Dérimay, F. et al. (2019) Predictive factors of discordance between the instantaneous wave‐free ratio and fractional flow reserve. Catheterization and Cardiovascular Interventions, 94(3), pp. 356-363. (doi: 10.1002/ccd.28116) (PMID:30702186)
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Abstract
Objectives: To identify clinical, angiographic and hemodynamic predictors of discordance between instantaneous wave‐free ratio (iFR) and fractional flow reserve (FFR). Background: The iFR was found to be non‐inferior to the gold‐standard FFR for guiding coronary revascularization, although it is discordant with FFR in 20% of cases. A better understanding of the causes of discordance may enhance application of these indices. Methods: Both FFR and iFR were measured in the prospective multicenter CONTRAST study. Clinical, angiographic and hemodynamic variables were compared between patients with concordant values of FFR and iFR (cutoff ≤0.80 and ≤0.89, respectively). Results: Out of the 587 patients included, in 466 patients (79.4%) FFR and iFR agreed: both negative, n = 244 (41.6%), or positive, n = 222 (37.8%). Compared with FFR, iFR was negative discordant (FFR+/iFR‐) in 69 (11.8%) patients and positive discordant (FFR‐/iFR+) in 52 (8.9%) patients. On multivariate regression, stenosis location (left main or proximal left anterior descending) (OR: 3.30[1.68;6.47]), more severe stenosis (OR: 1.77[1.35;2.30]), younger age (OR: 0.93[0.90;0.97]), and slower heart rate (OR: 0.59[0.42;0.75]) were predictors of a negative discordant iFR. Absence of a beta‐blocker (OR: 0.41[0.22;0.78]), older age (OR: 1.04[1.00;1.07]), and less severe stenosis (OR: 0.69[0.53;0.89]) were predictors of a positive discordant iFR. Conclusions: During iFR acquisition, stenosis location, stenosis degree, heart rate, age and use of beta blockers influence concordance with FFR and should be taken into account when interpreting iFR.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Berry, Professor Colin and Oldroyd, Dr Keith and Hennigan, Dr Barry |
Authors: | Dérimay, F., Johnson, N. P., Zimmermann, F. M., Adjedj, J., Witt, N., Hennigan, B., Koo, B.‐K., Barbato, E., Esposito, G., Trimarco, B., Rioufol, G., Park, S.‐J., Baptista, S. B., Chrysant, G. S., Leone, A. M., Jeremias, A., Berry, C., De Bruyne, B., Oldroyd, K. G., Pijls, N. H.J., and Fearon, W. F. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Catheterization and Cardiovascular Interventions |
Publisher: | Wiley |
ISSN: | 1522-1946 |
ISSN (Online): | 1522-726X |
Published Online: | 31 January 2019 |
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