TCT-723 Validation of the pullback pressure gradient in resting condition.

Abstract

Background: The pull back pressure gradient (PPG) quantifies patterns of coronary artery disease (CAD) as either focal or diffuse and has been shown to add clinical value to fractional flow reserve (FFR) in decision making about revascularization. Traditionally, PPG has been measured using hyperemic pressure pull backs. However, the validity of PPG measurements derived from resting pressure pull backs remains to be studied. We compared PPG derived from nonhyperemic pull backs using hyperemic PPG as the reference. Method(s): This was a prespecified subanalysis of the PPG Global Registry, a prospective, multicenter, international study. Resting and hyperemic pull backs were performed before percutaneous coronary intervention in vessels with hemodynamically significant lesions (FFR <=0.80). PPG was calculated using the commercially available software. The agreement between baseline and hyperemic pull backs was assessed using the median hyperemic PPG value (0.62) as the cutoff. Result(s): Overall, 88 patients (90 vessels) with resting and hyperemic pull backs were included in the present study. The mean age was 68.8 +/- 9.4 years, 75% were male, and 24% had diabetes. The left anterior descending artery was the target vessel in 83% of the cases. Resting PPG strongly correlated with hyperemic PPG (r = 0.80; 95% CI: 0.71-0.86). The mean difference between resting and hyperemic PPG was 0.04 (limits of agreement: -0.23 to 0.15). There was a substantial agreement in the functional CAD patterns between resting and hyperemic PPG (Cohen kappa = 0.64; 95% CI: 0.48-0.80). Resting PPG showed excellent capacity to predict post-PCI FFR >=0.88 (AUC: 0.76; 95% CI: 0.66-0.87). Conclusion(s): PPG derived from a resting pull back demonstrated good agreement with hyperemic PPG. This finding facilitates the quantification of CAD patterns using invasive coronary physiology. Categories: IMAGING AND PHYSIOLOGY: Physiologic Lesion Assessment.Copyright © 2024