Joo Myung Lee1, Ki Hong Choi1, Jonghanne Park2,3,4, Doyeon Hwang2, Tae-Min Rhee2, Jinseob Kim5, Jinhyoung Park, Hyung Yoon Kim6, Hae Won Jung7, Yun-Kyeong Cho8, Hyuck-Jun Yoon8, Young Bin Song1, Joo-Yong Hahn1, Chang-Wook Nam8, Eun-Seok Shin9,10, Joon-Hyung Doh11, Seung-Ho Hur8, Bon-Kwon Koo2,12. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.M.L., K.H.C., Y.B.S., J.-Y.H.). 2. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, South Korea (Jonghanne Park, D.H., T.-M.R., B.-K.K.). 3. Department of Internal Medicine, Naju National Hospital, Ministry of Health and Welfare, South Korea (Jonghanne Park). 4. Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea (Jinhyoung Park). 5. Department of Epidemiology, School of Public Health (J.K.), Seoul National University, South Korea. 6. Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, South Korea (H.Y.K.). 7. Department of Cardiology, Daegu Catholic University Medical Center, South Korea (H.W.J.). 8. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., H.-J.Y., C.-W.N., S.-H.H.). 9. Division of Cardiology, Ulsan Hospital, South Korea (E.-S.S.). 10. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea (E.-S.S.). 11. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.). 12. Institute on Aging (B.-K.K.), Seoul National University, South Korea.
Abstract
BACKGROUND: Recently, resting pressure-derived indexes such as resting full-cycle ratio (RFR) and diastolic pressure ratio (dPR) have been introduced to assess the functional significance of epicardial coronary stenosis. The present study sought to investigate the agreement of RFR or dPR with other pressure-derived indexes (instantaneous wave-free ratio [iFR] or fractional flow reserve), the sensitivity of RFR or dPR for anatomic or hemodynamic stenosis severity, and the prognostic implications of RFR or dPR compared with iFR Methods: RFR and dPR were calculated from resting pressure tracings by an independent core laboratory in 1024 vessels (435 patients). The changes in resting physiological indexes according to diameter stenosis were compared among iFR, RFR, and dPR. Among 115 patients who underwent 13N-ammonia positron emission tomography, the changes in those indexes according to basal and hyperemic stenosis resistance and absolute hyperemic myocardial blood flow were compared. The association between resting physiological indexes and the risk of 2-year vessel-oriented composite outcomes (a composite of cardiac death, vessel-related myocardial infarction, and vessel-related ischemia-driven revascularization) was analyzed among 864 deferred vessels. RESULTS: Both RFR and dPR showed a significant correlation with iFR ( R=0.979, P<0.001 for RFR; and R=0.985, P<0.001 for dPR), which was higher than that with fractional flow reserve ( R=0.822, P<0.001; and R=0.819, P<0.001, respectively). RFR and dPR showed a very high agreement with iFR (C index, 0.987 and 0.993). Percent difference of iFR, RFR, and dPR according to the increase in anatomic and hemodynamic severity was almost identical. The diagnostic performance of iFR, RFR, and dPR was not different in the prediction of myocardial ischemia defined by both low hyperemic myocardial blood flow and low coronary flow reserve by 13N-ammonia positron emission tomography. All resting physiological indexes showed significant association with the risk of 2-year vessel-oriented composite outcomes (iFR per 0.1 increase: hazard ratio, 0.514 [95% CI, 0.370-0.715], P<0.001; RFR per 0.1 increase: hazard ratio, 0.524 [95% CI, 0.378-0.725], P<0.001; dPR per 0.1 increase: hazard ratio, 0.587 [95% CI, 0.436-0.791], P<0.001) in deferred vessels. CONCLUSIONS: All resting pressure-derived physiological indexes (iFR, RFR, and dPR) can be used as invasive tools to guide treatment strategy in patients with coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01621438.
