October 1, 2015Catheterization and Cardiovascular Interventions16 citationsOpen Access

Diagnostic cutoff for pressure drop coefficient in relation to fractional flow reserve and coronary flow reserve: A Patient‐Level Analysis

KKKranthi K. Kolli THTim P. van de Hoef MEMohamed Effat

Structured PICO

Does the pressure drop coefficient (CDP) accurately predict the functional severity of intermediate coronary stenoses compared to FFR and CFR in patients with coronary artery disease?

Population

279 patients (350 lesions) with single- or double-vessel coronary artery disease and at least one intermediate coronary lesion (40-70% diameter stenosis on visual assessment), mean age 61, 73% male, multinational (USA and Netherlands). Key inclusion: chest pain, abnormal stress test, angiographically detectable stenosis of moderate severity, and LVEF >25%.

Intervention

Measurement of Pressure Drop Coefficient (CDP), a functional parameter derived from simultaneous intracoronary pressure and flow measurements during maximal hyperemia induced by adenosine (intravenous or intracoronary).

Comparator

Standard functional assessment using Fractional Flow Reserve (FFR) and Coronary Flow Reserve (CFR).

Outcome

Diagnostic efficiency (area under the receiver operating characteristic curve), sensitivity, and specificity of CDP to detect FFR < 0.80 and CFR < 2.0.surrogate

The pressure drop coefficient (CDP) is a novel, combined pressure-flow functional parameter that correlates strongly with FFR and can accurately distinguish between epicardial stenosis and microvascular dysfunction.

Abstract

OBJECTIVES AND BACKGROUND: Functional assessment of intermediate coronary stenosis during cardiac catheterization is conducted using diagnostic parameters like fractional flow reserve (FFR), coronary flow reserve (CFR), hyperemic stenosis resistance index (HSR), and hyperemic microvascular resistance (HMR). CDP (ratio of pressure drop across a stenosis to distal dynamic pressure), a nondimensional index derived from fundamental fluid dynamic principles, based on a combination of intracoronary pressure, and flow measurements may improve the functional assessment of coronary lesion severity. METHODS: Patient-level data pertaining to 350 intracoronary pressure and flow measurements across coronary stenoses was assessed to evaluate CFR, FFR, HSR, HMR, and CDP. CDP was calculated as (ΔP)/(0.5 × ρ × APV(2)). The density of blood (ρ) was assumed to be 1.05 g/cm(3). The correlation of current diagnostic parameters (CFR, FFR, HSR, and HMR) with CDP was evaluated. The receiver operating characteristic (ROC) curve was used to identify the optimal cut-off point of CDP, corresponding to the clinically used cut-off values (FFR = 0.80 and CFR = 2.0). RESULTS: CDP correlated significantly with FFR (r = 0.81, P 25.4. CDP also correlated significantly (r = 0.98, P < 0.05) with epicardial-specific parameter, HSR. CONCLUSIONS: CDP, a functional parameter based on both intracoronary pressure and flow measurements, has close agreement (area under ROC curve = 86%) with FFR, the frequently used method of evaluating stenosis severity.

Ask AI

Helpful

Bookmark

View Full Paper