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Published on: April 13, 2015
Coronary Angiography-Derived Diastolic Pressure Ratio
Yanjun Gong1, Yundi Feng2, Tieci Yi1
1Department of Cardiology, Peking University First Hospital, Beijing, China.
Insights
A new computational fluid dynamic (CFD) method, coronary angiography-derived diastolic pressure ratio (caDPR), shows high diagnostic accuracy for assessing coronary artery disease without invasive pressure wires. This non-invasive technique could improve hemodynamic assessment in clinical practice.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Computational Fluid Dynamics
Background:
- Invasive pressure wire measurements are standard for assessing coronary artery stenosis severity.
- Non-invasive methods are needed to improve diagnostic efficiency and patient comfort.
Purpose of the Study:
- To evaluate the diagnostic performance of a novel computational fluid dynamic (CFD) derived coronary angiography-derived diastolic pressure ratio (caDPR).
- To assess caDPR's accuracy compared to invasive wire-derived fractional flow reserve (FFR) in a multicenter setting.
Main Methods:
- A CFD method was developed to calculate caDPR from aortic pressure waveforms.
- Offline caDPR was compared to wire-derived FFR in 328 vessels from 330 patients with stable or unstable angina.
- Diagnostic performance metrics including accuracy, sensitivity, specificity, and AUC were calculated.
Main Results:
- The caDPR demonstrated high diagnostic accuracy (87.7%), sensitivity (89.5%), and specificity (86.8%) with an AUC of 0.940.
- A caDPR cutoff of 0.89 closely correlated with a wire-derived FFR cutoff of 0.80.
- The method was validated against invasive FFR in a multicenter cohort.
Conclusions:
- The novel CFD-designed caDPR exhibits good diagnostic performance for hemodynamic assessment of coronary lesions.
- caDPR offers a promising non-invasive alternative to traditional pressure wire measurements.
- This technique has the potential to enhance the assessment of coronary artery disease in the catheterization laboratory.
Aims:
Based on the aortic pressure waveform, a specially designed computational fluid dynamic (CFD) method was proposed to determine coronary angiography-derived diastolic pressure ratio (caDPR) without using invasive pressure wire. The aim of the study is to retrospectively assess diagnostic performance of the caDPR in the catheterization laboratory, based on a previous multicenter trial for online assessment of coronary angiography-derived FFR (caFFR).
Methods And Results:
Patients with diagnosis of stable or unstable angina pectoris were enrolled in six centers. Wire-derived FFR was measured in coronary arteries with 30-90% diameter stenosis. Offline caDPR was assessed in blinded fashion against wire-derived FFR at an independent core laboratory. A total of 330 patients who met the inclusion/exclusion criteria were enrolled from June 26 to December 18, 2018. Offline computed caDPR and wire-derived FFR were compared in 328 interrogated vessels. The caDPR with a cutoff value of 0.89 shows diagnostic accuracy of 87.7%, sensitivity of 89.5%, specificity of 86.8%, and AUC of 0.940 against the wire-derived FFR with a cutoff value of 0.80.
Conclusions:
Using wired-based FFR as the standard reference, there is good diagnostic performance of the novel-CFD-design caDPR. Hence, caDPR could enhance the hemodynamic assessment of coronary lesions.
