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Microvascular Function in Viable Myocardium After Chronic Infarction Does Not Influence Fractional Flow Reserve Measurements

¹ Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands; ² ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands; ³ Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, The Netherlands; and ⁴ Department of Pulmonary Diseases and Physiology, VU University Medical Center, Amsterdam, The Netherlands

Correspondence: For correspondence or reprints contact: Koen M. Marques, MD, Department of Cardiology, VU University Medical Center, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: km.marques{at}VUmc.nl

Fractional flow reserve (FFR) is an index of coronary stenosis severity. FFR is the ratio of hyperemic myocardial flow in the stenotic area to maximal flow in that same territory without stenosis and can be measured with a pressure wire. In patients with prior infarction, measuring FFR in infarct-related arteries may be different for 2 reasons: a smaller mass of viable myocardium depending on the stenotic infarct-related artery and greater microvascular resistance in the infarcted area than in the reference area. When microvascular resistance does not differ between the infarcted and the reference areas, FFR should equal relative flow reserve (RFR). RFR is the ratio of myocardial blood flow in the stenotic area to blood flow in a normally perfused reference area, at maximal hyperemia. H₂¹⁵O PET measures myocardial flow within only the viable areas of an infarct and can be used to measure RFR. The present study assessed in patients with chronic myocardial infarction whether microvascular resistance in the infarct is different from that in the reference area. Therefore, the correlation between FFR and RFR using H₂¹⁵O PET was studied. Methods: In the catheterization laboratory, FFR was measured in the infarct-related artery and a reference coronary artery. The H₂¹⁵O PET study and FFR measurements were performed on the same day in 22 patients. Results: In 27 patients, the mean interval between the PET study and infarction was 3.3 y. Most patients had an anterior infarction, and the mean ejection fraction was 44%. The mean FFR and RFR values were 0.75 ± 0.16 and 0.74 ± 0.18, respectively. A significant correlation (r = 0.81; P < 0.0001) was found between FFR and RFR. The linear regression line was close to the line of identity. Conclusion: In patients with chronic myocardial infarction and a reduced ejection fraction, a good correlation was found between FFR measurements in the infarct-related artery and RFR. Because the linear regression line between FFR and RFR was close to the line of identity, one can conclude that microvascular resistance in the viable myocardium does not differ from that in the reference area.

Key Words: fractional flow reserve • relative flow reserve • myocardial infarction

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