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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

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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Figure 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.

Mentions: The ROC curve for the resting baseline Pd/Pa, using an FFR ≤0.80 as the reference standard variable showed an AUC of 0.89 (95% CI=0.863-0.914, p<0.001). The resting baseline Pd/Pa ≤0.92 was associated with the greatest diagnostic accuracy (82.3%) for the prediction of FFR, whether positive or negative (Fig. 2, Table 2). Examining the diagnostic test performances according to the value for the resting baseline Pd/Pa more closely, we found two arbitrary points for the resting baseline Pd/Pa. At one point, the sensitivity and NPV began to decrease simultaneously and at the other point, the specificity and PPV began to descend simultaneously (Fig. 3). These patterns indicated that the resting baseline Pd/Pa >0.95 had >97% sensitivity and >98% NPV, and that the resting baseline Pd/Pa ≤0.88 had >98% specificity and >90% PPV.


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)

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

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

Figure 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.
Mentions: The ROC curve for the resting baseline Pd/Pa, using an FFR ≤0.80 as the reference standard variable showed an AUC of 0.89 (95% CI=0.863-0.914, p<0.001). The resting baseline Pd/Pa ≤0.92 was associated with the greatest diagnostic accuracy (82.3%) for the prediction of FFR, whether positive or negative (Fig. 2, Table 2). Examining the diagnostic test performances according to the value for the resting baseline Pd/Pa more closely, we found two arbitrary points for the resting baseline Pd/Pa. At one point, the sensitivity and NPV began to decrease simultaneously and at the other point, the specificity and PPV began to descend simultaneously (Fig. 3). These patterns indicated that the resting baseline Pd/Pa >0.95 had >97% sensitivity and >98% NPV, and that the resting baseline Pd/Pa ≤0.88 had >98% specificity and >90% PPV.

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