Abstract 13990: Functional Evaluation of Coronary Lesion Severity Using Pressure Drop Coefficient for an FFR Cut-off of 0.80: A Meta-Analysis
Background: Functional assessment of coronary lesion severity, during cardiac catheterization, is done using diagnostic parameters like fractional flow reserve (FFR; pressure derived) and coronary flow reserve (CFR; flow derived). However, the complex hemodynamics of stenosis might not be sufficiently explained by either pressure or flow alone, particularly in the case of intermediate stenosis. CDP (ratio of pressure drop across a stenosis to distal dynamic pressure), a non-dimensional index derived from fundamental fluid dynamic principles, based on a combination of intracoronary pressure and flow may improve the assessment of functional coronary lesion severity.
Hypothesis: We hypothesize that, CDP; an index based on combined pressure and flow measurements, has adequate diagnostic accuracy for functional assessment of coronary lesion severity.
Methods: We performed meta-analysis of 7 studies, retrieved from MEDLINE and PubMed, comparing the results of FFR and CFR of same lesions. Individual data, intracoronary pressure and flow measurements, were reported in 2 of these studies. For the remaining 5 studies, FFR and CFR data were digitized and individual data was extracted using the reported values of hemodynamic data over the respective patient population. The receiver operating characteristic (ROC) curve was used to identify the CDP optimal cut-point corresponding to FFR< 0.80.
Results: CDP correlated significantly with FFR (r=0.78, p<0.001; Fig-1A) and had statistically significant diagnostic efficiency (ROC- area under curve [AUC] of 89%, at FFR<0.8), specificity and sensitivity values of 83% and 81%, respectively (Fig-1B). The corresponding cut-off value for CDP to detect FFR<0.80 was at CDP>27.1.
Conclusion: CDP, a functional parameter based on both intracoronary pressure and flow measurements, has close agreement (area under ROC curve =89%) with FFR, the most frequently used method for evaluation of coronary stenosis severity.
- © 2013 by American Heart Association, Inc.