Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve.
Journal
Journal of interventional cardiology
ISSN: 1540-8183
Titre abrégé: J Interv Cardiol
Pays: United States
ID NLM: 8907826
Informations de publication
Date de publication:
2019
2019
Historique:
received:
26
04
2019
revised:
16
06
2019
accepted:
02
07
2019
entrez:
28
11
2019
pubmed:
28
11
2019
medline:
5
3
2020
Statut:
epublish
Résumé
The instantaneous wave-free ratio (iFR) is an invasive coronary physiological index that is not inferior to fractional flow reserve- (FFR-) guided revascularization. The indexes of iFR and FFR are similar and closely correlated, but there are a few key differences. Previous studies suggested that patient characteristics and lesion severity could induce discordance between iFR and FFR. This study aimed to clarify the hemodynamics and lesion characteristics that influence discordance between iFR and FFR. In this retrospective study, we enrolled 225 patients (304 lesions) who underwent clinically indicated invasive coronary angiography and both iFR and FFR examinations between 2012 and 2017. We included only patients who underwent right heart catheterization and had blood pressure and heart rates recorded immediately prior to iFR and FFR. Discordance (iFR ≤0.89 and FFR >0.8 or iFR >0.89 and FFR ≤0.8) was observed in 80 lesions (26.3%). The heart rate, rate-pressure product, and cardiac index tended to be higher in the iFR ≤0.89 group than in the iFR >0.89 group. These trends were not seen between the FFR ≤0.8 group and FFR >0.8 group. A multivariate analysis showed that independent predictors of iFR ≤0.89 and FFR >0.8 discordance were female sex and higher rate-pressure product. iFR >0.89 and FFR ≤0.8 discordance was rare in hemodialysis patients. Even if iFR is functionally significant in intermediate stenosis, additional FFR evaluations should be considered for women, especially those with a high rate-pressure product, to avoid unnecessary percutaneous coronary intervention. If iFR is not functionally significant with intermediate stenosis in hemodialysis patients, then further FFR evaluations are unnecessary.
Sections du résumé
BACKGROUND
BACKGROUND
The instantaneous wave-free ratio (iFR) is an invasive coronary physiological index that is not inferior to fractional flow reserve- (FFR-) guided revascularization. The indexes of iFR and FFR are similar and closely correlated, but there are a few key differences. Previous studies suggested that patient characteristics and lesion severity could induce discordance between iFR and FFR. This study aimed to clarify the hemodynamics and lesion characteristics that influence discordance between iFR and FFR.
METHODS
METHODS
In this retrospective study, we enrolled 225 patients (304 lesions) who underwent clinically indicated invasive coronary angiography and both iFR and FFR examinations between 2012 and 2017. We included only patients who underwent right heart catheterization and had blood pressure and heart rates recorded immediately prior to iFR and FFR.
RESULTS
RESULTS
Discordance (iFR ≤0.89 and FFR >0.8 or iFR >0.89 and FFR ≤0.8) was observed in 80 lesions (26.3%). The heart rate, rate-pressure product, and cardiac index tended to be higher in the iFR ≤0.89 group than in the iFR >0.89 group. These trends were not seen between the FFR ≤0.8 group and FFR >0.8 group. A multivariate analysis showed that independent predictors of iFR ≤0.89 and FFR >0.8 discordance were female sex and higher rate-pressure product. iFR >0.89 and FFR ≤0.8 discordance was rare in hemodialysis patients.
CONCLUSION
CONCLUSIONS
Even if iFR is functionally significant in intermediate stenosis, additional FFR evaluations should be considered for women, especially those with a high rate-pressure product, to avoid unnecessary percutaneous coronary intervention. If iFR is not functionally significant with intermediate stenosis in hemodialysis patients, then further FFR evaluations are unnecessary.
Identifiants
pubmed: 31772528
doi: 10.1155/2019/3765282
pmc: PMC6739793
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3765282Informations de copyright
Copyright © 2019 Hiroyuki Arashi et al.
Déclaration de conflit d'intérêts
Arashi has received lecture fees from Abbot Vascular, Philips Volcano, and Boston Scientific. Yamaguchi reports that he is associated with a division (Clinical Research Division for Cardiovascular Catheter Intervention) financially maintained by donations from Abbott Vascular and Boston Scientific. All other authors have no relationships relevant to the contents of this paper to disclose.
Références
Catheter Cardiovasc Interv. 2019 Sep 1;94(3):356-363
pubmed: 30702186
Cardiovasc Interv Ther. 2018 Jul;33(3):256-263
pubmed: 28643215
Circulation. 1993 Jul;88(1):62-9
pubmed: 8319357
Int J Cardiol. 2017 Oct 15;245:63-68
pubmed: 28789845
N Engl J Med. 2017 May 11;376(19):1824-1834
pubmed: 28317458
J Cardiol. 2018 Mar;71(3):237-243
pubmed: 29054592
JACC Cardiovasc Interv. 2015 Sep;8(11):1433-41
pubmed: 26404195
Int J Cardiol. 2019 Feb 1;276:125-129
pubmed: 30293667
J Am Coll Cardiol. 2007 May 29;49(21):2105-11
pubmed: 17531660
Int J Cardiol. 2019 Apr 1;280:19-28
pubmed: 30292436
N Engl J Med. 2017 May 11;376(19):1813-1823
pubmed: 28317438
N Engl J Med. 2012 Sep 13;367(11):991-1001
pubmed: 22924638
JACC Cardiovasc Interv. 2017 Dec 26;10(24):2514-2524
pubmed: 29268881
Circulation. 2018 Jan 30;137(5):480-487
pubmed: 29097450