Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan.
Department of Cardiovascular Medicine, William Beaumont University Hospital-Corewell Health East, Royal Oak, Michigan.
Am J Cardiol. 2024 Mar 1;214:55-58. doi: 10.1016/j.amjcard.2023.12.050. Epub 2024 Jan 9.
Hyperemic and nonhyperemic pressure ratios are frequently used to assess the hemodynamic significance of coronary artery disease and to guide the need for myocardial revascularization. However, there are limited data on the diagnostic performance of the diastolic hyperemia-free ratio (DFR). We evaluated the diagnostic performance of the DFR compared with invasive fractional flow reserve (FFR). We performed a prospective, single-center study of 308 patients (343 lesions) who underwent DFR and FFR for evaluation of visually estimated 40% to 90% stenoses. Diagnostic performance of the DFR compared with FFR was evaluated using linear regression, Bland-Altman analysis, and receiver operating characteristic curves. The overall diagnostic accuracy of the DFR was 83%; the accuracy rates were 86%, 40%, and 95% when the DFR was <0.86, 0.88 to 0.90, and >0.93, respectively. The sensitivity, specificity, positive predicative value, and negative predictive value were 60%, 91%, 71%, and 87%, respectively. The Pearson correlation coefficient was 0.75 (p <0.05). The Bland-Altman analysis showed a mean difference of 0.09, and the area under the receiver operating characteristic curve was 0.88 (95% confidence interval 0.84 to 0.92, p <0.05). In conclusion, the DFR has a good diagnostic performance compared with FFR but 17% of the measurements were discordant. The diagnostic accuracy of the DFR was only 40% when the DFR was 0.88 to 0.90, suggesting that FFR may be useful in these arteries.
高充血和非充血压力比常用于评估冠状动脉疾病的血液动力学意义，并指导是否需要进行心肌血运重建。然而，关于舒张期充血无压力比（DFR）的诊断性能数据有限。我们评估了 DFR 与有创性血流储备分数（FFR）相比的诊断性能。我们对 308 例（343 处病变）患者进行了前瞻性、单中心研究，这些患者接受了 DFR 和 FFR 检查，以评估视觉估计为 40%至 90%狭窄的病变。使用线性回归、Bland-Altman 分析和受试者工作特征曲线评估 DFR 与 FFR 的诊断性能。DFR 的总体诊断准确性为 83%；当 DFR<0.86、0.88 至 0.90 和>0.93 时，其准确性率分别为 86%、40%和 95%。灵敏度、特异性、阳性预测值和阴性预测值分别为 60%、91%、71%和 87%。Pearson 相关系数为 0.75（p<0.05）。Bland-Altman 分析显示平均差异为 0.09，受试者工作特征曲线下面积为 0.88（95%置信区间为 0.84 至 0.92，p<0.05）。总之，DFR 与 FFR 相比具有良好的诊断性能，但有 17%的测量值不一致。当 DFR 为 0.88 至 0.90 时，DFR 的诊断准确性仅为 40%，提示在这些动脉中 FFR 可能有用。
