Diagnostic Accuracy of Diastolic Fractional Flow Reserve for Functional Evaluation of Coronary Stenosis: DIASTOLE Study

Yasutsugu Shiono; Hitoshi Matsuo; Hiroshi Fujita; Nobuhiro Tanaka; Yasuo Ogasawara; Itta Kawamura; Yosuke Katayama; Akiko Matsuo; Yoshiaki Kawase; Tsunekazu Kakuta; Hiroaki Takashima; Hiroyoshi Yokoi; Hiroshi Ohira; Satoru Suwa; Mitsutoshi Oguri; Fumi Yamamoto; Takashi Kubo; Takashi Akasaka; DIASTOLE Investigators

doi:10.1016/j.jacasi.2021.07.008

Diagnostic Accuracy of Diastolic Fractional Flow Reserve for Functional Evaluation of Coronary Stenosis: DIASTOLE Study

JACC Asia. 2021 Sep 21;1(2):230-241. doi: 10.1016/j.jacasi.2021.07.008. eCollection 2021 Sep.

Authors

Yasutsugu Shiono¹, Hitoshi Matsuo², Hiroshi Fujita³, Nobuhiro Tanaka⁴, Yasuo Ogasawara⁵, Itta Kawamura², Yosuke Katayama¹, Akiko Matsuo⁶, Yoshiaki Kawase², Tsunekazu Kakuta⁷, Hiroaki Takashima⁸, Hiroyoshi Yokoi⁹, Hiroshi Ohira¹⁰, Satoru Suwa¹¹, Mitsutoshi Oguri¹², Fumi Yamamoto¹³, Takashi Kubo¹, Takashi Akasaka¹; DIASTOLE Investigators

Collaborators

DIASTOLE Investigators:
Y Shiono, Y Katayama, K Hironori, T Kubo, T Akasaka, N Tanaka, J Yamashita, H Fujita, A Matsuo, H Matsuo, Y Kawase, I Kawamura, T Kakuta, M Hoshino, T Sugano, H Takashima, T Amano, H Yokoi, Y Yamamoto, Y Nozaki, M Machida, M Kobori, T Kikuchi, H Ohira, H Yoshino, H Ishiguro, Y Wakabayashi, T Kondo, H Terai, T Suwa, T Kimura, T Kawajiri, A Hirohata, S Uemura, Y Neishi, T Sakamoto, M Yamada, K Okeie, K Hishikari, M Oguri, T Uetani, T Saegusa, F Yamamoto, M Yamada

Affiliations

¹ Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
² Department of Cardiology, Gifu Heart Center, Gifu, Japan.
³ Department of Cardiology, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan.
⁴ Department of Cardiology, Tokyo Medical University Hachioji Medical Care Center, Tokyo, Japan.
⁵ Department of Medical Engineering, Kawasaki University of Medical Welfare, Okayama, Japan.
⁶ Department of Cardiology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
⁷ Department of Cardiology, Tsuchiura Kyoto General Hospital, Ibaraki, Japan.
⁸ Department of Cardiology, Aichi Medical University, Aichi, Japan.
⁹ Department of Cardiology, Fukuoka Sanno Hospital, Fukuoka, Japan.
¹⁰ Department of Cardiology, Edogawa Hospital, Tokyo, Japan.
¹¹ Department of Cardiology, Juntendo University Shizuoka Hospital, Shizuoka, Japan.
¹² Department of Cardiology, Kasugai Municipal Hospital, Aichi, Japan.
¹³ Department of Cardiology, Ureshino Medical Center National Hospital Organization, Saga, Japan.

Abstract

Background: In the resting conditions, narrowing the window of coronary pressure measurements from the whole cardiac cycle to diastole improves diagnostic performance of coronary pressure-derived physiological index. However, whether this also applies to the hyperemic conditions has not yet been thoroughly evaluated.

Objectives: The purpose of this study was to assess whether diastolic fractional flow reserve (diastolic FFR) has better diagnostic performance in identifying ischemia-causing coronary lesions than conventional FFR in a prospective, multicenter, and independent core laboratory-based environment.

Methods: In this prospective multicenter registry at 29 Japanese centers, we compared the diagnostic performance of FFR, diastolic FFR, resting distal to aortic coronary pressure (Pd/Pa), and diastolic pressure ratio (dPR) using myocardial perfusion scintigraphy (MPS) as the reference standard in 378 patients with single-vessel coronary disease.

Results: Inducible myocardial ischemia was found on MPS in the relevant myocardial territory of the target vessel in 85 patients (22%). In the receiver-operating curve analyses, diastolic FFR had comparable area under the curve (AUC) compared with FFR (AUC_{diastolic FFR}: 0.66; 95% confidence interval [CI]: 0.58-0.73, vs AUC_FFR: 0.66; 95% CI: 0.58-0.74, P = 0.624). FFR and diastolic FFR showed significantly larger AUCs than resting Pd/Pa (0.62; 95% CI: 0.54-0.70; P = 0.033 and P = 0.046) but did not show significantly larger AUCs than dPR (0.62; 95% CI: 0.55-0.70; P = 0.102 and P = 0.113).

Conclusions: Diastolic FFR showed a similar diagnostic performance to FFR as compared with MPS. This result reaffirms the use of FFR as the most accurate invasive physiological lesion assessment. (Diagnostic accuracy of diastolic fractional flow reserve (d-FFR) for functional evaluation of coronary stenosis; UMIN000015906).

Keywords: FFR, fractional flow reserve; IQR, interquartile range; LAD, left anterior descending artery; LCX, left circumflex artery; MPS, myocardial perfusion scintigraphy; RCA, right coronary artery; ROC, receiver-operating characteristic; SDS, summed difference score; SRS, summed rest score; SSS, summed stress score; dPR, diastolic pressure ratio; fractional flow reserve; iFR, instantaneous wave-free ratio; myocardial ischemia; myocardial perfusion scintigraphy; stable coronary artery disease.