Stress Myocardial Perfusion Imaging Interpretation From the Viewpoint of Fractional Flow Reserve
Background:Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not we...
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| Veröffentlicht in: | Circulation Journal 2021/10/25, Vol.85(11), pp.2043-2049 |
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| creator | Kawamura, Itta Tanigaki, Toru Omori, Hiroyuki Mizukami, Takuya Hirata, Tetsuo Kikuchi, Jun Ota, Hideaki Sobue, Yoshihiro Miyake, Taiji Kawase, Yoshiaki Okubo, Munenori Kamiya, Hiroki Kawasaki, Masanori Tsuchiya, Kunihiko Nakagawa, Masayasu Kondo, Takeshi Suzuki, Takahiko Matsuo, Hitoshi |
| description | Background:Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established.Methods and Results:We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs |
| doi_str_mv | 10.1253/circj.CJ-21-0122 |
| format | Article |
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Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established.Methods and Results:We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs <0.80. However, MPI-negative lesions had an extremely low lesion rate with FFR <0.65 (6%). Conversely, 78% and 41% of MPI-positive lesions had FFR <0.80 and <0.65, respectively.Conclusions:The data confirmed that decisions based on MPI are reasonable because MPI-negative patients have an extremely low rate of lesions with a FFR below the cutoff point for a hard event, and MPI-positive lesions include many lesions with FFR <0.65.</description><identifier>ISSN: 1346-9843</identifier><identifier>ISSN: 1347-4820</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-21-0122</identifier><identifier>PMID: 34148928</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Coronary Angiography ; Coronary Artery Disease - diagnostic imaging ; Coronary Stenosis ; Fractional flow reserve ; Fractional Flow Reserve, Myocardial ; Humans ; Ischemic heart disease ; Myocardial Ischemia ; Myocardial perfusion imaging ; Myocardial Perfusion Imaging - methods ; Predictive Value of Tests ; Retrospective Studies ; Severity of Illness Index</subject><ispartof>Circulation Journal, 2021/10/25, Vol.85(11), pp.2043-2049</ispartof><rights>2021, THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c623t-6a4ebe1041eb4c1e08a54aa8d51ea72ef616f7896765c66bd95d1eaab702a5343</citedby><cites>FETCH-LOGICAL-c623t-6a4ebe1041eb4c1e08a54aa8d51ea72ef616f7896765c66bd95d1eaab702a5343</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1877,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34148928$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kawamura, Itta</creatorcontrib><creatorcontrib>Tanigaki, Toru</creatorcontrib><creatorcontrib>Omori, Hiroyuki</creatorcontrib><creatorcontrib>Mizukami, Takuya</creatorcontrib><creatorcontrib>Hirata, Tetsuo</creatorcontrib><creatorcontrib>Kikuchi, Jun</creatorcontrib><creatorcontrib>Ota, Hideaki</creatorcontrib><creatorcontrib>Sobue, Yoshihiro</creatorcontrib><creatorcontrib>Miyake, Taiji</creatorcontrib><creatorcontrib>Kawase, Yoshiaki</creatorcontrib><creatorcontrib>Okubo, Munenori</creatorcontrib><creatorcontrib>Kamiya, Hiroki</creatorcontrib><creatorcontrib>Kawasaki, Masanori</creatorcontrib><creatorcontrib>Tsuchiya, Kunihiko</creatorcontrib><creatorcontrib>Nakagawa, Masayasu</creatorcontrib><creatorcontrib>Kondo, Takeshi</creatorcontrib><creatorcontrib>Suzuki, Takahiko</creatorcontrib><creatorcontrib>Matsuo, Hitoshi</creatorcontrib><title>Stress Myocardial Perfusion Imaging Interpretation From the Viewpoint of Fractional Flow Reserve</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>Background:Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established.Methods and Results:We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs <0.80. However, MPI-negative lesions had an extremely low lesion rate with FFR <0.65 (6%). Conversely, 78% and 41% of MPI-positive lesions had FFR <0.80 and <0.65, respectively.Conclusions:The data confirmed that decisions based on MPI are reasonable because MPI-negative patients have an extremely low rate of lesions with a FFR below the cutoff point for a hard event, and MPI-positive lesions include many lesions with FFR <0.65.</description><subject>Coronary Angiography</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Stenosis</subject><subject>Fractional flow reserve</subject><subject>Fractional Flow Reserve, Myocardial</subject><subject>Humans</subject><subject>Ischemic heart disease</subject><subject>Myocardial Ischemia</subject><subject>Myocardial perfusion imaging</subject><subject>Myocardial Perfusion Imaging - methods</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><issn>1346-9843</issn><issn>1347-4820</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkE1v1DAQhi1ERb-4c0I5cknr7zhHtGLLVkVFQLmaiTPZepXEi-1t1X9P0l3ay8xo5pnn8BLygdELxpW4dD66zcXiuuSspIzzN-SECVmV0nD69nnWZW2kOCanKW0o5TVV9TtyLCSTpubmhPz5mSOmVHx7Cg5i66EvvmPsdsmHsVgNsPbjuliNGeM2YoY8r5cxDEW-x-K3x8dt8GMuQjdtwc3nybDsw2PxAxPGBzwnRx30Cd8f-hm5W375tfha3txerRafb0qnucilBokNMioZNtIxpAaUBDCtYggVx04z3VWm1pVWTuumrVU7XaCpKAclpDgjn_bebQx_d5iyHXxy2PcwYtgly5UUFVXCmAmle9TFkFLEzm6jHyA-WUbtnKt9ztUuri1nds51evl4sO-aAduXh_9BTsDVHtikDGt8ASBm73o8GI2yjM31Vf1K3EO0OIp_yh2PgA</recordid><startdate>20211025</startdate><enddate>20211025</enddate><creator>Kawamura, Itta</creator><creator>Tanigaki, Toru</creator><creator>Omori, Hiroyuki</creator><creator>Mizukami, Takuya</creator><creator>Hirata, Tetsuo</creator><creator>Kikuchi, Jun</creator><creator>Ota, Hideaki</creator><creator>Sobue, Yoshihiro</creator><creator>Miyake, Taiji</creator><creator>Kawase, Yoshiaki</creator><creator>Okubo, Munenori</creator><creator>Kamiya, Hiroki</creator><creator>Kawasaki, Masanori</creator><creator>Tsuchiya, Kunihiko</creator><creator>Nakagawa, Masayasu</creator><creator>Kondo, Takeshi</creator><creator>Suzuki, Takahiko</creator><creator>Matsuo, Hitoshi</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20211025</creationdate><title>Stress Myocardial Perfusion Imaging Interpretation From the Viewpoint of Fractional Flow Reserve</title><author>Kawamura, Itta ; Tanigaki, Toru ; Omori, Hiroyuki ; Mizukami, Takuya ; Hirata, Tetsuo ; Kikuchi, Jun ; Ota, Hideaki ; Sobue, Yoshihiro ; Miyake, Taiji ; Kawase, Yoshiaki ; Okubo, Munenori ; Kamiya, Hiroki ; Kawasaki, Masanori ; Tsuchiya, Kunihiko ; Nakagawa, Masayasu ; Kondo, Takeshi ; Suzuki, Takahiko ; Matsuo, Hitoshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c623t-6a4ebe1041eb4c1e08a54aa8d51ea72ef616f7896765c66bd95d1eaab702a5343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Coronary Angiography</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Stenosis</topic><topic>Fractional flow reserve</topic><topic>Fractional Flow Reserve, Myocardial</topic><topic>Humans</topic><topic>Ischemic heart disease</topic><topic>Myocardial Ischemia</topic><topic>Myocardial perfusion imaging</topic><topic>Myocardial Perfusion Imaging - methods</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kawamura, Itta</creatorcontrib><creatorcontrib>Tanigaki, Toru</creatorcontrib><creatorcontrib>Omori, Hiroyuki</creatorcontrib><creatorcontrib>Mizukami, Takuya</creatorcontrib><creatorcontrib>Hirata, Tetsuo</creatorcontrib><creatorcontrib>Kikuchi, Jun</creatorcontrib><creatorcontrib>Ota, Hideaki</creatorcontrib><creatorcontrib>Sobue, Yoshihiro</creatorcontrib><creatorcontrib>Miyake, Taiji</creatorcontrib><creatorcontrib>Kawase, Yoshiaki</creatorcontrib><creatorcontrib>Okubo, Munenori</creatorcontrib><creatorcontrib>Kamiya, Hiroki</creatorcontrib><creatorcontrib>Kawasaki, Masanori</creatorcontrib><creatorcontrib>Tsuchiya, Kunihiko</creatorcontrib><creatorcontrib>Nakagawa, Masayasu</creatorcontrib><creatorcontrib>Kondo, Takeshi</creatorcontrib><creatorcontrib>Suzuki, Takahiko</creatorcontrib><creatorcontrib>Matsuo, Hitoshi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kawamura, Itta</au><au>Tanigaki, Toru</au><au>Omori, Hiroyuki</au><au>Mizukami, Takuya</au><au>Hirata, Tetsuo</au><au>Kikuchi, Jun</au><au>Ota, Hideaki</au><au>Sobue, Yoshihiro</au><au>Miyake, Taiji</au><au>Kawase, Yoshiaki</au><au>Okubo, Munenori</au><au>Kamiya, Hiroki</au><au>Kawasaki, Masanori</au><au>Tsuchiya, Kunihiko</au><au>Nakagawa, Masayasu</au><au>Kondo, Takeshi</au><au>Suzuki, Takahiko</au><au>Matsuo, Hitoshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stress Myocardial Perfusion Imaging Interpretation From the Viewpoint of Fractional Flow Reserve</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2021-10-25</date><risdate>2021</risdate><volume>85</volume><issue>11</issue><spage>2043</spage><epage>2049</epage><pages>2043-2049</pages><artnum>CJ-21-0122</artnum><issn>1346-9843</issn><issn>1347-4820</issn><eissn>1347-4820</eissn><abstract>Background:Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established.Methods and Results:We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs <0.80. However, MPI-negative lesions had an extremely low lesion rate with FFR <0.65 (6%). Conversely, 78% and 41% of MPI-positive lesions had FFR <0.80 and <0.65, respectively.Conclusions:The data confirmed that decisions based on MPI are reasonable because MPI-negative patients have an extremely low rate of lesions with a FFR below the cutoff point for a hard event, and MPI-positive lesions include many lesions with FFR <0.65.</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>34148928</pmid><doi>10.1253/circj.CJ-21-0122</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Coronary Angiography Coronary Artery Disease - diagnostic imaging Coronary Stenosis Fractional flow reserve Fractional Flow Reserve, Myocardial Humans Ischemic heart disease Myocardial Ischemia Myocardial perfusion imaging Myocardial Perfusion Imaging - methods Predictive Value of Tests Retrospective Studies Severity of Illness Index |
| title | Stress Myocardial Perfusion Imaging Interpretation From the Viewpoint of Fractional Flow Reserve |
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