Diagnostic Performance of Resting and Hyperemic Invasive Physiological Indices to Define Myocardial Ischemia

• Published in: JACC. Cardiovascular interventions Vol. 10; no. 8; pp. 751 - 760
• Main Authors: Hwang, Doyeon, MD, Jeon, Ki-Hyun, MD, Lee, Joo Myung, MD, MPH, PhD, Park, Jonghanne, MD, PhD, Kim, Chee Hae, MD, Tong, Yaliang, MD, Zhang, Jinlong, MD, Bang, Ji-In, MD, Suh, Minseok, MD, Paeng, Jin Chul, MD, PhD, Na, Sang-Hoon, MD, PhD, Cheon, Gi Jeong, MD, PhD, Cook, Christopher M., MBBS, Davies, Justin E., MBBS, PhD, Koo, Bon-Kwon, MD, PhD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2017
• Subjects: 13N-ammonia positron emission tomography; Cardiovascular; coronary artery disease; fractional flow reserve; instantaneous wave-free ratio; myocardial ischemia; coronary artery disease; NRI; distal coronary artery pressure/aortic pressure; 13N-ammonia positron emission tomography; CFR; AUC; IDI; MBF; instantaneous wave-free ratio; area under curve; FFR; myocardial blood flow; fractional flow reserve; RFR; CI; integrated discrimination improvement; net reclassification index; coronary flow reserve; iFR; Pd/Pa; myocardial ischemia; confidence interval; relative flow reserve; positron emission tomography; PET
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2016.12.015

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.