Journal article
Predictive factors of discordance between the instantaneous wave-free ratio and fractional flow reserve.
- Dérimay F Department of cardiology, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA.
- Johnson NP Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas.
- Zimmermann FM Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
- Adjedj J Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
- Witt N Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Stockholm, Sweden.
- Hennigan B Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
- Koo BK Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
- Barbato E Department of Cardiology, Cardiovascular Center, OLV Clinic, Aalst, Belgium.
- Esposito G Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
- Trimarco B Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
- Rioufol G Department of Interventional Cardiology, Hospices Civils de Lyon and CARMEN, INSERM 1060, Lyon, France.
- Park SJ Department of Cardiology, Asan Medical Center, Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea.
- Baptista SB Department of Cardiology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
- Chrysant GS Department of Cardiology, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma.
- Leone AM Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
- Jeremias A Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, New York.
- Berry C Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
- De Bruyne B Department of Cardiology, Cardiovascular Center, OLV Clinic, Aalst, Belgium.
- Oldroyd KG Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
- Pijls NHJ Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
- Fearon WF Department of cardiology, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA.
- 2019-02-01
Published in:
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. - 2019
coronary physiology
fractional flow reserve
instantaneous wave-free ratio
Adrenergic beta-Antagonists
Age Factors
Aged
Cardiac Catheterization
Coronary Angiography
Coronary Artery Disease
Coronary Stenosis
Coronary Vessels
Female
Fractional Flow Reserve, Myocardial
Heart Rate
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Severity of Illness Index
English
OBJECTIVES
To identify clinical, angiographic and hemodynamic predictors of discordance between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR).
BACKGROUND
The iFR was found to be non-inferior to the gold-standard FFR for guiding coronary revascularization, although it is discordant with FFR in 20% of cases. A better understanding of the causes of discordance may enhance application of these indices.
METHODS
Both FFR and iFR were measured in the prospective multicenter CONTRAST study. Clinical, angiographic and hemodynamic variables were compared between patients with concordant values of FFR and iFR (cutoff ≤0.80 and ≤0.89, respectively).
RESULTS
Out of the 587 patients included, in 466 patients (79.4%) FFR and iFR agreed: both negative, n = 244 (41.6%), or positive, n = 222 (37.8%). Compared with FFR, iFR was negative discordant (FFR+/iFR-) in 69 (11.8%) patients and positive discordant (FFR-/iFR+) in 52 (8.9%) patients. On multivariate regression, stenosis location (left main or proximal left anterior descending) (OR: 3.30[1.68;6.47]), more severe stenosis (OR: 1.77[1.35;2.30]), younger age (OR: 0.93[0.90;0.97]), and slower heart rate (OR: 0.59[0.42;0.75]) were predictors of a negative discordant iFR. Absence of a beta-blocker (OR: 0.41[0.22;0.78]), older age (OR: 1.04[1.00;1.07]), and less severe stenosis (OR: 0.69[0.53;0.89]) were predictors of a positive discordant iFR.
CONCLUSIONS
During iFR acquisition, stenosis location, stenosis degree, heart rate, age and use of beta blockers influence concordance with FFR and should be taken into account when interpreting iFR.
To identify clinical, angiographic and hemodynamic predictors of discordance between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR).
BACKGROUND
The iFR was found to be non-inferior to the gold-standard FFR for guiding coronary revascularization, although it is discordant with FFR in 20% of cases. A better understanding of the causes of discordance may enhance application of these indices.
METHODS
Both FFR and iFR were measured in the prospective multicenter CONTRAST study. Clinical, angiographic and hemodynamic variables were compared between patients with concordant values of FFR and iFR (cutoff ≤0.80 and ≤0.89, respectively).
RESULTS
Out of the 587 patients included, in 466 patients (79.4%) FFR and iFR agreed: both negative, n = 244 (41.6%), or positive, n = 222 (37.8%). Compared with FFR, iFR was negative discordant (FFR+/iFR-) in 69 (11.8%) patients and positive discordant (FFR-/iFR+) in 52 (8.9%) patients. On multivariate regression, stenosis location (left main or proximal left anterior descending) (OR: 3.30[1.68;6.47]), more severe stenosis (OR: 1.77[1.35;2.30]), younger age (OR: 0.93[0.90;0.97]), and slower heart rate (OR: 0.59[0.42;0.75]) were predictors of a negative discordant iFR. Absence of a beta-blocker (OR: 0.41[0.22;0.78]), older age (OR: 1.04[1.00;1.07]), and less severe stenosis (OR: 0.69[0.53;0.89]) were predictors of a positive discordant iFR.
CONCLUSIONS
During iFR acquisition, stenosis location, stenosis degree, heart rate, age and use of beta blockers influence concordance with FFR and should be taken into account when interpreting iFR.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1002/ccd.28116
- PMID 30702186
- Persistent URL
- https://sonar.ch/global/documents/24737
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