Diagnostic Performance of Non‐Hyperemic Pressure Ratios Versus Fractional Flow Reserve Stratified by Coronary Artery: A Systematic Review and Meta‐Analysis of Individual Patient Data

Figures

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  Figure 1. Overview of included studies and the main findings. The top shows the sample size, number of vessels, and measurement types across the 5 studies included in the analysis. A, The diagnostic accuracy and sensitivity of NHPRs were higher in the LAD, while specificity was lower compared with non‐LAD vessels. There were no significant differences in the positive and negative predictive values. B, The optimal NHPR cutoff for detecting significant lesions was ≤0.88 for the LAD and ≤0.92 for non‐LAD vessels. FFR indicates fractional flow reserve; iFR, instantaneous wave‐free ratio; LAD, left anterior descending artery; NHPRs, non‐hyperemic pressure ratios; NPV, negative predictive value; PPV, positive predictive value; and RFR, resting full‐cycle ratio.

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  Figure 2. Mean difference of NHPRs and FFR between LAD and non‐LAD vessels across studies. A, Demonstrates the mean difference of NHPRs between LAD and non‐LAD vessels. B, Demonstrates the mean difference of FFR between LAD and non‐LAD vessels. Red squares indicate weighted point estimates of the mean difference for individual studies. The black diamond represents the pooled estimates with 95% CI in a random effects model. FFR indicates fractional flow reserve; I2, Higgin’s index of heterogeneity; LAD, left anterior descending artery; and NHPRs, non‐hyperemic pressure ratios.

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  Figure 3. Agreement between NHPRs and FFR stratified by coronary artery. Left: Scatter plot illustrating the correlation between NHPRs and FFR. Right: Pie charts showing the proportions of concordant and discordant results stratified by LAD (left) and non‐LAD vessels (right). A substantial agreement between NHPRs and FFR was observed in LAD vessels, particularly driven by positive–positive concordance. In contrast, non‐LAD vessels demonstrated moderate agreement with a more balanced distribution of positive–positive and negative–negative concordance. Discordance between NHPRs and FFR was higher in non‐LAD vessels compared with LAD. FFR indicates fractional flow reserve; LAD, left anterior descending artery; and NHPRs, non‐hyperemic pressure ratios.

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  Figure 4. Receiver operating characteristic curves of NHPRs to predict FFR ≤0.80 stratified by LAD versus non‐LAD vessels. Left: Shows the predictive capacity of NHPRs for FFR ≤0.80 in all vessels. Right: Shows the predictive capacity of NHPRs in LAD (red line) and non‐LAD (blue line). There was no significant difference between LAD vs non‐LAD in the predictive capacity of NHPRs for FFR ≤0.80 (P=0.148). AUC indicates area under the curve; FFR, fractional flow reserve; LAD, left anterior descending artery; and NHPRs, non‐hyperemic pressure ratios.