fractional flow reserve FFR CAGFR CAGFR 78 % 82 %

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1 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF Vol. 31, pp , 2003 FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF fractional flow reserve FFR (CAGFR) CAGFR % 92 FFR q u a n t i t a t i v e coronary analysis: QCA Gould CAGFR FFR FFR 0.74 FFR CAGFR FFR p < FFR M L D % DS CAGFR p < FFR QCA CAGFR p = FFR CAGFR 3.27 CAGFR 78 % 82 % CAGFR fractional flow reserve receiver operating characteristic curve 4) C T 1 ) quantitative coronary analysis: QCA M R I 2,3 ) 87

2 Fig. 1. Quantitative coronary analysis and CAGFR as the integrated functional measure. Fig. 2. Construction of WaveWire. coronary flow reserve: CFR 5 ) fractional flow reserve: FFR 6,7 ) Q C A Q C A C F R F F R 6 F 7 F Q C A Q C A Q C A G o u l d 8-10) CMS F F R C A G F R Q C A F i g. 1 C M S 5 0 % 7 5 % P c F F R 92 P a Maximum hyperemia 0. 5 m g 1 m g Q C A M E D I S C M S 2 m g F F R C A R D I O M E T R I C S W a v e W i r e W a v e M a p F i g ) 1 2 ) 88

3 Table 1. Clinical Characteristics Fig. 3. Relationship between QCA variables and FFR. Table 2. Various Parameters of QCA and FFR Fig. 4. Relationship between CAGFR and FFR. Table 3. Multiple Linear Regression for the Dependent Variable of FFR P c / P a 15) F F R F F R F F R 13 - StatFlex Ver s t u d e n t - t F F R Receiver operating characteristic R O C 16-18) P 0.05 F F R 29 F F R F F R Q C A Table 2 92 F F R 41 P < F F R F F R F F R Table % % P < Q C A F F R % F F R F F R m m m m C A G F R F F R % FFR 57 P<

4 Fig. 5. Receiver operating characteristic curves for comparison of CAGFR, %DS, and MLD. Fig. 6. The relation between sensitivity and specificity of FFR as a CAGFR. F F R F i g. 3 F F R R = P < F F R 19 ) Kirkeeide R=0.627, P< F F R C A G F R 6) R=0.691 P< Fig.4 F F R 13 ) F F R 15 ) 20 ) CAGFR 3 CFR F F R F F R C A G F R p = F F R C F R FFR Table 3 FFR C A G F R ROC Fig. 5 ROC % = % = % % = % CAGFR FFR ) CAGFR FFR Fig. 6 CAGFR % 82 % CFR FFR CFR FFR CFR ) Gould FFR m a x i m u m 90

5 hyperemia ATP 27 ) 1) Otsuka M, Hirohashi S, Uemura S, Watanabe M, F F R Ishigami K, Maekura T, Itoh A, Haze K, Saito Y and Kichikawa K. Assessment of coronary artery by fourdetector multislice computed tomography: diagnostic accuracy and limitations for coronary artery lesions. J 12 ) Cardiol 2003; 41: , 23) 2) Nagel E, Klein C, Paetsch I, Hettwer S, CAGFR FFR Schnackenburg B and Fleck E. Magnetic resonance Bartunek 2.6 mm perfusion measurements of the noninvasive detection of coronary artery disease. Circulation 2003; 29: ) ) Doyle M, Fuisz A, Kortright E, Biederman RW, Walsh EG, Martin ET, Tauxe L, Rogers WJ, Merz 2.72 mm CN, Pepine C, Sharaf B and Pohost GM. The impact Bartunek FFR of myocardial flow reserve on the detection of coronary artery disease by perfusion imaging methods: 23 ) R an NHLBI WISE study. J Cardiovasc Magn Reson 2003; 5: ) Lembcke A, Rogalla P, Mews J, Blobel J, Enzweiler CAGFR 3 FFR CN, Wiese TH, Hermann KG and Hamm B. Imaging CAGFR P of the coronary arteries by means of multislice helical CT: optimization of image quality with < multisegmental reconstruction and variable gantry ROC rotation time. Rofo Fortschr Geb Rontgenstr Neuen FFR ROC Bildgeb Verfahr 2003; 175: CAGFR 3 5) Doucett JW, Corl PD, Payne HM, Flynn AE, Goto M, FFR Nassi M and Segal J. Validation of a doppler 0.74 CAGFR guidewire for intravascular measurement of coronary 3.27 artery flow velocity. Circulation 1992; 85: QCA 6) Kirkeeide RL, Gould KL and Parsel L. Assessment of 29, 30) coronary stenosis by myocardial perfusion imaging FFR during pharmacologic coronary vasodilatation. VII. C A G F R Validation of coronary flow reserve as a single 78 % 82 % integrated functional measure of stenosis severity CAGFR reflecting all its geometric dimensions. J Am Coll Cardiol 1986; 7: ) Pijls NHJ, van Son JAM, Kirkeeide RL, De Bruyne B and Gould KL. Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing C A G F R functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation 1993; 86: ) Gould KL, Lipscomb K and Hamilton GW. Physiologic basis of assessing critical coronary stenosis. Am J Cardiol 1974; 33:

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8 Abstract A Search for a Functional Significance Stenosis Index by Quantitative Coronary Analysis and Its Applicability Taishi Mikami, Masayoshi Sakakibara, Kouji Inoue, Atsushi Seki, Masahiro Yamauchi, Tomoyuki Kunishima, Fumihiko Miyake The purpose of this study is to determine the correlation between myocardial fractional flow reserve (FFR) and angiographic coronary flow reserve (CAGFR), and subsequently examine the effect of CAGFR in assessing the functional severity of a coronary stenosis. Methods: This study included ninety-two lesions with coronary stenosis severity of 50 to 75% by visual assessment. The correlation between FFR and various quantitative coronary analysis (QCA) parameters was studied. CAGFR was calculated using a regression equation developed by Gould, and the correlation between FFR and CAGFR was studied. FFR<0.74 indicated a functionally significant stenosis. Results: No significant differences regarding reference diameter and lesion length were observed between the FFR-positive group and the FFR-negative group, whereas significant differences regarding minimal lumen diameter (MLD), % diameter stenosis (%DS) and CAGFR were observed between the FFR-positive group and the FFR-negative group (p<0.0001). FFR was significantly correlated with MLD, %DS, and CAGFR (p<0.0001). Multiple regression analysis of FFR and aforementioned QCA parameters indicated that CAGFR was the most important variable in explaining FFR (p=0.0007). Sensitivity/specificity curves showed that CAGFR<3.27 indicated a cut-off point for FFR-positive. This cut-off point achieved a sensitivity of 78% and a specificity of 82% for detection of functionally significant stenosis. Conclusion: CAGFR is a minimally invasive and effective index in assessing the functional severity of a coronary stenosis detected by coronary angiography. Division of Cardiology, Department of Internal Medicine 94