iFR-FFR comparison in daily practice

Fede, Alfredo; Zivelonghi, Carlo; Benfari, Giovanni; Pesarini, Gabriele; Pighi, Michele; Ferrara, Angela; Piccoli, Anna; Ariotti, Sara; Ferrero, Valeria; Mura, Daniela Dalla; Battistoni, Monica; Vassanelli, Corrado; Ribichini, Flavio

doi:10.2459/jcm.0000000000000272

Cited by 11 publications

(4 citation statements)

References 10 publications

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“…During the assessment of eligibility, further 6 studies were excluded. 8,[30][31][32][33][34] Finally, a total of 23 studies were available for the analysis, 7,[9][10][11][12][13][14][15][16][17][18][19][20][21]28,29,[35][36][37][38][39][40][41] including 6381 stenoses. The study selection procedure is reported in details in Figure 1 while the Table summarizes the most relevant characteristics of the selected studies.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Performance of the Instantaneous Wave-Free Ratio

Rosa

Polimeni

Petraco

et al. 2018

Circ: Cardiovascular Interventions

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Background— Aim of the present study was to perform a meta-analysis of all available studies comparing the instantaneous wave-free ratio (iFR) with fractional flow reserve (FFR). Methods and Results— Published trials comparing the iFR with FFR were searched for in PubMed, Google Scholar, and Scopus electronic databases. A total of 23 studies were available for the analysis, including 6381 stenoses. First, a meta-analysis of all studies was performed exploring the correlation between FFR and iFR. Interestingly, we found good correlation (0.798 [0.78–0.82]) between the 2 indices ( P <0.001). In addition, to evaluate the diagnostic performance of iFR to identify FFR-positive coronary stenoses, we performed an additional meta-analysis, summarizing the results of receiver operating characteristics analyses from individual studies reporting the area under the curve. Summing the results of these studies, we found that iFR has a good diagnostic performance for the identification of FFR-positive stenoses (area under the curve=0.88 [0.86–0.90]; P <0.001). Furthermore, our search results included 5 studies that compared iFR and FFR to a third independent reference standard. Interestingly, no significant differences between iFR and FFR were reported in those studies. Conclusions— The present meta-analysis shows that iFR significantly correlates with standard FFR and shows a good diagnostic performance in identifying FFR-positive coronary stenoses. Finally, iFR and FFR have similar diagnostic efficiency for detection of ischemia-inducing stenoses when tested against a third comparator.

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Section: Resultsmentioning

confidence: 99%

Diagnostic Performance of the Instantaneous Wave-Free Ratio

Rosa

Polimeni

Petraco

et al. 2018

Circ: Cardiovascular Interventions

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“…However, many studies use different threshold values of iFR to determine whether a patient needs further treatment . The estimation of the iFR diagnostic threshold ranges from 0.92, 0.9, 0.89, 0.88, and even 0.83, which obviously indicates that the best diagnostic threshold for iFR is still not known. The results from this paper indicate that the diagnostic threshold for iFR is close to 0.89 and that the relationship between ciFR and cFFR is quadratic in nature.…”

Section: Discussionmentioning

confidence: 99%

Computational instantaneous wave‐free ratio (IFR) for patient‐specific coronary artery stenoses using 1D network models

Carson

Roobottom

Alcock

et al. 2019

Numer Methods Biomed Eng

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In this work, we estimate the diagnostic threshold of the instantaneous wave‐free ratio (iFR) through the use of a one‐dimensional haemodynamic framework. To this end, we first compared the computed fractional flow reserve (cFFR) predicted from a 1D computational framework with invasive clinical measurements. The framework shows excellent promise and utilises minimal patient data from a cohort of 52 patients with a total of 66 stenoses. The diagnostic accuracy of the cFFR model was 75.76%, with a sensitivity of 71.43%, a specificity of 77.78%, a positive predictive value of 60%, and a negative predictive value of 85.37%. The validated model was then used to estimate the diagnostic threshold of iFR. The model determined a quadratic relationship between cFFR and the ciFR. The iFR diagnostic threshold was determined to be 0.8910 from a receiver operating characteristic curve that is in the range of 0.89 to 0.9 that is normally reported in clinical studies.

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“…Anyway, from the first reports emerged a discordance between FFR and iFR (positive versus negative and vice versa) in around 20% of cases. 10 The strongest predictors of iFR/FFR discordance were identified in stenosis location [left main (LM) or proximal left anterior descending (LAD)], stenosis severity or clinical conditions as hospital admission for acute coronary syndromes. Thus, it is not surprising that some authors started to report a potential benefit of an index (iFR) over the other (FFR) in some clinical scenarios.…”

mentioning

confidence: 99%

“…The iFR cut-off indicating the need for coronary revascularization (0.89) has been validated versus FFR (0.80). Anyway, from the first reports emerged a discordance between FFR and iFR (positive versus negative and vice versa) in around 20% of cases 10 . The strongest predictors of iFR/FFR discordance were identified in stenosis location [left main (LM) or proximal left anterior descending (LAD)], stenosis severity or clinical conditions as hospital admission for acute coronary syndromes.…”

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confidence: 99%