Abstract
Background: Angiography-based functional assessment of coronary stenoses emerges as a novel approach to assess coronary physiology. We sought to investigate the agreement between invasive coronary wire-based fractional flow reserve (FFR), resting full-cycle ratio (RFR), and angiography-based vessel FFR (vFFR) for the functional assessment of coronary stenoses in patients with coronary artery disease.Materials and Methods: Between Jan 01, 2018, and Dec 31, 2020, 298 patients with 385 intermediate lesions received invasive coronary wire-based functional assessment (FFR, RFR or both) at a single tertiary medical center. Coronary lesions involving ostium or left main artery were excluded. vFFR analysis was performed retrospectively based on aortic root pressure and two angiographic projections.Results: In total, 236 patients with 291 lesions were eligible for vFFR analysis. FFR and RFR were performed in 258 and 162 lesions, respectively. The mean FFR, RFR and vFFR value were 0.84 ± 0.08, 0.90 ± 0.09, and 0.83 ± 0.10. vFFR was significantly correlated with FFR (r = 0.708, P < 0.001) and RFR (r = 0.673, P < 0.001). The diagnostic performance of vFFR vs. FFR was accuracy 81.8%, sensitivity 77.4%, specificity 83.9%, positive predictive value 69.9%, and negative predictive value 88.5%. The discriminative power of vFFR for FFR ≤ 0.80 or RFR ≤ 0.89 was excellent. Area under the receiver operating characteristic curve (AUC) was 0.87 (95% CI:0.83–0.92) for FFR and 0.80 (95% CI:0.73–0.88) for RFR.Conclusion: Angiography-based vFFR has a substantial agreement with invasive wire-based FFR and RFR in patients with intermediate coronary stenoses. vFFR can be utilized to assess coronary physiology without a pressure wire in a post hoc manner.
Highlights
Fractional Flow Reserve (FFR) is an invasive wire-based physiology index for assessing the functional significance of coronary stenoses during adenosine-induced hyperemia
This study aimed to examine the agreement between invasive coronary wire-based FFR, resting full-cycle ratio (RFR), and vessel FFR (vFFR) for the functional assessment of coronary stenoses
Fifty-three lesions were excluded due to involving left main coronary artery, ostial lesion, myocardial bridge or aortic root pressure/angiogram was not available. vFFR was non-analyzable in 41 lesions, mainly due to no appropriate two angiographic projections or poor image quality
Summary
Fractional Flow Reserve (FFR) is an invasive wire-based physiology index for assessing the functional significance of coronary stenoses during adenosine-induced hyperemia. The FAME (Fractional Flow Reserve vs Angiography for Multivessel Evaluation) and FAME 2 trials have demonstrated that FFRguided percutaneous coronary intervention (PCI) strategy is associated with a significantly lower rate of cardiovascular events in patients with stable coronary artery disease [1, 2]. Novel physiological indices have been developed to reduce the procedural and invasive aspects for functional assessment of coronary artery disease. We sought to investigate the agreement between invasive coronary wire-based fractional flow reserve (FFR), resting full-cycle ratio (RFR), and angiography-based vessel FFR (vFFR) for the functional assessment of coronary stenoses in patients with coronary artery disease
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