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Catheter Cardiovasc Interv. 2019 Jan 31. doi: 10.1002/ccd.28116. [Epub ahead of print]

Predictive factors of discordance between the instantaneous wave-free ratio and fractional flow reserve.

Author information

1
Department of cardiology, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, CA.
2
Department of Interventional Cardiology, Hospices Civils de Lyon and CARMEN, INSERM 1060, Lyon, France.
3
Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas.
4
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
5
Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
6
Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Stockholm, Sweden.
7
Department of Cardiology, West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Clydebank, Scotland.
8
Department of Cardiology, British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland.
9
Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
10
Department of Cardiology, Cardiovascular Center, OLV Clinic, Aalst, Belgium.
11
Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
12
Department of Cardiology, Asan Medical Center, Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea.
13
Department of Cardiology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal.
14
Department of Cardiology, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma.
15
Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
16
Division of Cardiovascular Medicine, Stony Brook University Medical Center, Stony Brook, New York.
17
Department of Interventional Cardiology, Cardiovascular Research Foundation (CRF), New York, New York.
18
Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.

Abstract

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.

KEYWORDS:

coronary physiology; fractional flow reserve; instantaneous wave-free ratio

PMID:
30702186
DOI:
10.1002/ccd.28116

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