Diagnostic Performance of Resting and Hyperemic Invasive Physiological Indices to Define Myocardial Ischemia
Abstract Objectives The authors sought to compare the diagnostic performance of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and resting distal coronary artery pressure/aortic pressure (Pd/Pa) using13 N-ammonia positron emission tomography (PET). Background The diagnostic perf...
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Published in | JACC. Cardiovascular interventions Vol. 10; no. 8; pp. 751 - 760 |
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Main Authors | , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Elsevier Inc
01.04.2017
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Subjects | |
Online Access | Get full text |
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Summary: | Abstract Objectives The authors sought to compare the diagnostic performance of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and resting distal coronary artery pressure/aortic pressure (Pd/Pa) using13 N-ammonia positron emission tomography (PET). Background The diagnostic performance of invasive physiological indices was reported to be different according to the reference to define the presence of myocardial ischemia. Methods A total of 115 consecutive patients with left anterior descending artery stenosis who underwent both13 N-ammonia PET and invasive physiological measurement were included. Optimal cutoff values and diagnostic performance of FFR, iFR, and resting Pd/Pa were assessed using PET-derived coronary flow reserve (CFR) and relative flow reserve (RFR) as references. To compare discrimination and reclassification ability, each index was compared with integrated discrimination improvement (IDI) and category-free net reclassification index (NRI). Results All invasive physiological indices correlated with CFR and RFR (all p values <0.001). The overall diagnostic accuracies of FFR, iFR, and resting Pd/Pa were not different for CFR <2.0 (FFR 69.6%, iFR 73.9%, and resting Pd/Pa 70.4%) and RFR <0.75 (FFR 73.9%, iFR 71.3%, and resting Pd/Pa 74.8%). Discrimination and reclassification abilities of invasive physiological indices were comparable for CFR. For RFR, FFR showed better discrimination and reclassification ability than resting indices (IDI = 0.170 and category-free NRI = 0.971 for iFR; IDI = 0.183 and category-free NRI = 1.058 for resting Pd/Pa; all p values <0.001). Conclusions The diagnostic performance of invasive physiological indices showed no differences in the prediction of myocardial ischemia defined by CFR. Using RFR as a reference, FFR showed a better discrimination and reclassification ability than resting indices. |
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ISSN: | 1936-8798 1876-7605 |
DOI: | 10.1016/j.jcin.2016.12.015 |