title: Impact of Pressure Signal Drift on Fractional Flow Reserve-Based Decision-Making for Patients With Intermediate Coronary Artery Stenosis.
abstract: BACKGROUND
  Fractional flow reserve (FFR) is an important physiological measure of intermediate coronary artery stenosis. Pressure signal drift (PD) is widely recognized but has largely been ignored in FFR measurements. We sought to determine the effect of PD on FFR-derived decision-making.
  
  
  RESULTS
  We analyzed 1,218 FFR measurements for intermediate stenosis in 940 patients, in which the pullback maneuver confirmed PD ≤3 mmHg. The primary objectives were to determine the frequency and magnitude of PD and its effect on decision-making on the basis of an FFR cutoff of 0.80. In all, 479 (39.3%) measurements showed PD. PD was significantly associated with age, hypertension, reference diameter, left anterior descending artery lesion location, and read-out FFR values. Classification discordance between read-out and PD-corrected FFR values was detected in 44 (3.6%) measurements in total and in 9.2% of PD cases. The decision changed from FFR ≤0.80 to FFR >0.80 in 40 (3.3%) and vice versa in 4 (0.3%) measurements. PD showed no effect on decision-making when the FFR read-out value was ≤0.76 or ≥0.83.
  
  
  CONCLUSIONS
  PD is not uncommon, and its effect on FFR-based decision-making was not negligible in the range between 0.77 and 0.82 where reclassification occurred in 18.7% of FFR measurements. (Circ J 2016; 80: 1812-1819).
authors.affiliation: Department of Clinical Laboratory, Tsuchiura Kyodo General Hospital.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Wakasa
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kuramochi
authors.forename: Naoto
authors.initials: N
authors.lastname: Mihashi
authors.forename: Noriko
authors.initials: N
authors.lastname: Terada
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kanaji
authors.forename: Tadashi
authors.initials: T
authors.lastname: Murai
authors.forename: Tetsumin
authors.initials: T
authors.lastname: Lee
authors.forename: Taishi
authors.initials: T
authors.lastname: Yonetsu
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kobashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Miyamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tobata
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Kakuta
mesh_terms: D000368:Aged; D001794:Blood Pressure; D023921:Coronary Stenosis / Q000503:physiopathology*; D003657:Decision Making; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged