Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements

Christopher M Cook; Allen Jeremias; Ricardo Petraco; Sayan Sen; Sukhjinder Nijjer; Matthew J Shun-Shin; Yousif Ahmad; Guus de Waard; Tim van de Hoef; Mauro Echavarria-Pinto; Martijn van Lavieren; Rasha Al Lamee; Yuetsu Kikuta; Yasutsugu Shiono; Ashesh Buch; Martijn Meuwissen; Ibrahim Danad; Paul Knaapen; Akiko Maehara; Bon-Kwon Koo; Gary S Mintz; Javier Escaned; Gregg W Stone; Darrel P Francis; Jamil Mayet; Jan J Piek; Niels van Royen; Justin E Davies

doi:10.1016/j.jcin.2017.09.021

Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements

Christopher M Cook
, Allen Jeremias
, Ricardo Petraco
, Sayan Sen
, Sukhjinder Nijjer
, Matthew J Shun-Shin
, Yousif Ahmad
, Guus de Waard
, Tim van de Hoef
, Mauro Echavarria-Pinto
, Martijn van Lavieren
, Rasha Al Lamee
, Yuetsu Kikuta
, Yasutsugu Shiono
, Ashesh Buch
, Martijn Meuwissen
, Ibrahim Danad
, Paul Knaapen
, Akiko Maehara
, Bon-Kwon Koo

Gary S Mintz, Javier Escaned, Gregg W Stone, Darrel P Francis, Jamil Mayet, Jan J Piek, Niels van Royen, Justin E Davies

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Pages (from-to)	2514-2524
Number of pages	11
Journal	JACC. Cardiovascular Interventions
Volume	10
Issue number	24
DOIs	https://doi.org/10.1016/j.jcin.2017.09.021
Publication status	Published - 26 Dec 2017
Externally published	Yes

Keywords

Aged
Blood Flow Velocity
Cardiac Catheterization
Coronary Angiography
Coronary Stenosis/diagnostic imaging
Coronary Vessels/diagnostic imaging
Databases, Factual
Echocardiography, Doppler
Female
Fractional Flow Reserve, Myocardial
Humans
Hyperemia/physiopathology
Male
Middle Aged
Predictive Value of Tests
Prognosis
Reproducibility of Results
Retrospective Studies
Severity of Illness Index

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10.1016/j.jcin.2017.09.021

Cite this

Cook, C. M., Jeremias, A., Petraco, R., Sen, S., Nijjer, S., Shun-Shin, M. J., 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., ... Davies, J. E. (2017). Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements. JACC. Cardiovascular Interventions, 10(24), 2514-2524. https://doi.org/10.1016/j.jcin.2017.09.021

@article{31a1e69136c04dba82161d801d0a5883,

title = "Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements",

abstract = "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.",

keywords = "Aged, Blood Flow Velocity, Cardiac Catheterization, Coronary Angiography, Coronary Stenosis/diagnostic imaging, Coronary Vessels/diagnostic imaging, Databases, Factual, Echocardiography, Doppler, Female, Fractional Flow Reserve, Myocardial, Humans, Hyperemia/physiopathology, Male, Middle Aged, Predictive Value of Tests, Prognosis, Reproducibility of Results, Retrospective Studies, Severity of Illness Index",

author = "Cook, \{Christopher M\} and Allen Jeremias and Ricardo Petraco and Sayan Sen and Sukhjinder Nijjer and Shun-Shin, \{Matthew J\} and Yousif Ahmad and \{de Waard\}, Guus and \{van de Hoef\}, Tim and Mauro Echavarria-Pinto and \{van Lavieren\}, Martijn and \{Al Lamee\}, Rasha and Yuetsu Kikuta and Yasutsugu Shiono and Ashesh Buch and Martijn Meuwissen and Ibrahim Danad and Paul Knaapen and Akiko Maehara and Bon-Kwon Koo and Mintz, \{Gary S\} and Javier Escaned and Stone, \{Gregg W\} and Francis, \{Darrel P\} and Jamil Mayet and Piek, \{Jan J\} and \{van Royen\}, Niels and Davies, \{Justin E\}",

note = "Publisher Copyright: {\textcopyright} 2017 The Authors",

year = "2017",

month = dec,

day = "26",

doi = "10.1016/j.jcin.2017.09.021",

language = "English",

volume = "10",

pages = "2514--2524",

journal = "JACC. Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier",

number = "24",

}

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 2017, 'Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements', JACC. Cardiovascular Interventions, vol. 10, no. 24, pp. 2514-2524. https://doi.org/10.1016/j.jcin.2017.09.021

Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements. / Cook, Christopher M; Jeremias, Allen; Petraco, Ricardo et al.
In: JACC. Cardiovascular Interventions, Vol. 10, No. 24, 26.12.2017, p. 2514-2524.

Research output: Contribution to journal › Article › Academic › peer-review

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

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 -

Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements

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Keywords

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