Myocardial Fractional Flow Reserve Measurement Using Contrast Media as a First-Line Assessment of Coronary Lesions in Current Practice Vincent Spagnoli,

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Myocardial Fractional Flow Reserve Measurement Using Contrast Media as a First-Line Assessment of Coronary Lesions in Current Practice Vincent Spagnoli, MD, Nicolas Amabile, MD, PhD, Jean Guillaume Dillinger, MD, Aurélie Veugeois, MD, Damien Logeart, MD, Patrick Henry, MD, PhD, Christophe Caussin, MD, Michel S. Slama, MD Canadian Journal of Cardiology Volume 32, Issue 6, Pages 739-746 (June 2016) DOI: 10.1016/j.cjca.2015.09.009 Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 1 Contrast-enhanced fractional flow reserve (cFFR) dose ranging. Four progressive contrast doses (3, 6, 10, and 15 mL) were repetitively tested in 12 lesions and a dose-ranging response on resting distal coronary pressure to aortic pressure ratio (Pd/Pa) values was observed. FFR, fractional flow reserve; ns, not significant. ∗ P < 0.05 when compared to Pd/Pa. Canadian Journal of Cardiology 2016 32, 739-746DOI: (10.1016/j.cjca.2015.09.009) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 2 Bland-Altman plots analysis. Reproducibility of contrast-enhanced fractional flow reserve (cFFR) was assessed using repeated measurements in 18 lesions. The intermeasurement reproducibility was good with a very limited variability assessed according to the limits of agreement and the small estimated bias (mean estimated bias = 0.001 ± 0.014). Canadian Journal of Cardiology 2016 32, 739-746DOI: (10.1016/j.cjca.2015.09.009) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 3 A receiver-operating characteristic curve was calculated using the threshold cutoff for contrast-enhanced fractional flow reserve (cFFR) of 0.85 in the exploration cohort. The receiver-operating characteristic was found to have an area under the curve (AUC) of 0.94 ± 0.04, which suggests the high accuracy rate of contrast-enhanced FFR in predicting FFR. Canadian Journal of Cardiology 2016 32, 739-746DOI: (10.1016/j.cjca.2015.09.009) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions

Figure 4 The grey zone of contrast-enhanced fractional flow reserve (cFFR). All cFFR values, obtained from the 4 previous groups of patients (n = 138 lesions), divided in 3 groups: cFFR < 0.82 (n = 51 lesions), cFFR > 0.85 (n = 66 lesions), and cFFR ≥ 0.82 to ≤ 0.85 (n = 21 lesions). Pearson correlation r analysis between cFFR and fractional flow reserve (FFR) were respectively: r = 0.82 (P < 0.001), r = 0.77 (P < 0.001), and r = 0.44 (P = 0.06). Canadian Journal of Cardiology 2016 32, 739-746DOI: (10.1016/j.cjca.2015.09.009) Copyright © 2016 Canadian Cardiovascular Society Terms and Conditions