TY - JOUR
T1 - Stress Myocardial Perfusion Imaging Interpretation from the Viewpoint of Fractional Flow Reserve
AU - Kawamura, Itta
AU - Tanigaki, Toru
AU - Omori, Hiroyuki
AU - Mizukami, Takuya
AU - Hirata, Tetsuo
AU - Kikuchi, Jun
AU - Ota, Hideaki
AU - Sobue, Yoshihiro
AU - Miyake, Taiji
AU - Kawase, Yoshiaki
AU - Okubo, Munenori
AU - Kamiya, Hiroki
AU - Kawasaki, Masanori
AU - Tsuchiya, Kunihiko
AU - Nakagawa, Masayasu
AU - Kondo, Takeshi
AU - Suzuki, Takahiko
AU - Matsuo, Hitoshi
N1 - Publisher Copyright:
© 2021 Japanese Circulation Society. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background: Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established. Methods and Results: We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs <0.80. However, MPI-negative lesions had an extremely low lesion rate with FFR <0.65 (6%). Conversely, 78% and 41% of MPI-positive lesions had FFR <0.80 and <0.65, respectively. Conclusions: The data confirmed that decisions based on MPI are reasonable because MPI-negative patients have an extremely low rate of lesions with a FFR below the cutoff point for a hard event, and MPI-positive lesions include many lesions with FFR <0.65.
AB - Background: Myocardial perfusion imaging (MPI) and fractional flow reserve (FFR) are established approaches to the assessment of myocardial ischemia. Recently, various FFR cutoff values were proposed, but the diagnostic accuracy of MPI in identifying positive FFR using various cutoff values is not well established. Methods and Results: We retrospectively studied 273 patients who underwent stress MPI and FFR within a 3-month period. Results for FFR were obtained from 218 left anterior descending artery (LAD) lesions and 207 non-LAD lesions. Stress MPI and FFR demonstrated a good correlation in the detection of myocardial ischemia. However, the positive predictive value (PPV) of FFR for detecting MPI-positive lesions at the optimal FFR thresholds was insufficient (44% for LAD and 65% for non-LAD lesions). This was caused by a sharp drop in PPV at an FFR threshold of 0.7 or more. Notably, 41% of the lesions with normal MPI demonstrated FFRs <0.80. However, MPI-negative lesions had an extremely low lesion rate with FFR <0.65 (6%). Conversely, 78% and 41% of MPI-positive lesions had FFR <0.80 and <0.65, respectively. Conclusions: The data confirmed that decisions based on MPI are reasonable because MPI-negative patients have an extremely low rate of lesions with a FFR below the cutoff point for a hard event, and MPI-positive lesions include many lesions with FFR <0.65.
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U2 - 10.1253/circj.CJ-21-0122
DO - 10.1253/circj.CJ-21-0122
M3 - Article
C2 - 34148928
AN - SCOPUS:85117924701
SN - 1346-9843
VL - 85
SP - 2043
EP - 2049
JO - Circulation Journal
JF - Circulation Journal
IS - 11
ER -