The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)
Qualitative resting coronary pressure wave form analysis to predict fractional flow reserve
EuroIntervention 2019;14:e1601-e1608 published online March 2018. DOI: 10.4244/EIJ-D-17-01149
Mitsuaki Matsumura1, BS; Akiko Maehara1,2, MD; Nils P. Johnson3, MD, MS; William F. Fearon4, MD; Bernard De Bruyne5, MD, PhD; Keith G. Oldroyd6, MD; Nico H.J. Pijls7,8, MD, PhD; Paul Jenkins1, PhD; Ziad A. Ali1,2, MD, DPhil; Gary S. Mintz1, MD; Gregg W. Stone1,2, MD; Allen Jeremias1,9*, MD, MSc
1. Intravascular Imaging and Physiology Core Laboratory, Cardiovascular Research Foundation, New York, NY, USA; 2. Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA; 3. Department of Cardiology, McGovern Medical School at UT Health and Memorial Hermann Hospital, Houston, TX, USA; 4. Department of Cardiology, Stanford University Medical Center, Stanford, CA, USA; 5. Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; 6. Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee Hospital, Clydebank, Scotland, United Kingdom; 7. Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; 8. Department of Cardiology, Eindhoven University of Technology, Eindhoven, the Netherlands; 9. Department of Cardiology, St. Francis Hospital, Roslyn, NY, USA
Aims: The aim of this study was to evaluate the predictability of resting distal coronary pressure wave forms for fractional flow reserve (FFR).
Methods and results: Resting coronary wave forms were qualitatively evaluated for the presence of (i) dicrotic notch, (ii) diastolic dipping, and (iii) ventricularisation. In a development cohort (n=88), a scoring system was developed that was then applied to a validation cohort (n=428) using a multivariable linear regression model to predict FFR and receiver operating characteristics (ROC) to predict FFR ≤0.8. In the development cohort, all three qualitative parameters were independent predictors of FFR. However, in a multivariable linear regression model in the validation cohort, qualitative wave form analysis did not further improve the ability of resting distal coronary to aortic pressure ratio (Pd/Pa) (p=0.80) or instantaneous wave-free ratio (iFR) (p=0.26) to predict FFR. Using ROC, the area under the curve of resting Pd/Pa (0.86 versus 0.86, p=0.08) and iFR (0.86 versus 0.86, p=0.26) did not improve by adding qualitative analysis.
Conclusions: Qualitative coronary wave form analysis showed moderate classification agreement in predicting FFR but did not add substantially to the resting pressure gradients Pd/Pa and iFR; however, when discrepancies between quantitative and qualitative analyses are observed, artefact or pressure drift should be considered.