Abstract 17034: Diagnostic Accuracy of Diastolic Pressure Ratio Using a Microcatheter: An Analysis of the ACIST-FFR Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Matthew Price ◽  
Jaden Yang ◽  
Jeffrey Chambers ◽  
Arnold Seto ◽  
Iam Sarembock ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diastolic Pressure ◽  
Pressure Ratio ◽  
Aortic Pressure ◽  
Paired Data ◽  
System A ◽  
Pressure Wire ◽  
Stable Cad ◽  
Highly Correlated ◽  
Automated Software

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.

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

2015 ◽  
Vol 8 (6) ◽  
pp. 834-836 ◽  
Author(s):  
Mauro Echavarría-Pinto ◽  
Tim P. van de Hoef ◽  
Hector M. Garcia-Garcia ◽  
Ton de Vries ◽  
Patrick W. Serruys ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Coronary Stenosis ◽  
Pressure Ratio ◽  
Aortic Pressure ◽  
Stenosis Severity

scholarly journals Non-hyperaemic pressure ratios to guide percutaneous coronary intervention

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001308
Author(s):  
Michael Michail ◽  
Udit Thakur ◽  
Ojas Mehta ◽  
John M Ramzy ◽  
Andrea Comella ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Pressure Ratio ◽  
Coronary Intervention ◽  
Clinical Decision ◽  
Aortic Pressure ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Pressure Wire ◽  
Procedural Time ◽  
Catheter Laboratory

The use of fractional flow reserve (FFR) in guiding revascularisation improves patient outcomes and has been well-established in clinical guidelines. Despite this, the uptake of FFR has been limited, likely attributable to the perceived increase in procedural time and use of hyperaemic agents that can cause patient discomfort. This has led to the development of instantaneous wave-free ratio (iFR), an alternative non-hyperaemic pressure ratio (NHPR). Since its inception, the use of iFR has been supported by an increasing body of evidence and is now guideline recommended. More recently, other commercially available NHPRs including diastolic hyperaemia-free ratio and resting full-cycle ratio have emerged. Studies have demonstrated that these indices, in addition to mean distal coronary artery pressure to mean aortic pressure ratio, are mathematically analogous (with specific nuances) to iFR. Additionally, there is increasing data demonstrating the equivalent diagnostic performance of alternative NHPRs in comparison with iFR and FFR. These NHPRs are now integral within most current pressure wire systems and are commonly available in the catheter laboratory. It is therefore key to understand the fundamental differences and evidence for NHPRs to guide appropriate clinical decision-making.

P5619Comparison of different resting physiological indices: are diastolic pressure ratio and resting full-cycle ratio equal?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Hoshino ◽  
Y Kanaji ◽  
T Sugiyama ◽  
M Yamaguchi ◽  
H Ohya ◽  
...  
Keyword(s):  
Predictive Value ◽  
Diagnostic Performance ◽  
Diastolic Pressure ◽  
Characteristic Curve ◽  
Pressure Ratio ◽  
Pairwise Comparison ◽  
Roc Curve Analysis ◽  
Coronary Pressure ◽  
Significant Difference ◽  
Highly Correlated

Abstract Background Previous reports showed all diastolic resting indexes tested were virtually identical to the instantaneous wave-free ratio (iFR). Although RFR has been also reported to be diagnostically equivalent to iFR, no comparisons have been reported about the prevalence and characteristics of discordance in diagnosis between diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR). Purpose This study sought to determine the coronary pressure characteristics of lesions classified as discordant between dPR and RFR in angiographically intermediate stenoses. Methods We recruited 532 patients with 668 intermediate (angiographically stenosis between 30% to 70% severity) coronary lesions undergoing FFR assessment and analyzed DICOM pressure tracings of resting state (dPR and RFR) using a fully automated off-line software algorithm in a blind fashion. Diagnostic performance of dPR and RFR was evaluated using FFR as a reference. Furthermore, we investigated similarity and difference between dPR and RFR. Results Median FFR was 0.81 with an interquartile range of 0.74 to 0.87. RFR was highly correlated to dPR (R2=0.94, p<0.001), with a mean bias of 0.012 (95% limits of agreement −0.008 to 0.031). The diagnostic performance of RFR versus dPR was diagnostic accuracy 95.4%, sensitivity 100.0%, specificity 91.6%, positive predictive value 90.6%, negative predictive value 100.0%). Using the binary cut-off of dPR ≤0.89 as a cut-off value, RFR showed near identical agreement according to ROC curve analysis (AUC: 0.996, 95% CI: 0.994–0.999, p<0.001). Although dPR and RFR demonstrated equivalent performance against FFR ≤0.8 (79.5% vs. 79.3% accuracy; p=0.960; area under the receiver-operating characteristic curve: 0.869 vs. 0.870; p=0.528), RFR disagreed with dPR in 4.6% (31 of 668). When all lesions (668 vessels) were divided into groups according to the concordance and discordance between dPR and RFR: RFR+/dPR+ (298 vessels, n=240), RFR+/dPR– (31 vessels, n=31 patients), RFR-/dPR- (339 vessels, n=259). There was no lesion showing RFR-/dPR+. The prevalence of ischemia was tended to be higher in lesions evaluated by RFR (49.3% vs 44.6%, P=0.100) when using FFR ≤0.80 as a reference standard. An overall significant difference in the prevalence of FFR ≤0.80 and the FFR values were detected among these 3 groups. Furthermore, pairwise comparison also revealed the prevalence of FFR >0.80 and the FFR values were significantly lower in RFR+/dPR– than in RFR-/dPR-, and significantly higher in RFR+/dPR– than in RFR+/dPR+. (P<0.001 and P<0.001, respectively) Conclusion Significant difference in FFR values was observed according to dPR/RFR agreement and disagreement. Revascularization decision making might defer according to the resting index used. Compared with RFR, lesions might be more frequently deferred when dPR was used to assess physiological significance. Acknowledgement/Funding None

