TY - JOUR
T1 - Diagnostic Performance of Non-Hyperemic Pressure Ratios Versus Fractional Flow Reserve Stratified by Coronary Artery
T2 - A Systematic Review and Meta-Analysis of Individual Patient Data
AU - Storozhenko, Tatyana
AU - Collison, Damien
AU - Johnson, Nils P
AU - Sakai, Koshiro
AU - Mizukami, Takuya
AU - Shinke, Toshiro
AU - Matsuo, Hitoshi
AU - Munhoz, Daniel
AU - Buytaert, Dimitri
AU - Ando, Hirohiko
AU - Ko, Brian
AU - Ihdayhid, Abdul
AU - Biscaglia, Simone
AU - Rivero, Fernando
AU - Engstrøm, Thomas
AU - Arslani, Ketina
AU - Leone, Antonio Maria
AU - van Nunen, Lokien X
AU - Fearon, William F
AU - Christiansen, Evald Høj
AU - Nørgaard, Bjarne L
AU - Maeng, Michael
AU - Desta, Liyew
AU - Yong, Andy
AU - Otake, Hiromasa
AU - Takahashi, Yu
AU - Andreini, Daniele
AU - Leipsic, Jonathon
AU - Koo, Bon-Kwon
AU - Barbato, Paola Monique
AU - Bartunek, Jozef
AU - Barbato, Emanuele
AU - Sonck, Jeroen
AU - De Bruyne, Bernard
AU - Collet, Carlos
PY - 2026/1/20
Y1 - 2026/1/20
N2 - BACKGROUND: In the assessment of coronary physiology, non-hyperemic pressure ratios (NHPRs) provide an alternative to fractional flow reserve (FFR) without the need for hyperemic agents, reducing procedural time, side effects, and costs. However, it remains unclear whether NHPRs have similar diagnostic performance in the different coronary arteries. This study evaluates the diagnostic performance of NHPRs compared with FFR, stratified by coronary artery, in stable patients with coronary artery disease.METHODS: We conducted a systematic review and individual patient-level data meta-analysis from prospective studies involving patients with intermediate to severe coronary stenosis who underwent physiological assessment with NHPRs and FFR. NHPRs included resting full-cycle ratio or instantaneous wave-free ratio (iFR). The diagnostic performance of NHPRs was calculated using a threshold of ≤0.89 for NHPRs with FFR ≤0.80 as the reference and by stratifying between the left anterior descending artery (LAD) and non-LAD vessels.RESULTS: A total of 2120 paired FFR and NHPRs (1257 resting full-cycle ratio, 863 iFR) measurements were analyzed. The LAD artery was the interrogated vessel in 67% of cases, the left circumflex artery in 15%, and the right coronary artery in 17%. The mean NHPR and FFR values were 0.80±0.17 and 0.71±0.14, respectively. The overall sensitivity, specificity, and accuracy of NHPRs were 82%, 86%, and 83%. In non-LAD vessels, NHPRs had significantly lower sensitivity and accuracy, but higher specificity compared with LAD (69% versus 87%, 76% versus 86%, and 91% versus 81%, respectively, P<0.001 for all). The optimal NHPRs cutoff for detecting significant lesions differed between LAD (≤0.88) and non-LAD (≤0.92).CONCLUSIONS: NHPRs demonstrated lower diagnostic performance in non-LAD vessels compared with the LAD. These results underscore the need for vessel-specific interpretation of NHPR measurements.
AB - BACKGROUND: In the assessment of coronary physiology, non-hyperemic pressure ratios (NHPRs) provide an alternative to fractional flow reserve (FFR) without the need for hyperemic agents, reducing procedural time, side effects, and costs. However, it remains unclear whether NHPRs have similar diagnostic performance in the different coronary arteries. This study evaluates the diagnostic performance of NHPRs compared with FFR, stratified by coronary artery, in stable patients with coronary artery disease.METHODS: We conducted a systematic review and individual patient-level data meta-analysis from prospective studies involving patients with intermediate to severe coronary stenosis who underwent physiological assessment with NHPRs and FFR. NHPRs included resting full-cycle ratio or instantaneous wave-free ratio (iFR). The diagnostic performance of NHPRs was calculated using a threshold of ≤0.89 for NHPRs with FFR ≤0.80 as the reference and by stratifying between the left anterior descending artery (LAD) and non-LAD vessels.RESULTS: A total of 2120 paired FFR and NHPRs (1257 resting full-cycle ratio, 863 iFR) measurements were analyzed. The LAD artery was the interrogated vessel in 67% of cases, the left circumflex artery in 15%, and the right coronary artery in 17%. The mean NHPR and FFR values were 0.80±0.17 and 0.71±0.14, respectively. The overall sensitivity, specificity, and accuracy of NHPRs were 82%, 86%, and 83%. In non-LAD vessels, NHPRs had significantly lower sensitivity and accuracy, but higher specificity compared with LAD (69% versus 87%, 76% versus 86%, and 91% versus 81%, respectively, P<0.001 for all). The optimal NHPRs cutoff for detecting significant lesions differed between LAD (≤0.88) and non-LAD (≤0.92).CONCLUSIONS: NHPRs demonstrated lower diagnostic performance in non-LAD vessels compared with the LAD. These results underscore the need for vessel-specific interpretation of NHPR measurements.
KW - Humans
KW - Fractional Flow Reserve, Myocardial/physiology
KW - Coronary Vessels/physiopathology
KW - Coronary Artery Disease/physiopathology
KW - Coronary Stenosis/physiopathology
KW - Cardiac Catheterization
KW - Predictive Value of Tests
U2 - 10.1161/JAHA.124.040916
DO - 10.1161/JAHA.124.040916
M3 - Review
C2 - 41553082
SN - 2047-9980
VL - 15
SP - e040916
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
ER -