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Nitroglycerin-Derived Pd/Pa for the Assessment of Intermediate Coronary Lesions

Nitroglycerin-Derived Pd/Pa for the Assessment of Intermediate Coronary Lesions

Zeev Israeli, Rodrigo Bagur, Dorian Murariu, Sabrina Wall, Mistre Alemayehu, Yasir Parviz, Pantelis Diamantouros, Shahar Lavi

J Invasive Cardiol. 2017 Dec;29(12):E177-E183.

PMID: 28809723

Abstract:

Objectives:
To assess the predictive value of Pd/Pa after nitroglycerin administration (Pd/Pa[N]) as compared with standard fractional flow reserve (FFR).
Methods:
Consecutive patients with intermediate coronary lesions assessed by FFR between January 2014 and October 2015 were included. We measured Pd/Pa at baseline, Pd/Pa(N), and Pd/Pa after incremental doses of intracoronary adenosine.
Results:
A total of 134 patients (27% females; mean age, 65 years) were included. The diagnostic performance of Pd/Pa(N) and identification of cut-off value for Pd/Pa(N) compared with FFR threshold of 0.8 using receiver-operating characteristic (ROC) area under the curve analysis was between 0.98 (95% confidence interval, 0.95-1.00; P<.05) for 48 μg and 0.86 (95% confidence interval, 0.79-0.94; P<.05) for 240 μg adenosine. Pd/Pa(N) ≤0.8 had 100% positive predictive value. Pd/Pa(N) ≥0.94 provided 100% negative predictive value with a high sensitivity (>92%). Optimal diagnostic accuracy of Pd/Pa(N) was achieved for values ≤0.84. The Pearson's correlation between Pd/Pa(N) and FFR varied between 0.89 for 24 μg adenosine and 0.77 for 240 μg (P<.01).
Conclusion:
Pd/Pa(N) values can be used for diagnosis of hemodynamically significant lesions. Pd/Pa(N) correlates well with standard FFR. Pd/Pa(N) cut-off of ≤0.8 can be considered significant without need for adenosine injection. The value of using adenosine whenever Pd/Pa(N) is ≥0.94 is limited.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP861891727	PDP-EA		861891-72-7	Price

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