P5633Diagnostic impact of resting full-cycle ratio as newly developed non-hyperemic indices for physiological lesion assessment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Takashima ◽  
A Suzuki ◽  
S Sakurai ◽  
H Ando ◽  
Y Nakano ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Entire Range ◽  
Coronary Artery Stenosis ◽  
Stable Condition ◽  
Artery Stenosis ◽  
Lesion Length ◽  
Fractional Flow ◽  
Gold Standard Method ◽  
Flow Reserve ◽  
Lesion Severity

Abstract Background Although fractional flow reserve (FFR) is a gold standard method to evaluate functional lesion severity in the catheterization laboratory, the need of hyperemic condition limits the widespread adoption of FFR. Recently, the resting full-cycle ratio (RFR) which was newly developed resting indices was launched. It is unclear whether RFR as resting condition could assess physiological lesion severity of coronary artery stenosis. The aim of this study was to evaluate the diagnostic impact of RFR compared to FFR in entire range of coronary artery stenosis. Method A total of 53 patients with 70 lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis. Results In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.3±0.8mm, 44±12%, 14.6±7.2mm, 0.90±0.11, and 0.83±0.11, respectively. Functional significance was observed in 24 lesions (34%) of all lesions. The RFR showed a significant correlation with FFR (y = 0.800x + 0.239, R = 0.817, p<0.001). The Bland-Altman plot demonstrated a good agreement with a mean difference of 0.07 and a standard deviation of 0.06 between RFR and FFR across entire range of coronary artery stenosis. ROC curve analysis showed an excellent accuracy of RFR cut-off of ≤0.90 in predicting FFR ≤0.80 which had 78% sensitivity and 87% specificity (AUC 0.87, diagnostic accuracy 84%). Conclusion The RFR as newly resting indices is reliable to the assessment of functional lesion severity. This physiology-based approach may be a possible alternative method for FFR measurements in daily practice.

Abstract 10976: Diagnostic Ability of Contrast Media Induced Fractional Flow Reserve to Assess Functional Significance of Entire Coronary Artery Stenosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hiroaki Takashima ◽  
Akiyoshi Kurita ◽  
Yuki Saka ◽  
Katsuhisa Waseda ◽  
Hirohiko Ando ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Contrast Media ◽  
Functional Significance ◽  
Entire Range ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Fractional Flow ◽  
Diagnostic Ability ◽  
Flow Reserve ◽  
Lesion Severity

Introduction: Although fractional flow reserve (FFR) is helpful to evaluate functional lesion severity, the need of adenosine limits the widespread adoption of FFR. Hypothesis: We hypothesized that contrast media induced FFR (cFFR) with submaximal hyperemic condition could assess functional lesion severity of coronary artery stenos. The aim of this study was to evaluate the diagnostic ability of cFFR compared to FFR in entire range of coronary artery stenosis. Methods: A total of 96 patients with 123 lesions were prospectively enrolled in this study. At first, we measured resting Pd/Pa ratio before inducing hyperemia. Then, cFFR was obtained after intracoronary injection of 6 ml of contrast media, while FFR was measured after intravenous adenosine triphosphate administration (180 mcg/kg/min). Lesions with FFR less than or equal 0.80 were considered functional significance of coronary artery stenosis. Results: In 123 lesions, reference diameter, diameter stenosis, resting Pd/Pa ratio, cFFR, and FFR were 2.7±0.8 mm, 47±12%, 0.91±0.10, 0.83±0.12, and 0.81±0.12, respectively. Functional significance was observed in 41% of all lesions. Both of resting Pd/Pa and cFFR showed strong correlations with FFR (r=0.861, p<0.001, and r=0.930, p<0.001, respectively). The correlation coefficient of cFFR was significantly superior to that of resting Pd/Pa ratio (p<0.05). This strong correlation between cFFR and FFR was shown in every coronary artery (LAD; r=0.924, p<0.001, LCX; r=0.923, p<0.001, and RCA; r=0.926, p<0.001, respectively). The Bland-Altman plot demonstrated a good agreement with a mean difference of -0.02 and a standard deviation of 0.05 between cFFR and FFR across entire range of coronary artery stenosis. ROC curve analysis showed an excellent accuracy of cFFR <0.84 in predicting functional significance (AUC 0.96, sensitivity 90%, specificity 89%, and diagnostic accuracy 89%). Moreover, the cFFR >0.89 was not corresponded to functional significance of entire coronary artery stenosis. Conclusions: The cFFR is an accurate, rapid and easy method in predicting functional significance of entire coronary artery stenosis. This physiology-based approach may be a possible alternative method for FFR measurements in daily practice.

