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

Details

Serval ID
serval:BIB_46E6712C4E5C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Predictive factors of discordance between the instantaneous wave-free ratio and fractional flow reserve.
Journal
Catheterization and cardiovascular interventions
Author(s)
Dérimay F., Johnson N.P., Zimmermann F.M., Adjedj J., Witt N., Hennigan B., Koo B.K., Barbato E., Esposito G., Trimarco B., Rioufol G., Park S.J., Baptista S.B., Chrysant G.S., Leone A.M., Jeremias A., Berry C., De Bruyne B., Oldroyd K.G., Pijls NHJ, Fearon W.F.
ISSN
1522-726X (Electronic)
ISSN-L
1522-1946
Publication state
Published
Issued date
01/09/2019
Peer-reviewed
Oui
Volume
94
Number
3
Pages
356-363
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
To identify clinical, angiographic and hemodynamic predictors of discordance between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR).
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.
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).
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.
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
Pubmed
Web of science
Create date
25/03/2019 9:56
Last modification date
15/07/2020 6:26
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