Abstract
Background
The role of resting pressure parameters, i.e. instantaneous wave-free ratio (iFR),
and resting distal coronary pressure/aortic pressure (Pd/Pa) in assessing functionally
significant stenosis remains controversial. We sought to assess the diagnostic performance
of iFR and resting whole-cycle Pd/Pa in Asian patients.
Methods
In this study, 238 consecutive lesions (no total occlusions) in which fractional flow
reserve (FFR) was measured with both intravenous and intracoronary adenosine administration
were included. Coded resting pressure data were sent to the core laboratory in which
iFR was calculated in a blinded fashion.
Results
FFR and iFR had unimodal distributions and the correlation was r = 0.77 (95% confidence interval, 0.71 to 0.82). In a receiver-operating-characteristic
curve analysis, iFR had an area under the curve (AUC) of 0.9 at FFR ≤ 0.80. The best cut-off value for iFR was 0.90 with a sensitivity, specificity, positive
and negative predictive values, and diagnostic accuracy of 76%, 86%, 82% and 80%,
and 82%, respectively. The resting whole-cycle Pd/Pa cut-off of 0.91 demonstrated
a diagnostic accuracy of 82% (AUC 0.9). However, iFR had higher discriminatory power
than the resting whole-cycle Pd/Pa.
Conclusion
Both iFR and resting whole-cycle Pd/Pa showed good diagnostic performance to define
the functionally significant stenosis in an independent Asian cohort distributed unimodally
and without total occlusions. However, further validation is needed to explore the
areas of disagreement between different physiologic parameters prior to adoption of
resting pressure parameters into routine clinical practice.
Keywords
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Article info
Publication history
Published online: July 29, 2013
Accepted:
July 2,
2013
Received in revised form:
June 27,
2013
Received:
January 9,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
