Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools

Gilbert W M Wijntjens; Martijn A van Lavieren; Tim P van de Hoef; Mauro Echavarría-Pinto; Martijn Meuwissen; Valérie E Stegehuis; Tadashi Murai; Javier Escaned; Jan J Piek

doi:10.1016/j.ijcard.2018.11.013

Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools

Gilbert W M Wijntjens, Martijn A van Lavieren, Tim P van de Hoef, Mauro Echavarría-Pinto, Martijn Meuwissen, Valérie E Stegehuis, Tadashi Murai, Javier Escaned, Jan J Piek

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Pressure-derived coronary flow reserve (CFR_pres) and pressure-bounded CFR (CFR_pb) enable simple estimation of CFR from routine pressure measurements, but have been inadequately validated. We sought to compare CFR_pres and CFR_pb against flow-derived CFR (CFR_flow) in terms of diagnostic accuracy, as well as regarding their comparative prognostic relevance. Methods: We evaluated 453 intermediate coronary lesions with intracoronary pressure and flow measurements. CFR was defined as hyperemic flow/baseline flow. The lower bound (CFR_pres) and upper bound of CFR_pb were defined as √[(ΔP_hyperemia) / (ΔP_rest)] and [(ΔP_hyperemia) / (ΔP_rest)], respectively. Long-term follow-up (median: 11.8-years) was performed in 153 lesions deferred from treatment to document the occurrence of major adverse cardiac events (MACE) defined as a composite of cardiac death, myocardial infarction and target vessel revascularization. CFR < 2.0 was considered abnormal. Results: CFR_pb was normal or abnormal in 56.7% of stenoses, and indeterminate in 43.3% of stenoses. There was a poor diagnostic agreement between CFR_pres and CFR_pb with CFR_flow (overall agreement: 45.5% and 71.6% of vessels, respectively). There was equivalent risk for long-term MACE for lesions with abnormal versus normal CFR_pres (Breslow p = 0.562), whereas vessels with abnormal CFR_flow were significantly associated with increased long-term MACE (Breslow p < 0.001). For vessels where CFR_pb was abnormal or normal, there was equivalent risk for long-term MACE for vessels with abnormal versus normal CFR_pb (Breslow p = 0.194), whereas vessels with abnormal CFR_flow were associated with increased MACE rates over time (Breslow p < 0.001). Conclusions: Pressure-derived estimations of CFR poorly agree with flow-derived measurements of CFR, which may explain the inferior association with long-term MACE as compared to flow-derived CFR.

Original language	English
Pages (from-to)	6-11
Number of pages	6
Journal	International Journal of Cardiology
Volume	279
DOIs	https://doi.org/10.1016/j.ijcard.2018.11.013
Publication status	Published - 15 Mar 2019
Externally published	Yes

Keywords

Aged
Arterial Pressure/physiology
Coronary Circulation/physiology
Coronary Stenosis/diagnostic imaging
Female
Fractional Flow Reserve, Myocardial/physiology
Humans
Laser-Doppler Flowmetry/methods
Male
Middle Aged
Risk Assessment/methods

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10.1016/j.ijcard.2018.11.013

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Wijntjens, G. W. M., van Lavieren, M. A., van de Hoef, T. P., Echavarría-Pinto, M., Meuwissen, M., Stegehuis, V. E., Murai, T., Escaned, J., & Piek, J. J. (2019). Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools. International Journal of Cardiology, 279, 6-11. https://doi.org/10.1016/j.ijcard.2018.11.013

