In vivo validation of resting full-cycle ratio and diastolic pressure ratio: simultaneous measurement with instantaneous wave-free ratio

Kawase, Yoshiaki; Omori, Hiroyuki; Tanigaki, Toru; Hirakawa, Akihiro; Hirata, Tetsuya; Ota, Hiroyoshi; Kikuchi, Jun; Sobue, Yoshihiro; Okubo, Munenori; Kamiya, Hiroki; Kawasaki, Masanori; Suzuki, Takahiko; Matsuo, Hitoshi

doi:10.1007/s12928-020-00648-4

Cited by 7 publications

(10 citation statements)

References 10 publications

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“…Finally, the percentage of stenoses ≥70% was limited, which reduces validity in reference to angiographically significant lesions. However, the inclusion of lesions ≥70% was greater than that in previous studies [ 9 , 19 , 21 ].…”

Section: Discussionmentioning

confidence: 58%

“…This is because the inclusion criteria used were scantly restrictive, allowing the inclusion of patients with ischemic heart disease encompassing the entire spectrum of situations in which invasive physiological studies are used in routine clinical practice. Furthermore, in contrast to most published studies [ 9 , 19 , 21 ] that almost exclusively evaluate intermediate lesions in stable patients, our study included a modest percentage (19.5%) of lesions ≥70%. The lesions included in this range of stenoses corresponded mainly to patients referred to the hemodynamics laboratory without prior ischemia evaluation and patients with multivessel disease amenable to surgical revascularization.…”

Section: Discussionmentioning

confidence: 99%

“…Another strength of our study was the induction of coronary vasodilatation with adenosine—which is the drug most commonly used for this purpose—in contrast to other RFR validation studies involving other vasodilators (nitroglycerin, nicorandil, etc.) [ 9 , 19 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

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Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR—The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study

Casanova-Sandoval

Fernández-Rodríguez

Otaegui

et al. 2021

Journal of Interventional Cardiology

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Background. The resting full‐cycle ratio (RFR) is a novel resting index which in contrast to the gold standard (fractional flow reserve (FFR)) does not require maximum hyperemia induction. The objectives of this study were to evaluate the agreement between RFR and FFR with the currently recommended thresholds and to design a hybrid RFR-FFR ischemia detection strategy, allowing a reduction of coronary vasodilator use. Materials and Methods. Patients subjected to invasive physiological study in 9 Spanish centers were prospectively recruited between April 2019 and March 2020. Sensitivity and specificity studies were made to assess diagnostic accuracy between the recommended levels of RFR ≤0.89 and FFR ≤0.80 (primary objective) and to determine the RFR “grey zone” in order to define a hybrid strategy with FFR affording 95% global agreement compared with FFR alone (secondary objective). Results. A total of 380 lesions were evaluated in 311 patients. Significant correlation was observed (R2 = 0.81; P < 0.001 ) between the two techniques, with 79% agreement between RFR ≤ 0.89 and FFR ≤ 0.80 (positive predictive value, 68%, and negative predictive value, 80%). The hybrid RFR-FFR strategy, administering only adenosine in the “grey zone” (RFR: 0.86 to 0.92), exhibited an agreement of over 95% with FFR, with high predictive values (positive predictive value, 91%, and negative predictive value, 92%), reducing the need for vasodilators by 58%. Conclusions. Dichotomous agreement between RFR and FFR with the recommended thresholds is significant but limited. The adoption of a hybrid RFR-FFR strategy affords very high agreement, with minimization of vasodilator use.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR—The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study

Casanova-Sandoval

Fernández-Rodríguez

Otaegui

et al. 2021

Journal of Interventional Cardiology

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“…Today, fiber-optic systems have been associated with a decrease in risk of pressure drifts and much better wire behavior and present the optimal tool for physiological assessment after intervention. 6,11,12 It should be reminded that even though optical-based pressure wires are more reliable and provide operators with stable pressure measurements without drifts even after disconnection and reconnection, the stability issues of Pa measurements are yet to be In conclusion, introduction of fiber-optic based pressure wires in clinical practice provides clinicians improved tools to assess physiology pre-and post-PCI in a growing number of coronary lesions types.…”

Section: Discussionmentioning

confidence: 99%

A novel fiber‐optic based 0.014″ pressure wire: Designs of the OptoWire™, development phases, and the O₂ first‐in‐man results

Ulacia

Rimac

Lalancette³

et al. 2020

Cathet Cardio Intervent

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Objectives: To review the technical limitations of available pressure-wires, present the design evolution of a nitinol fiber-optic pressure wire and to summarize the Firstin-Man (FIM) O 2 pilot study results.Background: Despite increasing use of physiology assessment of coronary lesions, several technical limitations persist. We present technical details, design evolution and early clinical results with a novel 0.014" nitinol fiber-optic based pressure-wire.Methods and Results: The 0.014' OptoWire™ (Opsens Medical, Quebec, Canada) was designed to combine improved handling properties compared to standard pressure-wires and to offer extremely reliable pressure recording and transmission due to fiber-optic properties compared to piezo-electric sensors and electrical wires. In vitro assessment showed that OptoWire™ steerability, pushability and torquability properties were closer to regular PCI wires than standard electrical pressure wires. In the First-in-Man O 2 study, 60 patients were recruited at 2 centers in Canada. A total of 103 lesions were assessed with the OptoWire™ and OptoMonitor™, 75 lesions at baseline and 28 lesions post-PCI (without disconnection). In all crossed lesions (n = 100, 97%), mean Pd/Pa and FFR could be adequately measured. In 11 cases assessed successively with OptoWire™ and Aegis™ (Abbott Vascular, USA) bland-Altman analysis showed a mean difference of 0.002 ± 0.052 mmHg (p = .91) for Pd/Pa and 0.01 ± 0.06 for FFR calculation (p = .45). There was no device-related complication. Upon these initial results, several design changes aimed to improve overall performance including torquability, stiffness, resistance to kink and pressure drift were completed. Conclusion:The novel 0.014" fiber-optic OptoWire™ provides superior wire handling with reduced risk of pressure drift allowing reliable pre-and post-PCI physiology assessment.