Abstract 19170: Lesion Morphological Classification by Optical Coherence Tomography to Predict Therapeutic Efficacy After Balloon Pulmonary Angioplasty

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Taku Inohara ◽  
Takashi Kawakami ◽  
Masaharu Kataoka ◽  
Keiichi Fukuda
Keyword(s):  
Optical Coherence Tomography ◽  
Therapeutic Efficacy ◽  
Pressure Ratio ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Thick Wall ◽  
Thin Wall ◽  
Optical Coherence ◽  
Pressure Wire ◽  
Balloon Pulmonary Angioplasty ◽  
Lesion Morphology

Introduction: Conventionally, angiographic classification has been used for chronic thromboembolic pulmonary hypertension (CTEPH). However, a classification based on lesion morphology is needed in the era of balloon pulmonary angioplasty (BPA). We sought to propose a classification of CTEPH based on lesion morphology detected by optical coherence tomography (OCT) and to evaluate its association with physiological stenosis assessed with a pressure wire and therapeutic efficacy in BPA. Methods: We analyzed 43 lesions in 17 patients who were treated with BPA under OCT and pressure-wire guidance from November 2012 to March 2015. OCT findings were classified into the following 4 categories: 1) mono-hole, 2) septum, 3) multi-hole with thin wall, and 4) multi-hole with thick wall. Results: Angiographic findings did not match the specific morphologic classification based on OCT findings. At the pre-BPA assessment, the pressure ratio of the septum type was significantly higher than that of the mono-hole and multi-hole with thick wall types (p = 0.026 and 0.047, respectively). Under the OCT-based classification, more than 50% of the septum and multi-hole with thin wall types could accomplish >0.8 of the mean pressure ratio assessed by a pressure wire, and these proportions were significantly higher than those of the other 2 types: mono-hole and multi-hole with thick wall (p = 0.044). Based on angiographic classification, accomplishment of this criterion was not significantly different among angiographic types. Conclusions: OCT-based morphologic lesion classifications in CTEPH were useful to predict whether the lesion stenosis could improve to the acceptable level mediated by BPA.

INFLUENCE OF ACIDEMIA ON LEFT VENTRICULAR FUNCTION IN THE NEWBORN LAMB

PEDIATRICS ◽  
1966 ◽  
Vol 38 (3) ◽  
pp. 457-464
Author(s):  
Norman S. Talner ◽  
Thomas H. Gardner ◽  
S. Evans Downing
Keyword(s):  
Left Ventricle ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Diastolic Pressure ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Newborn Lamb ◽  
Precise Control ◽  
Significant Impairment ◽  
Ph Range

The performance of the left ventricle in 20 newborn lambs was examined in a preparation which allowed precise control of aortic pressure, cardiac output, heart rate, and temperature. Reduction of arterial pH from a normal range (7.35 to 7.5) to severe acidemia (6.8 to 7.0) by hydrochloric or lactic acid infusion resulted in no significant impairment of left ventricular function. Prolonged acidemia (over 2 hours) failed to produce a reduction in left ventricular stroke volume or mean ejection rate for a given left ventricular end-diastolic pressure. Responsiveness of the left ventricle of the lamb to catecholamine stimulation was not diminished over the pH range 7.5 to 6.8. Under conditions of these investigations the apparent resistance of the myocardium of the newborn lamb, as well as the adult cat, to wide variations in pH may reflect a buffering capacity of cardiac muscle which would allow minimal change in intracellular pH, even though extracellular pH may indicate the presence of severe metabolic acidosis.

The systolic to diastolic pressure ratio in non-dipping essential hypertension patients

2021 ◽  
Vol 429 ◽  
pp. 118865
Author(s):  
Andrea Bassi ◽  
Marco Iosa ◽  
Francesco Ruggiero ◽  
Laura Serra ◽  
Giulia Bechi Gabrielli ◽  
...  
Keyword(s):  
Essential Hypertension ◽  
Diastolic Pressure ◽  
Pressure Ratio

Interaction of interval-force relationship with aortic pressure and stroke volume

1976 ◽  
Vol 230 (4) ◽  
pp. 893-900 ◽  
Author(s):  
ER Powers ◽  
Foster ◽  
Powell WJ
Keyword(s):  
Heart Rate ◽  
Stroke Volume ◽  
Diastolic Pressure ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Cardiac Performance ◽  
Right Heart ◽  
Anesthetized Dogs ◽  
Right Heart Bypass ◽  
Force Relationship

The modification by aortic pressure and stroke volume of the response in cardiac performance to increases in heart rate (interval-force relationship) has not been previously studied. To investigate this interaction, 30 adrenergically blocked anesthetized dogs on right heart bypass were studied. At constant low aortic pressure and stroke volume, increasing heart rate (over the entire range 60-180) is associated with a continuously increasing stroke power, decreasing systolic ejection period, and an unchanging left ventricular end-diastolic pressure and circumference. At increased aortic pressure or stroke volume at low rates (60-120), increases in heart rate were associated with an increased performance. However, at increased aortic pressure or stroke volume at high rates (120-180), increases in heart rate were associated with a leveling or decrease in performance. Thus, an increase in aortic pressure or stroke volume results in an accentuation of the improvement in cardiac performance observed with increases in heart rate, but this response is limited to a low heart rate range. Therefore, the hemodynamic response to given increases in heart rate is critically dependent on aortic pressure and stroke volume.

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