TY - JOUR
T1 - Comparison of Doppler Flow Velocity and Thermodilution Derived Indexes of Coronary Physiology
AU - Demir, Ozan M.
AU - Boerhout, Coen K. M.
AU - de Waard, Guus A.
AU - van de Hoef, Tim P.
AU - Patel, Niket
AU - Beijk, Marcel A. M.
AU - Williams, Rupert
AU - Rahman, Haseeb
AU - Everaars, Henk
AU - Kharbanda, Rajesh K.
AU - Knaapen, Paul
AU - Oxford Acute Myocardial Infarction (OxAMI) Study
AU - van Royen, Niels
AU - Piek, Jan J.
AU - Perera, Divaka
N1 - Funding Information: This work was supported by the British Heart Foundation (PG/19/9/34228), the National Institute for Health Research via the Biomedical Research Centre award to Guy’s and St Thomas’ Hospital and King’s College London, and the National Institute for Health Research Oxford Biomedical Research Centre. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2022 The Authors
PY - 2022/5/23
Y1 - 2022/5/23
N2 - Objectives: The 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). Background: The majority of clinical data and diagnostic thresholds for flow-based indexes are derived from Doppler measurements, and correspondence with thermodilution-derived indices remain unclear. Methods: An 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. Results: Physiological 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). Conclusions: CFR 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.
AB - Objectives: The 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). Background: The majority of clinical data and diagnostic thresholds for flow-based indexes are derived from Doppler measurements, and correspondence with thermodilution-derived indices remain unclear. Methods: An 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. Results: Physiological 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). Conclusions: CFR 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.
KW - coronary flow reserve
KW - hyperemic microvascular resistance
KW - index of microvascular resistance
KW - microvascular dysfunction
UR - http://www.scopus.com/inward/record.url?scp=85129555925&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcin.2022.03.015
DO - https://doi.org/10.1016/j.jcin.2022.03.015
M3 - Article
C2 - 35589236
SN - 1936-8798
VL - 15
SP - 1060
EP - 1070
JO - JACC. Cardiovascular interventions
JF - JACC. Cardiovascular interventions
IS - 10
ER -