Abstract
Recently, instantaneous wave-free ratio (iFR) or diastolic pressure-ratio (dPR) have been used in practice. For these indices, the reliability of electrocardiography (ECG)-independent algorithm for pressure-only data is essential. The current study sought to compare the current to a new ECG-independent algorithm for calculating resting physiologic indices. The main purpose of developing a new ECG-independent algorithm was to raise the detection rates over the entire heart cycle despite irregular heartbeats. Both iFR and dPR were calculated from resting pressure tracings using current and new algorithms by a core laboratory in 975 vessels (393 patients). The diagnostic performance of resting physiologic indices with a new algorithm to predict fractional flow reserve (FFR) was compared with the current algorithm. Both algorithms provided nearly identical values of iFR or dPR without systemic bias. iFR and dPR, which were calculated using current and new ECG-independent algorithms, provided comparable discrimination ability and diagnostic performance to predict functionally significant stenosis defined by FFR≤0.80. However, detection rates of the new algorithm were significantly higher than current algorithm in the patients with irregular heartbeats (for per patient [59.5% vs. 83.8%] and per unit-heartbeats analysis [84.3% vs. 90.3%]), such as arterial fibrillation or multiple premature ventricular contractions.
Highlights
The presence of inducible myocardial ischemia is the prerequisite for the benefit of percutaneous coronary intervention (PCI)
STUDY DESIGN AND PATIENT POPULATION The study population was derived from the 3V FFRFRIENDS study (3-vessel fractional flow reserve for the assessment of total stenosis burden and its clinical impact in patients with coronary artery disease, NCT01621438) which was designed to investigate the clinical relevance of total stenosis burden assessed by 3-vessel FFR measurement
Most patients presented with stable angina (85.8%) and an intermediate stenosis with mean angiographic diameter stenosis of 44.2±17.5%, mean FFR of 0.87±0.11, and median SYNTAX score of 11.0 (Q1-Q3: 7.0-18.0)
Summary
The presence of inducible myocardial ischemia is the prerequisite for the benefit of percutaneous coronary intervention (PCI). Choi et al.: Comparison of Current and Novel ECG-Independent Algorithms outcome [4], [5] Based on these results, recent guidelines recommend the use of FFR or iFR to guide treatment for patients with coronary artery disease as Class IA recommendation [6]. After development of iFR, new resting pressurederived indices including resting full-cycle ratio (RFR) or diastolic pressure ratio (dPR) have been introduced as other substitutes for iFR [7]–[9] Since those resting pressurederived indices does not require administration of hyperemic agents, adoption of those indices is expected to raise the adoption rates of physiologic assessment of patients with coronary artery disease
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