Development, validation, and reproducibility of the pullback pressure gradient (PPG) derived from manual fractional flow reserve pullbacks

• DOI: 10.1002/ccd.30064
• Publication Date: 2022-03-02T08:58:23Z
• Authors: Jeroen Sonck; Takuya Mizukami; Nils P. Johnson; Sakura Nagumo; Emanuele Gallinoro; Alessandro Candreva; Niya Mileva; Daniel Munhoz; Toshiro Shinke; Johan Svanerud; Emanuele Barbato; Bernard De Bruyne; Carlos Collet
• Keywords: Coronary Stenosis; Reproducibility of Results; 610 Medicine & health; Coronary Artery Disease; Coronary Angiography; Coronary Vessels; 2705 Cardiology and Cardiovascular Medicine; Fractional Flow Reserve, Myocardial; 03 medical and health sciences; Percutaneous Coronary Intervention; Treatment Outcome; 0302 clinical medicine; cad; coronary artery disease; coronary physiology; ffr fractional flow reserve; ffr pullbacks; pci percutaneous coronary intervention; Predictive Value of Tests; 10209 Clinic for Cardiology; 2741 Radiology, Nuclear Medicine and Imaging; Humans

AbstractFractional flow reserve (FFR) pullbacks assess the location and magnitude of pressure drops along the coronary artery. The pullback pressure gradient (PPG) quantifies the FFR pullback curve and provides a numeric expression of focal versus diffuse coronary artery disease. This study aims (1) to validate the PPG using manual FFR pullbacks compared with motorized FFR pullbacks as a reference; and (2) to determine the intra‐ and interoperator reproducibility of the PPG derived from manual FFR pullbacks. Patients with stable coronary artery disease and an FFR ≤ 0.80 were included. All patients underwent FFR pullback evaluation either with a motorized device or manually, depending on the study cohort. The agreement of the PPG between repeated pullbacks was assessed using the Bland–Altman method. Overall, 116 FFR pullback maneuvers (96 manual and 20 motorized) were analyzed. There was excellent agreement between the PPG derived from manual and motorized pullbacks (mean difference −0.01 ± 0.07, 95% limits of agreement [LOA] −0.14 to 0.12). The intra‐ and interoperator reproducibility of PPG derived from manual pullbacks were excellent (mean difference <0.01, 95% LOA −0.11 to 0.12, and mean difference <0.01, 95% LOA −0.12 to 0.11, respectively). The duration of the pullback maneuver did not impact the reproducibility of the PPG (r = 0.12, 95% CI: −0.29 to 0.49, p = 0.567). Manual pullbacks allow for an accurate PPG calculation. The inter‐ and intraoperator reproducibility of PPG derived from manual pullbacks were excellent.