Per-Vessel Level Analysis of Fractional Flow Reserve and Instantaneous Wave-Free Ratio Discordance　― Insights From the AJIP Registry ―

Warisawa, Takayuki; Cook, Christopher; Seligman, Henry; Howard, James P.; Ahmad, Yousif; Rajkumar, Christopher; Doi, Shun’ichi; Nakayama, Masafumi; Tanigaki, Toru; Omori, Hiroyuki; Nakajima, Ayako; Yamanaka, Futoshi; Goto, Sonoka; Yakuta, Yohei; Karube, Kenichi; Uetani, Teruyoshi; Kikuta, Yuetsu; Shiono, Yasutsugu; Kawase, Yoshiaki; Nishina, Hidetaka; Nakamura, Sunao; Escaned, Javier; Akashi, Yoshihiro J.; Matsuo, Hitoshi; Davies, Justin E.

doi:10.1253/circj.cj-19-0785

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…In LAD, but not in other locations, physiologically diffuse disease assessed by pressure-wire pullback has been associated with FFR−/iFR+, while physiological focal disease has been associated with FFR+/iFR−. 12 We observed a better concordance between FFR and iFR when measures were performed from LCX (87%), compared to LAD (80%). This difference could be explained by the difference in flow between LAD and LCX (ratio 2:1) and by a lesser amount of subtended myocardium in the LCX.…”

Section: Discussionmentioning

confidence: 59%

Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study

Rodríguez-Leor

Camarero

Blanco

et al. 2022

Circ: Cardiovascular Interventions

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BACKGROUND:There is little information available on agreement between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in left main coronary artery (LMCA) intermediate stenosis. Besides, several meta-analyses support the use of FFR to guide LMCA revascularization, but limited information is available on iFR in this setting. Our aims were to establish the concordance between FFR and iFR in intermediate LMCA lesions, to evaluate with intravascular ultrasound (IVUS) in cases of FFR/iFR discordance, and to prospectively validate the safety of deferring revascularization based on a hybrid decision-making strategy combining iFR and IVUS.METHODS: Prospective, observational, multicenter registry with 300 consecutive patients with intermediate LMCA stenosis who underwent FFR and iFR and, in case of discordance, IVUS and minimal lumen area measurements. Primary clinical end point was a composite of cardiovascular death, LMCA lesion-related nonfatal myocardial infarction, or unplanned LMCA revascularization.RESULTS: FFR and iFR had an agreement of 80% (both positive in 67 and both negative in 167 patients); in case of disagreement (31 FFR+/iFR-and 29 FFR−/iFR+) minimal lumen area was ≥6 mm 2 in 8.7% of patients with FFR+ and 14.6% with iFR+. Among the 300 patients, 105 (35%) underwent revascularization and 181 (60%) were deferred according to iFR and IVUS. At a median follow-up of 20 months, major adverse cardiac events incidence was 8.3% in the defer group and 13.3% in the revascularization group (hazard ratio, 0.71 [95% CI 0.30-1.72]; P=0.45). CONCLUSIONS:In patients with intermediate LMCA stenosis, a physiology-guided treatment decision is feasible either with FFR or iFR with moderate concordance between both indices. In case of disagreement, the use of IVUS may be useful to indicate revascularization. Deferral of revascularization based on iFR appears to be safe in terms of major adverse cardiac events.

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Section: Discussionmentioning

confidence: 59%

Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study

Rodríguez-Leor

Camarero

Blanco

et al. 2022

Circ: Cardiovascular Interventions

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“…Previous studies have shown that FFR measurement is confounded between the anterior and posterior vessels due to structural differences in each coronary artery [14,15]. Furthermore, a discrepancy between the severity of stenosis on CAG and functional evaluations, such as FFR, was more common in the LAD [16][17][18].…”

Section: Plos Onementioning

confidence: 99%

Impact of height difference between coronary ostium and location of intracoronary pressure sensor on fractional flow reserve measurements

Soh,

Kim,

Kang

et al. 2023

PLoS ONE

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Background During fractional flow reserve (FFR) measurements, distal coronary pressure (Pd) can be influenced by hydrostatic pressure changes resulting from the height difference (HD) between the coronary ostium and the location of the distal pressure sensor. Aims We investigated the effect of aortocoronary HD on the FFR measurements in each coronary artery. Methods In this retrospective cohort study, we analyzed 257 patients who underwent FFR measurements and coronary computed tomography (CCTA) within a year. Using CCTA, we measured HD as the vertical distance between the coronary ostium and a matched point of the distal coronary pressure sensor identified on coronary angiography. Results The location of the Pd sensor was higher than the coronary ostium in the left anterior descending artery (LAD) (-4.64 ± 1.15 cm) and lower than the coronary ostium in the left circumflex artery (LCX) (2.54 ± 1.05 cm) and right coronary artery (RCA) (2.03 ± 1.28 cm). The corrected FFR values by HD were higher in the LAD (0.78 ± 0.09 to 0.82 ± 0.09, P<0.01) and lower in the LCX and RCA than the original FFR values (0.87 ± 0.07 to 0.85 ± 0.08, P<0.01; 0.87 ± 0.10 to 0.86 ± 0.10, P<0.01, respectively). Using an FFR cut-off value of 0.8, the concordance rates between the FFR and corrected FFR values were 77.8%, 95.2%, and 100% in the LAD, LCX, and RCA, respectively. Conclusion HD between the coronary ostium and the distal coronary pressure sensor may affect FFR measurements and FFR-guided treatment decisions for coronary artery disease.

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Clinical use of physiological lesion assessment using pressure guidewires: an expert consensus document of the Japanese association of cardiovascular intervention and therapeutics—update 2022

Kawase

Matsuo

Kuramitsu

et al. 2022

Cardiovasc Interv and Ther

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Per-Vessel Level Analysis of Fractional Flow Reserve and Instantaneous Wave-Free Ratio Discordance　― Insights From the AJIP Registry ―

Cited by 5 publications

References 12 publications

Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study

Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study

Impact of height difference between coronary ostium and location of intracoronary pressure sensor on fractional flow reserve measurements

Clinical use of physiological lesion assessment using pressure guidewires: an expert consensus document of the Japanese association of cardiovascular intervention and therapeutics—update 2022

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Per-Vessel Level Analysis of Fractional Flow Reserve and Instantaneous Wave-Free Ratio Discordance ― Insights From the AJIP Registry ―

Cited by 5 publications

References 12 publications

Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study

Instantaneous Wave-Free Ratio for the Assessment of Intermediate Left Main Coronary Artery Stenosis: Correlations With Fractional Flow Reserve/Intravascular Ultrasound and Prognostic Implications: The iLITRO-EPIC07 Study

Impact of height difference between coronary ostium and location of intracoronary pressure sensor on fractional flow reserve measurements

Clinical use of physiological lesion assessment using pressure guidewires: an expert consensus document of the Japanese association of cardiovascular intervention and therapeutics—update 2022

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Per-Vessel Level Analysis of Fractional Flow Reserve and Instantaneous Wave-Free Ratio Discordance　― Insights From the AJIP Registry ―