@article{370cadac693b452eb66a35f3d3135fc3,

title = "Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools",

abstract = "Background: Pressure-derived coronary flow reserve (CFRpres) and pressure-bounded CFR (CFRpb) enable simple estimation of CFR from routine pressure measurements, but have been inadequately validated. We sought to compare CFRpres and CFRpb against flow-derived CFR (CFRflow) in terms of diagnostic accuracy, as well as regarding their comparative prognostic relevance. Methods: We evaluated 453 intermediate coronary lesions with intracoronary pressure and flow measurements. CFR was defined as hyperemic flow/baseline flow. The lower bound (CFRpres) and upper bound of CFRpb were defined as √[(ΔPhyperemia) / (ΔPrest)] and [(ΔPhyperemia) / (ΔPrest)], respectively. Long-term follow-up (median: 11.8-years) was performed in 153 lesions deferred from treatment to document the occurrence of major adverse cardiac events (MACE) defined as a composite of cardiac death, myocardial infarction and target vessel revascularization. CFR < 2.0 was considered abnormal. Results: CFRpb was normal or abnormal in 56.7\% of stenoses, and indeterminate in 43.3\% of stenoses. There was a poor diagnostic agreement between CFRpres and CFRpb with CFRflow (overall agreement: 45.5\% and 71.6\% of vessels, respectively). There was equivalent risk for long-term MACE for lesions with abnormal versus normal CFRpres (Breslow p = 0.562), whereas vessels with abnormal CFRflow were significantly associated with increased long-term MACE (Breslow p < 0.001). For vessels where CFRpb was abnormal or normal, there was equivalent risk for long-term MACE for vessels with abnormal versus normal CFRpb (Breslow p = 0.194), whereas vessels with abnormal CFRflow were associated with increased MACE rates over time (Breslow p < 0.001). Conclusions: Pressure-derived estimations of CFR poorly agree with flow-derived measurements of CFR, which may explain the inferior association with long-term MACE as compared to flow-derived CFR.",

keywords = "Aged, Arterial Pressure/physiology, Coronary Circulation/physiology, Coronary Stenosis/diagnostic imaging, Female, Fractional Flow Reserve, Myocardial/physiology, Humans, Laser-Doppler Flowmetry/methods, Male, Middle Aged, Risk Assessment/methods",

author = "Wijntjens, \{Gilbert W M\} and \{van Lavieren\}, \{Martijn A\} and \{van de Hoef\}, \{Tim P\} and Mauro Echavarr{\'i}a-Pinto and Martijn Meuwissen and Stegehuis, \{Val{\'e}rie E\} and Tadashi Murai and Javier Escaned and Piek, \{Jan J\}",

note = "Publisher Copyright: {\textcopyright} 2018 Elsevier B.V.",

year = "2019",

month = mar,

day = "15",

doi = "10.1016/j.ijcard.2018.11.013",

language = "English",

volume = "279",

pages = "6--11",

journal = "International Journal of Cardiology",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

Wijntjens, GWM, van Lavieren, MA, van de Hoef, TP, Echavarría-Pinto, M, Meuwissen, M, Stegehuis, VE, Murai, T, Escaned, J & Piek, JJ 2019, 'Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools', International Journal of Cardiology, vol. 279, pp. 6-11. https://doi.org/10.1016/j.ijcard.2018.11.013

Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools. / Wijntjens, Gilbert W M; van Lavieren, Martijn A; van de Hoef, Tim P et al.
In: International Journal of Cardiology, Vol. 279, 15.03.2019, p. 6-11.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools

