Diagnostic accuracy of diastolic pressure ratio using a pressure microcatheter for intracoronary physiological assessment

Abstract Recently, instantaneous wave-free ratio (iFR) has emerged as an alternative to the fractional flow reserve (FFR) for intracoronary physiological assessment. Although all diastolic resting indices are reportedly identical to the iFR, limited data exist on diastolic pressure ratio (dPR) measu...
Ausführliche Beschreibung

Abstract Recently, instantaneous wave-free ratio (iFR) has emerged as an alternative to the fractional flow reserve (FFR) for intracoronary physiological assessment. Although all diastolic resting indices are reportedly identical to the iFR, limited data exist on diastolic pressure ratio (dPR) measured using a microcatheter ($ dPR_{micro} $). This study aimed to evaluate the diagnostic accuracy of $ dPR_{micro} $ compared to FFR measured using a microcatheter ($ FFR_{micro} $) in real-world practice for intracoronary physiological assessment. This was a single-center, retrospective, observational study. We identified 103 consecutive suspected angina pectoris patients (107 lesions) who underwent $ dPR_{micro} $ and $ FFR_{micro} $ measurement using the Navvus® catheter at Takasaki Heart Hospital from March 2019 to June 2019. A total of 103 lesions in 103 patients were finally included in the study. The mean $ FFR_{micro} $ and $ dPR_{micro} $ values were 0.80 and 0.88, respectively. With an $ FFR_{micro} $ ≤ 0.80, the $ dPR_{micro} $ showed a diagnostic accuracy of 79.6%, sensitivity of 74.6%, specificity of 87.5%, positive predictive value of 90.4%, and negative predictive value of 68.6%. The area under the receiver operating characteristic (ROC) curve was 0.894 (95% confidence interval, 0.833–0.956), and the optimal cut-off value for $ dPR_{micro} $ derived from the ROC analysis was 0.90. $ dPR_{micro} $ and $ FFR_{micro} $ values were discordant in 21/103 cases (20.4%). As a multivariable logistic regression analysis was performed, the male sex (vs. female) had a statistically significant association with a $ dPR_{micro} $-$ FFR_{micro} $ discordance (OR 4.91; 95% CI, 1.04–23.0; P = 0.044). No other factors were found to be significantly associated with the discordance. In conclusion, $ dPR_{micro} $ measured using a microcatheter had good diagnostic accuracy and correlation with $ FFR_{micro} $, hence, it can be useful for making revascularization decisions. However, re-studies in larger populations will be needed to better understand the properties of diastolic resting index measured using a microcatheter in clinical settings. Ausführliche Beschreibung

Autor*in:	Kubota, Masayuki [verfasserIn] Oguri, Atsushi

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	Fractional flow reserve Diastolic pressure ratio Diagnostic accuracy Diastolic resting index Non-hyperaemic pressure ratio

Anmerkung:	© Springer Nature Japan KK, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Übergeordnetes Werk:	Enthalten in: Heart and vessels - Tokyo : Springer, 1985, 38(2023), 12 vom: 26. Aug., Seite 1395-1403
Übergeordnetes Werk:	volume:38 ; year:2023 ; number:12 ; day:26 ; month:08 ; pages:1395-1403

Links:	Volltext

DOI / URN:	10.1007/s00380-023-02301-5

Katalog-ID:	SPR053530543