Key result
Basal Pd/Pa cutoffs accurately predict physiological significance, ruling in FFR ≤0.80 with ~100% precision.
Why the study?
The hyperemic response to adenosine and calculation of FFR may be affected by coronary microvascular dysfunction, necessitating understanding of the relationship between basal Pd/Pa and FFR and predictors of their change.
Cohort (n=166)
Basal Pd/Pa thresholds may aid FFR prediction in intermediate lesions; leaves open whether patient factors or microvascular dysfunction alter reliability in broader cohorts.
Aim Fractional flow reserve (FFR) allows for physiological definition of coronary lesion severity but requires induction of maximal coronary circulation hyperemia with administration of adenosine leading to coronary resistive vessel vasodilatation. However, the hyperemic response to adenosine, and therefore the calculation of FFR, may be affected by dysfunction of the coronary microvasculature. The aim was to define the relationship between basal Pd/Pa and FFR and identify lesion‐independent predictors of the change in Pd/Pa with hyperemia. Methods and Results One hundred and sixty‐six consecutive patients undergoing FFR measurement were prospectively enrolled (mean age 62.6 ± 10.3 years, 27% females). Basal Pd/Pa, FFR, and delta Pd/Pa (difference between basal Pd/Pa and FFR) were recorded. Independent predictors of delta Pd/Pa included angiographic lesion severity, lesion length, gender, body mass index, and total cholesterol:HDL cholesterol ratio. The best basal Pd/Pa cutoff value to predict lesion physiological significance was 0.87 (positive predictive value of 100% for an FFR value ≤0.80) and the best cutoff for nonsignificance was 0.93 (negative predictive value of 98% for an FFR value >0.80). Conclusion The delta Pd/Pa may be affected by patient gender, body mass index, and cholesterol profile. A basal Pd/Pa value of ≥0.93 is highly predictive of an FFR >0.80. Conversely, a basal Pd/Pa value of ≤0.87 is highly predictive of an FFR ≤0.80.
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WILSON et al. (2017) conducted a cohort in Coronary artery disease requiring physiological lesion assessment (n=166). Basal Pd/Pa was evaluated on Prediction of lesion physiological significance (FFR ≤0.80). A basal Pd/Pa ≤0.87 predicted a fractional flow reserve (FFR) ≤0.80 with 100% positive predictive value, whereas a basal Pd/Pa ≥0.93 predicted an FFR >0.80 with 98% negative predictive value.
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