Validation of virtual fractional flow reserve pullback curves

Ruiko Seki¹, Damien Collison^{2

3}, Kazumasa Ikeda¹, Jeroen Sonck¹, Daniel Munhoz^{1

4}, Dario Tino Bertolone^{1

4}, Brian Ko⁵, Michael Maeng^{6

7}, Hiromasa Otake⁸, Bon-Kon Koo⁹, Tatyana Storozhenko^{1

10}, Frederic Bouisset^{1

11}, Marta Belmonte^{1

4}, Attilio Leone^{1

4}, Monika Shumkova¹, Tom J Ford¹², Thabo Mahendiran^{1

13}, Colin Berry^{2

3}, Bernard De Bruyne^{1

13}, Keith Oldroyd³, Koshiro Sakai^{1

14

15}, Takuya Mizukami^{1

16}, Carlos Collet¹

Affiliations

¹ Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
² Department of cardiology, Golden Jubilee National Hospital, Glasgow, UK.
³ School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK.
⁴ Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
⁵ Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia.
⁶ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
⁸ Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
⁹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
¹⁰ L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine.
¹¹ Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse, France.
¹² Department of cardiology, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
¹³ Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.
¹⁴ Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
¹⁵ Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA.
¹⁶ Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan.

PMID: 39342486
DOI: 10.1002/ccd.31222

Comparative Study

Validation of virtual fractional flow reserve pullback curves

Ruiko Seki et al. Catheter Cardiovasc Interv. 2024 Nov.

. 2024 Nov;104(6):1178-1188.

doi: 10.1002/ccd.31222. Epub 2024 Sep 29.

Authors

Affiliations

¹ Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
² Department of cardiology, Golden Jubilee National Hospital, Glasgow, UK.
³ School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK.
⁴ Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
⁵ Monash Cardiovascular Research Centre, Monash University and Monash Heart, Monash Health, Clayton, Victoria, Australia.
⁶ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
⁸ Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
⁹ Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
¹⁰ L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine.
¹¹ Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse, France.
¹² Department of cardiology, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
¹³ Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland.
¹⁴ Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
¹⁵ Department of Cardiology, St Francis Hospital and Heart Center, Roslyn, New York, USA.
¹⁶ Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan.

PMID: 39342486
DOI: 10.1002/ccd.31222

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.

Trial registration: ClinicalTrials.gov NCT03782688 NCT03259815.

Keywords: PCI; angina; angiography‐derived fractional flow reserve; coronary artery disease; fractional flow reserve.

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References

REFERENCES

1. Lawton JS, Tamis‐Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. Jan 18 2022;145(3):18. doi:10.1161/CIR.0000000000001038
1. Knuuti J, Wijns W, Saraste A, et al 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407‐477. doi:10.1093/eurheartj/ehz425
1. Collet C, Sonck J, Vandeloo B, et al. Measurement of hyperemic pullback pressure gradients to characterize patterns of coronary atherosclerosis. J Am Coll Cardiol. 2019;74(14):1772‐1784. doi:10.1016/j.jacc.2019.07.072
1. Al‐Lamee R, Thompson D, Dehbi HM, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double‐blind, randomised controlled trial. The Lancet. 2018;391(10115):31‐40. doi:10.1016/S0140-6736(17)32714-9
1. Collison D, Didagelos M, Aetesam‐Ur‐Rahman M, et al. Post‐stenting fractional flow reserve vs coronary angiography for optimization of percutaneous coronary intervention (TARGET‐FFR). Eur Heart J. 2021;42(45):4656‐4668. doi:10.1093/eurheartj/ehab449

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Validation of virtual fractional flow reserve pullback curves

Affiliations

Validation of virtual fractional flow reserve pullback curves

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous