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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 - Korean Circ J (2013)

Bottom Line: These results showed that certain cutoff values can reliably predict FFR, whether positive or negative.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.

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 ≤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 ≤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 ≤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.

No MeSH data available.


Related in: MedlinePlus

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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Figure 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.

Mentions: The range of resting baseline Pd/Pa values was 0.81 to 1.0, and the range of FFR values was 0.47 to 1.0. Based on the established FFR cutoff threshold of 0.8 to define a positive result, 183 of 622 (29.4%) lesions were considered functionally significant (positive) and 439 of 622 (70.6%) lesions were considered functionally non-significant (negative). Pearson's correlation analysis between the resting baseline Pd/Pa and diameter stenosis, as well as between FFR and diameter stenosis showed poor linear relationships in terms of its strength: r=-0.285 between the resting baseline Pd/Pa and diameter stenosis (p<0.001) (Fig. 1A), and r=-0.373 between FFR and diameter stenosis (p<0.001) (Fig. 1B). By contrast, there was a good linear relationship between the resting baseline Pd/Pa and FFR (r=0.746, p<0.001) (Fig. 1C).


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 - Korean Circ J (2013)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3675305&req=5

Figure 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.
Mentions: The range of resting baseline Pd/Pa values was 0.81 to 1.0, and the range of FFR values was 0.47 to 1.0. Based on the established FFR cutoff threshold of 0.8 to define a positive result, 183 of 622 (29.4%) lesions were considered functionally significant (positive) and 439 of 622 (70.6%) lesions were considered functionally non-significant (negative). Pearson's correlation analysis between the resting baseline Pd/Pa and diameter stenosis, as well as between FFR and diameter stenosis showed poor linear relationships in terms of its strength: r=-0.285 between the resting baseline Pd/Pa and diameter stenosis (p<0.001) (Fig. 1A), and r=-0.373 between FFR and diameter stenosis (p<0.001) (Fig. 1B). By contrast, there was a good linear relationship between the resting baseline Pd/Pa and FFR (r=0.746, p<0.001) (Fig. 1C).

Bottom Line: These results showed that certain cutoff values can reliably predict FFR, whether positive or negative.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.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.

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 ≤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 ≤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 ≤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.

No MeSH data available.


Related in: MedlinePlus