Correlation Between Quantitative Angiography Derived Translesional Pressure and Fractional Flow Reserve

Abstract Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. However, it has the disadvantage of cost and invasive complication risks. We investigated the usefulness of quantitative coronary angiography (QCA)-derived translesional pressure for predicting functional myocardial ischemia, using FFR as the gold standard. We retrospectively analyzed 152 coronary narrowings [98 left anterior descending arteries (LAD), 28 left circumflex arteries (LC), and 26 right] in 132 patients with mild-severe coronary stenosis who underwent coronary angiography and FFR measurements simultaneously. QCA-derived translesional pressure was calculated using software implemented in the QCA software. Coronary morphology was calculated using both densitometry and lumen edges. Functional myocardial ischemia was defined as an FFR of 0.8 or less. The mean values of diameter stenosis by QCA and FFR were 48.9% ± 14.9 and 0.76 ± 0.14, respectively. QCA-derived translesional pressure was significantly correlated with FFR (r = 0.76, p < 0.01). The cut-off values of QCA-derived translesional pressure for predicting functional myocardial ischemia based on FFR were 72.8 mmHg for the LAD [accuracy, 86.7 %; area under the curve (AUC), 0.93], 60.5 mmHg for the LC (accuracy, 89.3 %; AUC, 0.88), and 64.4 mmHg for the right (accuracy, 88.5 %; AUC, 0.94). Therefore, our data suggest that QCA-derived translesional pressure can predict myocardial ischemia with high diagnostic accuracy.