R Martin-Reyes1, J M de la Torre Hernandez2, J Franco-Pelaez1, R Lopez-Palop3, M Telleria Arrieta4, I J Amat Santos5, P Carrillo Saez3, A Sanchez-Recalde6, J C Sanmartin Pena4, T Garcia Camarero2, S Brugaletta7, F Gimeno de Carlos5, A Pinero1, D C Sorto Sanchez2, A Frutos3, G Lasa Larraya4, F Navarro1, J Farre1. 1. Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Fundacion Jimenez Diaz-IDC Salud, Madrid, Spain. 2. Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario Marques De Valdecilla, Santander, Cantabria Spain. 3. Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Universitario San Juan, Alicante, Spain. 4. Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Policlinica Gipuzkoa, San Sebastian, Guipuzcoa, Spain. 5. Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Clinico Universitario, Valladolid, Spain. 6. Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Univesitario La Paz, Madrid, Spain. 7. Unidad de Cardiologia Intervencionista, Servicio de Cardiologia, Hospital Clinic, Barcelona, Spain.
Abstract
OBJECTIVE: Functional assessment of coronary artery stenosis is performed by measuring the fractional flow reserve (FFR) under hyperemic conditions (Adenosine). However, the use of adenosine portends limitations. OBJECTIVE: We sought to investigate the relationship and correlation between FFR and the Pd/Pa value obtained just after the intracoronary infusion (acute drop) of nitroglycerin (Pd/Pa-NTG) and if this parameter enhances diagnostic accuracy for FFR prediction compared to the resting baseline Pd/Pa. METHODS: We conducted a multicenter study including prospectively patients presenting intermediate coronary artery stenosis (30-70%) evaluated with pressure wire. Resting baseline Pd/Pa, Pd/Pa-NTG and FFR were measured. RESULTS: 283 patients (335 lesions) were included. Resting baseline Pd/Pa value was 0.72 to 1.0 (0.93 ± 0.04), Pd/Pa-NTG was 0.60 to 1.0 (0.87 ± 0.07) and FFR 0.55 to 1.0 (0.83 ± 0.08). The ROC curves for resting baseline Pd/Pa and for Pd/Pa-NTG, using a FFR ≤ 0.80 showed an AUC of 0.88 (95% CI: 0.84-0.92, P < 0.001) and 0.94 (95% CI: 0.92-0.96, P < 0.001) respectively. The optimal cutoff values of resting baseline Pd/Pa and Pd/Pa-NTG for an FFR > 0.80, were >0.96 and >0.88, respectively. These values were present in a 29.8% (n = 100) and a 47.1% (n = 158), of the total lesions. Scatter plots showed a better correlation and agreement points with Pd/Pa-NTG than resting baseline Pd/Pa. The cutoff value of Pd/Pa-NTG > 0.88 showed an excellent NPV (96.2% for FFR > 0.8 and 100% for FFR > 0.75) and sensitivity (95% for FFR > 0.8 and 100% for FFR > 0.75) which were consistently high across all the subgroups analysis. CONCLUSION: The cutoff value of acute Pd/Pa-NTG > 0.88 has a high NPV meaning adenosine-FFR can be avoided in almost half of lesions.
OBJECTIVE: Functional assessment of coronary artery stenosis is performed by measuring the fractional flow reserve (FFR) under hyperemic conditions (Adenosine). However, the use of adenosine portends limitations. OBJECTIVE: We sought to investigate the relationship and correlation between FFR and the Pd/Pa value obtained just after the intracoronary infusion (acute drop) of nitroglycerin (Pd/Pa-NTG) and if this parameter enhances diagnostic accuracy for FFR prediction compared to the resting baseline Pd/Pa. METHODS: We conducted a multicenter study including prospectively patients presenting intermediate coronary artery stenosis (30-70%) evaluated with pressure wire. Resting baseline Pd/Pa, Pd/Pa-NTG and FFR were measured. RESULTS: 283 patients (335 lesions) were included. Resting baseline Pd/Pa value was 0.72 to 1.0 (0.93 ± 0.04), Pd/Pa-NTG was 0.60 to 1.0 (0.87 ± 0.07) and FFR 0.55 to 1.0 (0.83 ± 0.08). The ROC curves for resting baseline Pd/Pa and for Pd/Pa-NTG, using a FFR ≤ 0.80 showed an AUC of 0.88 (95% CI: 0.84-0.92, P < 0.001) and 0.94 (95% CI: 0.92-0.96, P < 0.001) respectively. The optimal cutoff values of resting baseline Pd/Pa and Pd/Pa-NTG for an FFR > 0.80, were >0.96 and >0.88, respectively. These values were present in a 29.8% (n = 100) and a 47.1% (n = 158), of the total lesions. Scatter plots showed a better correlation and agreement points with Pd/Pa-NTG than resting baseline Pd/Pa. The cutoff value of Pd/Pa-NTG > 0.88 showed an excellent NPV (96.2% for FFR > 0.8 and 100% for FFR > 0.75) and sensitivity (95% for FFR > 0.8 and 100% for FFR > 0.75) which were consistently high across all the subgroups analysis. CONCLUSION: The cutoff value of acute Pd/Pa-NTG > 0.88 has a high NPV meaning adenosine-FFR can be avoided in almost half of lesions.
Authors: Colin Berry; David Corcoran; Barry Hennigan; Stuart Watkins; Jamie Layland; Keith G Oldroyd Journal: Eur Heart J Date: 2015-06-02 Impact factor: 29.983
Authors: Selim Topcu; Ibrahim Halil Tanboğa; Enbiya Aksakal; Uğur Aksu; Oktay Gulcu; Oğuzhan Birdal; Arif Arısoy; Arzu Kalaycı; Fatih Rifat Ulusoy; Serdar Sevimli Journal: Postepy Kardiol Interwencyjnej Date: 2016-08-19 Impact factor: 1.426