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Published on: October 22, 2014
Diastolic Hyperemia-Free Ratio in Patients With Coronary Artery Disease: A Prospective Observational Study
Ji Woong Roh1, Oh-Hyun Lee1, Yongcheol Kim2
1Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea.
Insights
Diastolic hyperemia-free ratio (DFR) shows high accuracy in assessing coronary artery stenosis compared to fractional flow reserve (FFR). This study validates DFR as a reliable tool for guiding revascularization decisions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Intermediate coronary artery stenosis requires accurate physiological assessment.
- Fractional flow reserve (FFR) is a standard but invasive method.
- Diastolic hyperemia-free ratio (DFR) offers a less invasive alternative.
Purpose of the Study:
- To evaluate the diagnostic accuracy of DFR compared to FFR.
- To assess the correlation between DFR and FFR measurements.
- To determine the effectiveness of DFR in guiding revascularization decisions.
Main Methods:
- Prospective recruitment of 300 patients with intermediate coronary stenosis.
- Simultaneous invasive physiological assessment using DFR and FFR.
- Analysis of DFR's accuracy in predicting FFR values and correlation across coronary arteries.
Main Results:
- A strong linear relationship was found between DFR and FFR (r=0.80).
- DFR demonstrated high diagnostic accuracy (92.0%) in predicting significant stenosis (FFR ≤0.80).
- Consistent strong correlations were observed across all coronary arteries.
Conclusions:
- DFR strongly correlates with FFR and exhibits high diagnostic accuracy.
- DFR is a reliable and accurate tool for assessing intermediate coronary artery stenosis.
- The findings support DFR's utility in clinical decision-making for revascularization.
Background And Objectives:
Diastolic hyperemia-free ratio (DFR), an alternative to fractional flow reserve (FFR) for the assessment of intermediate coronary artery stenosis, helps reduce patients' time, and inconvenience. However, the validation data for DFR and FFR are lacking. We aimed to evaluate the diagnostic accuracy of DFR and FFR and to assess the effective decision making for revascularization using their values.
Methods:
Patients subjected to an invasive physiological study for intermediate coronary artery stenosis at a single center in South Korea between August 2022 and January 2024 were prospectively recruited. We evaluated the correlation between DFR and FFR measurements and the diagnostic accuracy of DFR ≤0.89 to predict FFR ≤ 0.80. We also compared the correlation for each coronary artery.
Results:
A total of 324 intermediate coronary stenotic lesions from 300 patients were evaluated using DFR and FFR values simultaneously. There was a strong linear relationship between DFR and FFR (r = 0.80; 95% confidence interval [CI], 0.76-0.84; p < 0.001). The diagnostic accuracy of the DFR was 92.0% in predicting FFR ≤0.80. When compared separately for each coronary artery, all vessels showed a strong linear relationship with no statistical differences between any of the vessels (p=0.641). There was also a strong linear relationship between DFR and distal coronary pressure/aorta pressure (r=0.93; 95% CI, 0.91-0.94; p<0.001).
Conclusions:
There was a strong correlation between DFR and FFR and a high diagnostic accuracy rate of DFR compared to FFR. Good diagnostic performance of DFR was also observed in each coronary artery.
Trial Registration:
ClinicalTrials.gov Identifier: NCT05421169.
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