title: The Influence of Lesion Location on the Diagnostic Accuracy of Adenosine-Free Coronary Pressure Wire Measurements.
abstract: This work compares the diagnostic performance of adenosine-free coronary pressure wire indices based on lesion location.
  
  
  
  Several adenosine-free coronary pressure wire indices have been proposed to assess the functional significance of coronary artery lesions; however, there is a theoretical concern that lesion location and the mass of perfused myocardium may affect diagnostic performance.
  
  
  
  A total of 763 patients were prospectively enrolled from 12 institutions. Fractional flow reserve (FFR) and contrast-based FFR (cFFR) were obtained during adenosine-induced maximal hyperemia and contrast-induced submaximal hyperemia respectively, whereas the instantaneous wave-free ratio (iFR) and distal pressure/aortic pressure (Pd/Pa) were obtained at rest. Using an FFR of ≤0.80 as a reference standard, the diagnostic accuracy of each index was compared based on lesion location (left main or proximal left anterior descending artery [LM/pLAD] compared with other lesion locations).
  
  
  
  The median FFR, cFFR, iFR, and Pd/Pa were 0.81 (interquartile range [IQR]: 0.74 to 0.87), 0.86 (IQR: 0.79 to 0.91), 0.90 (IQR: 0.85 to 0.94), and 0.92 (IQR: 0.88 to 0.95), respectively. The cFFR, iFR, and Pd/Pa were less accurate in LM/pLAD compared with other lesion locations (cFFR: 80.3% vs. 87.8%; iFR: 73.3% vs. 81.8%; Pd/Pa: 71.4% vs. 81.1%, respectively). By receiver-operating characteristics curve analysis, cFFR provided better diagnostic accuracy than resting indices regardless of lesion location (p ≤0.0001 vs. iFR and Pd/Pa for both groups).
  
  
  
  The cFFR, iFR, and Pd/Pa are less accurate in LM/pLAD compared with other lesion locations, likely related to the larger amount of myocardium supplied by LM/pLAD. Nevertheless, cFFR provides the best diagnostic accuracy among the adenosine-free indices, regardless of lesion location.
authors.affiliation: Stanford University Medical Center, Stanford, California; Stanford Cardiovascular Institute, Stanford, California.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas.
authors.forename: Nils P
authors.initials: NP
authors.lastname: Johnson
authors.affiliation: West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland; British Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland.
authors.forename: Colin
authors.initials: C
authors.lastname: Berry
authors.affiliation: Cardiovascular Center Aalst, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: University of Texas Medical School and Memorial Hermann Hospital, Houston, Texas.
authors.forename: K Lance
authors.initials: KL
authors.lastname: Gould
authors.affiliation: Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, New York; Cardiovascular Research Foundation (CFR), New York, New York.
authors.forename: Allen
authors.initials: A
authors.lastname: Jeremias
authors.affiliation: West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, Scotland.
authors.forename: Keith G
authors.initials: KG
authors.lastname: Oldroyd
authors.affiliation: Catharina Hospital, Eindhoven, the Netherlands; Eindhoven University of Technology, Eindhoven, the Netherlands.
authors.forename: Nico H J
authors.initials: NHJ
authors.lastname: Pijls
authors.affiliation: Stanford University Medical Center, Stanford, California; Stanford Cardiovascular Institute, Stanford, California. Electronic address: wfearon@stanford.edu.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
mesh_terms: D000241:Adenosine / Q000008:administration & dosage*; D000368:Aged; D019540:Area Under Curve; D062186:Arterial Pressure; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D062906:Cardiac Catheters; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D004867:Equipment Design; D005060:Europe; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D014160:Transducers, Pressure; D014481:United States; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine
keywords: contrast fractional flow reserve; fractional flow reserve; instantaneous wave-free ratio