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Instantaneous wave free ratio

Barry Hennigan, Keith G Oldroyd, Colin Berry, Nils Johnson, John McClure, Peter McCartney, Margaret B McEntegart, Hany Eteiba, Mark C Petrie, Paul Rocchiccioli, Richard Good, Martin M Lindsay, Stuart Hood, Stuart Watkins
BACKGROUND: Distal coronary to aortic pressure ratio (Pd/Pa) and instantaneous wave-free ratio (iFR) are indices of functional significance of a coronary stenosis measured without hyperemia. It has been suggested that iFR has superior diagnostic accuracy to Pd/Pa when compared with fractional flow reserve (FFR).We hypothesized that in comparison with FFR, revascularization decisions based on either binary cutoff values for iFR and Pd/Pa or hybrid strategies incorporating iFR or Pd/Pa will result in similar levels of disagreement...
November 2016: Circulation. Cardiovascular Interventions
P Meimoun, J Clerc, D Ardourel, U Djou, S Martis, T Botoro, F Elmkies, H Zemir, A Luycx-Bore, J Boulanger
To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50-70 % diameter stenosis), were prospectively studied...
October 17, 2016: International Journal of Cardiovascular Imaging
Wanrong Man, Jianqiang Hu, Zhijing Zhao, Mingming Zhang, Tingting Wang, Jie Lin, Yu Duan, Ling Wang, Haichang Wang, Dongdong Sun, Yan Li
BACKGROUND: The instantaneous wave-free ratio (iFR) is a new vasodilator-free index of coronary stenosis severity. The aim of this meta-analysis is to assess the diagnostic performance of iFR for the evaluation of coronary stenosis severity with fractional flow reserve as standard reference. METHODS: We searched PubMed, EMBASE, CENTRAL, ProQuest, Web of Science, and International Clinical Trials Registry Platform (ICTRP) for publications concerning the diagnostic value of iFR...
September 2016: Medicine (Baltimore)
T Härle, S Meyer, W Bojara, F Vahldiek, A Elsässer
INTRODUCTION: Intracoronary pressure measurements have improved assessment of angiographic intermediate coronary stenoses. Methodically, pressure equalization and actual measurements are frequently performed at different height levels, depending on the particular coronary territory analyzed. Considering a hypothetical influence of hydrostatic pressure and the supine position of the patient, differences in the results of intracoronary measurements between anterior and posterior vessels seem likely...
August 31, 2016: Herz
Luigi Di Serafino, Gabriella Scognamiglio, Maurizio Turturo, Giovanni Esposito, Riccardo Savastano, Saverio Lanzone, Bruno Trimarco, Carlo D'Agostino
BACKGROUND: Coronary angiography has poor predictive value for functionally significant coronary artery stenosis. The Fractional Flow Reserve (FFR) currently represents the gold standard to define the ischemic potential of epicardial stenosis and, recently, the instantaneous wave-free ratio (iFR), has also been introduced as alternative to the FFR, but it still remains an invasive procedure. We aimed this study in order to evaluate the accuracy of the "Angiography-DeriveD hEmoDynamic index" (ADDED index) to predict the FFR as compared with the iFR...
November 15, 2016: International Journal of Cardiology
Ashkan Javadzadegan, Andy S C Yong, Michael Chang, Martin K C Ng, Masud Behnia, Leonard Kritharides
: Abnormal haemodynamic parameters are associated with atheroma plaque progression and instability in coronary arteries. Flow recirculation, shear stress and pressure gradient are understood to be important pathogenic mediators in coronary disease. The effect of freedom of coronary artery movement on these parameters is still unknown. Fluid-structure interaction (FSI) simulations were carried out in 25 coronary artery models derived from authentic human coronaries in order to investigate the effect of degree of freedom of movement of the coronary arteries on flow recirculation, wall shear stress (WSS) and wall pressure gradient (WPG)...
July 28, 2016: Computer Methods in Biomechanics and Biomedical Engineering
Khawaja Afzal Ammar, Syed Shahab Kazmi, Mirza Nubair Ahmad, Mirza Mujadil Ahmad, Arsalan Riaz, Imran Husain, Fatima Husain, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta
OBJECTIVES: Recent studies have suggested that fractional flow reserve (FFR) measurement can be avoided by using similar ranges of baseline mean coronary pressure (Pd) to mean aortic pressure (Pa) ratio (0.88-0.95). Further studies have suggested that too many significant coronary stenoses are misclassified based on these ranges. We hypothesized that with a certain range of baseline Pd/Pa, 100% positive predictive value (PPV) and negative predictive value (NPV) can be achieved to avoid misclassification...
