Conversation in cardiology: Is there a need for clinical trials for the nonhyperemic pressure ratios?

Kern, Morton J.; Berry, Colin; Debruyne, B.; Fearon, William F.; Jeremias, Allen; Johnson, Nils P.; Kandzari, David E.; Kirtane, Ajay J.; Moses, Jeffery W.; Krucoff, Mitchell W.; Stone, Gregg W.

doi:10.1002/ccd.28336

Cited by 4 publications

(1 citation statement)

References 14 publications

(23 reference statements)

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“…Because the usefulness of iFR was validated in noninferiority clinical trials [4,5], various nonhyperemic pressure ratios (NHPRs) including whole-cycle distal to aortic pressure ratio (Pd/Pa), diastolic pressure ratio (DPR), resting full-cycle ratio (RFR) and diastolic hyperemia-free ratio (DFR) have also been developed and introduced into the cardiac catheterization laboratory [6]. A previous study confirmed that NHPRs are correlated extremely well with each other [7], and the newer indices are interchangeably used in clinical practice, although they have never been validated in clinical trials [8].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performances of Nonhyperemic Pressure Ratios and Coronary Angiography-Based Fractional Flow Reserve against conventional Wire-Based Fractional Flow Reserve

Li,

Takahashi,

Sehatbakhsh

et al. 2023

Coronary Artery Disease

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Background Nonhyperemic pressure ratios (NHPRs) have been proposed as alternatives to fractional flow reserve (FFR) without induction of hyperemia. More recently, imaging based-FFR estimation, especially coronary angiography-derived FFR (Angio-FFR) measurement, is proposed to estimate wire-based FFR. However, little is known about the diagnostic performance of these indices against conventional FFR. Aims We aimed to assess and compare the diagnostic performance of both NHPRs and coronary Angio-FFR against wire-based conventional FFR. Methods PubMed and Embase databases were systematically searched for peer-reviewed original articles up to 08/2022. The primary outcomes were the pooled sensitivity and specificity as well as the area under the curve (AUC) of the summary receiver-operating characteristic curve of those indices. Results A total of 6693 records were identified after a literature search, including 37 reports for NHPRs and 34 for Angio-FFR. Overall, NHPRs have a lower diagnostic performance in estimating wire-based FFR with an AUC of 0.85 (0.81, 0.88) when compared with Angio-FFR of 0.95 (0.93, 0.97). When all four modalities of NHPRs (iFR, Pd/Pa, DPR, RFR) were compared, those had overlapping AUCs without major differences among each other. Similarly, when the two most commonly used Angio-FFR (QFR, FFRangio) were compared, those had overlapping AUCs without major differences among each other. Conclusion Angio-FFR may offer a better estimation of wire-based FFR than NHPRs. Our results support a wider use of Angio-FFR in the cardiac catheterization laboratory to streamline our workflow for coronary physiologic assessment. Classifications: FFR,, stable ischemic disease and non-ST elevation acute coronary syndrome.

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Section: Introductionmentioning

confidence: 99%

Diagnostic performances of Nonhyperemic Pressure Ratios and Coronary Angiography-Based Fractional Flow Reserve against conventional Wire-Based Fractional Flow Reserve

Li,

Takahashi,

Sehatbakhsh

et al. 2023

Coronary Artery Disease

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Changes in Resting Coronary Blood Flow During a Cardiac Catheterization Procedure - Implications for Use of Non-Hyperemic Pressure Ratios for Lesion Assessment

Kern

Seto

2019

Cardiovascular Revascularization Medicine

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Physiology-Based Revascularization of Left Main Coronary Artery Disease

Kayaert

Coeman²,

Gevaert

et al. 2021

Journal of Interventional Cardiology

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It is of critical importance to correctly assess the significance of a left main lesion. Underestimation of significance beholds the risk of inappropriate deferral of revascularization, whereas overestimation may trigger major but unnecessary interventions. This article addresses the invasive physiological assessment of left main disease and its role in deciding upon revascularization. It mainly focuses on the available evidence for fractional flow reserve and instantaneous wave-free ratio, their interpretation, and limitations. We also discuss alternative invasive physiological indices and imaging, as well as the link between physiology, ischemia, and prognosis.

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Conversation in cardiology: Is there a need for clinical trials for the nonhyperemic pressure ratios?

Cited by 4 publications

References 14 publications

Diagnostic performances of Nonhyperemic Pressure Ratios and Coronary Angiography-Based Fractional Flow Reserve against conventional Wire-Based Fractional Flow Reserve

Diagnostic performances of Nonhyperemic Pressure Ratios and Coronary Angiography-Based Fractional Flow Reserve against conventional Wire-Based Fractional Flow Reserve

Changes in Resting Coronary Blood Flow During a Cardiac Catheterization Procedure - Implications for Use of Non-Hyperemic Pressure Ratios for Lesion Assessment

Physiology-Based Revascularization of Left Main Coronary Artery Disease

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