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Li Q, Zhang Y, Wang C, Dong S, Mao Y, Tang Y, Zeng Y. Diagnostic performance of CT-derived resting distal to aortic pressure ratio (resting Pd/Pa) vs. CT-derived fractional flow reserve (CT-FFR) in coronary lesion severity assessment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1390. [PMID: 34733942 PMCID: PMC8506529 DOI: 10.21037/atm-21-4325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/03/2021] [Indexed: 12/21/2022]
Abstract
Background Computed tomography-derived fractional flow reserve (CT-FFR) has emerged as a promising non-invasive substitute for fractional flow reserve (FFR) measurement. Normally, CT-FFR providing functional significance of coronary artery disease (CAD) by using a simplified total coronary resistance index (TCRI) model. Yet the error or discrepancy caused by this simplified model remains unclear. Methods A total of 20 consecutive patients with suspected CAD who underwent CTA and invasive FFR measurement were retrospectively analyzed. CT-FFR and CT-(Pd/Pa)rest values derived from the coronary CTA images. The diagnostic performance of CT-FFR and CT-(Pd/Pa)rest were evaluated on a per-vessel level using C statistics with invasive FFR<0.80 as the reference standard. Results Of the 25 vessels eventually analyzed, the prevalence of functionally significant CAD were 64%. The Youden index of the ROC curve indicated that the best cutoff value of invasive resting Pd/Pa was 0.945 for identifying functionally significant lesions. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy were 85%, 91%, 92%, 83% and 88% for CT-(Pd/Pa)rest and 85%, 58% 69%, 78% and 72% for CT-FFR. Area under the receiver-operating characteristic curve (AUC) to detect functionally significant stenoses of CT-(Pd/Pa)rest and CT-FFR were 0.87 and 0.90. Conclusions In this study, the results suggest CT-derived resting Pd/Pa has a potential advantage over CT-FFR in triaging patients for revascularization.
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Affiliation(s)
- Quan Li
- Center for Coronary Artery Disease, Division of Cardiology Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Center for Coronary Artery Disease, Division of Cardiology Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chunliang Wang
- Departement of Biomedical Engineering and Health Systems, KTH - Royal Institute of Technology, Stockholm, Sweden.,Shenzhen Escope Tech Inc., China
| | - Shiming Dong
- Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | | | - Yida Tang
- Department of Cardiovascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yong Zeng
- Center for Coronary Artery Disease, Division of Cardiology Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Ahn JM, Park DW, Kim SO, Kang DY, Lee CH, Lee PH, Lee SW, Park SW, Park SJ. Prognostic Value of Resting Distal-to-Aortic Coronary Pressure in Clinical Practice. Circ Cardiovasc Interv 2020; 13:e007868. [PMID: 32345039 DOI: 10.1161/circinterventions.118.007868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The resting distal-to-aortic coronary pressure ratio (Pd/Pa) is a universally available, hyperemia-free physiological index of coronary stenosis. We investigated clinical outcomes according to resting Pd/Pa versus hyperemic fractional flow reserve (FFR). METHODS From the IRIS-FFR (Interventional Cardiology Research Incooperation Society Fractional Flow Reserve) registry, 7014 lesions in 4707 patients with valid resting Pd/Pa and FFR were included in this study. The primary outcome was major adverse cardiac events (MACE; a composite of cardiac death, myocardial infarction, and repeat intervention). The MACE rate was compared among resting Pd/Pa ≤0.92 and FFR ≤0.80. A marginal Cox model accounted for correlated data in patients with multiple lesions. RESULTS During a median follow-up of 2.0 years, 223 MACEs occurred. Resting Pd/Pa was an independent predictor for the occurrence of MACE (adjusted hazard ratio [aHR], 1.89 [95% CI, 1.32-2.71]; P=0.001) over clinical and angiographic variables. When resting Pd/Pa and FFR were added into a multivariable model, MACE was no longer significantly associated with resting Pd/Pa (aHR, 1.35 [95% CI, 0.93-1.97]; P=0.12) but remained to be associated with FFR (aHR, 2.34 [95% CI, 1.56-3.54]; P<0.001). Compared with lesions with normal value of resting Pa/Pa and FFR, lesions with abnormal values of either resting Pd/Pa (aHR, 2.12 [95% CI, 1.17-3.84]; P=0.014) or FFR (aHR, 2.32 [95% CI, 1.52-3.55]; P<0.001) or both (aHR, 2.37 [95% CI, 1.57-3.57]; P<0.001) showed a significantly increased risk of the occurrence of MACE. CONCLUSIONS Resting Pd/Pa appeared to be a less-robust prognostic index than FFR. Resting Pd/Pa could be used as a prognostic index when hyperemic agents are contraindicated or not easily available. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01366404.