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“…3,4 No entanto, a escolha dos limiares de corte usando a análise da curva característica de operação do receptor (ROC) significa que alterações mínimas no limiar de corte podem levar a alterações relevantes na sensibilidade e especificidade. [5][6][7] Além disso, os limiares de corte otimizados variam entre séries, sugerindo que a heterogeneidade das populações estudadas pode influenciar a capacidade diagnóstica desses índices. [5][6][7] O conceito de "zona cinzenta" na reserva de fluxo coronariano ou reserva de fluxo fracionado (FFR) 8,9 referese a uma faixa de valores próximos ao limiar de corte cujos extremos têm altos valores preditivos para confirmar ou descartar isquemia.…”

Section: Introductionunclassified

Ajustando a RFR por Preditores de Discordância, “A RFR Ajustada”: Uma Metodologia Alternativa para Melhorar a Capacidade Diagnóstica dos Índices Coronarianos

Fernández-Rodríguez¹,

Casanova-Sandoval²,

Barriuso³

et al. 2022

Arquivos Brasileiros De Cardiologia

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Fundamento: Os limiares de corte para a "relação do ciclo completo de repouso" (RFR) oscilam em diferentes séries, sugerindo que as características da população podem influenciá-los. Da mesma forma, foram documentados preditores de discordância entre a RFR e a reserva de fluxo fracionado (FFR). O Estudo RECOPA, mostrou que a capacidade diagnóstica está reduzida na "zona cinzenta" da RFR, tornando necessária a realização de FFR para descartar ou confirmar isquemia.Objetivos: Determinar os preditores de discordância, integrar as informações que eles fornecem em um índice clínicofisiológico: a "RFR Ajustada", e comparar sua concordância com o FFR.Métodos: Usando dados do Estudo RECOPA, os preditores de discordância em relação à FFR foram determinados na "zona cinzenta" da RFR (0,86 a 0,92) para construir um índice ("RFR Ajustada") que pesaria a RFR juntamente com os preditores de discordância e avaliar sua concordância com a FFR.Resultados: Foram avaliadas 156 lesões em 141 pacientes. Os preditores de discordância foram: doença renal crônica, cardiopatia isquêmica prévia, lesões não envolvendo a artéria descendente anterior esquerda e síndrome coronariana aguda. Embora limitada, a "RFR Ajustada" melhorou a capacidade diagnóstica em comparação com a RFR na "zona cinzenta" (AUC-RFR = 0,651 versus AUC-"RFR Ajustada" = 0,749), mostrando também uma melhora em todos os índices diagnósticos quando foram estabelecidos limiares de corte otimizados (sensibilidade: 59% a 68%; especificidade: 62% a 75%; acurácia diagnóstica: 60% a 71%; razão de verossimilhança positiva: 1,51 a 2,34; razão de verossimilhança negativa: 0,64 a 0,37).Conclusões: Ajustar a RFR integrando as informações fornecidas pelos preditores de discordância para obter a "RFR Ajustada" melhorou a capacidade diagnóstica em nossa população. Mais estudos são necessários para avaliar se os índices clínico-fisiológicos melhoram a capacidade diagnóstica da RFR ou de outros índices coronarianos.Palavras-chave: Angina; Reserva de Fluxo Fracionado; Relação do Ciclo Completo de Repouso; Sensibilidade; Especificidade.

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In vivo validation of resting full-cycle ratio and diastolic pressure ratio: simultaneous measurement with instantaneous wave-free ratio

Cited by 7 publications

References 10 publications

Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR—The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study

Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR—The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study

A novel fiber‐optic based 0.014″ pressure wire: Designs of the OptoWire™, development phases, and the O₂ first‐in‐man results

Ajustando a RFR por Preditores de Discordância, “A RFR Ajustada”: Uma Metodologia Alternativa para Melhorar a Capacidade Diagnóstica dos Índices Coronarianos

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In vivo validation of resting full-cycle ratio and diastolic pressure ratio: simultaneous measurement with instantaneous wave-free ratio

Cited by 7 publications

References 10 publications

Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR—The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study

Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR—The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study

A novel fiber‐optic based 0.014″ pressure wire: Designs of the OptoWire™, development phases, and the O2 first‐in‐man results

Ajustando a RFR por Preditores de Discordância, “A RFR Ajustada”: Uma Metodologia Alternativa para Melhorar a Capacidade Diagnóstica dos Índices Coronarianos

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A novel fiber‐optic based 0.014″ pressure wire: Designs of the OptoWire™, development phases, and the O₂ first‐in‐man results