Sex differences in adenosine-free coronary pressure indexes: a CONTRAST substudy

CONTRAST Study Investigators

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1454-1463
Number of pages10
JournalJACC: Cardiovascular Interventions
Volume11
Issue number15
DOIs
Publication statusPublished - 13 Aug 2018

Keywords

  • contrast fractional flow reserve
  • fractional flow reserve
  • sex differences
  • Transducers, Pressure
  • Predictive Value of Tests
  • Reproducibility of Results
  • Prospective Studies
  • Coronary Stenosis/diagnosis
  • Humans
  • Middle Aged
  • Adenosine/administration & dosage
  • Male
  • Cardiac Catheters
  • Coronary Artery Disease/diagnosis
  • Arterial Pressure
  • Fractional Flow Reserve, Myocardial
  • Sex Factors
  • Cardiac Catheterization/instrumentation
  • Female
  • Aged
  • Contrast Media/administration & dosage
  • Vasodilator Agents/administration & dosage
  • Hyperemia/physiopathology

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