Clinical outcomes of combined flow-pressure drop measurements using newly developed diagnostic endpoint: Pressure drop coefficient in patients with coronary artery dysfunction

Effat, Mohamed; Peelukhana, Srikara V.; Banerjee, Rupak K.

doi:10.4330/wjc.v8.i3.283

Cited by 4 publications

(23 citation statements)

References 28 publications

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“…The protocol[ 19 ] for the study was approved by the institutional review board at the University of Cincinnati (UC) and Cincinnati Veteran Affairs Medical Center (CVAMC), and informed consent was obtained from all the participants. Patients who underwent exercise testing and myocardial perfusion scans were consented based on the inclusion and exclusion criteria, which are reported in detail in our earlier study for the complete patient group[ 22 ]. The study population consisted of 86 patients enrolled at the UC and CVAMC.…”

Section: Methodsmentioning

confidence: 99%

“…Standard-of-care catheterization techniques[ 22 ] were utilized to obtain intra-coronary pressure and flow measurements across the stenosis. All signals were recorded continuously through rest, and induction as well as decline of maximal hyperemia.…”

Section: Methodsmentioning

confidence: 99%

“…The authors had sufficient prior biostatistics background, as evidenced by previous publications[ 19 - 22 ]. First, correlations were performed between CDP and HMR in the diabetic and CFR < 2.0 subgroups using linear regression to evaluate the agreement of CDP with HMR, a parameter reported to identify the severity of MVD.…”

Section: Methodsmentioning

confidence: 99%

“…Our earlier pilot clinical study[ 22 ] validated the proposed cut-off value for CDP with positive clinical outcomes associated with the CDP > 27.9 group when compared with the FFR < 0.75 group. The objective of the current study is to assess the efficacy of CDP in delineating ES within patient subgroups suffering from MVD only.…”

Section: Introductionmentioning

confidence: 98%

“…The objective of the current study is to assess the efficacy of CDP in delineating ES within patient subgroups suffering from MVD only. Therefore, this follow-up pilot study compares the outcomes between CDP > 27.9 and FFR < 0.75 for MVD patient subgroups extracted from the complete patient data analyzed previously[ 22 ]. Accordingly, two subgroups having possible MVD were studied: One consisting of patients with abnormal CFR (CFR < 2.0), and the other consisting of patients suffering from diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Delineation of epicardial stenosis in patients with microvascular disease using pressure drop coefficient: A pilot outcome study

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Effat

Peelukhana

et al. 2017

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AIMTo investigate the patient-outcomes of newly developed pressure drop coefficient (CDP) in diagnosing epicardial stenosis (ES) in the presence of concomitant microvascular disease (MVD).METHODSPatients from our clinical trial were divided into two subgroups with: (1) cut-off of coronary flow reserve (CFR) < 2.0; and (2) diabetes. First, correlations were performed for both subgroups between CDP and hyperemic microvascular resistance (HMR), a diagnostic parameter for assessing the severity of MVD. Linear regression analysis was used for these correlations. Further, in each of the subgroups, comparisons were made between fractional flow reserve (FFR) < 0.75 and CDP > 27.9 groups for assessing major adverse cardiac events (MACE: Primary outcome). Comparisons were also made between the survival curves for FFR < 0.75 and CDP > 27.9 groups. Two tailed chi-squared and Fischer’s exact tests were performed for comparison of the primary outcomes, and the log-rank test was used to compare the Kaplan-Meier survival curves. P < 0.05 for all tests was considered statistically significant.RESULTSSignificant linear correlations were observed between CDP and HMR for both CFR < 2.0 (r = 0.58, P < 0.001) and diabetic (r = 0.61, P < 0.001) patients. In the CFR < 2.0 subgroup, the %MACE (primary outcomes) for CDP > 27.9 group (7.7%, 2/26) was lower than FFR < 0.75 group (3/14, 21.4%); P = 0.21. Similarly, in the diabetic subgroup, the %MACE for CDP > 27.9 group (12.5%, 2/16) was lower than FFR < 0.75 group (18.2%, 2/11); P = 0.69. Survival analysis for CFR < 2.0 subgroup indicated better event-free survival for CDP > 27.9 group (n = 26) when compared with FFR < 0.75 group (n = 14); P = 0.10. Similarly, for the diabetic subgroup, CDP > 27.9 group (n = 16) showed higher survival times compared to FFR group (n = 11); P = 0.58.CONCLUSIONCDP correlated significantly with HMR and resulted in better %MACE as well as survival rates in comparison to FFR. These positive trends demonstrate that CDP could be a potential diagnostic endpoint for delineating MVD with or without ES.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Delineation of epicardial stenosis in patients with microvascular disease using pressure drop coefficient: A pilot outcome study

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Effat

Peelukhana

et al. 2017

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Evaluation of pulmonary artery stenosis in congenital heart disease patients using functional diagnostic parameters: An in vitro study

D’Souza

Banerjee

Taylor

2018

Journal of Biomechanics

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Comparison Between 5- and 1-Year Outcomes Using Cutoff Values of Pressure Drop Coefficient and Fractional Flow Reserve for Diagnosing Coronary Artery Diseases

et al. 2021

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BackgroundThe current pressure-based coronary diagnostic index, fractional flow reserve (FFR), has a limited efficacy in the presence of microvascular disease (MVD). To overcome the limitations of FFR, the objective is to assess the recently introduced pressure drop coefficient (CDP), a fundamental fluid dynamics-based combined pressure–flow index.MethodsWe hypothesize that CDP will result in improved clinical outcomes in comparison to FFR. To test the hypothesis, chi-square test was performed to compare the percent major adverse cardiac events (%MACE) at 5 years between (a) FFR < 0.75 and CDP > 27.9 and (b) FFR < 0.80 and CDP > 25.4 groups using a prospective cohort study. Furthermore, Kaplan–Meier survival curves were compared between the FFR and CDP groups. The results were considered statistically significant for p < 0.05. The outcomes of the CDP arm were presumptive as clinical decision was solely based on the FFR.ResultsFor the complete patient group, the %MACE in the CDP > 27.9 group (10 out of 35, 29%) was lower in comparison to the FFR < 0.75 group (11 out of 20, 55%), and the difference was near significant (p = 0.05). The survival analysis showed a significantly higher survival rate (p = 0.01) in the CDP > 27.9 group (n = 35) when compared to the FFR < 0.75 group (n = 20). The results remained similar for the FFR = 0.80 cutoff. The comparison of the 5-year MACE outcomes with the 1-year outcomes for the complete patient group showed similar trends, with a higher statistical significance for a longer follow-up period of 5 years.ConclusionBased on the MACE and survival analysis outcomes, CDP could possibly be an alternate diagnostic index for decision-making in the cardiac catheterization laboratory.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT01719016.

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Clinical outcomes of combined flow-pressure drop measurements using newly developed diagnostic endpoint: Pressure drop coefficient in patients with coronary artery dysfunction

Abstract: Based on the above, CDP could prove to be a better diagnostic end-point for clinical revascularization decision-making in the cardiac catheterization laboratories.

Cited by 4 publications

References 28 publications

Delineation of epicardial stenosis in patients with microvascular disease using pressure drop coefficient: A pilot outcome study

Delineation of epicardial stenosis in patients with microvascular disease using pressure drop coefficient: A pilot outcome study

Evaluation of pulmonary artery stenosis in congenital heart disease patients using functional diagnostic parameters: An in vitro study

Comparison Between 5- and 1-Year Outcomes Using Cutoff Values of Pressure Drop Coefficient and Fractional Flow Reserve for Diagnosing Coronary Artery Diseases

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