Key result
Diastolic FFR performs similarly to conventional FFR for identifying ischemia-causing coronary lesions.
Why the study?
Whether narrowing coronary pressure measurements to diastole improves diagnostic performance under hyperemic conditions had not been thoroughly evaluated.
Does diastolic fractional flow reserve have better diagnostic performance in identifying ischemia-causing coronary lesions than conventional FFR in patients with single-vessel coronary disease?
Observational (n=378)
Yes
Does diastolic fractional flow reserve have better diagnostic performance in identifying ischemia-causing coronary lesions than conventional FFR in patients with single-vessel coronary disease?
Absolute Event Rate: 0.66% vs 0.66%
p-value: p=0.624
Diastolic FFR does not offer superior diagnostic performance over conventional FFR for identifying ischemia-causing coronary lesions, reaffirming conventional FFR as the standard invasive physiological assessment.
Diastolic FFR matches conventional FFR accuracy for ischemia detection; does not support adoption and leaves open any incremental value.
In the resting conditions, narrowing the window of coronary pressure measurements from the whole cardiac cycle to diastole improves diagnostic performance of coronary pressure–derived physiological index. However, whether this also applies to the hyperemic conditions has not yet been thoroughly evaluated. The purpose of this study was to assess whether diastolic fractional flow reserve (diastolic FFR) has better diagnostic performance in identifying ischemia-causing coronary lesions than conventional FFR in a prospective, multicenter, and independent core laboratory–based environment. In this prospective multicenter registry at 29 Japanese centers, we compared the diagnostic performance of FFR, diastolic FFR, resting distal to aortic coronary pressure (Pd/Pa), and diastolic pressure ratio (dPR) using myocardial perfusion scintigraphy (MPS) as the reference standard in 378 patients with single-vessel coronary disease. Inducible myocardial ischemia was found on MPS in the relevant myocardial territory of the target vessel in 85 patients (22%). In the receiver-operating curve analyses, diastolic FFR had comparable area under the curve (AUC) compared with FFR (AUCdiastolic FFR: 0.66; 95% confidence interval [CI]: 0.58-0.73, vs AUCFFR: 0.66; 95% CI: 0.58-0.74, P = 0.624). FFR and diastolic FFR showed significantly larger AUCs than resting Pd/Pa (0.62; 95% CI: 0.54-0.70; P = 0.033 and P = 0.046) but did not show significantly larger AUCs than dPR (0.62; 95% CI: 0.55-0.70; P = 0.102 and P = 0.113). Diastolic FFR showed a similar diagnostic performance to FFR as compared with MPS. This result reaffirms the use of FFR as the most accurate invasive physiological lesion assessment. (Diagnostic accuracy of diastolic fractional flow reserve (d-FFR) for functional evaluation of coronary stenosis; UMIN000015906)
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Shiono et al. (2021) conducted an observational in single-vessel coronary disease (n=378). Diastolic fractional flow reserve (diastolic FFR) vs. Conventional FFR was evaluated on Area under the curve (AUC) for identifying inducible myocardial ischemia on myocardial perfusion scintigraphy (p=0.624). Diastolic fractional flow reserve showed similar diagnostic performance to conventional FFR for identifying ischemia-causing coronary lesions (AUC 0.66 vs 0.66; P=0.624).
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