Clinical validation of the resting pressure parameters in the assessment of
functionally significant coronary stenosis; results of an independent,
blinded comparison with fractional flow reserve
- Affiliated Author(s)
- 남창욱
- Alternative Author(s)
- Nam, Chang Wook
- Journal Title
- International Journal of Cardiology
- ISSN
- 0167-5273
- Issued Date
- 2013
- Abstract
- Background: The role of resting pressure parameters, i.e. instantaneous wave-free ratio (iFR), and resting distal
coronary pressure/aortic pressure (Pd/Pa) in assessing functionally significant stenosis remains controversial.
We sought to assess the diagnostic performance of iFR and resting whole-cycle Pd/Pa in Asian patients.
Methods: In this study, 238 consecutive lesions (no total occlusions) in which fractional flow reserve (FFR) was
measured with both intravenous and intracoronary adenosine administration were included. Coded resting
pressure data were sent to the core laboratory in which iFR was calculated in a blinded fashion.
Results: FFR and iFR had unimodal distributions and the correlation was r = 0.77(95%confidence interval, 0.71
to 0.82). In a receiver-operating-characteristic curve analysis, iFR had an area under the curve (AUC) of 0.9 at
FFR ≤ 0.80. The best cut-off value for iFR was 0.90 with a sensitivity, specificity, positive and negative predictive
values, and diagnostic accuracy of 76%, 86%, 82% and 80%, and 82%, respectively. The resting whole-cycle Pd/Pa
cut-off of 0.91 demonstrated a diagnostic accuracy of 82% (AUC 0.9). However, iFR had higher discriminatory
power than the resting whole-cycle Pd/Pa.
Conclusion: Both iFR and resting whole-cycle Pd/Pa showed good diagnostic performance to define the functionally
significant stenosis in an independent Asian cohort distributed unimodally and without total occlusions.
However, further validation is needed to explore the areas of disagreement between different physiologic parameters
prior to adoption of resting pressure parameters into routine clinical practice.
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