Validation of resting full-cycle ratio and diastolic pressure ratio with [15O]H2O positron emission tomography myocardial perfusion

• Published in: Heart and vessels Vol. 39; no. 4; pp. 299 - 309
• Main Authors: Dahdal, Jorge, Bakker, Frank, Svanerud, Johan, Danad, Ibrahim, Driessen, Roel S., Raijmakers, Pieter G., Harms, Hendrik J., Lammertsma, Adriaan A., van de Hoef, Tim P., Appelman, Yolande, van Royen, Niels, Knaapen, Paul, de Waard, Guus A.
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.04.2024; Springer Nature B.V
• Subjects: Angiography; Biomedical Engineering and Bioengineering; Blood flow; Blood pressure; Blood vessels; Cardiac Surgery; Cardiology; Cardiovascular disease; Clinical trials; Coronary artery disease; Coronary vessels; Cycle ratio; Diagnostic systems; Diastolic pressure; Emissions; Heart diseases; Hemodynamics; Hyperemia; Ischemia; Medical imaging; Medical treatment; Medicine; Medicine & Public Health; Myocardial ischemia; Original Article; Patients; Perfusion; Positron emission; Positron emission tomography; Pressure ratio; Regional analysis; Stenosis; Tomography; Vascular Surgery; NHPR; FFR; Positron emission tomography; dPR; RFR
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-023-02356-4

Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive techniques used to evaluate the hemodynamic significance of coronary artery stenosis. These methods have been validated through perfusion imaging and clinical trials. New invasive pressure ratios that do not require hyperemia have recently emerged, and it is essential to confirm their diagnostic efficacy. The aim of this study was to validate the resting full-cycle ratio (RFR) and the diastolic pressure ratio (dPR), against [ 15 O]H 2 O positron emission tomography (PET) imaging. A total of 129 symptomatic patients with an intermediate risk of coronary artery disease (CAD) were included. All patients underwent cardiac [ 15 O]H 2 O PET with quantitative assessment of resting and hyperemic myocardial perfusion. Within a 2 week period, coronary angiography was performed. Intracoronary pressure measurements were obtained in 320 vessels and RFR, dPR, and FFR were computed. PET derived regional hyperemic myocardial blood flow (hMBF) and myocardial perfusion reserve (MPR) served as reference standards. In coronary arteries with stenoses (43%, 136 of 320), the overall diagnostic accuracies of RFR, dPR, and FFR did not differ when PET hyperemic MBF < 2.3 ml min −1 (69.9%, 70.6%, and 77.1%, respectively) and PET MPR < 2.5 (70.6%, 71.3%, and 66.9%, respectively) were considered as the reference for myocardial ischemia. Non-significant differences between the areas under the receiver operating characteristic (ROC) curve were found between the different indices. Furthermore, the integration of FFR with RFR (or dPR) does not enhance the diagnostic information already achieved by FFR in the characterization of ischemia via PET perfusion. In conclusion, the novel non-hyperemic pressure ratios, RFR and dPR, have a diagnostic performance comparable to FFR in assessing regional myocardial ischemia. These findings suggest that RFR and dPR may be considered as an FFR alternative for invasively guiding revascularization treatment in symptomatic patients with CAD.