The diagnostic value of combining visual estimation with a Poiseuille-based index in improving screening for functional coronary ischemia
- VernacularTitle:联合目测评估及泊肃叶方程指数对于优化冠状动脉功能性缺血筛查的价值
- Author:
Xiaoguo ZHANG
1
;
Wenjie ZUO
1
;
Zhenjun JI
1
;
Genshan MA
1
Author Information
- Publication Type:Journal Article
- Keywords: coronary artery disease; fractional flow reserve; ischemia
- From: Journal of Xi'an Jiaotong University(Medical Sciences) 2021;42(6):923-928
- CountryChina
- Language:Chinese
- Abstract: 【Objective】 To develop a simple and practical diagnostic protocol to optimize patient screening for fractional flow reserve（FFR）. 【Methods】 Consecutive patients who underwent both invasive coronary angiography and lesion-specific FFR measurement from July 2013 to August 2018 were retrospectively screened， resulting in a total of 372 patients（390 lesions） for inclusion. Visual estimation（VE） of stenosis was obtained from experts while percent diameter stenosis（DS%）， percent area stenosis（AS%）， lesion length（LL）， minimal lumen diameter（MLD）， and the ratio of LL to the fourth power of MLD（LL/MLD4） were recorded by quantitative software. An FFR value of ≤0.80 was considered to indicate the physiological significance of stenosis. 【Results】 The median age（25th-75th percentiles） of the included patients was 66 years（59-74 years） and positive FFR results were identified in 77 lesions（19.7%）. The area under the receiver-operating characteristic curve was revealed as 0.711（95% CI 0.663-0.755） for VE， significantly greater than DS%（0.605）， AS%（0.608）， and LL（0.612； P<0.05 for all）， but without significant difference from that of MLD（0.667） and LL/MLD4（0.702）. The combination of VE with LL/MLD4 yielded a high sensitivity of 89.6%（95% confidence interval ［CI］， 80.6-95.4） and a negative predictive value of 94.4%（95% CI， 89.2-97.5）. 【Conclusion】 Overall， the combination of VE with LL/MLD4 can effectively identify those low-risk lesions for ischemia to avoid unnecessary FFR measurement， thus optimizing the use of pressure wire as well as reducing total medical expenditure and potential complications.
