Predictive Value of Resting Pd/Pa for Fractional Flow Reserve Assessed with Monorail Pressure Microcatheter in Real-World Practice

Background and Objectives:The aims of this study were(1)to examine the diagnostic accuracy of resting timeaveraged distal coronary pressure(Pd)to mean aortic pressure(Pa)ratio to predict hyperemic fractional flow reserve(FFR)and(2)to identify a resting Pd/Pa value that can preclude the need for hyperemic FFR assessed with use of a monorail pressure catheter.Methods:A total of 191 stenoses were assessed.After exclusions,157 FFR data sets from 103 patients were analyzed.Results:Resting Pd/Pa showed poor agreement with hyperemic FFR(r=0.619,P<0.001).The receiver operating characteristic curve for resting Pd/Pa with reference to hyperemic FFR of 0.80 or less showed an area under the curve of 0.800(95%confi dence interval 0.732– 0.868,P<0.001),with the greatest diagnostic accuracy of 74.5%for resting Pd/Pa of less than 0.85.Resting Pd/Pa of 0.96 or greater had a sensitivity of 100%and a negative predictive value of 100%,and resting Pd/Pa of 0.82 or less had a specifi city of 98.9%and a positive predictive value of 94.1%to predict abnormal FFR of 0.80 or less.These results were consistent regardless of the vessels studied,the location of lesions,and the severity of stenosis.Conclusions:Resting Pd/Pa showed poor agreement with hyperemic FFR assessed with use of a monorail pressure microcatheter.However,resting Pd/Pa of 0.96 or greater had excellent sensitivity and negative predictive value to predict normal hyperemic FFR,and resting Pd/Pa of 0.82 or less had excellent specifi city and positive predictive value to predict abnormal hyperemic FFR.