Abstract
Instantaneous wave-free ratio (iFR)-guided coronary revascularization has similar clinical outcomes compared to fractional flow reserve (FFR)-guided revascularization strategy. However, some studies have shown a discordance of around 20% between iFR and FFR. Although various factors have been reported in the literature to affect pressure indices and lead to such discordance, there is a paucity of data regarding the effect of diastolic dysfunction on functional assessment of coronary arteries. Our study aimed to investigate whether there was an association between echocardiographic left ventricular diastolic dysfunction and iFR/FFR discordance. This retrospective observational study evaluated 100 patients with angiographically intermediate coronary stenosis (50–70%) who underwent physiological testing with iFR and FFR. Transthoracic echocardiograms were reviewed to assess echocardiographic indices of diastolic function. The study population was divided into two groups based on diastolic function. iFR and FFR discordance was measured in each group and compared to evaluate the statistical difference. The mean age of the study population was 66.22 ± 10.02 years. Discordance between iFR and FFR was seen in 45.16% of patients with diastolic dysfunction compared to 24.64% of patients with normal diastolic function (p = 0.04). Multivariable logistic regression analysis indicated that echocardiographic E/e′ was independently associated with iFR/FFR discordance (p = 0.02). Left ventricular diastolic dysfunction is a significant factor that can lead to discordance between iFR and FFR and should be taken into account during coronary physiological testing.
Highlights
Functional assessment with instantaneous wave-free ratio and fractional flow reserve (FFR) can help in the assessment of angiographically intermediate lesions in patients with stable ischemic heart disease and multivessel disease [1,2,3]
The baseline characteristics of patients were similar between the two groups except for the increased prevalence of chronic systolic heart failure in patients with diastolic dysfunction
Some of the factors affecting the discordance of instantaneous wave-free ratio (iFR) and FFR have been previously evaluated, we report for the first time that echocardiographic diastolic dysfunction can impact invasive hemodynamic assessment with IFR and increase the discordance between iFR and FFR
Summary
Functional assessment with instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) can help in the assessment of angiographically intermediate lesions in patients with stable ischemic heart disease and multivessel disease [1,2,3]. FFR correlates well with noninvasive stress tests regarding the functional significance of the coronary lesions [4]. FFR use has been limited by many factors in clinical practice, such as the use of vasodilator with its resultant side effects, cost, and procedure time [5]. There has been an increase in the use of non-hyperemic pressure indices due to the ease of use and similar diagnostic accuracy as FFR [3,7]. Various factors can lead to discordance between iFR and FFR, the effect of diastolic dysfunction on their discordance has not been studied before
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