Diagnostic Accuracy of Baseline Distal-to-Aortic Pressure Ratio to Assess Coronary Stenosis Severity

Background: The diastolic pressure ratio (dPR) is a non-hyperemic index used to measure the ratio of distal coronary to aortic pressure during a diastolic portion of the cardiac cycle. dPR indices measured by a pressure wire have similar diagnostic accuracy as iFR for FFR. The accuracy of dPR using a microcatheter (MC) has not been defined. Methods: The ACIST-FFR study was a prospective, multicenter study of a pressure-monitoring MC in patients with stable CAD. Using an automated software algorithm, dPR with the MC was defined as the Pd/Pa at the location within the diastolic period that was 50% of the distance from the peak of one waveform to the peak of the next waveform, averaged over a 5-beat period. iFR with the MC was computed in the usual fashion by the core laboratory from the original pressure tracings. Results: A total of 161 paired data samples from 11 sites were analyzed. dPR was highly correlated with iFR (R 2 =0.992, AUC=0.998 with a mean bias of -0.0237 (95% CI, -0.0041 to -0.0011) and provided a sensitivity of 98%, specificity 96%, and diagnostic accuracy of 96.9%. The optimal cutpoint of dPR for FFR was 0.91 (AUC=0.886), which provided a sensitivity of 82%, specificity of 80%, and diagnostic accuracy of 81%. The diagnostic accuracy of iFR for FFR was 81%, with a sensitivity of 82%, and specificity 80%. Conclusions: With a MC system, a non-hyperemic diastolic pressure ratio is highly correlated with iFR, and provides similar diagnostic accuracy as iFR for FFR.

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Temporal dissociation between the minimal distal-to-aortic pressure ratio and peak hyperemia during intravenous adenosine infusion

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00632.2016 ◽

2017 ◽

Vol 312 (5) ◽

pp. H992-H1001 ◽

Cited By ~ 4

Author(s):

Lorena Casadonte ◽

Koen M. Marques ◽

Jos A. E. Spaan ◽

Maria Siebes

Keyword(s):

Flow Velocity ◽

Coronary Flow ◽

Fluid Dynamic ◽

Pressure Ratio ◽

Aortic Pressure ◽

Adenosine Infusion ◽

Maximal Velocity ◽

Systemic Hemodynamic ◽

Stenosis Severity ◽

Adenosine Administration

The present study sought to compare the temporal relation between maximal coronary flow (peak hyperemia) and minimal coronary-to-aortic pressure ratio (Pd/Pa) for intracoronary (IC) and intravenous (IV) adenosine administration. Peak hyperemia is assumed to coincide with the minimal Pd/Pa value. However, this has not been confirmed for systemic hemodynamic variations during IV adenosine infusion. Hemodynamic responses to IV and IC adenosine administration were obtained in 12 patients (14 lesions) using combined IC pressure and flow velocity measurements. A fluid dynamic model was used to predict the change in Pd/Pa for different stenosis severities and varying Pa. Hemodynamic variability during IV adenosine hyperemia was greater than during IC adenosine, as assessed by the coefficient of variation. During IV adenosine, flow velocity peaked 28 ± 4 (SE) s after the onset of hyperemia, while Pd/Pa reached a minimum (0.82 ± 0.01) 22 ± 7 s later ( P < 0.05), when Pa had declined by 6.1% and hyperemic velocity by 4.5% ( P < 0.01). Model outcomes corroborated the role of variable Pa in this dissociation. In contrast, maximal flow and minimal Pd/Pa coincided for IC adenosine, with IV-equivalent peak velocities and a higher Pd/Pa ratio (0.86 ± 0.01, P < 0.01). Hemodynamic variability during continuous IV adenosine infusion can lead to temporal dissociation of minimal Pd/Pa and peak hyperemia, in contrast to IC adenosine injection, where maximal velocity and minimal Pd/Pa coincide. Despite this variability, stenosis hemodynamics remained stable with both ways of adenosine administration. Our findings suggest advantages of IC over IV adenosine to identify maximal hyperemia from pressure-only measurements. NEW & NOTEWORTHY Systemic hemodynamic variability during intravenous adenosine infusion produces substantial temporal dissociation between peak hyperemia appraised by coronary flow velocity and the minimal distal-to-aortic pressure ratio commonly used to determine functional stenosis severity. This dissociation was absent for intracoronary adenosine administration and tended to be mitigated in patients receiving Ca2+ antagonists.

