title: Diagnostic Performance of Resting and Hyperemic Invasive Physiological Indices to Define Myocardial Ischemia: Validation With13N-Ammonia Positron Emission Tomography.
abstract: The authors sought to compare the diagnostic performance of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and resting distal coronary artery pressure/aortic pressure (Pd/Pa) using13N-ammonia positron emission tomography (PET).
  
  
  
  The diagnostic performance of invasive physiological indices was reported to be different according to the reference to define the presence of myocardial ischemia.
  
  
  
  A total of 115 consecutive patients with left anterior descending artery stenosis who underwent both13N-ammonia PET and invasive physiological measurement were included. Optimal cutoff values and diagnostic performance of FFR, iFR, and resting Pd/Pa were assessed using PET-derived coronary flow reserve (CFR) and relative flow reserve (RFR) as references. To compare discrimination and reclassification ability, each index was compared with integrated discrimination improvement (IDI) and category-free net reclassification index (NRI).
  
  
  
  All invasive physiological indices correlated with CFR and RFR (all p values <0.001). The overall diagnostic accuracies of FFR, iFR, and resting Pd/Pa were not different for CFR <2.0 (FFR 69.6%, iFR 73.9%, and resting Pd/Pa 70.4%) and RFR <0.75 (FFR 73.9%, iFR 71.3%, and resting Pd/Pa 74.8%). Discrimination and reclassification abilities of invasive physiological indices were comparable for CFR. For RFR, FFR showed better discrimination and reclassification ability than resting indices (IDI = 0.170 and category-free NRI = 0.971 for iFR; IDI = 0.183 and category-free NRI = 1.058 for resting Pd/Pa; all p values <0.001).
  
  
  
  The diagnostic performance of invasive physiological indices showed no differences in the prediction of myocardial ischemia defined by CFR. Using RFR as a reference, FFR showed a better discrimination and reclassification ability than resting indices.
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Doyeon
authors.initials: D
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, Sejong General Hospital, Bucheon, Korea.
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Jeon
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea.
authors.forename: Joo Myung
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jonghanne
authors.initials: J
authors.lastname: Park
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Chee Hae
authors.initials: CH
authors.lastname: Kim
authors.affiliation: China-Japan Union Hospital of Jilin University, China.
authors.forename: Yaliang
authors.initials: Y
authors.lastname: Tong
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jinlong
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ji-In
authors.initials: JI
authors.lastname: Bang
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Minseok
authors.initials: M
authors.lastname: Suh
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jin Chul
authors.initials: JC
authors.lastname: Paeng
authors.affiliation: Department of Internal Medicine and Emergency Medical Center, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea.
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Na
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Gi Jeong
authors.initials: GJ
authors.lastname: Cheon
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Cook
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare National Health Service Trust, London, United Kingdom.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Davies
authors.affiliation: Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea; Institute of Aging, Seoul National University, Seoul, Korea. Electronic address: bkkoo@snu.ac.kr.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
mesh_terms: D000368:Aged; D000641:Ammonia / Q000008:administration & dosage*; D019540:Area Under Curve; D062186:Arterial Pressure; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods* / Q000592:standards; D009590:Nitrogen Radioisotopes / Q000008:administration & dosage*; D049268:Positron-Emission Tomography / Q000592:standards; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000008:administration & dosage*; D012015:Reference Standards; D012042:Registries; D015203:Reproducibility of Results; D056910:Republic of Korea; D012720:Severity of Illness Index
chemical_list: D009590:Nitrogen Radioisotopes; D019275:Radiopharmaceuticals; D000641:Ammonia
keywords: (13)N-ammonia positron emission tomography; coronary artery disease; fractional flow reserve; instantaneous wave-free ratio; myocardial ischemia