Development and Validation of a New Adenosine-Independent Index of Stenosis Severity From Coronary Wave–Intensity Analysis

Sen, Sayan; Escaned, Javier; Malik, Iqbal; Mikhail, Ghada; Foale, Rodney A.; Mila, Rafael; Tarkin, Jason M.; Petraco, Ricardo; Broyd, Christopher; Jabbour, Richard J.; Sethi, Amarjit Singh; Baker, Christopher; Bellamy, Micheal; Al-Bustami, Mahmud; Hackett, D.; Khan, Masood; Lefroy, David; Parker, Kim H.; Hughes, Alun D.; Francis, Dárrel P.; Mario, Carlo Di; Mayet, Jamil; Davies, Justin E.

doi:10.1016/j.jacc.2011.11.003

Cited by 611 publications

(478 citation statements)

References 22 publications

Supporting

Mentioning

460

Contrasting

Unclassified

Order By: Relevance

“…Previous trials have shown 80 to 85% agreement between iFR and FFR in the classification of lesions as hemodynamically important when the iFR threshold is 0.89. [8][9][10] Disagreement between the methods has usually been found to occur when the stenosis severity is in the intermediate range, close to the threshold. [8][9][10] This variation is unlikely to have an important effect on clinical outcomes, since observed rates of death and myocardial infarction are low in patient populations with FFR values close to the threshold of 0.80.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Disagreement between the methods has usually been found to occur when the stenosis severity is in the intermediate range, close to the threshold. [8][9][10] This variation is unlikely to have an important effect on clinical outcomes, since observed rates of death and myocardial infarction are low in patient populations with FFR values close to the threshold of 0.80. [1][2][3]17 Data suggest that in cases in which iFR and FFR classify lesions differently, iFR is the more accurate measure.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] The instantaneous wave-free ratio (iFR) is a recently developed physiological index used to assess the severity of stenosis.The iFR is calculated by measuring the resting pressure gradient across a coronary lesion during the portion of diastole when microvascular resistance is low and stable. 8 Benefits of iFR include the ability to obtain an instantaneous lesion assessment without the need to administer a hyperemic agent, such as adenosine. Although there are some differences between FFR and iFR in diagnostic results, a large outcome-based clinical trial has yet to establish whether such differences are of clinical relevance.…”

mentioning

confidence: 99%

“…Although there are some differences between FFR and iFR in diagnostic results, a large outcome-based clinical trial has yet to establish whether such differences are of clinical relevance. [8][9][10] The aim of this trial was to investigate whether iFR is noninferior to FFR with respect to subsequent clinical outcomes among patients who have an indication for physiologically guided assessment of coronary-artery stenosis.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

et al. 2017

View full text Add to dashboard Cite

BACKGROUNDThe instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. METHODSWe conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure. RESULTSA primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], −1.5 to 2.8; P = 0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P = 0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure. CONCLUSIONSAmong patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months. (Funded by Philips Volcano; iFR SWEDEHEART ClinicalTrials.gov number, NCT02166736.) a bs tr ac t

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This method has been proved to be influenced by hemodynamic variations and has not been validated for use in clinical practice. 32 …”

Section: Determination Of Coronary Flow Velocity Reservementioning

confidence: 99%

Invasive FFR — Current Applications and New Developments

Chițu¹,

Raț²,

Opincariu

et al. 2016

Journal of Interdisciplinary Medicine

View full text Add to dashboard Cite

Myocardial ischemia caused by coronary atherosclerosis is the main cause of cardiovascular mortality, which is the first cause of death in developed countries. Inducible myocardial ischemia is a negative prognostic factor for coronary artery disease patients, and it represents a major risk stratification marker for predicting mortality. The evolution of these patients depends largely on the extension of the ischemic myocardial mass and the severity of the inducible ischemia. Most patients do not show angiographically significant coronary stenosis. Therefore, such patients do not undergo coronary revascularization therapies, even though they present functional stenoses that trigger myocardial ischemia under stress conditions, which subsequently lead to a high risk for major adverse cardiovascular events. We performed a review that aims to pinpoint invasive techniques used for evaluating the functional impact of a coronary lesion that is considered non-significant upon angiographic examination, but which triggers episodes of myocardial ischemia under stress conditions, and to describe the functional markers that show the highest specificity for predicting ischemic risk, in order to recommend invasive coronary revascularization.Keywords: invasive fractional flow reserve, inducible myocardial ischemia, functional significance of coronary stenosis REVIEWCARDIOLOGY // IMAGING

show abstract

Physiology-Guided Management of Serial Coronary Artery Disease

et al. 2018

View full text Add to dashboard Cite

Serial coronary artery disease is common, and physiological assessment is prone to errors. The future, whether it be in improving the interpretation of fractional flow reserve, using resting indices such as instantaneous wave-free ratio, or examining novel flow-based resistance indices, will hopefully improve our management of this common yet unresolved clinical conundrum. In the meantime, revascularisation decisions in this challenging scenario should focus on clinical presentation and physiologic evaluation using a pressure-wire pullback maneuver and left main disease-free side branch where appropriate.

show abstract

Development and Validation of a New Adenosine-Independent Index of Stenosis Severity From Coronary Wave–Intensity Analysis

Cited by 611 publications

References 22 publications

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI

Invasive FFR — Current Applications and New Developments

Physiology-Guided Management of Serial Coronary Artery Disease

Contact Info

Product

Resources

About