How good are experienced cardiologists at predicting the hemodynamic severity of coronary stenoses when taking fractional flow reserve as the gold standard

• Published in: The international journal of cardiovascular imaging Vol. 18; no. 2; pp. 73 - 76
• Main Authors: BRUEREN, B. R. G, TEN BERG, J. M, SUTTORP, M. J, BAL, E. T, ERNST, J. M. P. G, MAST, E. G, PLOKKER, H. W. M
• Format: Journal Article
• Language: English
• Published: Dordrecht Kluwer Academic Publishers 01.04.2002; Springer Nature B.V
• Subjects: Aged; Biological and medical sciences; Cardiovascular system; Coronary Circulation; Coronary Stenosis - diagnosis; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Female; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Predictive Value of Tests; Radiography; Risk Factors; Human; Reserve; Decision making; Estimation; Coronary artery; Physician; Stenosis; Cardiovascular disease; Coronary heart disease; Standards; Arterial disease; Vascular disease; Severity score; Hemodynamics
• ISSN: 1569-5794; 1875-8312; 1573-0743
• DOI: 10.1023/A:1014638917413

Coronary angioplasty should be based on documented ischemia. However, in daily clinical practice the indication for angioplasty is often based on eyeball assessment of the severity of the stenosis. This study was performed to assess the accuracy of eyeball estimation of coronary stenosis when taking functional flow reserve (FFR) as gold standard. Study lesions were where no mutual agreement on the severity of the stenosis was obtained. The procedure consisted of a repeat control angiogram, FFR measurement and in case of FFR<75% percutaneous coronary intervention. The eyeball assessment of the stenosis was written down before further execution of the procedure. FFR was measured with a pressure monitoring guide. Maximal myocardial hyperemia was induced by intravenous adenosine infusion. Fifty-two patients were studied. Agreement between eyeball assessment and FFR existed in a total of 36 cases (69.2%). Over estimation of hemodynamic severity occurred in six cases (11.5%) and under estimation in 10 cases (19.2%). Consequently, the positive predictive value of eyeball assessment for pressure-derived FFR was 63% and the negative predictive value 76%. The assessment of the hemodynamic severity of intermediate coronary stenosis should not be based on eyeball assessment even by experienced interventional cardiologists.