Author + information
- Received February 12, 2018
- Revision received March 21, 2018
- Accepted March 21, 2018
- Published online August 6, 2018.
- Sonia V. Shah, MDa,b,
- Frederik M. Zimmermann, MDc,
- Nils P. Johnson, MD, MSd,
- Takeshi Nishi, MD, PhDa,b,
- Yuhei Kobayashi, MDa,b,
- Nils Witt, MD, PhDe,
- Colin Berry, MBChB, PhDf,g,
- Allen Jeremias, MD, MSch,i,
- Bon-Kwon Koo, MD, PhDj,
- Giovanni Esposito, MD, PhDk,
- Gilles Rioufol, MD, PhDl,
- Seung-Jung Park, MD, PhDm,
- Keith G. Oldroyd, MBChB, MDf,
- Emanuele Barbato, MDk,n,
- Nico H.J. Pijls, MD, PhDc,o,
- Bernard De Bruyne, MD, PhDn,
- William F. Fearon, MDa,b,∗ (, )
- on behalf of the CONTRAST Study Investigators
- aStanford University School of Medicine, Stanford, California
- bStanford Cardiovascular Institute, Stanford, California
- cCatharina Hospital, Eindhoven, the Netherlands
- dMcGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
- eKarolinska Institutet, Södersjukhuset, Stockholm, Sweden
- fWest of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Clydebank, United Kingdom
- gBritish Heart Foundation Glasgow Cardiovascular Research Center, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- hDivision of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, New York
- iCardiovascular Research Foundation, New York, New York
- jSeoul National University Hospital, Seoul, South Korea
- kUniversity of Naples Federico II, Naples, Italy
- lHospices Civils de Lyon and CARMEN, Lyon, France
- mUniversity of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
- nCardiovascular Center Aalst, Aalst, Belgium
- oEindhoven University of Technology, Eindhoven, the Netherlands
- ↵∗Address for correspondence:
Dr. William F. Fearon, Stanford University School of Medicine, 300 Pasteur Drive, H2103, Stanford, California 94305-5218.
Objectives The goal of this study was to investigate sex differences in adenosine-free coronary pressure indexes.
Background Several adenosine-free coronary pressure wire indexes have been proposed to assess the functional significance of coronary artery lesions; however, there is a theoretical concern that sex differences may affect diagnostic performance because of differences in resting flow and distal myocardial mass.
Methods In this CONTRAST (Can Contrast Injection Better Approximate FFR Compared to Pure Resting Physiology?) substudy, contrast fractional flow reserve (cFFR), obtained during contrast-induced submaximal hyperemia, the instantaneous wave-free ratio (iFR), and distal/proximal coronary pressure ratio (Pd/Pa) were compared with fractional flow reserve (FFR) in 547 men and 216 women. Using FFR ≤0.8 as a reference, the diagnostic performance of each index was compared.
Results Men and women had similar diameter stenosis (p = 0.78), but women were less likely to have FFR ≤0.80 than men (42.5% vs. 51.5%, p = 0.04). Sensitivity was similar among cFFR, iFR, and Pd/Pa when comparing women and men, respectively (cFFR, 77.5% vs. 75.3%; p = 0.69; iFR, 84.9% vs. 79.4%; p = 0.30; Pd/Pa, 78.8% vs. 77.3%; p = 0.78). cFFR was more specific than iFR or Pd/Pa regardless of sex (cFFR, 94.3% vs. 95.8%; p = 0.56; iFR, 75.6% vs. 80.1%; p = 0.38; Pd/Pa, 80.6% vs. 78.7%; p = 0.69). By receiver-operating characteristic curve analysis, cFFR provided better diagnostic accuracy than resting indexes irrespective of sex (p ≤ 0.0001).
Conclusions Despite the theoretical concern, the diagnostic sensitivity and specificity of cFFR, iFR, and Pd/Pa did not differ between the sexes. Irrespective of sex, cFFR provides the best diagnostic performance.
Dr. Fearon has received research support from ACIST Medical Systems, Abbott, Medtronic, and CathWorks; and has a consulting relationship with HeartFlow and Boston Scientific. Dr. Jeremias is a consultant for Abbott Vascular and Philips; and a member of the Speakers Bureau for Medtronic. Dr. Pijls has received institutional research grants from St. Jude Medical, Abbott, and Maquet; and is a consultant for St. Jude Medical, Boston Scientific, and Opsens. Dr. Oldroyd has received institutional research support and consulting fees from Abbott Vascular and Boston Scientific. Dr. De Bruyne has received institutional research grants from Abbott, Boston Scientific, and Biotronik; and the Cardiovascular Research Center Aalst receives consultancy fees on his behalf from St. Jude Medical, Boston Scientific, and Opsens. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 12, 2018.
- Revision received March 21, 2018.
- Accepted March 21, 2018.
- 2018 American College of Cardiology Foundation