Dataset Information

Prognostic significance of thermodilution-derived coronary flow capacity in patients with deferred revascularisation.

ABSTRACT:

Aims

The aim of this study was to investigate the prognostic value of thermodilution-derived coronary flow capacity (T-CFC) in patients with stable coronary artery disease and deferred revascularisation.

Methods and results

We evaluated 308 lesions in 308 patients with deferred revascularisation, stratifying the cohort according to T-CFC. Ischaemic T-CFC was defined as a composite of mildly, moderately, and severely reduced T-CFC. Clinical outcomes were assessed by vessel-oriented composite endpoints (VOCE) and major adverse cardiac events (MACE). VOCE and MACE occurred in 19 and 28 patients, respectively. Ischaemic T-CFC was found in 88 lesions (28.6%). Kaplan-Meier analysis revealed that lesions with ischaemic T-CFC had a significantly higher risk of both VOCE and MACE. The net reclassification index and integrated discrimination improvement index were both significantly improved when ischaemic T-CFC was added to the clinical risk model (age, sex, prior stent implantation, and lesion length) for predicting VOCE and MACE. Furthermore, ischaemic T-CFC showed significant incremental predictive ability for VOCE and MACE when compared with the clinical risk model + fractional flow reserve ≤0.8, or with the clinical model + coronary flow reserve ≤2.0.

Conclusions

T-CFC categorisation improved the risk stratification for both VOCE and MACE and showed incremental prognostic value in patients with deferred revascularisation.

SUBMITTER: Hoshino M

PROVIDER: S-EPMC9724992 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Prognostic significance of thermodilution-derived coronary flow capacity in patients with deferred revascularisation.

Hoshino Masahiro M Kanaji Yoshihisa Y Hamaya Rikuta R Kanno Yoshinori Y Hada Masahiro M Yamaguchi Masao M Sumino Yohei Y Usui Eisuke E Murai Tadashi T Lee Tetsumin T Yonetsu Taishi T Kakuta Tsunekazu T

EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 20210201 14

<h4>Aims</h4>The aim of this study was to investigate the prognostic value of thermodilution-derived coronary flow capacity (T-CFC) in patients with stable coronary artery disease and deferred revascularisation.<h4>Methods and results</h4>We evaluated 308 lesions in 308 patients with deferred revascularisation, stratifying the cohort according to T-CFC. Ischaemic T-CFC was defined as a composite of mildly, moderately, and severely reduced T-CFC. Clinical outcomes were assessed by vessel-oriented ...[more]

PMID: 31186227

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Project description:ObjectivesThe aim of this study was to compare Doppler flow velocity and thermodilution-derived indexes and to determine the optimal thermodilution-based diagnostic thresholds for coronary flow reserve (CFR).BackgroundThe majority of clinical data and diagnostic thresholds for flow-based indexes are derived from Doppler measurements, and correspondence with thermodilution-derived indices remain unclear.MethodsAn international multicenter registry was conducted among patients who had coronary flow measurements using both Doppler and thermodilution techniques in the same vessel and during the same procedure.ResultsPhysiological data from 250 vessels (in 149 patients) were included in the study. A modest correlation was found between thermodilution-derived CFR (CFRthermo) and Doppler-derived CFR (CFRDoppler) (r2 = 0.36; P < 0.0001). CFRthermo overestimated CFRDoppler (mean 2.59 ± 1.46 vs 2.05 ± 0.89; P < 0.0001; mean bias 0.59 ± 1.24 by Bland-Altman analysis), the relationship being described by the equation CFRthermo = 1.04 × CFRDoppler + 0.50. The commonly used dichotomous CFRthermo threshold of 2.0 had poor sensitivity at predicting a CFRDoppler value <2.5. The optimal CFRthermo threshold was 2.5 (sensitivity 75.54%, specificity 81.25%). There was only a weak correlation between hyperemic microvascular resistance and index of microvascular resistance (r2 = 0.19; P < 0.0001), due largely to variation in the measurement of flow by each modality. Forty-four percent of patients were discordantly classified as having abnormal microvascular resistance by hyperemic microvascular resistance (≥2.5 mm Hg · cm-1 · s) and index of microvascular resistance (≥25).ConclusionsCFR calculated by thermodilution overestimates Doppler-derived CFR, while both parameters show modest correlation. The commonly used CFRthermo threshold of 2.0 has poor sensitivity for identifying vessels with diminished CFR, but using the same binary diagnostic threshold as for Doppler (<2.5) yields reasonable diagnostic accuracy. There was only a weak correlation between microvascular resistance indexes assessed by the 2 modalities.

Dataset Information

Prognostic significance of thermodilution-derived coronary flow capacity in patients with deferred revascularisation.

Aims

Methods and results

Conclusions

Publications

Prognostic significance of thermodilution-derived coronary flow capacity in patients with deferred revascularisation.

Similar Datasets

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