Influence of contrast media dose and osmolality on the diagnostic performance of contrast fractional flow reserve

Nishi, T. et al. (2017) Influence of contrast media dose and osmolality on the diagnostic performance of contrast fractional flow reserve. Circulation: Cardiovascular Interventions, 10(10), e004985. (doi: 10.1161/CIRCINTERVENTIONS.117.004985) (PMID:29042397)

Abstract

Background—Contrast fractional flow reserve (cFFR) is a method for assessing functional significance of coronary stenoses, which is more accurate than resting indices and does not require adenosine. However, contrast media volume and osmolality may affect the degree of hyperemia and therefore diagnostic performance. Methods and Results—cFFR, instantaneous wave–free ratio, distal pressure/aortic pressure at rest, and FFR were measured in 763 patients from 12 centers. We compared the diagnostic performance of cFFR between patients receiving low or iso-osmolality contrast (n=574 versus 189) and low or high contrast volume (n=341 versus 422) using FFR≤0.80 as a reference standard. The sensitivity, specificity, and overall accuracy of cFFR for the low versus iso-osmolality groups were 73%, 93%, and 85% versus 87%, 90%, and 89%, and for the low versus high contrast volume groups were 69%, 99%, and 83% versus 82%, 93%, and 88%. By receiver operating characteristics (ROC) analysis, cFFR provided better diagnostic performance than resting indices regardless of contrast osmolality and volume (P<0.001 for all groups). There was no significant difference between the area under the curve of cFFR in the low- and iso-osmolality groups (0.938 versus 0.957; P=0.40) and in the low- and high-volume groups (0.939 versus 0.949; P=0.61). Multivariable logistic regression analysis showed that neither contrast osmolality nor volume affected the overall accuracy of cFFR; however, both affected the sensitivity and specificity. Conclusions—The overall accuracy of cFFR is greater than instantaneous wave–free ratio and distal pressure/aortic pressure and not significantly affected by contrast volume and osmolality. However, contrast volume and osmolality do affect the sensitivity and specificity of cFFR.

• Item Type: Articles
• Additional Information: The CONTRAST study (Can Contrast Injection Better Approximate FFR Compared ToPure Resting Physiology?) was sponsored by St. Jude Medical.
• Keywords: Adenosine, contrast fractional flow reserve, coronary stenosis, fractional flow reserve, hyperemia.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Oldroyd, Dr Keith and Berry, Professor Colin
• Authors: Nishi, T., Johnson, N. P., De Bruyne, B., Berry, C., Gould, K. L., Jeremias, A., Oldroyd, K. G., Kobayashi, Y., Choi, D.-H., Pijls, N. H.J., and Fearon, W. F.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Circulation: Cardiovascular Interventions
• Publisher: American Heart Assocation
• ISSN: 1941-7640
• ISSN (Online): 1941-7632
• Published Online: 17 October 2017
• Copyright Holders: Copyright © 2017 American Heart Association, Inc.
• First Published: First published in Circulation: Cardiovascular Interventions 10(10): e004985
• Publisher Policy: Reproduced in accordance with the publisher copyright policy