title: Use of Resting Non-hyperemic Indices for Avoidance of Fractional Flow Reserve Measurement: The Goal of 100% Accuracy.
abstract: OBJECTIVE
  Recent studies have suggested that fractional flow reserve (FFR) measurement can be avoided by using similar ranges of baseline mean coronary pressure (Pd) to mean aortic pressure (Pa) ratio (0.88-0.95). Further studies have suggested that too many significant coronary stenoses are misclassified based on these ranges. We hypothesized that with a certain range of baseline Pd/Pa, 100% positive predictive value (PPV) and negative predictive value (NPV) can be achieved to avoid misclassification.
  
  
  METHODS
  We retrospectively evaluated the pressure tracings of 555 consecutive intermediate coronary stenotic lesions that had undergone FFR measurement in the cardiac catheterization laboratory of a tertiary-care center. The baseline Pd/Pa was manually measured and correlated with final FFR. The operating test characteristics were calculated using an abnormal FFR of ≤0.80 as the criterion standard for the presence of hemodynamic, significant coronary stenosis.
  
  
  RESULTS
  The area under the receiver-operating characteristics curve of baseline Pd/Pa for predicting FFR was 0.89, very similar to published results for instantaneous wave-free ratio and Pd/Pa. However, a significant number of lesions were mischaracterized (ie, using a baseline Pd/Pa of ≤0.88 to >0.95, there were 22 misclassifications, with 6 false-positive and 16 false-negative results). At a Pd/Pa of ≤0.86, 100% PPV was achieved, and 100% NPV was achieved at >1.00.
  
  
  CONCLUSIONS
  A baseline Pd/Pa of ≤0.86 is associated with a PPV of 100%, which can avoid the misclassification errors seen in prior studies. This provides a more clinically useful application of baseline Pd/Pa.
authors.forename: Khawaja Afzal
authors.initials: KA
authors.lastname: Ammar
authors.forename: Syed Shahab
authors.initials: SS
authors.lastname: Kazmi
authors.forename: Mirza Nubair
authors.initials: MN
authors.lastname: Ahmad
authors.forename: Mirza Mujadil
authors.initials: MM
authors.lastname: Ahmad
authors.forename: Arsalan
authors.initials: A
authors.lastname: Riaz
authors.forename: Imran
authors.initials: I
authors.lastname: Husain
authors.forename: Fatima
authors.initials: F
authors.lastname: Husain
authors.forename: Suhail
authors.initials: S
authors.lastname: Allaqaband
authors.forename: Tanvir
authors.initials: T
authors.lastname: Bajwa
authors.affiliation: Aurora Cardiovascular Services, Aurora St. Luke's Medical Center POB, 2801 W. Kinnickinnic River Parkway, Suite 840, Milwaukee, WI 53215 USA. publishing5@aurora.org.
authors.forename: Anjan
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D006328:Cardiac Catheterization / Q000379:methods; D023921:Coronary Stenosis / Q000175:diagnosis / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology; D006439:Hemodynamics; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine