Author + information
- Gilbert Wijntjens1,
- Tim van de Hoef2,
- Valérie Stegehuis3,
- Martijn Meuwissen4,
- Mauro Echavarria Pinto5,
- Steven Chamuleau6,
- Michiel Voskuil7,
- Karel Koch2,
- Robbert de Winter2 and
- Jan Piek8
- 1Academisch Medisch Centrum, Amsterdam, Netherlands
- 2Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
- 3Academic Medical Center, Amsterdam, Netherlands
- 4Breda Amphia Ziekenhuis, Breda, Netherlands
- 5Hospital General ISSSTE, Queretaro, Querétaro, Mexico
- 6UMCU, Utrecht, Netherlands
- 7University Medical Center Utrecht, Utrecht, Netherlands
- 8Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
Coronary flow capacity (CFC) is a new concept that integrates coronary flow reserve (CFR) with hyperemic flow to provide an enhanced diagnosis of myocardial ischemia. CFC distinguishes severely, moderately and mildly reduced CFC from normal CFC, wherein moderately and severely reduced CFC are associated with ischemia. We compared the diagnostic accuracy of combined pressure and flow indices like hyperemic stenosis resistance (HSR) and basal stenosis resistance (BSR), with pressure-only indices for moderately/severely reduced CFC.
We evaluated 299 lesions with combined pressure and flow measurements during rest and hyperemia. The discriminative value for moderately/severely reduced CFC was compared by means of the area under the receiver operating characteristic (ROC) curves (AUC). Classification agreement with the reference standard was determined using ROC curve-derived ischemic cut-off values.
The discriminative value of HSR for moderately/severely reduced CFC significantly exceeded that of BSR, Pd/Pa and fractional flow reserve (FFR)(AUC: 0.906 versus 0.853, 0.842 and 0.820, respectively, p<0.001)(fig 1). Optimal ischemic cut-points for HSR, BSR, Pd/Pa and FFR were ≥0.72mmHg (sens 82.5%, spec 81.7%), ≥0.65mmHg (sens 76.3%, spec 81.7%), ≤0.89 (sens 75.0%, spec 85.4%) and ≤0.76 (sens 72.5%, spec 76.3%), respectively. The classification agreement of HSR, BSR, and Pd/Pa with moderately/severely reduced CFC was equivalent, but exceeded that of FFR.
HSR is a better diagnostic index to identify myocardial ischemia as defined by moderately/reduced CFC as compared to pressure-only indices.
IMAGING: FFR and Physiologic Lesion Assessment