TY - JOUR
T1 - Impact of stenosis resistance and coronary flow capacity on fractional flow reserve and instantaneous wave-free ratio discordance
T2 - a combined analysis of DEFINE-FLOW and IDEAL
AU - Stegehuis, Valérie
AU - Boerhout, Coen
AU - Kikuta, Yuetsu
AU - Cambero-Madera, Maribel
AU - van Royen, Niels
AU - Matsuo, Hitoshi
AU - Nakayama, Masafumi
AU - de Waard, Guus
AU - Knaapen, Paul
AU - Nijjer, Sukhjinder
AU - Petraco, Ricardo
AU - Siebes, Maria
AU - Davies, Justin
AU - Escaned, Javier
AU - van de Hoef, Tim
AU - Piek, Jan
N1 - Funding Information: This work was supported by Philips-Volcano, the Medical Research Council (UK), British Heart Foundation and the National Institute for Health Research Imperial Biomedical Research Centre [S.S.N, S.S. and R.P.] and the Institute for Cardiovascular Research of the VU University of Amsterdam (ICaR-VU) [G.d.W. and N.v.R.]. Funding Information: J. Piek received significant institutional research support from Philips Volcano Corporation for DEFINE FLOW. T. van de Hoef, J. Davies and J. Piek report consultancy fees for Philips-Volcano. J. Davies reports consultancy fees for Philips-Volcano and St Jude Medical, manufacturers of sensor-equipped guidewires. M. Siebes received institutional research support from the University of Texas Health Science Center at Houston (for the DEFINE-FLOW study). V. Stegehuis, C. Boerhout, Y. Kikuta, M. Cambero-Madera, N. van Royen, H. Matsuo, M. Nakayama, G. de Waard, P. Knaapen, S. Nijjer, R. Petraco and J. Escaned declare that they have no competing interests. Publisher Copyright: © 2023, The Author(s).
PY - 2023/11
Y1 - 2023/11
N2 - Background: The pressure-derived parameters fractional flow reserve (FFR) and the emerging instantaneous wave-free ratio (iFR) are the most widely applied invasive coronary physiology indices to guide revascularisation. However, approximately 15–20% of intermediate stenoses show discordant FFR and iFR, and therapeutical consensus is lacking. Aims: We sought to associate hyperaemic stenosis resistance index, coronary flow reserve (CFR) and coronary flow capacity (CFC) to FFR/iFR discordance. Methods: We assessed pressure and flow measurements of 647 intermediate lesions (593 patients) of two multi-centre international studies. Results: FFR and iFR were discordant in 15% of all lesions (97 out of 647). FFR+/iFR− lesions had similar hyperaemic average peak velocity (hAPV), CFR and CFC as FFR−/iFR− lesions, whereas FFR−/iFR+ lesions had similar hAPV, CFR and CFC as FFR+/iFR+ lesions (p > 0.05 for all). FFR+/iFR− lesions were associated with lower baseline stenosis resistance, but not hyperaemic stenosis resistance, compared with FFR−/iFR+ lesions (p < 0.001). Conclusions: Discordance with FFR+/iFR− is characterised by maximal flow values, CFR, and CFC patterns similar to FFR−/iFR− concordance that justifies conservative therapy. Discordance with FFR−/iFR+ on the other hand, is characterised by low flow values, CFR, and CFC patterns similar to iFR+/FFR+ concordance that may benefit from percutaneous coronary intervention.
AB - Background: The pressure-derived parameters fractional flow reserve (FFR) and the emerging instantaneous wave-free ratio (iFR) are the most widely applied invasive coronary physiology indices to guide revascularisation. However, approximately 15–20% of intermediate stenoses show discordant FFR and iFR, and therapeutical consensus is lacking. Aims: We sought to associate hyperaemic stenosis resistance index, coronary flow reserve (CFR) and coronary flow capacity (CFC) to FFR/iFR discordance. Methods: We assessed pressure and flow measurements of 647 intermediate lesions (593 patients) of two multi-centre international studies. Results: FFR and iFR were discordant in 15% of all lesions (97 out of 647). FFR+/iFR− lesions had similar hyperaemic average peak velocity (hAPV), CFR and CFC as FFR−/iFR− lesions, whereas FFR−/iFR+ lesions had similar hAPV, CFR and CFC as FFR+/iFR+ lesions (p > 0.05 for all). FFR+/iFR− lesions were associated with lower baseline stenosis resistance, but not hyperaemic stenosis resistance, compared with FFR−/iFR+ lesions (p < 0.001). Conclusions: Discordance with FFR+/iFR− is characterised by maximal flow values, CFR, and CFC patterns similar to FFR−/iFR− concordance that justifies conservative therapy. Discordance with FFR−/iFR+ on the other hand, is characterised by low flow values, CFR, and CFC patterns similar to iFR+/FFR+ concordance that may benefit from percutaneous coronary intervention.
KW - Coronary flow capacity
KW - Coronary flow reserve
KW - Fractional flow reserve
KW - Instantaneous wave-free ratio
UR - http://www.scopus.com/inward/record.url?scp=85168342487&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s12471-023-01796-x
DO - https://doi.org/10.1007/s12471-023-01796-x
M3 - Article
C2 - 37594612
SN - 1568-5888
VL - 31
SP - 434
EP - 443
JO - Netherlands heart journal
JF - Netherlands heart journal
IS - 11
ER -