Diagnostic cutoff for pressure drop coefficient in relation to fractional flow reserve and coronary flow reserve: A patient-level analysis

Kranthi K Kolli, Tim P van de Hoef, Mohamed A Effat, Rupak K Banerjee, Srikara V Peelukhana, Paul Succop, Massoud A Leesar, Arif Imran, Jan J Piek, Tarek A Helmy

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES AND BACKGROUND: Functional assessment of intermediate coronary stenosis during cardiac catheterization is conducted using diagnostic parameters like fractional flow reserve (FFR), coronary flow reserve (CFR), hyperemic stenosis resistance index (HSR), and hyperemic microvascular resistance (HMR). CDP (ratio of pressure drop across a stenosis to distal dynamic pressure), a nondimensional index derived from fundamental fluid dynamic principles, based on a combination of intracoronary pressure, and flow measurements may improve the functional assessment of coronary lesion severity.

METHODS: Patient-level data pertaining to 350 intracoronary pressure and flow measurements across coronary stenoses was assessed to evaluate CFR, FFR, HSR, HMR, and CDP. CDP was calculated as (ΔP)/(0.5 × ρ × APV(2)). The density of blood (ρ) was assumed to be 1.05 g/cm(3). The correlation of current diagnostic parameters (CFR, FFR, HSR, and HMR) with CDP was evaluated. The receiver operating characteristic (ROC) curve was used to identify the optimal cut-off point of CDP, corresponding to the clinically used cut-off values (FFR = 0.80 and CFR = 2.0).

RESULTS: CDP correlated significantly with FFR (r = 0.81, P < 0.05) and had significant diagnostic efficiency (ROC-area under curve of 86%), specificity (72%) and sensitivity (85%) at FFR < 0.8. The corresponding cut-off value for CDP to detect FFR < 0.8 was at CDP>25.4. CDP also correlated significantly (r = 0.98, P < 0.05) with epicardial-specific parameter, HSR.

CONCLUSIONS: CDP, a functional parameter based on both intracoronary pressure and flow measurements, has close agreement (area under ROC curve = 86%) with FFR, the frequently used method of evaluating stenosis severity.

Original languageEnglish
Pages (from-to)273-82
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume87
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016
Externally publishedYes

Keywords

  • Aged
  • Area Under Curve
  • Arterial Pressure
  • Cardiac Catheterization
  • Coronary Angiography
  • Coronary Stenosis/diagnosis
  • Coronary Vessels/diagnostic imaging
  • Female
  • Fractional Flow Reserve, Myocardial
  • Humans
  • Hyperemia/physiopathology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • ROC Curve
  • Reproducibility of Results
  • Severity of Illness Index

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