Agreement Between Invasive Wire-Based and Angiography-Based Vessel Fractional Flow Reserve Assessment on Intermediate Coronary Stenoses

Abstract

Background: Angiography-based functional assessment of coronary stenoses emerges as a novel approach to assess coronary physiology. We sought to investigate the agreement between invasive coronary wire-based fractional flow reserve (FFR), resting full-cycle ratio (RFR), and angiography-based vessel FFR (vFFR) for the functional assessment of coronary stenoses in patients with coronary artery disease.Materials and Methods: Between Jan 01, 2018, and Dec 31, 2020, 298 patients with 385 intermediate lesions received invasive coronary wire-based functional assessment (FFR, RFR or both) at a single tertiary medical center. Coronary lesions involving ostium or left main artery were excluded. vFFR analysis was performed retrospectively based on aortic root pressure and two angiographic projections.Results: In total, 236 patients with 291 lesions were eligible for vFFR analysis. FFR and RFR were performed in 258 and 162 lesions, respectively. The mean FFR, RFR and vFFR value were 0.84 ± 0.08, 0.90 ± 0.09, and 0.83 ± 0.10. vFFR was significantly correlated with FFR (r = 0.708, P < 0.001) and RFR (r = 0.673, P < 0.001). The diagnostic performance of vFFR vs. FFR was accuracy 81.8%, sensitivity 77.4%, specificity 83.9%, positive predictive value 69.9%, and negative predictive value 88.5%. The discriminative power of vFFR for FFR ≤ 0.80 or RFR ≤ 0.89 was excellent. Area under the receiver operating characteristic curve (AUC) was 0.87 (95% CI:0.83–0.92) for FFR and 0.80 (95% CI:0.73–0.88) for RFR.Conclusion: Angiography-based vFFR has a substantial agreement with invasive wire-based FFR and RFR in patients with intermediate coronary stenoses. vFFR can be utilized to assess coronary physiology without a pressure wire in a post hoc manner.

Comparison between the diagnostic performance of vessel fractional flow reserve and nonhyperemic pressure ratio for functionally significant coronary stenosis severity as assessed by fractional flow reserve

“…More importantly, among the patients with more severe coronary stenosis, we demonstrated a high diagnostic performance of vFFR. Consistent with previous findings, 5,6,14 our results suggested that vFFR is a clinically feasible alternative to FFR, even in patients with such functionally severe coronary stenosis. In addition, to the best of our knowledge, our study is the first to demonstrate similar diagnostic performance between vFFR and NHPRs for coronary stenosis as evaluated by FFR.…”

“…In addition, to the best of our knowledge, our study is the first to demonstrate similar diagnostic performance between vFFR and NHPRs for coronary stenosis as evaluated by FFR. Previous reports also demonstrated good agreement between FFR and NHPRs, irrespective of coronary artery phenotypes (i.e., stable coronary artery and acute myocardial infarction), 14,15 which may support our findings emphasizing the significance and feasibility of evaluating coronary stenosis based on vFFR.…”

“…In addition, to the best of our knowledge, our study is the first to demonstrate similar diagnostic performance between vFFR and NHPRs for coronary stenosis as evaluated by FFR. Previous reports also demonstrated good agreement between FFR and NHPRs, irrespective of coronary artery phenotypes (i.e., stable coronary artery and acute myocardial infarction),14,15 which may support our findings emphasizing the significance and feasibility of evaluating coronary stenosis based on vFFR.Overall, our subgroup analysis provided an excellent homogeneous diagnostic performance of vFFR across various subgroups (i.e., elderly and diabetes). However, the present study suggested that the presence of LVH may have affected the diagnostic performance of vFFR.…”

Is it the Time to Move Towards Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve Guided Percutaneous Coronary Intervention? The Pros and Cons

“…The pressure wire–derived FFR became widely used after that, owing to its independence from the baseline flow and relative simplicity and cost-effectiveness for treatment decision-making compared with ICA [ 35 - 37 ]. However, some have suggested the higher [ 38 ] or comparable [ 39 ] diagnostic accuracy of ICA-FFR, compared with wire-based, which unnecessarily imposes the patients to the wire pressure. In this method, coronary stenosis is measured by the reduction of perfusion pressure induced by the viscous and expansion losses of the narrowed vessel, calculated by the Poiseuille’s law and Bernoulli’s equation, and reported by the fraction from the normal value of 1.0 in every patient and every vessel [ 40 ].…”