Ajustando a RFR por Preditores de Discordância, 'A RFR Ajustada': Uma Metodologia Alternativa para Melhorar a Capacidade Diagnóstica dos Índices Coronarianos
| Autor: | Fernández-Rodríguez, Diego, Casanova-Sandoval, Juan, Barriuso Barrado, Ignacio, Rivera, Kristian, Otaegui Irurueta, Imanol, García del Blanco, Bruno |
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| Přispěvatelé: | Institut Català de la Salut, [Fernández-Rodríguez D, Casanova-Sandoval J, Barriuso I, Rivera K] Hospital Universitari Arnau de Vilanova. Lleida, Spain. Institut de Recerca Biomédica de Lleida (IRBLleida), Lleida, Spain. [Otaegui I, García del Blanco B] Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Circulatory and Respiratory Physiological Phenomena::Cardiovascular Physiological Phenomena::Blood Circulation::Coronary Circulation::Fractional Flow Reserve
Myocardial [PHENOMENA AND PROCESSES] diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::técnicas de imagen cardíaca::angiografía coronaria [TÉCNICAS Y EQUIPOS ANALÍTICOS DIAGNÓSTICOS Y TERAPÉUTICOS] Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Coronary Disease::Coronary Artery Disease [DISEASES] Other subheadings::/diagnosis [Other subheadings] enfermedades cardiovasculares::enfermedades cardíacas::isquemia miocárdica::enfermedad coronaria::enfermedad arterial coronaria [ENFERMEDADES] Otros calificadores::/diagnóstico [Otros calificadores] Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Cardiac Imaging Techniques::Coronary Angiography [ANALYTICAL DIAGNOSTIC AND THERAPEUTIC TECHNIQUES AND EQUIPMENT] Cor - Malalties - Diagnòstic Angiografia fenómenos fisiológicos respiratorios y circulatorios::fenómenos fisiológicos cardiovasculares::circulación sanguínea::circulación coronaria::reserva fraccional de flujo miocárdico [FENÓMENOS Y PROCESOS] |
| Zdroj: | Scientia |
| Popis: | Angina de pecho; Reserva de flujo fraccional; Sensibilidad Angina de pit; Reserva de flux fraccionari; Sensibilitat Angina; Fractional flow reserve; Sensitivity Background Cutoff thresholds for the “resting full-cycle ratio” (RFR) oscillate in different series, suggesting that population characteristics may influence them. Likewise, predictors of discordance between the RFR and fractional flow reserve (FFR) have been documented. The RECOPA Study showed that diagnostic capacity is reduced in the RFR “grey zone”, requiring the performance of FFR to rule out or confirm ischemia. Objectives To determine predictors of discordance, integrate the information they provide in a clinical-physiological index, the “Adjusted RFR”, and compare its agreement with the FFR. Methods Using data from the RECOPA Study, predictors of discordance with respect to FFR were determined in the RFR “grey zone” (0.86 to 0.92) to construct an index (“Adjusted RFR”) that would weigh RFR together with predictors of discordance and evaluate its agreement with FFR. Results A total of 156 lesions were evaluated in 141 patients. Predictors of discordance were: chronic kidney disease, previous ischemic heart disease, lesions not involving the anterior descending artery, and acute coronary syndrome. Though limited, the “Adjusted RFR” improved the diagnostic capacity compared to the RFR in the “grey zone” (AUC-RFR = 0.651 versus AUC-“Adjusted RFR” = 0.749), also showing an improvement in all diagnostic indices when optimal cutoff thresholds were established (sensitivity: 59% to 68%; specificity: 62% to 75%; diagnostic accuracy: 60% to 71%; positive likelihood ratio: 1.51 to 2.34; negative likelihood ratio: 0.64 to 0.37). Conclusions Adjusting the RFR by integrating the information provided by predictors of discordance to obtain the “Adjusted RFR” improved the diagnostic capacity in our population. Further studies are required to evaluate whether clinical-physiological indices improve the diagnostic capacity of RFR or other coronary indices. |
| Databáze: | OpenAIRE |
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