TY - JOUR
T1 - Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses
T2 - An Analysis Using Doppler-Derived Coronary Flow Measurements
AU - Cook, Christopher M
AU - Jeremias, Allen
AU - Petraco, Ricardo
AU - Sen, Sayan
AU - Nijjer, Sukhjinder
AU - Shun-Shin, Matthew J
AU - Ahmad, Yousif
AU - de Waard, Guus
AU - van de Hoef, Tim
AU - Echavarria-Pinto, Mauro
AU - van Lavieren, Martijn
AU - Al Lamee, Rasha
AU - Kikuta, Yuetsu
AU - Shiono, Yasutsugu
AU - Buch, Ashesh
AU - Meuwissen, Martijn
AU - Danad, Ibrahim
AU - Knaapen, Paul
AU - Maehara, Akiko
AU - Koo, Bon-Kwon
AU - Mintz, Gary S
AU - Escaned, Javier
AU - Stone, Gregg W
AU - Francis, Darrel P
AU - Mayet, Jamil
AU - Piek, Jan J
AU - van Royen, Niels
AU - Davies, Justin E
N1 - Publisher Copyright:
© 2017 The Authors
PY - 2017/12/26
Y1 - 2017/12/26
N2 - 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.
AB - 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.
KW - Aged
KW - Blood Flow Velocity
KW - Cardiac Catheterization
KW - Coronary Angiography
KW - Coronary Stenosis/diagnostic imaging
KW - Coronary Vessels/diagnostic imaging
KW - Databases, Factual
KW - Echocardiography, Doppler
KW - Female
KW - Fractional Flow Reserve, Myocardial
KW - Humans
KW - Hyperemia/physiopathology
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Prognosis
KW - Reproducibility of Results
KW - Retrospective Studies
KW - Severity of Illness Index
UR - https://www.scopus.com/pages/publications/85039935704
U2 - 10.1016/j.jcin.2017.09.021
DO - 10.1016/j.jcin.2017.09.021
M3 - Article
C2 - 29268881
SN - 1936-8798
VL - 10
SP - 2514
EP - 2524
JO - JACC. Cardiovascular Interventions
JF - JACC. Cardiovascular Interventions
IS - 24
ER -