Commentary on 'Hybrid iFR-FFR decision-making strategy…' by Petraco et al
| Autor: | Mamas A. Mamas, Magdi El-Omar |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Operations research business.industry Decision Making Pressure wire Predictive value Fractional Flow Reserve Myocardial Internal medicine Positive predicative value Myocardial Revascularization medicine Cardiology Humans Vasodilator drugs Female Linear correlation Cardiology and Cardiovascular Medicine business |
| Zdroj: | EuroIntervention. 9:169-172 |
| ISSN: | 1774-024X |
| DOI: | 10.4244/eijv9i1a26 |
| Popis: | For an iFR of 0.93, they recommend deferring treatment and for the intermediate range of iFRs (0.86-0.93), they recommend proceeding to FFR. By pursuing such hybrid strategy, the need for vasodilator drugs (and thus FFR) is obviated in 57% of cases, whilst maintaining 95% agreement with an FFR only strat- egy. Petraco et al's study was a multicentre study, composed of two independent study cohorts and using two pressure wire systems, different routes of administration of adenosine (i.v. and/or i.c.) and different i.v. adenosine dosages (ranging from 140-200 µg/kg/min). As acknowledged by the authors, such methodological differences may have introduced some differences between the groups, and thus influenced their final conclusions. In our large, single-centre study 2 , we investigated the relationship between resting Pd/Pa and FFR in 528 consecutive, "real-world" pressure wire studies. We consistently used the Radi pressure wire and a continuous i.v . infusion of adenosine at a dose of 140 µg/kg/ min in all cases. We demonstrated a linear correlation between rest- ing Pd/Pa and FFR, with a correlation coef ficient of 0.74. When an FFR of ≤0.80 was defined as positive (as per FAME), a resting Pd/Pa of ≤0.87 had a positive predictive value (PPV) of 94.6%, whilst a resting Pd/Pa of ≥0.96 had a negative predictive value (NPV) of 93%. When an FFR of ≤0.75 was defined as positive (as per DEFER), the corresponding values for the resting Pd/Pa were ≤0.85 (with a PPV of 95%) and ≥0.93 (with a NPV of 95.7%). With such high positive and negative predictive values, we concluded that pharma- cological vasodilatation and FFR measurement may not be necessary in 66% and 47% of patients, depending on whether DEFER or FAME criteria, respectively, are used to define a positive result. We also argued that the greatest utility of the resting Pd/Pa appears to be in predicting a negative FFR since resting values of Pd/Pa which predict a positive FFR constitute a minority of cases. At a time when iFR technology is still maturing and in need of fur- ther validation before it can be more widely accepted, perhaps inter- ventional cardiologists should consider using the much simpler, yet equally informative index, resting Pd/Pa, to guide their coronary interventions. After all, resting Pd/Pa is a readily available index which constitutes an integral part of any pressure wire procedure and does not require any sophisticated algorithms for its computation. |
| Databáze: | OpenAIRE |
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