Abstract
<p><span style="font-size: medium;"><strong>Background:</strong> The fractional flow reserve (FFR) has been established as a physiological tool for the assessment of coronary ischemia. The instantaneous wave-free ratio (iFR) is an alternative pressure-derived physiologic index from the diastolic wave-free period in stable conditions. The hyperemic iFR (h-iFR) may represent a diagnostic tool; however, its diagnostic performance is unclear. Thus, we aimed to assess the diagnostic performance of the h-iFR compared with the conventional whole-cycle FFR. </span></p><p><span style="font-size: medium;"><strong>Methods:</strong> Fifty consecutive lesions, which were diagnosed as 50-75% stenosis by coronary angiography, were analyzed regarding the h-iFR and FFR during the intravenous administration of adenosine using a pressure wire. The h-iFR and FFR were calculated via automated algorithms.</span></p><p><span style="font-size: medium;"><strong>Results:</strong> Twenty-two stenoses were positive (FFR ≦0.8), and 28 stenoses were negative (FFR &gt;0.8). The slope of the regression line was 1.28 in the positive group and 1.61 in the negative group. The FFR and h-iFR values ranged from 0.64 to 0.80 (0.75±0.04) and 0.52 to 0.82 (0.66±0.07), respectively, in the positive group and 0.81 to 1.02 (0.90±0.05) and 0.69 to 1.02 (0.87±0.08), respectively, in the negative group. The means of the differences between the FFR and h-iFR were 0.027 and 0.090 in the FFR positive and negative groups, respectively. </span></p><p><span style="font-size: medium;"><strong>Conclusions:</strong> The hyperemic iFR, which is calculated using the diastolic phase and exhibited a larger dynamic range than the FFR, especially in FFR-positive stenosis, may be a better physiological tool than the cardiac full-cycle FFR in the evaluation of coronary ischemia.</span></p><strong><br clear="all" /> </strong>
Highlights
Fractional flow reserve (FFR) is considered a useful physiological index to assess the functional status of coronary artery stenosis severity.[1,2,3,4] The fractional flow reserve (FFR) is calculated as the ratio of the mean distal intracoronary artery pressure to the aortic pressure at maximal hyperemia, and it has a normal value of 1.0.2-4 Recent mega studies have demonstrated that a clinical cutoff FFR value of 0.80 is the threshold below which the stenosis is considered for coronary artery intervention therapy, in addition to standard medical therapy.[5]
The FFR is calculated as the ratio of the mean distal intracoronary artery pressure to the aortic pressure at maximal hyperemia, and it has a normal value of 1.0.2-4 Recent mega studies have demonstrated that a clinical cutoff FFR value of 0.80 is the threshold below which the stenosis is considered for coronary artery intervention therapy, in addition to standard medical therapy.[5]
It has been reported that the diastolic FFR, which is obtained by the mean pressure only during the diastolic phase, is more sensitive and accurate regarding the physiological status in clinical and animal studies.[6,7]
Summary
Fractional flow reserve (FFR) is considered a useful physiological index to assess the functional status of coronary artery stenosis severity.[1,2,3,4] The FFR is calculated as the ratio of the mean distal intracoronary artery pressure to the aortic pressure at maximal hyperemia, and it has a normal value of 1.0.2-4 Recent mega studies have demonstrated that a clinical cutoff FFR value of 0.80 is the threshold below which the stenosis is considered for coronary artery intervention therapy, in addition to standard medical therapy.[5]. The instantaneous wave-free ratio (iFR) is an alternative pressure index without hyperemia, which is used to assess the physiological status of coronary artery stenosis. The fractional flow reserve (FFR) has been established as a physiological tool for the assessment of coronary ischemia. The instantaneous wave-free ratio (iFR) is an alternative pressure-derived physiologic index from the diastolic wave-free period in stable conditions. We aimed to assess the diagnostic performance of the h-iFR compared with the conventional whole-cycle FFR
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