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Is the diagnostic performance of FFRangio affected by coronary microvascular dysfunction?
Takuya Makita1, Hiroyuki Omori2, Yusuke Miyazaki3
1Department of Clinical Engineering, Gifu Prefectural General Medical Center, Gifu, Japan.
Background:
FFRangio, which derives FFR from coronary angiography, has been reported to exhibit high diagnostic concordance with invasive FFR, rendering it an appealing diagnostic tool. However, its diagnostic performance in the presence of coronary microvascular dysfunction (CMD) remains unexamined. Consequently, we conducted a study to assess the diagnostic performance of FFRangio in patients with CMD.
Methods:
The study included 111 vessels (94 patients) in which FFRangio, invasive FFR, and the index of microcirculatory resistance (IMR) were measured. CMD status was categorized into two groups: low IMR (IMR < 25) and high IMR (IMR ≥ 25). The impact of CMD on the diagnostic performance of FFRangio was assessed with invasive FFR as the reference standard.
Results:
The diagnostic performance (area under the curve: AUC) of FFRangio was high in the overall cohort (AUC: 0.92 [95% CI: 0.87 to 0.98]). However, when assessed according to microcirculatory status, the AUC of FFRangio was significantly lower in the high-IMR group compared to the low-IMR group (low-IMR group 0.98 [95% CI: 0.94 to 1.00] vs. high-IMR group 0.83 [95% CI: 0.69 to 0.96]; p = 0.04). The correlation between invasive FFR and FFRangio was lower in the high-IMR group than in the low-IMR group (r = 0.60 vs. 0.79). The agreement between FFRangio and invasive FFR was -0.03 (limits of agreement: -0.14-0.08) in the low-IMR group and - 0.06 (limits of agreement: -0.22-0.09) in the high-IMR group.
Conclusions:
CMD may contribute to reduced diagnostic concordance between FFRangio and invasive FFR.
