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JACC Cardiovasc Interv. 2017 Dec 26;10(24):2514-2524. 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.

Author information

1
Imperial College London, London, United Kingdom.
2
St. Francis Hospital, Roslyn, New York; Cardiovascular Research Foundation, New York, New York.
3
VU University Medical Centre, Amsterdam, the Netherlands.
4
Academic Medical Centre, Amsterdam, the Netherlands.
5
Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City.
6
East Carolina Heart Institute at East Carolina University, Greenville, North Carolina.
7
Amphia Hospital, Breda, the Netherlands.
8
Cardiovascular Research Foundation, New York, New York; Department of Medicine, Columbia University Medical Center, New York, New York.
9
Seoul National University Hospital, Seoul, Republic of Korea.
10
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
11
Imperial College London, London, United Kingdom. Electronic address: Justin.davies@imperial.ac.uk.

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:

CFR; FFR; coronary flow reserve; coronary physiology; fractional flow reserve; iFR; instantaneous wave-free ratio

Comment in

PMID:
29268881
PMCID:
PMC5743106
DOI:
10.1016/j.jcin.2017.09.021
[Indexed for MEDLINE]
Free PMC Article

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