Insufficient adenosine-induced hyperemia is a major determinant of discordance between non-hyperemic pressure ratio and fractional flow reserve

Figures

• 

  Figure 1. Scatter plot of resting Pd/Pa and FFRADN. The vessels were classified into four groups by using the predefined cut-off values of 0.92 for resting Pd/Pa and 0.80 for FFRADN. Among 326 vessels, 68 (21%) demonstrated discordance: low resting Pd/Pa–high FFRADN in 26 vessels (8%) and high Pd/Pa–low FFRADN in 42 vessels (13%). FFRADN fractional flow reserve value associated with adenosine, Pd/Pa distal-to-aortic pressure ratio.

• 

  Figure 2. Comparison of FFRADN and FFRPAP. (A) Scatter plot. FFRADN and FFRPAP were highly correlated (ρ = 0.926, p < 0.001). FFRADN fractional flow reserve value associated with adenosine, FFRPAP fractional flow reserve value associated with papaverine. (B) Bland–Altman plot. There was a positive bias towards the overestimation of FFR by adenosine (p < 0.001), with the mean difference of 0.02 and the 95% limits of agreements of − 0.05 and 0.10.

• 

  Figure 3. Comparison of FFRADN overestimation between low Pd/Pa–high FFRADN and high Pd/Pa–low FFRADN groups. Distributions of FFRADN overestimation with box-and-whisker plots are shown. FFRADN overestimation was defined as FFRADN– FFRPAP. FFRADN fractional flow reserve value associated with adenosine, FFRPAP fractional flow reserve value associated with papaverine, Pd/Pa distal-to-aortic pressure ratio.

• 

  Figure 4. Individual resting Pd/Pa, FFRADN, and FFRPAP values in the low Pd/Pa − high FFRADN and high Pd/Pa − low FFRADN groups. (A) Low Pd/Pa − high FFRADN group (resting Pd/Pa > 0.92 and FFRADN ≤ 0.80). (B) High Pd/Pa − low FFRADN group (resting Pd/Pa ≤ 0.92 and FFRADN > 0.80). FFRADN fractional flow reserve value associated with adenosine, FFRPAP fractional flow reserve value associated with papaverine, IQR interquartile range, Pd/Pa distal-to-aortic pressure ratio.