Independent predictors of discordance between the resting full-cycle ratio and fractional flow reserve

Goto, Reiji; Takashima, Hiroaki; Ohashi, Hirofumi; Ando, Hirohiko; Suzuki, Akihiro; Sakurai, Shinichiro; Nakano, Yusuke; Fujimoto, Masanobu; Suzuki, Yasushi; Waseda, Katsuhisa; Ohashi, Wataru; Amano, Tetsuya

doi:10.1007/s00380-020-01763-1

Cited by 21 publications

(44 citation statements)

References 28 publications

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“…Multivariate analysis revealed LAD lesions as a highly relevant predictor for RFR ≤ 0.89/FFR > 0.8 with an odds ratio of 3.17, confirming the findings of present studies of NHPRs (26,29).…”

Section: Values Are N (%) or N (95% Confidence Interval)supporting

confidence: 89%

“…PAD was a relevant predictor of discrepancy of RFR ≤ 0.89 /FFR > 0.8 with an odds ratio of 2.63. The same finding was reported by Goto et al (26). Pellegrino et al reported that the coronary flow reserve (CFR) was significantly lower in patients with PAD than in those without PAD (30), which could explain the discordance, since reduced flow may lead to an underestimation of stenosis severity by FFR.…”

Section: Values Are N (%) or N (95% Confidence Interval)supporting

confidence: 79%

“…to previous smaller studies with a range from 7.2-19.7% (14,22,(26)(27)(28). This may be attributed to the broad inclusion criteria, which may affect physiologic measurements and cause discrepancies (21).…”

Section: Values Are N (%) or N (95% Confidence Interval)mentioning

confidence: 87%

“…Two randomized trials have demonstrated that iFR-guided treatment is non-inferior to FFR-guided treatment (11,12), while other NHPRs were not yet validated in randomized trials. However, discrepancies between NHPRs and FFR have been reported, and literature about this topic is growing (17,20,25), but still limited by a small number of examined patients (26).…”

Section: Discussionmentioning

confidence: 99%

“…Since a single index is usually applied in clinical practice and determination of both resting and hyperemic indices is performed only in the minority of cases, discordance of results is usually inapparent, which increases the importance of potential predictors of discordant findings. Several clinical factors such as gender, anemia, LV diastolic dysfunction, diabetes mellitus and angiographic factors have been proposed as predictors of discordance of low NHPRs /high FFR (19,20,22,26,29), i.e., revascularization would be performed based on an NHPRs but deferred based on FFR. In our population, female sex, age, LAD lesion, PAD and non-focal lesion were predictors of RFR ≤ 0.89/FFR > 0.8.…”

Section: Values Are N (%) or N (95% Confidence Interval)mentioning

confidence: 99%

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Comparison of Resting Full-Cycle Ratio and Fractional Flow Reserve in a German Real-World Cohort

Wienemann

Meyer

Mauri

et al. 2021

Front. Cardiovasc. Med.

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Objective: The aim of this study was to evaluate non-hyperemic resting pressure ratios (NHPRs), especially the novel “resting full-cycle ratio” (RFR; lowest pressure distal to the stenosis/aortic pressure during the entire cardiac cycle), compared to the gold standard fractional flow reserve (FFR) in a “real-world” setting.Methods: The study included patients undergoing coronary pressure wire studies at one German University Hospital. No patients were excluded based on any baseline or procedural characteristics, except for insufficient quality of traces. The diagnostic performance of four NHPRs vs. FFR ≤ 0.80 was tested. Morphological characteristics of stenoses were analyzed by quantitative coronary angiography.Results: 617 patients with 712 coronary lesions were included. RFR showed a significant correlation with FFR (r = 0.766, p < 0.01). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of RFR were 78% (95% confidence interval = 75; 81), 72% (65; 78), 81% (77; 84), 63% (57; 69), and 86% (83; 89). Relevant predictors for discordance of RFR ≤ 0.89/FFR > 0.8 were LAD lesions, peripheral artery disease, age, female sex and non-focal stenoses. Predictors for discordance of RFR > 0.89/FFR ≤ 0.8 included non-LCX lesions, percent diameter stenosis and previous percutaneous coronary intervention in the target vessel. RFR and all other NHPRs were highly correlated with each other.Conclusion: All NHPRs have a similar correlation with the gold standard FFR and may facilitate the acceptance and implementation of physiological assessments of lesion severity. However, we found ~20% discordant results between NHPRs and FFR in our “all-comers” German cohort.

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Section: Values Are N (%) or N (95% Confidence Interval)supporting

confidence: 89%

Section: Values Are N (%) or N (95% Confidence Interval)supporting

confidence: 79%