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Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity

EuroIntervention ◽

10.4244/eij-d-19-00182 ◽

2019 ◽

Vol 15 (2) ◽

pp. 189-197 ◽

Cited By ~ 13

Author(s):

Wei Yu ◽

Jiayue Huang ◽

Dean Jia ◽

Shaoliang Chen ◽

Owen Christopher Raffel ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Diagnostic Accuracy ◽

Fractional Flow Reserve ◽

Coronary Stenosis ◽

Optical Coherence ◽

Fractional Flow ◽

Flow Reserve ◽

Stenosis Severity

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Influence of increased heart rate and aortic pressure on resting indices of functional coronary stenosis severity

Basic Research in Cardiology ◽

10.1007/s00395-017-0651-0 ◽

2017 ◽

Vol 112 (6) ◽

Cited By ~ 14

Author(s):

Lorena Casadonte ◽

Bart-Jan Verhoeff ◽

Jan J. Piek ◽

Ed VanBavel ◽

Jos A. E. Spaan ◽

...

Keyword(s):

Heart Rate ◽

Coronary Stenosis ◽

Aortic Pressure ◽

Stenosis Severity

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Transesophageal dobutamine–atropine stress echocardiography: diagnostic accuracy for coronary stenosis detection and localization

International Journal of Cardiology ◽

10.1016/s0167-5273(96)02722-2 ◽

1996 ◽

Vol 56 (2) ◽

pp. 185-192

Author(s):

M Shahi

Keyword(s):

Diagnostic Accuracy ◽

Coronary Stenosis ◽

Stress Echocardiography ◽

Stenosis Detection ◽

Detection And Localization

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Abstract 18795: Resting Patient- and Vessel-Specific Myocardial Perfusion Attenuation Patterns Improves Diagnostic Performance of Coronary Computed Tomographic Angiography

Circulation ◽

10.1161/circ.130.suppl_2.18795 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Guanglei Xiong ◽

Iksung Cho ◽

Heidi Gransar ◽

Deeksha Kola ◽

Kimberly Elmore ◽

...

Keyword(s):

Myocardial Perfusion ◽

Diagnostic Accuracy ◽

Coronary Stenosis ◽

Diagnostic Performance ◽

Ct Perfusion ◽

Quantitative Coronary Angiography ◽

High Grade ◽

Operating Characteristics ◽

Luminal Diameter ◽

Coronary Stenoses

Introduction: Coronary CT angiography (CCTA) demonstrates improved performance for diagnosis of high-grade coronary stenoses, but may be affected by artifacts and overestimation of stenosis severity. Whether the addition of resting myocardial perfusion attenuation patterns subtended by stenosis seen on CCTA improves diagnostic performance has not been examined to date. Methods: We evaluated 127 patients (mean age 53.0, 54.3% male) who underwent CCTA and ICA. Percentage of coronary stenosis was assessed by quantitative coronary angiography (QCA), which served as the reference comparator to CCTA. CCTA stenosis was categorized as 0%, 1-24%, 25-49%, 50-69%, 70-99%, and 100% luminal diameter reduction. Automated software (SmartHeart, Redwood City, CA) was used to measure resting CT perfusion attenuation patterns in myocardial segments by AHA 17-segment model. Segmental CT attenuation values were assigned to territories subtended by left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). Per-patient and per-vessel analyses were based on highest severity (maximal stenosis, minimal attenuation). On both per-patient and per-vessel basis, logistic regression was devised for CCTA stenosis alone and for CCTA plus resting myocardial attenuation. Diagnostic accuracy and area under the receiver operating characteristics curve (AUC) were determined. Results: Diagnostic accuracy of CCTA alone was 84.0%, 85.5%, 90.4%, and 88.6%, at per-patient, per-LAD, per-LCX and per-RCA level, respectively. In comparison, the accuracy of CCTA plus myocardial attenuation were 89.6%, 91.9%, 95.2%, and 92.7%. The AUCs using CCTA alone to discriminate QCA-confirmed coronary stenoses >70% were 0.823 (95% CI: 0.737-0.909), 0.782 (95% CI: 0.667-0.898), 0.690 (95% CI: 0.503-0.878), and 0.793 (95% CI: 0.640-0.945) for per-patient, per-LAD, per-LCX, and per-RCA analysis, respectively. The AUCs using CCTA plus myocardial attenuation improved to 0.864 (95% CI: 0.765-0.962), 0.881 (95% CI: 0.793-0.968), 0.772 (95% CI: 0.535-1.000), and 0.820 (95% CI: 0.685-0.954). Conclusions: The addition of resting CT myocardial perfusion attenuation patterns improves identification and discrimination of high-grade coronary stenosis by CCTA.

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