The relationship between the basal coronary translesional pressure ratio and fractional flow reserve

Wilson, William; Shah, Anoop; Birse, Duncan; Harley, Emma; Northridge, David B.; Uren, Neal

doi:10.1002/ccd.27027

Cited by 5 publications

(4 citation statements)

References 40 publications

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“…More recently, Seo and colleagues demonstrated that ΔPd/Pa correlated negatively and independently with hyperemic microvascular resistance index in stable patients with intermediate stenosis 19 . ΔPd/Pa values were found to be reduced among female subjects and older patients, increased in patients with negative cholesterol profile, and affected by stenosis severity and length 20,21 …”

Section: Discussionmentioning

confidence: 99%

“…19 ΔPd/ Pa values were found to be reduced among female subjects and older patients, increased in patients with negative cholesterol profile, and affected by stenosis severity and length. 20,21 Pressure-wire-derived measurements are the resultant of the complex interplay between epicardial stenosis and microcirculation.…”

Section: Predictive Role Of Intracoronary Pressure Parametersmentioning

confidence: 99%

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Intracoronary pressures to predict myocardial viability in patients with ischemic left ventricular dysfunction

Marchese

Barbato

Gioia

et al. 2022

Cathet Cardio Intervent

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To investigate the role of intracoronary pressure parameters in the assessment of viability in the myocardium subtending a significant coronary stenosis. In patients with ischemic left ventricular dysfunction, the presence of myocardial viability is related to the expected benefits derived from coronary revascularization.Intracoronary pressure wire-based measurements were performed in 64 coronary lesions of ≥50% stenosis severity of 59 patients with postischemic left ventricular dysfunction, segmental left ventricular wall motion abnormalities, and substantial viability in the myocardial territory subtending the investigated stenotic coronaries, defined as the percent summed rest score in the target territory (%SRS target ) ≤60% at the single-photon emission tomography. Invasive pressure-derived indexes like resting and hyperemic Pd/Pa, ΔPd/Pa, and %ΔPd/Pa (defined as the absolute difference and percent decrease between resting and hyperemic Pd/Pa respectively) were compared with %SRS target . A significant correlation was found between ΔPd/Pa (Spearman's p: −0.760, p < 0.001) and %ΔPd/Pa (p: −0.733; p < 0.001) with %SRS target. These results were confirmed after correction for potential confounders.According to %SRS target median value, myocardial areas with high and low viability were compared: ΔPd/Pa and %ΔPd/Pa were significantly higher in areas with high viability (p < 0.001 for both). According to receiver operating characteristic curves, we identified two cut-offs (ΔPd/Pa > 0.11 and %ΔPd/Pa > 15%) able to predict >80% viability with good sensitivity and specificity. Our study suggests that, in patients with postischemic left ventricular dysfunction and significant coronary stenosis, intracoronary pressures indexes like ΔPd/Pa and %ΔPd/Pa are able to predict the magnitude of downstream myocardial viability.

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Section: Discussionmentioning

confidence: 99%

Section: Predictive Role Of Intracoronary Pressure Parametersmentioning

confidence: 99%

Intracoronary pressures to predict myocardial viability in patients with ischemic left ventricular dysfunction

Marchese

Barbato

Gioia

et al. 2022

Cathet Cardio Intervent

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“…Many studies comparing functional and anatomical assessments of coronary stenosis using FFR and coronary angiography or intravascular imaging showed significant anatomical–functional discordance. Although previous explanations for functional information using anatomical features have not yielded satisfactory results [ 19 – 21 ], the LAD has been consistently identified as an independent predictor of functional significance based on FFR throughout the studies [ 22 ], which could be due to its larger myocardial mass, requiring the highest amount of coronary blood flow [ 23 , 24 ]. However, our study suggests that HD can be added as a plausible explanation for relatively lower FFR values in the LAD than in the LCX and RCA [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of height difference between coronary ostium and location of intracoronary pressure sensor on fractional flow reserve measurements

Soh,

Kim,

Kang

et al. 2023

PLoS ONE

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Background During fractional flow reserve (FFR) measurements, distal coronary pressure (Pd) can be influenced by hydrostatic pressure changes resulting from the height difference (HD) between the coronary ostium and the location of the distal pressure sensor. Aims We investigated the effect of aortocoronary HD on the FFR measurements in each coronary artery. Methods In this retrospective cohort study, we analyzed 257 patients who underwent FFR measurements and coronary computed tomography (CCTA) within a year. Using CCTA, we measured HD as the vertical distance between the coronary ostium and a matched point of the distal coronary pressure sensor identified on coronary angiography. Results The location of the Pd sensor was higher than the coronary ostium in the left anterior descending artery (LAD) (-4.64 ± 1.15 cm) and lower than the coronary ostium in the left circumflex artery (LCX) (2.54 ± 1.05 cm) and right coronary artery (RCA) (2.03 ± 1.28 cm). The corrected FFR values by HD were higher in the LAD (0.78 ± 0.09 to 0.82 ± 0.09, P<0.01) and lower in the LCX and RCA than the original FFR values (0.87 ± 0.07 to 0.85 ± 0.08, P<0.01; 0.87 ± 0.10 to 0.86 ± 0.10, P<0.01, respectively). Using an FFR cut-off value of 0.8, the concordance rates between the FFR and corrected FFR values were 77.8%, 95.2%, and 100% in the LAD, LCX, and RCA, respectively. Conclusion HD between the coronary ostium and the distal coronary pressure sensor may affect FFR measurements and FFR-guided treatment decisions for coronary artery disease.

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“…The present study defined cutoff points for resting gradients prospectively, assessing the relationship between the basal coronary translesional pressure ratio and FFR. The proposed algorithm determined a Pd/Pa cutoff ≤0.87 to predict physiologic lesion significance (positive predictive value of 100% for an FFR value ≤0.80) and ≥0.93 to predict non‐significance (negative predictive value of 98% for an FFR value >0.80) . Using resting Pd/Pa in this subset of patients, 2/3 of lesions can be evaluated with great accuracy without the use of adenosine.…”

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confidence: 99%

Coronary resting gradients for hemodynamic lesion assessment ‐ The future of coronary physiology?

Shlofmitz

Jeremias

2017

Cathet Cardio Intervent

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Coronary resting gradient measurements with cut-off values of ≤0.87 and ≥0.93 portend a high degree of certainty with respect to appropriateness of coronary revascularization Less agreement exists in patients in the so called indeterminate "gray zone" Pressure-bounded coronary flow reserve may aid in our understanding of the underlying physiologic principles and facilitate the clinical assessment of these lesions.

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The relationship between the basal coronary translesional pressure ratio and fractional flow reserve

Abstract: The delta P /P may be affected by patient gender, body mass index, and cholesterol profile. A basal P /P value of ≥0.93 is highly predictive of an FFR >0.80. Conversely, a basal P /P value of ≤0.87 is highly predictive of an FFR ≤0.80. © 2017 Wiley Periodicals, Inc.

Cited by 5 publications

References 40 publications

Intracoronary pressures to predict myocardial viability in patients with ischemic left ventricular dysfunction

Intracoronary pressures to predict myocardial viability in patients with ischemic left ventricular dysfunction

Impact of height difference between coronary ostium and location of intracoronary pressure sensor on fractional flow reserve measurements

Coronary resting gradients for hemodynamic lesion assessment ‐ The future of coronary physiology?

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