Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve
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 sugge...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2019/3765282 |
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| author | Hiroyuki Arashi Natsuko Satomi Issei Ishida Kanintorn Soontorndhada Suguru Ebihara Kazuki Tanaka Hisao Otsuki Masashi Nakao Kentaro Jujo Junichi Yamaguchi Nobuhisa Hagiwara |
| author_facet | Hiroyuki Arashi Natsuko Satomi Issei Ishida Kanintorn Soontorndhada Suguru Ebihara Kazuki Tanaka Hisao Otsuki Masashi Nakao Kentaro Jujo Junichi Yamaguchi Nobuhisa Hagiwara |
| author_sort | Hiroyuki Arashi |
| collection | DOAJ |
| description | 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. 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. 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. 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. |
| format | Article |
| id | doaj-art-3f4f30c616d942d6bfdcdd1e57a8cbc9 |
| institution | Kabale University |
| issn | 0896-4327 1540-8183 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-3f4f30c616d942d6bfdcdd1e57a8cbc92025-02-03T06:06:07ZengWileyJournal of Interventional Cardiology0896-43271540-81832019-01-01201910.1155/2019/37652823765282Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow ReserveHiroyuki Arashi0Natsuko Satomi1Issei Ishida2Kanintorn Soontorndhada3Suguru Ebihara4Kazuki Tanaka5Hisao Otsuki6Masashi Nakao7Kentaro Jujo8Junichi Yamaguchi9Nobuhisa Hagiwara10Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanDepartment of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, JapanBackground. 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. 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. 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. 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.http://dx.doi.org/10.1155/2019/3765282 |
| spellingShingle | Hiroyuki Arashi Natsuko Satomi Issei Ishida Kanintorn Soontorndhada Suguru Ebihara Kazuki Tanaka Hisao Otsuki Masashi Nakao Kentaro Jujo Junichi Yamaguchi Nobuhisa Hagiwara Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve Journal of Interventional Cardiology |
| title | Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve |
| title_full | Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve |
| title_fullStr | Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve |
| title_full_unstemmed | Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve |
| title_short | Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve |
| title_sort | hemodynamic and lesion characteristics associated with discordance between the instantaneous wave free ratio and fractional flow reserve |
| url | http://dx.doi.org/10.1155/2019/3765282 |
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