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Affiliation(s)
- Jung-Min Ahn
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics (S.-O.K.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Cheol-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, South Korea (C.-H.L.)
| | - Pil Hyung Lee
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Wook Park
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Department of Cardiology, Asan Medical Center (J.-M.A., D.-W.P., D.-Y.K., P.H.L., S.-W.L., S.-W.P., S.-J.P.), University of Ulsan College of Medicine, Seoul, South Korea
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Lotfi A, Davies JE, Fearon WF, Grines CL, Kern MJ, Klein LW. Focused update of expert consensus statement: Use of invasive assessments of coronary physiology and structure: A position statement of the society of cardiac angiography and interventions. Catheter Cardiovasc Interv 2018; 92:336-347. [DOI: 10.1002/ccd.27672] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Amir Lotfi
- Baystate Medical Center; Tufts University School of Medicine; Springfield Massachusetts
| | | | | | - Cindy L. Grines
- Northwell Health, North Shore University Hospital; Manhasset New York
| | - Morton J. Kern
- Long Beach Veterans Administration Hospital; University of California, Irvine; Irvine California
| | - Lloyd W. Klein
- Advocate Illinois Masonic Medical Center, Rush Medical College; Chicago Illinois
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Influence of increased heart rate and aortic pressure on resting indices of functional coronary stenosis severity. Basic Res Cardiol 2017; 112:61. [PMID: 28905113 PMCID: PMC5597688 DOI: 10.1007/s00395-017-0651-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Abstract
Baseline assessment of functional stenosis severity has been proposed as a practical alternative to hyperemic indices. However, intact autoregulation mechanisms may affect intracoronary hemodynamics. The aim of this study was to investigate the effect of changes in aortic pressure (Pa) and heart rate (HR) on baseline coronary hemodynamics and functional stenosis assessment. In 15 patients (55 ± 3% diameter stenosis) Pa, intracoronary pressure (Pd) and flow velocity were obtained at control, and during atrial pacing at 120 bpm, increased Pa (+30 mmHg) with intravenous phenylephrine (PE), and elevated Pa while pacing at sinus heart rate (PE + sHR). We derived rate pressure product (RPP = systolic Pa × HR), baseline microvascular resistance (BMR = Pd/velocity), and stenosis resistance [BSR = (Pa − Pd)/velocity] as well as whole-cycle Pd/Pa. Tachycardia (120 ± 1 bpm) raised RPP by 74% vs. control. Accordingly, BMR decreased by 27% (p < 0.01) and velocity increased by 36% (p < 0.05), while Pd/Pa decreased by 0.05 ± 0.02 (p < 0.05) and BSR remained similar to control. Raising Pa to 121 ± 3 mmHg (PE) with concomitant reflex bradycardia increased BMR by 26% (p < 0.001) at essentially unchanged RPP and velocity. Consequently, BSR and Pd/Pa were only marginally affected. During PE + sHR, velocity increased by 21% (p < 0.01) attributable to a 46% higher RPP (p < 0.001). However, BMR, BSR, and Pd/Pa remained statistically unaffected. Nonetheless, the interventions tended to increase functional stenosis severity, causing Pd/Pa and BSR of borderline lesions to cross the diagnostic threshold. In conclusion, coronary microvascular adaptation to physiological conditions affecting metabolic demand at rest influences intracoronary hemodynamics, which may lead to altered basal stenosis indices used for clinical decision-making.
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