Korean Circ J.  2013 May;43(5):309-315. 10.4070/kcj.2013.43.5.309.

Prediction of Fractional Flow Reserve without Hyperemic Induction Based on Resting Baseline Pd/Pa

• Kim JS
• Lee HD
• Suh YK
• Kim JH
• Chun KJ
• Park YH
• Kim J
• Han DC
• Sohn CB

• KMID: 2224923
• DOI: http://doi.org/10.4070/kcj.2013.43.5.309

Abstract

BACKGROUND AND OBJECTIVES
The purposes of this study are 1) to investigate the relationship between resting baseline Pd/Pa, determined by the ratio of the pressures proximal (Pa) and distal (Pd) to the target lesion before, inducing hyperemia and fractional flow reserve (FFR) and 2) to identify a resting baseline Pd/Pa range that might reliably preclude the need for hyperemic induction.
SUBJECTS AND METHODS
A total of 622 pressure wire data sets obtained from intermediate stenotic lesions were analyzed.
RESULTS
There was a good linear relationship between resting baseline Pd/Pa and FFR (r=0.746, p<0.001). Receiver-operating characteristic curves of the resting baseline Pd/Pa with FFR < or =0.80 as the reference variable showed an area under the curve of 0.89 (95% confidence intervals 0.863-0.914, p<0.001) with a diagnostic accuracy of 82.3% when the resting baseline Pd/Pa was < or =0.92. These results showed that certain cutoff values can reliably predict FFR, whether positive or negative. The resting baseline Pd/Pa >0.95 (n=257, 41.3%) had a negative predictive value (NPV) of 98.1% and a sensitivity of 97.3%. the resting baseline Pd/Pa < or =0.88 (n=65, 10.5%) had a positive predictive value (PPV) of 96.2% and a specificity of 99.8%. These were consistent regardless of coronary vessel, lesion location, lesion length, or degree of stenosis.
CONCLUSION
In intermediate lesions, the resting baseline Pd/Pa was linearly related to FFR. A certain range of the resting baseline Pd/Pa values had an excellent NPV with high sensitivity or excellent PPV with high specificity for determining the lesion significance.

Keyword

Cardiovascular physiological phenomana; Fractional flow reserve, myocardial

MeSH Terms

Coronary Vessels
Fractional Flow Reserve, Myocardial
Glycosaminoglycans
Hyperemia
Sensitivity and Specificity
Glycosaminoglycans

Figure

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  Fig. 1 Scatter plots. A: scatter plots of diameter stenosis versus the resting baseline Pd/Pa (n=622, r=-0.285, p<0.001). B: scatter plots of diameter stenosis vs. FFR (n=622, r=-0.373, p<0.001). C: scatter plots of the resting baseline Pd/Pa vs. FFR (n=622, r=0.746, p<0.001). A single dot may represent many identical pressure wire data points. FFR: fractional flow reserve, r: Pearson's correlation coefficient.

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  Fig. 2 Receiver operating characteristic area under the curve (AUC) of the resting baseline Pd/Pa values, using FFR ≤0.80 as the reference standard variable. A: all vessels (AUC 0.89, n=662). B: left anterior descending artery (LAD; AUC 0.85, n=332). C: right coronary artery (RCA; AUC 0.93, n=150). D: left circumflex artery (LCx; AUC 0.84, n=127). FFR: fractional flow reserve.

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  Fig. 3 Diagnostic test performances according to the resting baseline Pd/Pa. When the resting baseline Pd/Pa was >0.95, sensitivity was 97.3% (95% CI=93.7-99.1%) and negative predictive value was 98.1% (95% CI=95.5-99.4%). When the resting baseline Pd/Pa was ≤0.88, specificity was 98.6% (95% CI=97.0-99.5%) and positive predictive value was 90.8% (95% CI=81.0-96.5%). CI: confidence intervals.

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