The impact of left ventricular ejection fraction on fractional flow reserve: Insights from the FAME (Fractional flow reserve versus Angiography for Multivessel Evaluation) trial

Yuhei Kobayashi, Pim A.L. Tonino, Bernard De Bruyne, Hyoung Mo Yang, Hong Seok Lim, Nico H.J. Pijls, William F. Fearon

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) significantly improves outcomes compared with angio-guided PCI in patients with multivessel coronary artery disease. However, there is a theoretical concern that in patients with reduced left ventricular ejection fraction (EF) FFR may be less accurate and FFR-guided PCI less beneficial. Methods From the FAME (Fractional flow reserve versus Angiography for Multivessel Evaluation) trial database, we compared FFR values between patients with reduced EF (both ≤ 40%, n = 90 and ≤ 50%, n = 252) and preserved EF (> 40%, n = 825 and > 50%, n = 663) according to the angiographic stenosis severity. We also compared differences in 1 year outcomes between FFR- vs. angio-guided PCI in patients with reduced and preserved EF. Results Both groups had similar FFR values in lesions with 50-70% stenosis (p = 0.49) and with 71-90% stenosis (p = 0.89). The reduced EF group had a higher mean FFR compared to the preserved EF group across lesions with 91-99% stenosis (0.55 vs. 0.50, p = 0.02), although the vast majority of FFR values remained ≤ 0.80. There was a similar reduction in the composite end point of death, nonfatal myocardial infarction, and repeat revascularization with FFR-guided compared to angio-guided PCI for both the reduced (14.5% vs. 19.0%, relative risk = 0.76, p = 0.34) and the preserved EF group (13.8 vs. 17.0%, relative risk = 0.81, p = 0.25). The results were similar with an EF cutoff of 40%. Conclusion Reduced EF has no influence on the FFR value unless the stenosis is very tight, in which case a theoretically explainable, but clinically irrelevant overestimation might occur. As a result, FFR-guided PCI remains beneficial regardless of EF.

Original languageEnglish (US)
Pages (from-to)206-210
Number of pages5
JournalInternational Journal of Cardiology
Volume204
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

Keywords

  • Ejection fraction
  • Fractional flow reserve
  • Multivessel revascularization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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