeboina¹, Carmine Morisco², Frank Van Praet¹, Filip Casselman¹, Ivan Degrieck¹, Bernard Stockman¹, Marc Vanderheyden¹, Emanuele Barbato^{1

2}

Affiliations

¹ Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.
² Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy.

PMID: 31419282
DOI: 10.1093/eurheartj/ehz571

Abstract

Aims: Fractional flow reserve (FFR) has never been investigated in patients with reduced ejection fraction and associated coronary artery disease (CAD). We evaluated the impact of FFR on the management strategies of these patients and related outcomes.

Methods and results: From 2002 to 2010, all consecutive patients with left ventricular ejection fraction (LVEF) ≤50% undergoing coronary angiography with ≥1 intermediate coronary stenosis [diameter stenosis (DS)% 50-70%] treated based on angiography (Angiography-guided group) or according to FFR (FFR-guided group) were screened for inclusion. In the FFR-guided group, 433 patients were matched with 866 contemporary patients of the Angiography-guided group. For outcome comparison, 617 control patients with LVEF >50% were included. After FFR, stenotic vessels per patient were significantly downgraded compared with the Angiography-guided group (1.43 ± 0.98 vs. 1.97 ± 0.84; P < 0.001). This was associated with lower revascularization rate (52% vs. 62%; P < 0.001) in the FFR-guided vs. the Angiography-guided group. All-cause death at 5 years of follow-up was significantly lower in the FFR-guided as compared with Angiography-guided group [22% vs. 31%. HR (95% CI) 0.64 (0.51-0.81); P < 0.001]. Similarly, rate of major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, revascularization, and stroke) was significantly lower in the FFR-guided group [40% vs. 46% in the Angiography-guided group. HR (95% CI) 0.81 (0.67-0.97); P = 0.019]. Higher rates of death and MACCE were observed in patients with reduced LVEF compared with the control cohort.

Conclusions: In patients with reduced LVEF and CAD, FFR-guided revascularization was associated with lower rates of death and MACCE at 5 years as compared with the Angiography-guided strategy. This beneficial impact was observed in parallel with less coronary artery bypass grafting and more patients deferred to percutaneous coronary intervention or medical therapy.

Keywords: Clinical outcome; Coronary physiology; Fractional flow reserve; Heart failure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Coronary Angiography
Coronary Artery Disease*
Coronary Stenosis*
Fractional Flow Reserve, Myocardial*
Humans
Percutaneous Coronary Intervention*
Stroke Volume
Treatment Outcome
Ventricular Function, Left