BACKGROUND: Recently, resting pressure-derived indexes such as resting full-cycle ratio (RFR) and diastolic pressure ratio (dPR) have been introduced to assess the functional significance of epicardial coronary stenosis. The present study sought to investigate the agreement of RFR or dPR with other pressure-derived indexes (instantaneous wave-free ratio [iFR] or fractional flow reserve), the sensitivity of RFR or dPR for anatomic or hemodynamic stenosis severity, and the prognostic implications of RFR or dPR compared with iFR Methods: RFR and dPR were calculated from resting pressure tracings by an independent core laboratory in 1024 vessels (435 patients). The changes in resting physiological indexes according to diameter stenosis were compared among iFR, RFR, and dPR. Among 115 patients who underwent 13N-ammonia positron emission tomography, the changes in those indexes according to basal and hyperemic stenosis resistance and absolute hyperemic myocardial blood flow were compared. The association between resting physiological indexes and the risk of 2-year vessel-oriented composite outcomes (a composite of cardiac death, vessel-related myocardial infarction, and vessel-related ischemia-driven revascularization) was analyzed among 864 deferred vessels. RESULTS: Both RFR and dPR showed a significant correlation with iFR ( R=0.979, P<0.001 for RFR; and R=0.985, P<0.001 for dPR), which was higher than that with fractional flow reserve ( R=0.822, P<0.001; and R=0.819, P<0.001, respectively). RFR and dPR showed a very high agreement with iFR (C index, 0.987 and 0.993). Percent difference of iFR, RFR, and dPR according to the increase in anatomic and hemodynamic severity was almost identical. The diagnostic performance of iFR, RFR, and dPR was not different in the prediction of myocardial ischemia defined by both low hyperemic myocardial blood flow and low coronary flow reserve by 13N-ammonia positron emission tomography. All resting physiological indexes showed significant association with the risk of 2-year vessel-oriented composite outcomes (iFR per 0.1 increase: hazard ratio, 0.514 [95% CI, 0.370-0.715], P<0.001; RFR per 0.1 increase: hazard ratio, 0.524 [95% CI, 0.378-0.725], P<0.001; dPR per 0.1 increase: hazard ratio, 0.587 [95% CI, 0.436-0.791], P<0.001) in deferred vessels. CONCLUSIONS: All resting pressure-derived physiological indexes (iFR, RFR, and dPR) can be used as invasive tools to guide treatment strategy in patients with coronary artery disease. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01621438.
Authors: Tim P van de Hoef; Joo Myung Lee; Mauro Echavarria-Pinto; Bon-Kwon Koo; Hitoshi Matsuo; Manesh R Patel; Justin E Davies; Javier Escaned; Jan J Piek Journal: Nat Rev Cardiol Date: 2020-05-14 Impact factor: 32.419
Authors: Vijay Kunadian; Alaide Chieffo; Paolo G Camici; Colin Berry; Javier Escaned; Angela H E M Maas; Eva Prescott; Nicole Karam; Yolande Appelman; Chiara Fraccaro; Gill Louise Buchanan; Stephane Manzo-Silberman; Rasha Al-Lamee; Evelyn Regar; Alexandra Lansky; J Dawn Abbott; Lina Badimon; Dirk J Duncker; Roxana Mehran; Davide Capodanno; Andreas Baumbach Journal: Eur Heart J Date: 2020-10-01 Impact factor: 29.983
Authors: Stefan Baumann; Markus Hirt; Christina Rott; Gökce H Özdemir; Christian Tesche; Tobias Becher; Christel Weiss; Svetlana Hetjens; Ibrahim Akin; Stefan O Schoenberg; Martin Borggrefe; Sonja Janssen; Daniel Overhoff; Dirk Lossnitzer Journal: J Clin Med Date: 2020-03-06 Impact factor: 4.241
Authors: Michael Michail; Udit Thakur; Ojas Mehta; John M Ramzy; Andrea Comella; Abdul Rahman Ihdayhid; James D Cameron; Stephen J Nicholls; Stephen P Hoole; Adam J Brown Journal: Open Heart Date: 2020-10