Evidence mapPaperPMID 37554658Full record

ArticleCardiology and cardiovascular medicine2023

Improved Diagnosis through Diastolic Hyperemia-Free Ratio (DFR) over Fractional Flow Reserve (FFR) in Intermediate Coronary Lesions.

Muralidharan Thoddi Ramamurthy, Vinod Kumar Balakrishnan, Mano Vikash Vallivedu, Nagendra Boopathy Senguttuvan, Panchanatham Manokar, Ramesh Sankaran, Shanmugasundaram Sadhanandham, Jayanthi Venkata Balasubramaniyan, Jebaraj Rathinasamy, Preetam Krishnamurthy and 6 more

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Article in Cardiology and cardiovascular medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

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3citing papers in PubMed
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1 · What the graph read from it

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3 · Its place in the literature

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3 citing papers in PubMed.

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5 · Who and what money

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16 authors.

Muralidharan Thoddi RamamurthyDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Vinod Kumar BalakrishnanDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Mano Vikash ValliveduDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Nagendra Boopathy SenguttuvanDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Panchanatham ManokarDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Ramesh SankaranDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Shanmugasundaram SadhanandhamDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Jayanthi Venkata BalasubramaniyanDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Jebaraj RathinasamyDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Preetam KrishnamurthyDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Sandhya SundaramDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Jayanthi Sri Sathiyanarayana MurthyDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Sadagopan ThanikachalamDepartment of Cardiology, Sri Ramachandra Medical University & Research Institute, Chennai, India.
Steven PogwizdComprehensive Cardiovascular Center, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
John R HoidalDivision of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
Rajasekaran Namakkal-SoorappanDivision of Cardiovascular Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA.

Funding

NHLBI NIH HHS R01 HL118067
6 · The paper itself

Abstract

Objectives: To compare the fractional flow reserve (FFR) and diastolic hyperemia-free ratio (DFR) measurements in a population with intermediate coronary artery stenosis and improve the diagnosis. Background: Visual assessment of coronary artery stenosis severity, particularly in intermediate lesions, is prone to errors in decision-making. FFR provides a reliable assessment of functional severity in these cases but requires hyperemia induction by adenosine, which has side effects and increased cost. DFR is a novel hyperemia-independent index, which could be used as an alternative to adenosine-based hyperemia induction. Methods and Results: Between September 2019 to March 2020, 25 patients with 38 intermediate coronary stenotic lesions were included in the study. All patients underwent assessment of whole cycle Pd/Pa (ratio of distal coronary pressure to proximal aortic pressure), DFR and FFR. Mean whole cycle Pd/Pa, DFR and FFR were 0.93±0.06, 0.88±0.09, and 0.85±0.08, respectively. A significant positive correlation between DFR and FFR [r = 0.74; p<0.001] was observed. Receiver operating characteristic analysis showed an area under the curve of 0.90. DFR-only strategy with a treatment cut-off of ≤0.89 showed a diagnostic agreement with the FFR-only strategy in 74% of lesions, with a sensitivity of 54%, specificity of 82%, a positive predictive value of 60%, and a negative predictive value of 79%. Conclusions: Real-time DFR measurements show a clinically reliable correlation with FFR. Hence, using DFR is likely to avoid adenosine administration as well as reduce the cost and procedural time. Further studies with a larger sample size would be ideal to evaluate specific cut-off values and endpoints.

Indexed as

Diastolic Hyperemia Free RatioFractional Flow ReserveIntermediate Coronary Artery Stenosis

Identifiers

PMID37554658
PMCPMC10409495

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.