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KMID : 0368120130430050309
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Korean Circulation Journal
2013 Volume.43 No. 5 p.309 ~ p.315
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Prediction of Fractional Flow Reserve without Hyperemic Induction Based on Resting Baseline Pd/Pa
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Kim Jeong-Su
Lee Heon-Deok
Suh Yong-Kweon
Kim June-Hong
Chun Kook-Jin
Park Yong-Hyun
Han Dong-Cheul
Sohn Chang-Bae
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Abstract
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Background/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.
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KEYWORD
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Cardiovascular physiological phenomana, Fractional flow reserve, myocardial
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