2017
DOI: 10.1016/j.jacc.2017.07.770
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The Evolving Future of Instantaneous Wave-Free Ratio and Fractional Flow Reserve

Abstract: In this review, the authors reflect upon the role of coronary physiology in the modern management of coronary artery disease. They critically appraise the scientific background of the instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR), from early experimental studies to validation studies against indexes of ischemia, to clinical trials assessing outcome. At this important juncture for the field, the authors make predictions for the future of physiological stenosis assessment, outlining devel… Show more

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Cited by 166 publications
(146 citation statements)
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“…The clinical adaption of FFR is increasing, but remains low 1, 2, 19. The underlying reasons may include the high cost of pressure wires, tortuous vessels, and the need for pharmacological hyperemia induction.…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…The clinical adaption of FFR is increasing, but remains low 1, 2, 19. The underlying reasons may include the high cost of pressure wires, tortuous vessels, and the need for pharmacological hyperemia induction.…”
Section: Discussionmentioning
confidence: 99%
“…Following the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation [fractional flow reserve versus angiography for guiding percutaneous coronary intervention]) trials, the adoption of fractional flow reserve (FFR) has improved with a 16‐fold increase in FFR‐guided percutaneous coronary intervention in the United States from 2008 to 2012 1. Globally, the use of physiological lesion assessment remains low, with large areas performing less than 15% of eligible procedures with physiology guidance 2, 3…”
Section: Introductionmentioning
confidence: 99%
“…Conflicting data exits on whether deferral of nonculprit lesions should be iFR‐ or FFR‐guided in patients with acute coronary syndrome . QFR has been calibrated to mimic FFR despite being an adenosine‐free method.…”
Section: Discussionmentioning
confidence: 99%
“…A significant roadblock to utilization of Pd/Pa is the lack of randomized clinical trials that evaluate its effects on CV outcomes. While the CV benefit of FFR is robust and iFR, the same cannot be said of Pd/Pa . However, Pd/Pa appears to have nearly identical reproducibility to iFR which does have randomized outcomes data in two large trials “iFR‐SWEDEHEART” and “DEFINE‐FLAIR” totaling 4529 patients .…”
Section: Discussionmentioning
confidence: 99%
“…Although the wave‐free period has been proposed to have a specific diagnostic benefit, several different diastolic resting indexes have >99% correlation with iFR, which perhaps extends to whole‐cycle Pd/Pa . On the other hand, valid concerns about using whole‐cycle Pd/Pa rather than iFR must be considered including increased variability of measurements, lack of a well‐defined cutoff, pullback challenges, and greater susceptibility to wire drift . Also, iFR has been shown to be of high utility in tandem lesions and has a co‐registration technology to aid in lesion specific analysis which Pd/Pa has not yet been studied …”
Section: Discussionmentioning
confidence: 99%