Development, validation, and reproducibility of the pullback pressure gradient (PPG) derived from manual fractional flow reserve pullbacks

Sonck, Jeroen; Mizukami, Takuya; Johnson, Nils P.; Nagumo, Sakura; Gallinoro, Emanuele; Candreva, Alessandro; Mileva, Niya; Munhoz, Daniel; Shinke, Toshiro; Svanerud, Johan; Barbato, Emanuele; Bruyne, Bernard De; Collet, Carlos

doi:10.1002/ccd.30064

Cited by 12 publications

(3 citation statements)

References 14 publications

(32 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PPG is an objective, operator‐independent method that can be obtained with high reproducibility after manual FFR pullback maneuvers. 29 This additional level of disease discrimination opens the door for personalized management of patients with CAD. Based on the results of the present study, patients with high PPG appear to derive the greatest benefit from PCI.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease

Mizukami

Sonck

Sakai

et al. 2022

JAHA

Self Cite

View full text Add to dashboard Cite

Background Coronary artery disease (CAD) patterns play an essential role in the decision‐making process about revascularization. The pullback pressure gradient (PPG) quantifies CAD patterns as either focal or diffuse based on fractional flow reserve (FFR) pullbacks. The objective of this study was to evaluate the impact of CAD patterns on acute percutaneous coronary intervention (PCI) results considered surrogates of clinical outcomes. Methods and Results This was a prospective, multicenter study of patients with hemodynamically significant CAD undergoing PCI. Motorized FFR pullbacks and optical coherence tomography (OCT) were performed before and after PCI. Post‐PCI FFR >0.90 was considered an optimal result. Focal disease was defined as PPG >0.73 (highest PPG tertile). Overall, 113 patients (116 vessels) were included. Patients with focal disease were younger than those with diffuse CAD (61.4±9.9 versus 65.1±8.7 years, P =0.042). PCI in vessels with high PPG (focal CAD) resulted in higher post‐PCI FFR (0.91±0.07 in the focal group versus 0.86±0.05 in the diffuse group, P <0.001) and larger minimal stent area (6.3±2.3 mm 2 in focal versus 5.3±1.8 mm 2 in diffuse CAD, P =0.015) compared withvessels with low PPG (diffuse CAD). The PPG was associated with the change in FFR after PCI ( R 2 =0.51, P <0.001). The PPG significantly improved the capacity to predict optimal PCI results compared with an angiographic assessment of CAD patterns (area under the curve PPG 0.81 [95% CI, 0.73–0.88] versus area under the curve angio 0.51 [95% CI, 0.42–0.60]; P <0.001). Conclusions PCI in vessels with focal disease defined by the PPG resulted in greater improvement in epicardial conductance and larger minimal stent area compared with diffuse disease. PPG, but not angiographically defined CAD patterns, distinguished patients attaining superior procedural outcomes. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03782688

show abstract

Section: Discussionmentioning

confidence: 99%

“…However, the PPG can be similarly derived from manual FFR pullbacks with excellent reproducibility. 29 Third, the definition of focal CAD was based on the highest tertile of the PPG distribution rather than a threshold. .…”

Section: Discussionmentioning

confidence: 99%

Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease

Mizukami

Sonck

Sakai

et al. 2022

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Prior to PCI, longitudinal vessel assessment informs on the distribution of pressure losses along the epicardial vessel and can differentiate focal and/or diffuse patterns of flow-limiting disease (Figure 1). Longitudinal vessel analysis allows for the identification of focal and diffuse patterns of flow-limiting disease, either subjectively by visual inspection of the pullback curve or objectively by using the pressure pullback gradient index (PPG index ) 45 , which can be performed manually with high inter-and intraoperator reproducibility 48 . Differentiation of diffuse from focal disease is also feasible with an automated algorithm that analyses the instantaneous FFR gradient per time unit, the dFFR(t)/dt index 49 .…”

Section: Longitudinal Physiological Vessel Analysismentioning

confidence: 99%

Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology

et al. 2023

Self Cite

View full text Add to dashboard Cite

The clinical value of fractional flow reserve and non-hyperaemic pressure ratios are well established in determining an indication for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD). In addition, over the last 5 years we have witnessed a shift towards the use of physiology to enhance procedural planning, assess post-PCI functional results, and guide PCI optimisation. In this regard, clinical studies have reported compelling data supporting the use of longitudinal vessel analysis, obtained with pressure guidewire pullbacks, to better understand how obstructive CAD contributes to myocardial ischaemia, to establish the likelihood of functionally successful PCI, to identify the presence and location of residual flow-limiting stenoses and to predict long-term outcomes. The introduction of new functional coronary angiography tools, which merge angiographic information with fluid dynamic equations to deliver information equivalent to intracoronary pressure measurements, are now available and potentially also applicable to these endeavours. Furthermore, the ability of longitudinal vessel analysis to predict the functional results of stenting has played an integral role in the evolving field of simulated PCI. Nevertheless, it is important to have an awareness of the value and challenges of physiology-guided PCI in specific clinical and anatomical contexts. The main aim of this European Association of Percutaneous Cardiovascular Interventions clinical consensus statement is to offer up-to-date evidence and expert opinion on the use of applied coronary physiology for procedural PCI planning, disease pattern recognition and post-PCI optimisation.

show abstract

Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and long-term clinical outcomes

Fezzi,

Del Sole,

Burzotta

et al. 2024

Clin Res Cardiol

View full text Add to dashboard Cite

Background Physiological patterns of coronary artery disease (CAD) have emerged as potential determinants of functional results of percutaneous coronary interventions (PCI) and of vessel-oriented clinical outcomes (VOCE). Objectives In this study, we evaluated the impact of angiography-derived physiological patterns of CAD on post-PCI functional results and long-term clinical outcomes. Methods Pre-PCI angiography-derived fractional flow reserve (FFR) virtual pullbacks were quantitatively interpreted and used to determine the physiological patterns of CAD. Suboptimal post-PCI physiology was defined as an angiography-derived FFR value ≤ 0.91. The primary endpoint was the occurrence of VOCE at the longest available follow-up. Results Six hundred fifteen lesions from 516 patients were stratified into predominantly focal (n = 322, 52.3%) and predominantly diffuse (n = 293, 47.7%). Diffuse pattern of CAD was associated with lower post-PCI angiography-derived FFR values (0.91 ± 0.05 vs. 0.94 ± 0.05; p = 0.001) and larger rate of suboptimal post-PCI physiology (43.0 vs. 22.7%; p = 0.001), as compared to focal CAD. At the median follow-up time of 37 months (33–58), post-PCI suboptimal physiology was related to a higher risk of VOCE (16.2% vs. 7.6%; HR: 2.311; 95% CI 1.410–3.794; p = 0.0009), while no significant difference was noted according to baseline physiological pattern. In diffuse disease, the use of intracoronary imaging was associated with a lower incidence of long-term VOCE (5.1% vs 14.8%; HR: 0.313, 95% CI 0.167–0.614, p = 0.030). Conclusions Suboptimal post-PCI physiology is observed more often in diffusely diseased arteries and it is associated with higher risk of VOCE at follow-up. The use of intravascular imaging might improve clinical outcomes in the setting of diffuse CAD.

show abstract

Development, validation, and reproducibility of the pullback pressure gradient (PPG) derived from manual fractional flow reserve pullbacks

Cited by 12 publications

References 14 publications

Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease

Procedural Outcomes After Percutaneous Coronary Interventions in Focal and Diffuse Coronary Artery Disease

Applied coronary physiology for planning and guidance of percutaneous coronary interventions. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology

Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and long-term clinical outcomes

Contact Info

Product

Resources

About