The instantaneous wave-free ratio (iFR) for evaluation of non-culprit lesions in patients with acute coronary syndrome and multivessel disease

Indolfi, Ciro; Mongiardo, Annalisa; Spaccarotella, Carmen; Torella, Daniele; Caiazzo, Gianluca; Polimeni, Alberto; Sorrentino, Sabato; Micieli, Mariella; Sabatino, Jolanda; Curcio, Antonio; Rosa, Salvatore De

doi:10.1016/j.ijcard.2014.03.210

Cited by 38 publications

(30 citation statements)

References 53 publications

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“…Reproduced with permission from Petraco R, et al 66 Current Developments in Pressure-Only Indices stenoses in 82 patients with ACS and stable disease, an iFR threshold of 0.92 best matched an FFR of 0.80 with a diagnostic concordance with FFR of 81.3%. 71 No difference in diagnostic efficiency between ACS patients and those with stable disease was found and all apparent discrepancies were within the FFR 0.75-0.80 gray-zone. 71 Furthermore, when using a hybrid iFR-FFR approach, they found 68% of patients would be spared adenosine.…”

Section: Clinical Application Of Ifr: Using the Ifr-ffr Hybrid Approachmentioning

confidence: 82%

“…71 No difference in diagnostic efficiency between ACS patients and those with stable disease was found and all apparent discrepancies were within the FFR 0.75-0.80 gray-zone. 71 Furthermore, when using a hybrid iFR-FFR approach, they found 68% of patients would be spared adenosine. Further data will come from the DEFINE-FLAIR study, which is including patients with ACS.…”

Section: Clinical Application Of Ifr: Using the Ifr-ffr Hybrid Approachmentioning

confidence: 82%

“…The FORECAST study is an independent study using offline iFR calculation that demonstrated the feasibility of iFR measurements in nonculprit vessels in ACS patients. 71 In 123 resting state to be restored to allow measurement. If adenosine has been administered, time should be allowed for recovery, which can vary among patients.…”

Section: Ifr In Acsmentioning

confidence: 99%

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Advances in Coronary Physiology

Nijjer

Sen

Petraco

et al. 2015

Circ J

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Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting. (Circ J 2015; 79: 1172 -1184

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Section: Clinical Application Of Ifr: Using the Ifr-ffr Hybrid Approachmentioning

confidence: 82%

Section: Clinical Application Of Ifr: Using the Ifr-ffr Hybrid Approachmentioning

confidence: 82%

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Advances in Coronary Physiology

Nijjer

Sen

Petraco

et al. 2015

Circ J

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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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“…Further key elements in the decision-making process for treating ULMCA disease that are missing in the article by Mahmoud and colleagues but are well worth a mention are: (I) the known difference in terms of technical execution and clinical outcome for PCI between stenting of the LM ostium or trunk and the treatment of bifurcation or trifurcation lesions, that are associated with a higher rate of restenosis, while lesion location has no relevant influence on long-term results of CABG; (II) the angiographic definition of "significant" ULMCA disease remains challenging, whereas intracoronary evaluation techniques such as intracoronary imaging (IVUS/OCT) or iFR/FFR might be very helpful in this setting (15)(16)(17)(18); (III) PCI techniques to treat the stenosis of ULMCA are different and quite heterogeneous, and we know that implantation techniques have a significant impact on clinical results for PCI of a ULMCA (18); (IV) in our recent meta-regression analysis, older patients did better with PCI than CABG (12).…”

mentioning

confidence: 99%