Diagnostic feasibility of resting full-cycle ratio between systole and diastole to assess functional lesion severity of intermediate coronary artery stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Takashima ◽  
H Ohashi ◽  
H Ando ◽  
S Sakurai ◽  
Y Nakano ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Cycle ◽  
Coronary Artery Stenosis ◽  
Stable Condition ◽  
Artery Stenosis ◽  
Lesion Length ◽  
Roc Curve Analysis ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Lesion Severity

Abstract Background Recently, non-hyperemic physiologic indices have become widespread for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique non-hyperemic index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether RFR may detect functionally significant coronary stenosis that cannot be detected with other resting indices due to differences in the cardiac cycle. The aim of this study is to compare the diagnostic performance of RFR based on cardiac cycle. Method This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis. Results In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR systole was observed in 24 lesions (10.9%). Regarding to the coronary lesions, RFR systole was more frequent in non-LAD (LAD; 4.2%, left circumflex artery (LCX); 9.8%, and right coronary artery (RCA); 30.4%, respectively, p&lt;0.018). RFR showed a significant correlation with FFR in both systole and diastole (R = 0.918, p&lt;0.001, R = 0.733, p&lt;0.001, respectively). The ROC curve analysis showed similar agreement in both systole and diastole (AUC: 0.881, p&lt;0.001, AUC: 0.864, p&lt;0.001, respectively). RFR provided a good diagnostic accuracy and no difference in both systole and diastole (79.6% and 87.5%, respectively, p=0.58). Conclusion RFR is feasible and reliable non-hyperemic index regardless of the difference of cardiac cycle to evaluate physiological lesion severity in daily practice. Funding Acknowledgement Type of funding source: None

Differential impact of target vessel on the diagnostic performance of resting full-cycle ratio as non-hyperemic physiological assessment

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Takashima ◽  
H Ohashi ◽  
H Ando ◽  
A Suzuki ◽  
S Sakurai ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Functional Significance ◽  
Diagnostic Performance ◽  
Coronary Artery Stenosis ◽  
Stable Condition ◽  
Artery Stenosis ◽  
Lesion Length ◽  
Target Vessel ◽  
Roc Curve Analysis

Abstract Background Recently, wire-based resting indices have been recognized as gold standard for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique resting index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether the diagnostic performance of RFR for detecting functional coronary artery stenosis is similar in each coronary artery. The aim of this study is to compare the diagnostic performance of RFR based on target coronary vessel. Method This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis. Results In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR showed a significant correlation with FFR in overall lesions (r=0.774, p&lt;0.001). The ROC curve analysis of RFR showed good accuracy for predicting functional significance (AUC 0.87, diagnostic accuracy 81%) in all subjects. Regarding each target vessel, there were similar and significant positive correlation between RFR and FFR (LAD; r=0.733, p&lt;0.001, LCX; r=0.771, p&lt;0.001, RCA; r=0.769, p&lt;0.001, respectively). The prevalence of discordant between RFR and FFR was significantly different among 3 vessels (LAD 26%, LCX 12%, RCA 13%, respectively, p&lt;0.05 for among 3 groups). Regarding the comparison of ROC curves according to lesion location, AUC was significantly lower in LAD than in LCX and RCA (LAD 0.780, LCX 0.947, RCA 0.926, p&lt;0.01 for LAD compared to LCX, p&lt;0.01 for LAD compared to RCA, respectively). Furthermore, the diagnostic accuracy was significantly different according to target vessel (LAD 74%, LCX 88%, RCA 87%, respectively, p&lt;0.05 for among 3 vessels). Conclusion RFR demonstrated better diagnostic accuracy for evaluating functional lesion severity. The diagnostic performance of RFR was different based on target vessel. RFR is a unique and useful resting index, and it may detect functionally significant coronary stenosis that cannot be detected with other resting indices in daily practice. Funding Acknowledgement Type of funding source: None

