https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland
Background:
Vessel fractional flow reserve (vFFR) is a novel angiography-derived index for the estimation of FFR without the need for pressure wires and hyperemic agents. vFFR has already demonstrated very good diagnostic performance compared with the hyperemic index fractional flow reserve (FFR) and resting full-cycle ratio (RFR) in patients with intermediate coronary lesions. The aim of this study was to compare vFFR to the non-hyperemic pressure ratio resting full-cycle ratio (RFR) in patients with intermediate coronary bifurcation lesions.
Methods:
This was a retrospective, observational, single-center study of an all-comer cohort undergoing RFR assessment. Invasive coronary angiography was obtained without a dedicated vFFR acquisition protocol, and vFFR calculation was attempted in all main vessels of bifurcation lesions (side branch ≥ 2.0 mm) interrogated by RFR (113 lesions of 111 patients) using CAAS Workstation (Pie Medical Imaging, Maastricht, the Netherlands).
Results:
Median vFFR was 0.88 (IQR: 0.81-0.93) and RFR 0.93 (IQR: (0.87-0.96). The correlation coefficient r between vFFR and RFR was 0.60 (95% confidence interval (CI): 0.48–0.71, p < 0.01). Using RFR ≤0.89 as reference, the sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy for vFFR were 58%, 92%, 78%, and 82% and 81%. vFFR yielded a good area under the curve (AUC) of 0.84 (95% CI: 0.76-0.91) (Figure 1).
Conclusion:
In bifurcation lesions vFFR has a moderate diagnostic performance taking RFR as the reference standard for evaluating the functional significance of coronary stenoses of the main vessel with a good specificity, but suboptimal sensitivity. Interestingly, this result is inferior as compared to the diagnostic performance of vFFR we found before in intermediate coronary lesions as a whole.
Figure 1: Receiver operating characteristics curve
Receiver operating characteristics curve analysis for the diagnostic accuracy of vFFR in predicting RFR ≤0.89 in main vessels of bifurcation lesions. AUC, area under receiver operating characteristic curve. vFFR, vessel fractional flow reserve. RFR, resting full-cycle ratio.
|
Table Diagnostic performance of vessel fractional flow reserve to predict resting-full cylce ratio ≤0.89 (main vessel) | |||
|
95% CI |
lower |
upper | |
|
Sensitivity |
58.33 |
40.76 |
74.49 |
|
Specificity |
92.11 |
83.60 |
97.05 |
|
Accuracy |
81.25 |
72.78 |
88.00 |
|
Positive predictive value |
77.78 |
57.74 |
91.38 |
|
Negative predictive value |
82.35 |
72.57 |
89.77 |
|
Positive likelihood ratio |
7.39 |
3.27 |
16.71 |
|
Negative likelihood ratio |
45.24 |
30.57 |
66.95 |