title: Comparison between fractional flow reserve and visual assessment for moderate coronary artery stenosis.
abstract: BACKGROUND
  Fractional flow reserve (FFR) is an interventional diagnostic method, based on intracoronary pressure measurement, used for the assessment of the severity of coronary artery stenoses.
  
  
  OBJECTIVE
  Our study aimed to compare visual measurements made by multiple observers with FFR measurement in the assessment of angiographically moderate coronary artery stenosis.
  
  
  METHODS
  The angiographic images of moderate coronary artery lesions of 359 patients enrolled in the study were interpreted independently by three interventional cardiologists assigned as observers (O1, O2, O3).
  
  
  RESULTS
  In FFR, 37.9% were haemodynamically significant, while 62.1% were insignificant. 40.3% of the lesions were considered severe by O1, 39.9% by O2, and 44.4% by O3. When we compare the FFR results to the observers' decisions about lesion severity, the serious lesion percentages of all three observers were different both from each other and from the FFR result, at a statistically significant level (respectively, p < 0.001, p < 0.001). The kappa analysis performed to check the agreement between the observers' decisions and FFR revealed significant difference between FFR results and the decisions made by all observers (p < 0.001). The kappa agreement analysis performed by matching observers' decisions in pairs revealed a good agreement between O1 and O2 and a moderate agreement between O2 and O3 as well as O1 and O3, although there was still a significant disagreement between all pairs of observers (p < 0.001).
  
  
  CONCLUSIONS
  Visual assessment, even when performed by experienced interventional cardiologists, does not yield similar results with FFR procedure in the process of determination of the functional importance of moderately severe coronary artery stenoses.
authors.forename: Bilge
authors.initials: B
authors.lastname: Duran Karaduman
authors.forename: Murat
authors.initials: M
authors.lastname: Akçay
authors.affiliation: Department of Cardiology, Yıldırım Beyazıt University, Faculty of Medicine, Turkey, Turkey. huseyinayhan44@yahoo.com.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ayhan
authors.forename: Hacı Ahmet
authors.initials: HA
authors.lastname: Kasapkara
authors.forename: Murat Can
authors.initials: MC
authors.lastname: Güney
authors.forename: Tahir
authors.initials: T
authors.lastname: Durmaz
authors.forename: Telat
authors.initials: T
authors.lastname: Keleş
authors.forename: Nihal
authors.initials: N
authors.lastname: Akar Bayram
authors.forename: Emine
authors.initials: E
authors.lastname: Bilen
authors.forename: Engin
authors.initials: E
authors.lastname: Bozkurt
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
keywords: fractional flow reserve; moderate coronary artery stenosis; visual assessment