Validation of virtual fractional flow reserve pullback curves

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-09-29 DOI:10.1002/ccd.31222

Ruiko Seki MD, Damien Collison MB, BCh, MD, Kazumasa Ikeda MD, Jeroen Sonck MD, PhD, Daniel Munhoz MD, PhD, Dario Tino Bertolone MD, Brian Ko MD, PhD, Michael Maeng MD, PhD, Hiromasa Otake MD, FACC, Bon-Kon Koo MD, PhD, Tatyana Storozhenko MD, Frederic Bouisset MD, Marta Belmonte MD, Attilio Leone MD, Monika Shumkova MD, Tom J. Ford MBChB, PhD, Thabo Mahendiran BMBCh, MD, Colin Berry MBChB, PhD, Bernard De Bruyne MD, PhD, Keith Oldroyd MBChB, MD, Koshiro Sakai MD, PhD, Takuya Mizukami MD, PhD, Carlos Collet MD, PhD

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引用次数: 0

Abstract

Background

Angiography-derived fractional flow reserve (virtual FFR) has shown excellent diagnostic performance compared with wire-based FFR. However, virtual FFR pullback curves have not been validated yet.

Objectives

To validate the accuracy of virtual FFR pullback curves compared to wire-based FFR pullbacks and to assess their clinical utility using patient-reported outcomes.

Methods

Pooled analysis of two prospective studies, including patients with hemodynamically significant (FFR ≤ 0.80) coronary artery disease (CAD). Virtual and wire-based FFR pullbacks were compared to assess the accuracy of virtual pullbacks to characterize CAD as focal or diffuse. Pullbacks were analyzed visually and quantitatively using the pullback pressure gradient (PPG). Patients underwent PCI, and the Seattle Angina Questionnaire (SAQ) was administered at 3-month follow-up.

Results

A total of 298 patients (300 vessels) with both virtual and wire-based pullbacks who underwent PCI were included in the analysis. The mean age was 61.8 ± 8.8, and 15% were female. The agreement on the visual adjudication of the CAD pattern was fair (Cohen's Kappa: 0.31, 95% confidence interval: 0.18–0.45). The mean PPG were 0.65 ± 0.18 from virtual pullbacks and 0.65 ± 0.13 from wire-based pullbacks (r = 0.68, mean difference 0, limits of agreement −0.27 to 0.28). At follow-up, patients with high virtual PPG (>0.67) had higher SAQ angina frequency scores (i.e., less angina) than those with low virtual PPG (SAQ scores 92.0 ± 14.3 vs. 85.5 ± 23.1, p = 0.022).

Conclusion

Virtual FFR pullback curves showed moderate agreement with wire-based FFR pullbacks. Nonetheless, patients with focal disease based on virtual PPG reported greater improvement in angina after PCI.

查看原文本刊更多论文

虚拟部分流量储备回撤曲线的验证。

背景：与基于导线的 FFR 相比，血管造影衍生的分数血流储备（虚拟 FFR）显示出卓越的诊断性能。然而，虚拟 FFR 回抽曲线尚未得到验证：验证虚拟 FFR 回抽曲线与线控 FFR 回抽曲线相比的准确性，并使用患者报告的结果评估其临床实用性：两项前瞻性研究的汇总分析，包括血流动力学显著（FFR ≤ 0.80）的冠状动脉疾病（CAD）患者。对虚拟和基于导线的 FFR 回抽进行比较，以评估虚拟回抽将 CAD 定性为局灶性或弥漫性的准确性。使用回拉压力梯度（PPG）对回拉进行视觉和定量分析。患者接受了 PCI 治疗，并在 3 个月随访时进行了西雅图心绞痛问卷调查（SAQ）：共有 298 名患者（300 根血管）同时接受了虚拟和线性回拉，并进行了 PCI 治疗。平均年龄为（61.8±8.8）岁，15%为女性。对 CAD 模式的视觉判定的一致性尚可（Cohen's Kappa：0.31，95% 置信区间：0.18-0.45）。虚拟回拉的平均 PPG 值为 0.65 ± 0.18，线性回拉的平均 PPG 值为 0.65 ± 0.13（r = 0.68，平均差为 0，一致性界限为 -0.27 至 0.28）。随访时，虚拟 PPG 高（>0.67）的患者的 SAQ 心绞痛频率评分（即心绞痛较少）高于虚拟 PPG 低的患者（SAQ 评分 92.0 ± 14.3 vs. 85.5 ± 23.1，p = 0.022）：结论：虚拟 FFR 回抽曲线与基于导线的 FFR 回抽曲线显示出适度的一致性。结论：虚拟 FFR 回拉曲线与基于导线的 FFR 回拉曲线显示出中等程度的一致性，然而，基于虚拟 PPG 的局灶性疾病患者在 PCI 后的心绞痛改善程度更大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.