July 2016: Journal of Invasive Cardiology
Hitoshi Matsuo, Yoshiaki Kawase
Fractional flow reserve (FFR) is an invasive physiologic index measured in the cardiac catheterization laboratory to assess the functional significance of a coronary stenosis. It is now accepted as the reference standard to indicate whether a stenosis is likely to be responsible for ischemia. It is generally accepted that a stenosis with an ischemic value of FFR is responsible for symptom and a worse outcome and should be revascularized, whereas lesions with a non-ischemic FFR have a more favorable prognosis and can be treated medically...
July 2016: Cardiovascular Intervention and Therapeutics
F Picard, V X Tadros, M Pighi, V Spagnoli, Q De Hemptinne, H Q Ly
In recent years, a large body of evidence has revealed the limitations of angiographic evaluation in determining the physiological significance of coronary stenosis, particularly when these are intermediate lesions. Percutaneous coronary interventions (PCI) guided by physiological assessment using fractional flow reserve (FFR) have been shown to reduce cardiovascular events when compared to angiography alone. Recently, another coronary physiologic parameter has been introduced: the "instantaneous wave-free ratio" (iFR)...
May 19, 2016: Annales de Cardiologie et D'angéiologie
Doyeon Hwang, Joo Myung Lee, Bon-Kwon Koo
The presence of myocardial ischemia is the most important prognostic factor in patients with ischemic heart disease. Fractional flow reserve (FFR) is a gold standard invasive method used to detect the stenosis-specific myocardial ischemia. FFR-guided revascularization strategy is superior to angiography-guided strategy. The recently developed hyperemia-free index, instantaneous wave free ratio is being actively investigated. A non-invasive FFR derived from coronary CT angiography is now used in clinical practice...
May 2016: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Nils P Johnson, Allen Jeremias, Frederik M Zimmermann, Julien Adjedj, Nils Witt, Barry Hennigan, Bon-Kwon Koo, Akiko Maehara, Mitsuaki Matsumura, Emanuele Barbato, Giovanni Esposito, Bruno Trimarco, Gilles Rioufol, Seung-Jung Park, Hyoung-Mo Yang, Sérgio B Baptista, George S Chrysant, Antonio M Leone, Colin Berry, Bernard De Bruyne, K Lance Gould, Richard L Kirkeeide, Keith G Oldroyd, Nico H J Pijls, William F Fearon
OBJECTIVES: This study compared the diagnostic performance with adenosine-derived fractional flow reserve (FFR) ≤0.8 of contrast-based FFR (cFFR), resting distal pressure (Pd)/aortic pressure (Pa), and the instantaneous wave-free ratio (iFR). BACKGROUND: FFR objectively identifies lesions that benefit from medical therapy versus revascularization. However, FFR requires maximal vasodilation, usually achieved with adenosine. Radiographic contrast injection causes submaximal coronary hyperemia...
April 25, 2016: JACC. Cardiovascular Interventions
Bjarne L Nørgaard, Jakob Hjort, Sara Gaur, Nicolaj Hansson, Hans Erik Bøtker, Jonathon Leipsic, Ole N Mathiassen, Erik L Grove, Kamilla Pedersen, Evald H Christiansen, Anne Kaltoft, Lars C Gormsen, Michael Mæng, Christian J Terkelsen, Steen D Kristensen, Lars R Krusell, Jesper M Jensen
OBJECTIVES: The goal of this study was to assess the real-world clinical utility of fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFRCT) for decision-making in patients with stable coronary artery disease (CAD). BACKGROUND: FFRCT has shown promising results in identifying lesion-specific ischemia. The real-world feasibility and influence on the diagnostic work-up of FFRCT testing in patients suspected of having CAD are unknown...
April 7, 2016: JACC. Cardiovascular Imaging
Christopher M Cook, Yousif Ahmad, Matthew J Shun-Shin, Sukhjinder Nijjer, Ricardo Petraco, Rasha Al-Lamee, Jamil Mayet, Darrel P Francis, Sayan Sen, Justin E Davies
BACKGROUND: Small drifts in intracoronary pressure measurements (±2 mm Hg) can affect stenosis categorization using pressure indices. This has not previously been assessed for fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and whole-cycle distal pressure/proximal pressure (Pd/Pa) indices. METHODS AND RESULTS: Four hundred forty-seven stenoses were assessed with FFR, iFR, and whole-cycle Pd/Pa. Cut point values for significance were predefined as ≤0...
