| Title |
Repeatability of Fractional Flow Reserve Despite Variations in Systemic and Coronary Hemodynamics
|
|---|---|
| Published in |
JACC: Cardiovascular Interventions, July 2015
|
| DOI | 10.1016/j.jcin.2015.01.039 |
| Pubmed ID | |
| Authors |
Nils P. Johnson, Daniel T. Johnson, Richard L. Kirkeeide, Colin Berry, Bernard De Bruyne, William F. Fearon, Keith G. Oldroyd, Nico H.J. Pijls, K. Lance Gould |
| Abstract |
This study classified and quantified the variation in fractional flow reserve (FFR) due to fluctuations in systemic and coronary hemodynamics during intravenous adenosine infusion. Although FFR has become a key invasive tool to guide treatment, questions remain regarding its repeatability and stability during intravenous adenosine infusion because of systemic effects that can alter driving pressure and heart rate. We reanalyzed data from the VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice) study, which enrolled consecutive patients who were infused with intravenous adenosine at 140 μg/kg/min and measured FFR twice. Raw phasic pressure tracings from the aorta (Pa) and distal coronary artery (Pd) were transformed into moving averages of Pd/Pa. Visual analysis grouped Pd/Pa curves into patterns of similar response. Quantitative analysis of the Pd/Pa curves identified the "smart minimum" FFR using a novel algorithm, which was compared with human core laboratory analysis. A total of 190 complete pairs came from 206 patients after exclusions. Visual analysis revealed 3 Pd/Pa patterns: "classic" (sigmoid) in 57%, "humped" (sigmoid with superimposed bumps of varying height) in 39%, and "unusual" (no pattern) in 4%. The Pd/Pa pattern repeated itself in 67% of patient pairs. Despite variability of Pd/Pa during the hyperemic period, the "smart minimum" FFR demonstrated excellent repeatability (bias -0.001, SD 0.018, paired p = 0.93, r(2) = 98.2%, coefficient of variation = 2.5%). Our algorithm produced FFR values not significantly different from human core laboratory analysis (paired p = 0.43 vs. VERIFY; p = 0.34 vs. RESOLVE). Intravenous adenosine produced 3 general patterns of Pd/Pa response, with associated variability in aortic and coronary pressure and heart rate during the hyperemic period. Nevertheless, FFR - when chosen appropriately - proved to be a highly reproducible value. Therefore, operators can confidently select the "smart minimum" FFR for patient care. Our results suggest that this selection process can be automated, yet comparable to human core laboratory analysis. |
Mendeley readers
The data shown below were compiled from readership statistics for 79 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Japan | 2 | 3% |
| United States | 1 | 1% |
| Italy | 1 | 1% |
| Unknown | 75 | 95% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 22 | 28% |
| Other | 11 | 14% |
| Student > Master | 6 | 8% |
| Student > Ph. D. Student | 5 | 6% |
| Student > Postgraduate | 3 | 4% |
| Other | 10 | 13% |
| Unknown | 22 | 28% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 30 | 38% |
| Engineering | 6 | 8% |
| Computer Science | 5 | 6% |
| Sports and Recreations | 2 | 3% |
| Psychology | 2 | 3% |
| Other | 4 | 5% |
| Unknown | 30 | 38% |
Attention Score in Context
This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 January 2020.
All research outputs
#8,534,976
of 25,373,627 outputs
Outputs from JACC: Cardiovascular Interventions
#2,603
of 4,030 outputs
Outputs of similar age
#95,129
of 277,610 outputs
Outputs of similar age from JACC: Cardiovascular Interventions
#21
of 41 outputs
Altmetric has tracked 25,373,627 research outputs across all sources so far. This one is in the 43rd percentile – i.e., 43% of other outputs scored the same or lower than it.
So far Altmetric has tracked 4,030 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 15.2. This one is in the 30th percentile – i.e., 30% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 277,610 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 55% of its contemporaries.
We're also able to compare this research output to 41 others from the same source and published within six weeks on either side of this one. This one is in the 41st percentile – i.e., 41% of its contemporaries scored the same or lower than it.