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Updated: Oct 1, 2025
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Assessing Cerebral Autoregulation via Oscillatory Lower Body Negative Pressure and Projection Pursuit Regression
Published on: December 10, 2014
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Development, validation, and reproducibility of the pullback pressure gradient (PPG) derived from manual fractional
Jeroen Sonck1,2, Takuya Mizukami1,3, Nils P Johnson4
1Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
Summary
Manual fractional flow reserve (FFR) pullbacks accurately calculate the pullback pressure gradient (PPG), effectively assessing coronary artery disease. This method demonstrates excellent reproducibility for both intra- and interoperator assessments.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Diagnostic imaging
Background:
- Fractional flow reserve (FFR) pullbacks are crucial for evaluating coronary artery pressure gradients.
- The pullback pressure gradient (PPG) quantifies these assessments, differentiating focal from diffuse coronary artery disease.
- Manual FFR pullbacks offer a potentially more accessible method for PPG calculation.
Purpose of the Study:
- To validate the accuracy of PPG derived from manual FFR pullbacks against motorized pullbacks.
- To assess the intra- and interoperator reproducibility of PPG measurements using manual FFR pullbacks.
- To determine if pullback maneuver duration affects PPG reproducibility.
Main Methods:
- Compared PPG from manual FFR pullbacks with a reference standard (motorized pullbacks).
- Assessed agreement using the Bland-Altman method for repeated manual pullbacks.
- Analyzed 116 FFR pullback maneuvers (96 manual, 20 motorized) in patients with stable coronary artery disease (FFR ≤ 0.80).
Main Results:
- Excellent agreement was found between manual and motorized PPG (mean difference -0.01 ± 0.07).
- Intra- and interoperator reproducibility for manual PPG were excellent (LOA -0.11 to 0.12 and -0.12 to 0.11).
- Pullback duration did not significantly impact PPG reproducibility (r = 0.12, p = 0.567).
Conclusions:
- Manual FFR pullbacks provide an accurate method for PPG calculation.
- The PPG derived from manual pullbacks exhibits excellent intra- and interoperator reproducibility.
- Manual FFR pullbacks are a reliable tool for assessing coronary artery disease severity and distribution.
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