April 2016: Circulation. Cardiovascular Interventions
Antonio Nenna, Cristiano Spadaccio, Mario Lusini, Raffaele Barbato, Massimo Chello, Francesco Nappi
Optimal revascularization strategy in patients with multi-vessel coronary artery disease remains a matter of debate, with advantages and disadvantages in both surgical and percutaneous procedures. A combined approach to achieve coronary revascularization, termed "hybrid coronary revascularization" (HCR), has been recently introduced in clinical practice. HCR is defined as a scheduled combination of surgical left internal mammary artery to left anterior descending (LIMA-LAD) grafting and percutaneous treatment of at least one non-LAD coronary arteries, with both procedures planned and performed within a defined time limit...
April 2016: Surgical Technology International
Yoshihisa Kanaji, Tadashi Murai, Tetsumin Lee, Junji Matsuda, Eisuke Usui, Makoto Araki, Takayuki Niida, Sadamitsu Ichijyo, Rikuta Hamaya, Taishi Yonetsu, Shigeki Kimura, Tsunekazu Kakuta
BACKGROUND: Despite evidence demonstrating the benefits of percutaneous coronary intervention guided by fractional flow reserve (FFR), FFR evaluation has not been widely adopted. We sought to compare the diagnostic performances of instantaneous wave-free ratio (iFR) to a novel contrast medium-induced index in FFR prediction, hypothesizing that the latter parameter would offer superior diagnostic agreement with FFR. METHODS & RESULTS: We studied 132 intermediate stenoses in 97 patients prospectively...
April 1, 2016: International Journal of Cardiology
Matthias Götberg, Evald H Christiansen, Ingibjörg Gudmundsdottir, Lennart Sandhall, Elmir Omerovic, Stefan K James, David Erlinge, Ole Fröbert
BACKGROUND: Instantaneous wave-free ratio (iFR) is a new hemodynamic resting index for assessment of coronary artery stenosis severity. iFR uses high frequency sampling to calculate a gradient across a coronary lesion during a period of diastole. The index has been tested against fractional flow reserve (FFR) and found to have an overall classification agreement of 80% to 85%. Whether the level of disagreement is clinically relevant is unknown. Clinical outcome data on iFR are scarce...
November 2015: American Heart Journal
Raffaele Piccolo, Gennaro Giustino, Roxana Mehran, Stephan Windecker
Stable coronary artery disease is the most common clinical manifestation of ischaemic heart disease and a leading cause of mortality worldwide. Myocardial revascularisation is a mainstay in the treatment of symptomatic patients or those with ischaemia-producing coronary lesions, and reduces ischaemia to a greater extent than medical treatment. Documentation of ischaemia and plaque burden is fundamental in the risk stratification of patients with stable coronary artery disease, and several invasive and non-invasive techniques are available (eg, fractional flow reserve or intravascular ultrasound) or being validated (eg, instantaneous wave-free ratio and optical coherence tomography)...
August 15, 2015: Lancet
Tobias Härle, Sven Meyer, Felix Vahldiek, Albrecht Elsässer
BACKGROUND: Measurement of fractional flow reserve (FFR) has become a standard diagnostic tool in the catheterization laboratory. FFR evaluation studies were based on pressure recordings during steady-state maximum hyperemia. Commercially available computer systems detect the lowest Pd/Pa ratio automatically, which might not always be measured during steady-state hyperemia. We sought to compare the automatically detected FFR and true steady-state FFR. METHODS AND RESULTS: Pressure measurement traces of 105 coronary lesions from 77 patients with intermediate coronary lesions or multivessel disease were reviewed...
February 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Nils P Johnson, Daniel T Johnson, Richard L Kirkeeide, Colin Berry, Bernard De Bruyne, William F Fearon, Keith G Oldroyd, Nico H J Pijls, K Lance Gould
OBJECTIVES: This study classified and quantified the variation in fractional flow reserve (FFR) due to fluctuations in systemic and coronary hemodynamics during intravenous adenosine infusion. BACKGROUND: Although FFR has become a key invasive tool to guide treatment, questions remain regarding its repeatability and stability during intravenous adenosine infusion because of systemic effects that can alter driving pressure and heart rate. METHODS: We reanalyzed data from the VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice) study, which enrolled consecutive patients who were infused with intravenous adenosine at 140 μg/kg/min and measured FFR twice...
July 2015: JACC. Cardiovascular Interventions
Tobias Härle, Waldemar Bojara, Sven Meyer, Albrecht Elsässer
BACKGROUND: The instantaneous wave-free ratio (iFR) is a new adenosine-independent index of coronary stenosis severity. Most published data have been based on off-line analyses of pressure recordings in a core laboratory. We prospectively compared real-time iFR and fractional flow reserve (FFR) measurements. METHODS AND RESULTS: iFR and FFR were measured in 151 coronary stenoses in 108 patients. Repeated iFR measurements were technically simple, showed excellent agreement [rs=0...
November 15, 2015: International Journal of Cardiology
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