before, although it has been suggested that assuming a P ra value of 5 mm Hg results in insignificant differences in CFI (5). In contrast, our findings show that substantial errors occur when right atrial pressure is assumed to be a fixed value. It is interesting to note that Seiler et al. (6) found a better correlation between Doppler-and pressure-derived CFI when a measurement of central venous pressure was included, as compared with those calculations where venous pressure was assumed to be 5 mm Hg. Given that almost one-sixth of patients in our study were assigned to the wrong CFI category when P ra was assumed to be negligible or a fixed value, we believe that measurement of right atrial pressure is imperative when calculating CFI.The FFR and CFI were derived and validated with the inclusion of right atrial pressure. Ignoring P ra in everyday practice debases the fidelity of FFR and may lead to inappropriate therapy in some cases. Similarly, assuming a fixed arbitrary P ra value leads to substantial errors in CFI calculations. Therefore, right atrial pressure should always be measured when calculating these physiologic indexes. If the simplified index P d /P a is used, values between 0.70 and 0.80 mandate recalculation of true FFR, after measurement of P ra .
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