| Title: |
Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements |
| Authors: |
Cook, CM; Jeremias, A; Petraco, R; Sen, S; Nijjer, S; Shun-Shin, MJ; Ahmad, Y; De Waard, G; Van de Hoef, T; Echavarria-Pinto, M; Van Lavieren, M; Al Lamee, R; Kikuta, Y; Shiono, Y; Buch, A; Meuwissen, M; Danad, I; Knaapen, P; Maehara, A; Koo, B-K; Mintz, GS; Escaned, J; Stone, GW; Francis, DP; Mayet, J; Piek, JJ; Van Royen, N; Davies, JE |
| Contributors: |
Medical Research Council (MRC) |
| Source: |
2524 ; 2514 |
| Publisher Information: |
Elsevier |
| Publication Year: |
2017 |
| Collection: |
Imperial College London: Spiral |
| Subject Terms: |
Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; CFR; coronary flow reserve; coronary physiology; FFR; fractional flow reserve; iFR; instantaneous wave-free ratio; RESERVE; PRESSURE; SEVERITY; PCI; REVASCULARIZATION; INTERVENTIONS; HEMODYNAMICS; MULTICENTER; THRESHOLDS; VELOCITY; 1102 Cardiovascular Medicine And Haematology; Cardiovascular System & Hematology |
| Description: |
Objectives The study sought to determine the coronary flow characteristics of angiographically intermediate stenoses classified as discordant by fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). Background Discordance between FFR and iFR occurs in up to 20% of cases. No comparisons have been reported between the coronary flow characteristics of FFR/iFR discordant and angiographically unobstructed vessels. Methods Baseline and hyperemic coronary flow velocity and coronary flow reserve (CFR) were compared across 5 vessel groups: FFR+/iFR+ (108 vessels, n = 91), FFR–/iFR+ (28 vessels, n = 24), FFR+/iFR– (22 vessels, n = 22), FFR–/iFR– (208 vessels, n = 154), and an unobstructed vessel group (201 vessels, n = 153), in a post hoc analysis of the largest combined pressure and Doppler flow velocity registry (IDEAL [Iberian-Dutch-English] collaborators study). Results FFR disagreed with iFR in 14% (50 of 366). Baseline flow velocity was similar across all 5 vessel groups, including the unobstructed vessel group (p = 0.34 for variance). In FFR+/iFR– discordants, hyperemic flow velocity and CFR were similar to both FFR–/iFR– and unobstructed groups; 37.6 (interquartile range [IQR]: 26.1 to 50.4) cm/s vs. 40.0 [IQR: 29.7 to 52.3] cm/s and 42.2 [IQR: 33.8 to 53.2] cm/s and CFR 2.36 [IQR: 1.93 to 2.81] vs. 2.41 [IQR: 1.84 to 2.94] and 2.50 [IQR: 2.11 to 3.17], respectively (p > 0.05 for all). In FFR–/iFR+ discordants, hyperemic flow velocity, and CFR were similar to the FFR+/iFR+ group; 28.2 (IQR: 20.5 to 39.7) cm/s versus 23.5 (IQR: 16.4 to 34.9) cm/s and CFR 1.44 (IQR: 1.29 to 1.85) versus 1.39 (IQR: 1.06 to 1.88), respectively (p > 0.05 for all). Conclusions FFR/iFR disagreement was explained by differences in hyperemic coronary flow velocity. Furthermore, coronary stenoses classified as FFR+/iFR– demonstrated similar coronary flow characteristics to angiographically unobstructed vessels. |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| Relation: |
JACC: Cardiovascular Interventions; http://hdl.handle.net/10044/1/51260; https://dx.doi.org/10.1016/j.jcin.2017.09.021; MR/M018369/1 |
| DOI: |
10.1016/j.jcin.2017.09.021 |
| Availability: |
http://hdl.handle.net/10044/1/51260; https://doi.org/10.1016/j.jcin.2017.09.021 |
| Rights: |
© 2017 THE AUTHORS. PUBLISHED BY ELSEVIER ON BEHALF OF THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION. THIS IS AN OPEN ACCESS ARTICLE UNDER THE CC BY LICENSE ( http://creativecommons.org/licenses/by/4.0/ ) . |
| Accession Number: |
edsbas.3C12DD8B |
| Database: |
BASE |