BackgroundAngiography‐derived fractional flow reserve (virtual FFR) has shown excellent diagnostic performance compared with wire‐based FFR. However, virtual FFR pullback curves have not been validated yet.ObjectivesTo validate the accuracy of virtual FFR pullback curves compared to wire‐based FFR pullbacks and to assess their clinical utility using patient‐reported outcomes.MethodsPooled analysis of two prospective studies, including patients with hemodynamically significant (FFR ≤ 0.80) coronary artery disease (CAD). Virtual and wire‐based FFR pullbacks were compared to assess the accuracy of virtual pullbacks to characterize CAD as focal or diffuse. Pullbacks were analyzed visually and quantitatively using the pullback pressure gradient (PPG). Patients underwent PCI, and the Seattle Angina Questionnaire (SAQ) was administered at 3‐month follow‐up.ResultsA total of 298 patients (300 vessels) with both virtual and wire‐based pullbacks who underwent PCI were included in the analysis. The mean age was 61.8 ± 8.8, and 15% were female. The agreement on the visual adjudication of the CAD pattern was fair (Cohen's Kappa: 0.31, 95% confidence interval: 0.18–0.45). The mean PPG were 0.65 ± 0.18 from virtual pullbacks and 0.65 ± 0.13 from wire‐based pullbacks (r = 0.68, mean difference 0, limits of agreement −0.27 to 0.28). At follow‐up, patients with high virtual PPG (>0.67) had higher SAQ angina frequency scores (i.e., less angina) than those with low virtual PPG (SAQ scores 92.0 ± 14.3 vs. 85.5 ± 23.1, p = 0.022).ConclusionVirtual FFR pullback curves showed moderate agreement with wire‐based FFR pullbacks. Nonetheless, patients with focal disease based on virtual PPG reported greater improvement in angina after PCI.

中文翻译：

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虚拟血流储备分数回拉曲线的验证


背景与基于线的 FFR 相比，血管造影衍生的血流储备分数（虚拟 FFR）显示出出色的诊断性能。然而，虚拟 FFR 回拉曲线尚未得到验证。 目的 验证虚拟 FFR 回拉曲线与基于线的 FFR 回拉相比的准确性，并使用患者报告的结果评估其临床效用。方法对两项前瞻性研究进行汇总分析，包括患有以下疾病的患者：血流动力学显着（FFR ≤ 0.80）的冠状动脉疾病（CAD）。对虚拟和基于线的 FFR 回调进行比较，以评估虚拟回调将 CAD 描述为焦点或扩散的准确性。使用回拉压力梯度（PPG）对回拉进行视觉和定量分析。患者接受了 PCI，并在 3 个月随访时进行了西雅图心绞痛问卷 (SAQ)。 结果 共有 298 名接受 PCI 的虚拟和线拉回患者（300 条血管）纳入分析。平均年龄为 61.8 ± 8.8 岁，其中 15% 为女性。 CAD 图案的视觉判定的一致性是公平的（Cohen 的 Kappa：0.31，95% 置信区间：0.18–0.45）。虚拟回调的平均 PPG 为 0.65 ± 0.18，基于线的回调的平均 PPG 为 0.65 ± 0.13（r = 0.68，平均差为 0，一致性限制为 -0.27 至 0.28）。随访时，虚拟 PPG 高 (>0.67) 的患者比虚拟 PPG 低的患者具有更高的 SAQ 心绞痛频率评分（即心绞痛较少）（SAQ 评分 92.0 ± 14.3 vs. 85.5 ± 23.1，p = 0.022）结论虚拟 FFR 回调曲线与基于线的 FFR 回调表现出适度的一致性。尽管如此，基于虚拟 PPG 的局灶性病变患者在 PCI 后报告心绞痛有更大的改善。