Extent of the difference between microcatheter and pressure wire-derived fractional flow reserve and its relation to optical coherence tomography-derived parameters

Abstract

Background: Although previous studies demonstrated that microcatheter-derived fractional flow reserve (mc-FFR) tends to overestimate lesion severity compared to pressure wire-derived FFR (pw-FFR), the clinical utility of mc-FFR remains obscure. The extent of differences between the two FFR systems and its relation to a lesion-specific parameter remain unknown. In this study, we sought to compare mc-FFR with pw-FFR and determine the lower and upper mc-FFR cut-offs predicting ischemic and non-ischemic stenosis, using an ischemic and a clinical FFR threshold of 0.75 and 0.80 as references, respectively. We further explored optical coherence tomography (OCT) parameters influencing the difference in FFR between the two systems. Methods and results: In this study, 44 target vessels with intermediate de novo coronary artery lesion in 36 patients with stable ischemic heart disease were evaluated with mc-FFR, pw-FFR and OCT. Bland-Altman plots for mc-FFR versus pw-FFR showed a bias of −0.04 for lower mc-FFR values compared to pw-FFR values. The mc-FFR cut-off values of 0.73 and 0.79 corresponded to the 0.75 ischemic pw-FFR and 0.80 clinical pw-FFR thresholds with high predictive values, respectively. The differences in the two FFR measurements (pw-FFR minus mc-FFR) were negatively correlated with OCT-derived minimum lumen area (MLA) (R = −0.359, p = 0.011). The OCT-derived MLA of 1.36 mm2 was a cut-off value for predicting the clinically significant difference between the two FFR measurements defined as >0.03. Conclusion: Mc-FFR is clinically useful when the specific cut-offs are applied. An OCT-derived MLA accounts for the clinically significant difference in FFR between the two systems. Keywords: Fractional flow reserve, Microcatheter, Pressure wire, Optical coherence tomography, Decision-making, Minimum lumen area