Fractional flow reserve and instantaneous wave-free ratio discordance in patients with severe aortic valve stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Yamanaka ◽  
K Shishido ◽  
S Yokota ◽  
N Moriyama ◽  
Y Mashimo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Fractional Flow Reserve ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Aortic Valve Area ◽  
Fractional Flow ◽  
Left Anterior Descending Artery ◽  
Flow Reserve

Abstract Background It has been reported that discordance between fractional flow reserve (FFR) and Instantaneous Wave-Free Ratio (iFR) could occur in up to 20% of cases. However, there are no reports regarding discordance between FFR and iFR in patients with severe aortic valve stenosis (AS). Purpose We aimed to investigate the discordance between FFR and iFR in patients with severe AS. Methods Severe AS was defined as an aortic-valve area of ≤1.0 cm2, a mean aortic-valve gradient of 40mmHg or more, or a peak aortic-jet velocity of 4.0 m/s or more. Intermediate coronary artery stenosis was defined as 30% to 70% stenosis (visual estimation). FFR and iFR were calculated in 4 quadrants based on values of FFR ≤0.8 and iFR ≤0.89 (positive discordance; low FFR and high iFR, negative discordance; high FFR and low iFR). Results We examined consecutive 140 patients (164 intermediate coronary artery stenosis vessels). Mean FFR and iFR ± standard deviation was 0.82±0.09 and 0.82±0.14, respectively. The discordance was observed in 48 vessels (29.3%). In the discordant group, most of cases were negative discordance (45 cases, 93.6%). Binary logistic regression analysis showed that left anterior descending artery (Hazard Ratio 3.80; 1.55 to 9.31, p=0.0036) was independently associated with negative discordance. Conclusions In patients with severe AS, the discordance between FFR and iFR could be observed in 29.3% of the vessels, mostly negative discordance. The left anterior descending artery is an independent predictor for negative discordance. Funding Acknowledgement Type of funding source: None

Systemic immune-inflammation index is a novel marker to predict functionally significant coronary artery stenosis

2020 ◽  
Vol 14 (16) ◽  
pp. 1553-1561
Author(s):  
Mehmet Erdoğan ◽  
Mehmet A Erdöl ◽  
Selçuk Öztürk ◽  
Tahir Durmaz
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Fractional Flow ◽  
Predictive Capacity ◽  
Significant Coronary Artery Stenosis ◽  
Lymphocyte Ratio ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Immune Inflammation

Aim: The study aimed to investigate and compare the predictive capacity of a systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) to determine a hemodynamically significant coronary artery stenosis assessed by fractional flow reserve (FFR). Patients & methods: A total of 207 chronic coronary syndrome patients with FFR measurement were enrolled in the study. NLR, PLR and SII levels were calculated. Results: The cut-off value of the SII (620) was associated with 78.4% sensitivity and 64.0% specificity to predict a hemodynamically significant stenosis. SII level independently predicted FFR ≤0.80. Conclusion: SII is an independent predictor of functionally significant coronary stenosis detected by FFR in chronic coronary syndrome patients. SII levels can predict hemodynamically severe obstruction better than NLR and PLR.

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