Diagnostic Performance of Angiography‐Based Vessel‐Fractional Flow Reserve Compared with Various Wire‐Based Physiological Assessments

Background Although considered the gold standard, pressure wire‐derived fractional flow reserve (PW‐FFR) and instantaneous wave‐free ratio (PW‐iFR) are not sufficiently adopted. Vessel fractional flow reserve (vFFR) is a potentially less invasive surrogate. Aims To validate the diagnostic performance of vFFR against the wire‐based physiological assessments in real‐world clinical settings. Methods In this single‐center retrospective study, we analyzed 479 patients (586 vessels) who underwent PW‐FFR and vFFR in the same vessel, and evaluated the correlation between vFFR and PW‐FFR using PW‐FFR ≦ 0.80 as the reference. Additionally, we analyzed 378 patients (455 vessels) with vFFR, PW‐FFR, and PW‐iFR, and 93 patients (119 vessels) with vFFR, PW‐FFR, and resting full‐cycle ratio (RFR). Results The indications for coronary angiography were stable angina (92%), unstable angina (6.3%), and non‐ST‐elevation myocardial infarction (1.5%). The target vessels were the left anterior descending artery (61%), left circumflex artery (20%), and right coronary artery (19%). A good correlation was found between vFFR and PW‐FFR ( R = 0.67; p < 0.001) with a mean bias of 0.0068 ± 0.0786. vFFR demonstrated good accuracy at predicting PW‐FFR ≦0.80 (area under the curve [AUC] = 0.86; 95% confidence interval [CI]: 0.83‐0.89). At a vFFR cut‐off value of ≦0.80, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for predicting PW‐FFR ≦0.80 were 78.8%, 82.5%, 77.6%, 83.5%, and 80.9%, respectively, with a Cohen's Kappa coefficient of 0.612. Similar results were observed for vFFR with PW‐iFR and RFR. Conclusion vFFR demonstrated good correlation and diagnostic performance compared with wire‐based physiological assessments.