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Prediction of fractional flow reserve with angiographic DILEMMA score
Osman Beton1, Hakkı Kaya2, Okan Onur Turgut2
1Department of Cardiology, Heart Center, Cumhuriyet University Health Services Training and Research Hospital, Cumhuriyet University; Sivas-Turkey. obeton@cumhuriyet.edu.tr.
Insights
The DILEMMA score shows good accuracy in identifying significant coronary lesions, correlating moderately with fractional flow reserve (FFR). However, its correlation with resting distal coronary pressure is weak.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Fractional flow reserve (FFR) is the gold standard for assessing the functional significance of coronary artery stenosis.
- Angiographic assessment alone has limitations in predicting functionally significant lesions.
- The DILEMMA score, incorporating minimal lumen diameter (MLD), lesion length (LL), and BARI Myocardial Jeopardy Index (MJI), is a novel angiographic tool.
Purpose of the Study:
- To evaluate the predictive value of the DILEMMA score for functionally significant coronary lesions (FFR ≤0.80).
- To assess the relationship between the DILEMMA score and resting distal coronary artery pressure/aortic pressure (Pd/Pa).
Main Methods:
- Retrospective analysis of 185 datasets from 150 patients undergoing coronary angiography and FFR.
- Quantitative coronary angiography for MLD and LL assessment.
- Calculation of BARI MJI and DILEMMA score.
Main Results:
- The DILEMMA score demonstrated a negative correlation with FFR (r=-0.494, p<0.001).
- Resting Pd/Pa showed a strong positive correlation with FFR (r=0.713, p<0.001).
- The DILEMMA score had an area under the curve of 0.793 for diagnosing FFR ≤0.80, while resting Pd/Pa had an AUC of 0.862.
Conclusions:
- The DILEMMA score is a valuable angiographic tool with good accuracy for diagnosing significant FFR.
- The DILEMMA score exhibits a moderate correlation with FFR but a weak correlation with resting Pd/Pa.
- Resting Pd/Pa is a superior predictor of significant FFR compared to the DILEMMA score.
Objective:
Angiographic assessment of stenosis has limited predictive value for functionally significant lesions compared with fractional flow reserve (FFR). The recently developed angiographic DILEMMA score, which consists of minimal lumen diameter (MLD), lesion length (LL) and Bypass Angioplasty Revascularization Investigation (BARI) Myocardial Jeopardy Index (MJI) was found to have diagnostic value in predicting FFR ≤0.80. The present study was an investigation of prediction of FFR ≤0.80 using DILEMMA score and its relationship to resting distal coronary artery pressure/aortic pressure (Pd/Pa).
Methods:
Records of consecutive patients who underwent coronary angiography and FFR were retrospectively analyzed. Assessment of MLD and LL was performed using quantitative coronary angiography. BARI MJI was calculated using angiographic calculation index.
Results:
A total of 185 pressure wire analysis data sets from 150 patients were analyzed retrospectively. There were 82 lesions in FFR >0.80 group and 103 lesions in FFR ≤0.80 group. Negative correlation was found between FFR and DILEMMA score (r=-0.494; p<0.001), FFR and BARI-MJI (r=-0.378; p<0.001), and between FFR and LL (r=-0.314; p<0.001). Positive correlation was found between FFR and baseline Pd/Pa (r=0.713; p<0.001), and between FFR and MLD (r=0.415; p<0.001). DILEMMA score had negative correlation with resting Pd/Pa (r=-0.389; p<0.001). In receiver operating characteristic analysis for diagnosing FFR≤0.80, area under curve values of resting Pd/Pa, DILEMMA score, MLD, BARI-MJI, and LL were 0.862, 0.793, 0.780, 0.728, and 0.686, respectively.
Conclusion:
DILEMMA score had moderately strong correlation with FFR and good accuracy in diagnosing significant FFR, but it had weak correlation with resting Pd/Pa.
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