Roh Ji Woong, Lee Oh-Hyun, Kim Yongcheol, Heo Seok-Jae, Im Eui, Cho Deok-Kyu
Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea.
Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2025 Jul;55(7):600-610. doi: 10.4070/kcj.2024.0351. Epub 2025 Feb 17.
Diastolic hyperemia-free ratio (DFR), an alternative to fractional flow reserve (FFR) for the assessment of intermediate coronary artery stenosis, helps reduce patients' time, and inconvenience. However, the validation data for DFR and FFR are lacking. We aimed to evaluate the diagnostic accuracy of DFR and FFR and to assess the effective decision making for revascularization using their values.
Patients subjected to an invasive physiological study for intermediate coronary artery stenosis at a single center in South Korea between August 2022 and January 2024 were prospectively recruited. We evaluated the correlation between DFR and FFR measurements and the diagnostic accuracy of DFR ≤0.89 to predict FFR ≤ 0.80. We also compared the correlation for each coronary artery.
A total of 324 intermediate coronary stenotic lesions from 300 patients were evaluated using DFR and FFR values simultaneously. There was a strong linear relationship between DFR and FFR (r = 0.80; 95% confidence interval [CI], 0.76-0.84; p < 0.001). The diagnostic accuracy of the DFR was 92.0% in predicting FFR ≤0.80. When compared separately for each coronary artery, all vessels showed a strong linear relationship with no statistical differences between any of the vessels (p=0.641). There was also a strong linear relationship between DFR and distal coronary pressure/aorta pressure (r=0.93; 95% CI, 0.91-0.94; p<0.001).
There was a strong correlation between DFR and FFR and a high diagnostic accuracy rate of DFR compared to FFR. Good diagnostic performance of DFR was also observed in each coronary artery.
ClinicalTrials.gov Identifier: NCT05421169.
舒张期无充血比值（DFR）作为分数血流储备（FFR）的替代指标用于评估中度冠状动脉狭窄，有助于减少患者的时间和不便。然而，DFR和FFR的验证数据尚缺乏。我们旨在评估DFR和FFR的诊断准确性，并利用其数值评估血管重建的有效决策。
前瞻性招募2022年8月至2024年1月在韩国单中心接受中度冠状动脉狭窄侵入性生理研究的患者。我们评估了DFR和FFR测量值之间的相关性，以及DFR≤0.89预测FFR≤0.80的诊断准确性。我们还比较了各冠状动脉的相关性。
共对300例患者的324处中度冠状动脉狭窄病变同时使用DFR和FFR值进行评估。DFR和FFR之间存在强线性关系（r = 0.80；95%置信区间[CI]，0.76 - 0.84；p < 0.001）。DFR预测FFR≤0.80的诊断准确性为92.0%。当对各冠状动脉分别进行比较时，所有血管均显示出强线性关系，任何血管之间均无统计学差异（p = 0.641）。DFR与冠状动脉远端压力/主动脉压力之间也存在强线性关系（r = 0.93；95%CI，0.91 - 0.94；p < 0.001）。
DFR与FFR之间存在强相关性，与FFR相比，DFR具有较高的诊断准确率。在各冠状动脉中也观察到DFR具有良好的诊断性能。
ClinicalTrials.gov标识符：NCT05421169。
