ArticleInternational journal of cardiology. Heart & vasculature2026
Differential stress-induced ischemic electrocardiographic changes in acute versus stable coronary syndromes with severely reduced fractional flow reserve (≤0.60).
Article in International journal of cardiology. Heart & vasculature, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Fractional flow reserve (FFR) is widely used to guide percutaneous coronary intervention (PCI) as a surrogate of inducible myocardial ischemia (IMI). However, the relationship between very low FFR, electrically manifest ischemia, and subsequent symptomatic benefit remains incompletely understood. Methods: We investigated stress-induced ischemic electrocardiographic changes in 79 patients with FFR ≤ 0.60, comparing acute coronary syndrome (ACS) and stable coronary artery disease (CAD), and its association with post-PCI symptom improvement. IMI was defined by ischemic ST-segment changes during adenosine stress testing. Pressure-derived physiologic indices, including the instantaneous wave-free ratio (iFR) and resting Pd/Pa, were measured, and angina-related symptoms were assessed using the Seattle Angina Questionnaire. Results: IMI was present in all patients with ACS but was absent in 40 % of patients with stable CAD ( Conclusions: At extremely low FFR values (≤0.60), substantial discordance exists between pressure-derived physiology and IMI, which is closely related to clinical presentation and symptomatic benefit after PCI.
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