Delineation of epicardial stenosis in patients with microvascular disease using pressure drop coefficient:A pilot outcome study

AIM To investigate the patient-outcomes of newly developed pressure drop coefficient(CDP) in diagnosing epicardial stenosis(ES) in the presence of concomitant microvascular disease(MVD).METHODS Patients from our clinical trial were divided into two subgroups with:(1) cut-off of coronary flow reserve(CFR) < 2.0;and(2) diabetes.First,correlations were performed for both subgroups between CDP and hyperemic microvascular resistance(HMR),a diagnostic parameter for assessing the severity of MVD.Linear regression analysis was used for these correlations.Further,in each of the subgroups,comparisons were made between fractional flow reserve(FFR) < 0.75 and CDP > 27.9 groups for assessing major adverse cardiac events(MACE:Primary outcome).Comparisons were also made between the survival curves for FFR < 0.75 and CDP > 27.9 groups.Two tailed chi-squared and Fischer's exact tests were performed for comparison of the primary outcomes,and the log-rank test was used to compare the Kaplan-Meier survival curves.P < 0.05 for all tests was considered statistically significant.RESULTS Significant linear correlations were observed between CDP and HMR for both CFR < 2.0(r = 0.58,P < 0.001) and diabetic(r = 0.61,P < 0.001) patients.In the CFR < 2.0 subgroup,the %MACE(primary outcomes) for CDP > 27.9 group(7.7%,2/26) was lower than FFR < 0.75 group(3/14,21.4%);P = 0.21.Similarly,in the diabetic subgroup,the %MACE for CDP > 27.9 group(12.5%,2/16) was lower than FFR < 0.75 group(18.2%,2/11);P = 0.69.Survival analysis for CFR < 2.0 subgroup indicated better event-free survival for CDP > 27.9 group(n = 26) when compared with FFR < 0.75 group(n = 14);P = 0.10.Similarly,for the diabetic subgroup,CDP > 27.9 group(n = 16) showed higher survival times compared to FFR group(n = 11);P = 0.58.CONCLUSION CDP correlated significantly with HMR and resulted in better %MACE as well as survival rates in comparison to FFR.These positive trends demonstrate that CDP could be a potential diagnostic endpoint for delineating MVD with or without ES.

Clinical outcomes of combined flow-pressure drop measurements using newly developed diagnostic endpoint:Pressure drop coefficient in patients with coronary artery dysfunction

AIM:To combine pressure and flow parameter, pressure drop coefficient(CDP) will result in better clinical outcomes in comparison to the fractional flow reserve(FFR) group. METHODS:To test this hypothesis, a comparison was made between the FFR < 0.75 and CDP > 27.9 groups in this study, for the major adverse cardiac events [major adverse cardiac events(MACE): Primary outcome] and patients’ quality of life(secondary outcome). Further, a comparison was also made between the survival curves for the FFR < 0.75 and CDP > 27.9 groups. Two-tailed χ~2 test proportions were performed for the comparison of primary and secondary outcomes. Kaplan-Meier survival analysis was performed to compare the survival curves of FFR < 0.75 and CDP > 27.9 groups(MedcalcV10.2, Mariakerke, Belgium). Results were considered statistically significant for P < 0.05. RESULTS: The primary outcomes(%MACE) in the FFR < 0.75 group(20%, 4 out of 20) was not statistically different(P = 0.24) from the %MACE occurring in CDP > 27.9 group(8.57%, 2 out of 35). Noteworthy is the reduction in the %MACE in the CDP > 27.9 group, in comparison to the FFR < 0.75 group. Further, the secondary outcomes were not statistically significant between the FFR < 0.75 and CDP > 27.9 groups. Survival analysis results suggest that the survival time for the CDP > 27.9 group(n = 35) is significantly higher(P = 0.048) in comparison to the survival time for the FFR < 0.75 group(n = 20). The results remained similar for a FFR = 0.80 cut-off. CONCLUSION: Based on the above, CDP could prove to be a better diagnostic end-point for clinical revascularization decision-making in the cardiac catheterization laboratories.

Correction to“Clinical outcomes of combined flow-pressure drop measurements using newly developed diagnostic endpoint:Pressure drop coefficient in patients with coronary artery dysfunction”

Correction to“Clinical outcomes of combined flow-pressure drop measurements using newly developed diagnostic endpoint:Pressure drop coefficient in patients with coronary artery dysfunction”.World J Cardiol 2016;8(3):283-292 PMID:27022460 DOI:10.4330/wjc.v8.i3.283.Correction 1 The percentage value of 8.57%,in page 284,line 10 and in page 287,lines 4 and 8,is a typo[1].It should read as 5.7%,which corresponds to 2/35,as correctly reported within the parentheses.