Predictive Value of Resting Pd/Pa for Fractional Flow Reserve Assessed with Monorail Pressure Microcatheter in Real-World Practice

Abstract

Background and Objectives: The aims of this study were (1) to examine the diagnostic accuracy of resting time-averaged distal coronary pressure (Pd) to mean aortic pressure (Pa) ratio to predict hyperemic fractional flow reserve (FFR) and (2) to identify a resting Pd/Pa value that can preclude the need for hyperemic FFR assessed with use of a monorail pressure catheter. Methods: A total of 191 stenoses were assessed. After exclusions, 157 FFR data sets from 103 patients were analyzed. Results: Resting Pd/Pa showed poor agreement with hyperemic FFR (r=0.619, P<0.001). The receiver operating characteristic curve for resting Pd/Pa with reference to hyperemic FFR of 0.80 or less showed an area under the curve of 0.800 (95% confidence interval 0.732–0.868, P<0.001), with the greatest diagnostic accuracy of 74.5% for resting Pd/Pa of less than 0.85. Resting Pd/Pa of 0.96 or greater had a sensitivity of 100% and a negative predictive value of 100%, and resting Pd/Pa of 0.82 or less had a specificity of 98.9% and a positive predictive value of 94.1% to predict abnormal FFR of 0.80 or less. These results were consistent regardless of the vessels studied, the location of lesions, and the severity of stenosis. Conclusions: Resting Pd/Pa showed poor agreement with hyperemic FFR assessed with use of a monorail pressure microcatheter. However, resting Pd/Pa of 0.96 or greater had excellent sensitivity and negative predictive value to predict normal hyperemic FFR, and resting Pd/Pa of 0.82 or less had excellent specificity and positive predictive value to predict abnormal hyperemic FFR.

Advances in Multifunctional Electronic Catheters for Precise and Intelligent Diagnosis and Therapy in Minimally Invasive Surgery

“…Pressure parameters provide an important basis for understanding the changes in the internal environment and the damage to surrounding tissues. Pressure microcatheters can also be used for pressure testing of intracardiac pressure, pulmonary artery pressure, intrarenal pressure, and other organs. − For intracardiac pressure, thermal dilution or piezoelectric sensing principles are usually used for detection. The thermodilution technique is a method of determining the magnitude of intracardiac pressure by detecting temperature changes within the heart or blood vessels due to an indicator fluid by a catheter or guidewire .…”