AU - Wijntjens, Gilbert W M

AU - van Lavieren, Martijn A

AU - van de Hoef, Tim P

AU - Echavarría-Pinto, Mauro

AU - Meuwissen, Martijn

AU - Stegehuis, Valérie E

AU - Murai, Tadashi

AU - Escaned, Javier

AU - Piek, Jan J

PY - 2019/3/15

Y1 - 2019/3/15

N2 - Background: Pressure-derived coronary flow reserve (CFRpres) and pressure-bounded CFR (CFRpb) enable simple estimation of CFR from routine pressure measurements, but have been inadequately validated. We sought to compare CFRpres and CFRpb against flow-derived CFR (CFRflow) in terms of diagnostic accuracy, as well as regarding their comparative prognostic relevance. Methods: We evaluated 453 intermediate coronary lesions with intracoronary pressure and flow measurements. CFR was defined as hyperemic flow/baseline flow. The lower bound (CFRpres) and upper bound of CFRpb were defined as √[(ΔPhyperemia) / (ΔPrest)] and [(ΔPhyperemia) / (ΔPrest)], respectively. Long-term follow-up (median: 11.8-years) was performed in 153 lesions deferred from treatment to document the occurrence of major adverse cardiac events (MACE) defined as a composite of cardiac death, myocardial infarction and target vessel revascularization. CFR < 2.0 was considered abnormal. Results: CFRpb was normal or abnormal in 56.7% of stenoses, and indeterminate in 43.3% of stenoses. There was a poor diagnostic agreement between CFRpres and CFRpb with CFRflow (overall agreement: 45.5% and 71.6% of vessels, respectively). There was equivalent risk for long-term MACE for lesions with abnormal versus normal CFRpres (Breslow p = 0.562), whereas vessels with abnormal CFRflow were significantly associated with increased long-term MACE (Breslow p < 0.001). For vessels where CFRpb was abnormal or normal, there was equivalent risk for long-term MACE for vessels with abnormal versus normal CFRpb (Breslow p = 0.194), whereas vessels with abnormal CFRflow were associated with increased MACE rates over time (Breslow p < 0.001). Conclusions: Pressure-derived estimations of CFR poorly agree with flow-derived measurements of CFR, which may explain the inferior association with long-term MACE as compared to flow-derived CFR.

AB - Background: Pressure-derived coronary flow reserve (CFRpres) and pressure-bounded CFR (CFRpb) enable simple estimation of CFR from routine pressure measurements, but have been inadequately validated. We sought to compare CFRpres and CFRpb against flow-derived CFR (CFRflow) in terms of diagnostic accuracy, as well as regarding their comparative prognostic relevance. Methods: We evaluated 453 intermediate coronary lesions with intracoronary pressure and flow measurements. CFR was defined as hyperemic flow/baseline flow. The lower bound (CFRpres) and upper bound of CFRpb were defined as √[(ΔPhyperemia) / (ΔPrest)] and [(ΔPhyperemia) / (ΔPrest)], respectively. Long-term follow-up (median: 11.8-years) was performed in 153 lesions deferred from treatment to document the occurrence of major adverse cardiac events (MACE) defined as a composite of cardiac death, myocardial infarction and target vessel revascularization. CFR < 2.0 was considered abnormal. Results: CFRpb was normal or abnormal in 56.7% of stenoses, and indeterminate in 43.3% of stenoses. There was a poor diagnostic agreement between CFRpres and CFRpb with CFRflow (overall agreement: 45.5% and 71.6% of vessels, respectively). There was equivalent risk for long-term MACE for lesions with abnormal versus normal CFRpres (Breslow p = 0.562), whereas vessels with abnormal CFRflow were significantly associated with increased long-term MACE (Breslow p < 0.001). For vessels where CFRpb was abnormal or normal, there was equivalent risk for long-term MACE for vessels with abnormal versus normal CFRpb (Breslow p = 0.194), whereas vessels with abnormal CFRflow were associated with increased MACE rates over time (Breslow p < 0.001). Conclusions: Pressure-derived estimations of CFR poorly agree with flow-derived measurements of CFR, which may explain the inferior association with long-term MACE as compared to flow-derived CFR.

KW - Aged

KW - Arterial Pressure/physiology

KW - Coronary Circulation/physiology

KW - Coronary Stenosis/diagnostic imaging

KW - Female

KW - Fractional Flow Reserve, Myocardial/physiology

KW - Humans

KW - Laser-Doppler Flowmetry/methods

KW - Male

KW - Middle Aged

KW - Risk Assessment/methods

UR - https://www.scopus.com/pages/publications/85057062435

U2 - 10.1016/j.ijcard.2018.11.013

DO - 10.1016/j.ijcard.2018.11.013

M3 - Article

C2 - 30482445

SN - 0167-5273

VL - 279

SP - 6

EP - 11

JO - International Journal of Cardiology

JF - International Journal of Cardiology

ER -

Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools

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Keywords

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