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

Kolli, Kranthi K.; Hoef, Tim P. van de; Effat, Mohamed; Banerjee, Rupak K.; Peelukhana, Srikara V.; Succop, Paul; Leesar, Massoud A.; Arif, Imran; Piek, Jan J.; Helmy, Tarek

doi:10.1002/ccd.26063

Cited by 13 publications

(22 citation statements)

References 32 publications

(36 reference statements)

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“…The advantages of using CDP, a combined pressure-flow diagnostic endpoint, have been reported in earlier studies[ 14 , 20 - 22 ]. However, the applicability of such a parameter in clinically relevant scenarios, particularly in the presence of MVD needs further assessment.…”

Section: Discussionmentioning

confidence: 95%

“…The complex interaction of pressure and flow seen in such scenarios may not be captured adequately by FFR or CFR alone, since these parameters depend solely on pressure and flow, respectively. In contrast, CDP is a combined physiological parameter derived from fundamental fluid dynamics principles involving both pressure and flow measurements, and can adequately distinguish between ES and MVD[ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…The patient data for each subgroup was then divided per the cut-off value of FFR < 0.75 for significant ES. On a similar note, CDP > 27.9[ 20 , 21 ] was used as an equivalent cut-off for significant stenosis. In the primary outcome study, for each subgroup (CFR < 2.0 and diabetic), the %MACE in the FFR < 0.75 group was quantified and compared with the %MACE in the corresponding CDP > 27.9 group.…”

Section: Methodsmentioning

confidence: 99%

“…The CDP was recently employed to differentiate between degrees of stenotic severity in a patient population[ 19 ]. In order to make interventional decisions, an equivalent cut-off to FFR < 0.75 for single vessel disease was established for CDP (CDP > 27.9)[ 20 , 21 ] as a marker for significant ES.…”

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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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: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Hebbar

Effat

Peelukhana

et al. 2017

WJC

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“…Compared with pressure-derived indices (FFR), CDP directly quantifies the hemodynamic behavior of a stenosis section [ 26 ]. Thus, the presence of microvascular disease has limited impact on CDP [ 27 – 29 ]. However, due to the limitation of the invasive procedure (the viscous loss is not considered in order to get a result with a single measurement; the flow velocity is measured, but not the flow rate), CDP is still dependent on the flow rate across a stenosis [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

A new CFD based non-invasive method for functional diagnosis of coronary stenosis

et al. 2018

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BackgroundAccurate functional diagnosis of coronary stenosis is vital for decision making in coronary revascularization. With recent advances in computational fluid dynamics (CFD), fractional flow reserve (FFR) can be derived non-invasively from coronary computed tomography angiography images (FFRCT) for functional measurement of stenosis. However, the accuracy of FFRCT is limited due to the approximate modeling approach of maximal hyperemia conditions. To overcome this problem, a new CFD based non-invasive method is proposed.MethodsInstead of modeling maximal hyperemia condition, a series of boundary conditions are specified and those simulated results are combined to provide a pressure-flow curve for a stenosis. Then, functional diagnosis of stenosis is assessed based on parameters derived from the obtained pressure-flow curve.ResultsThe proposed method is applied to both idealized and patient-specific models, and validated with invasive FFR in six patients. Results show that additional hemodynamic information about the flow resistances of a stenosis is provided, which cannot be directly obtained from anatomy information. Parameters derived from the simulated pressure-flow curve show a linear and significant correlations with invasive FFR (r > 0.95, P < 0.05).ConclusionThe proposed method can assess flow resistances by the pressure-flow curve derived parameters without modeling of maximal hyperemia condition, which is a new promising approach for non-invasive functional assessment of coronary stenosis.

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Pressure-flow curve derived from coronary CT angiography for detection of significant hemodynamic stenosis

et al. 2020

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Objectives Coronary CT angiography (cCTA) has been used to non-invasively assess both the anatomical and hemodynamic significance of coronary stenosis. The current study investigated a new CFD-based method of evaluating pressure-flow curves across a stenosis to further enhance the diagnostic value of cCTA imaging. Methods Fifty-eight patients who underwent both cCTA imaging and invasive coronary angiography (ICA) with fractional flow reserve (FFR) within 2 weeks were enrolled. The pressure-flow curve-derived parameters, viscous friction (VF) and expansion loss (EL), were compared with conventional cCTA parameters including percent area stenosis (AS) and minimum lumen area (MLA) by receiver operating characteristic (ROC) curve analysis. FFR ≤ 0.80 was used to indicate ischemia-causing stenosis. Correlations between FFR and other measurements were calculated by Spearman's rank correlation coefficient (rho). Results Sixty-eight stenoses from 58 patients were analyzed. VF, EL, and AS were significantly larger in the group of FFR ≤ 0.8 while smaller MLA values were observed. The ROC-AUC of VF (0.91, 95% CI 0.81-0.96) was better than that of AS (change in AUC (ΔAUC) 0.27, p < 0.05) and MLA (ΔAUC 0.17, p < 0.05), and ROC-AUC of EL (0.90, 95%CI 0.80-0.96) was also better than that of AS (ΔAUC 0.26, p < 0.05) and MLA (ΔAUC 0.16, p < 0.05). FFR values correlated well with VF (rho = − 0.74 (95% CI − 0.83 to − 0.61, p < 0.0001) and EL (rho = − 0.74 (95% CI − 0.83 to − 0.61, p < 0.0001). Conclusion Pressure-flow curve-derived parameters enhance the diagnostic value of cCTA examination. Key Points• Pressure-flow curve derived from cCTA can assess coronary lesion severity.• VF and EL are superior to cCTA alone for indicating ischemic lesions.• Pressure-flow curve derived from cCTA may assist in clinical decision-making.

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

Abstract: 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.

Cited by 13 publications

References 32 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

A new CFD based non-invasive method for functional diagnosis of coronary stenosis

Pressure-flow curve derived from coronary CT angiography for detection of significant hemodynamic stenosis

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