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Instantaneous wave free ratio

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https://www.readbyqxmd.com/read/28882237/the-evolving-future-of-instantaneous%C3%A2-wave-free-ratio-and-fractional-flow%C3%A2-reserve
#1
REVIEW
Matthias Götberg, Christopher M Cook, Sayan Sen, Sukhjinder Nijjer, Javier Escaned, Justin E Davies
In this review, the authors reflect upon the role of coronary physiology in the modern management of coronary artery disease. They critically appraise the scientific background of the instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR), from early experimental studies to validation studies against indexes of ischemia, to clinical trials assessing outcome. At this important juncture for the field, the authors make predictions for the future of physiological stenosis assessment, outlining developments for both iFR and FFR in new clinical domains beyond the confines of stable angina...
September 12, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28853190/diagnostic-accuracy-of-instantaneous-wave-free-ratio-in-clinical-practice
#2
Wern Yew Ding, Satheesh Nair, Clare Appleby
AIMS: To evaluate the correlation between iFR and FFR in real-world clinical practice. METHODS AND RESULTS: Retrospective, single-centre study of 229 consecutive pressure-wire studies (np  = 158). Real-time iFR and FFR measurements were performed for angiographically borderline stenoses. Functionally significant stenoses were defined as iFR <0.86 or FFR ≤0.80. An iFR between 0.86 and 0.93 was considered within the grey zone (Hybrid approach). Median iFR and FFR (IQR) were 0...
August 29, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28851731/exploring-coronary-circulatory-response-to-stenosis-and-its-association-with-invasive-physiologic-indices-using-absolute-myocardial-blood-flow-and-coronary-pressure
#3
Joo Myung Lee, Doyeon Hwang, Jonghanne Park, Jinlong Zhang, Yaliang Tong, Chee Hae Kim, Ji-In Bang, Minseok Suh, Jin Chul Paeng, Gi Jeong Cheon, Bon-Kwon Koo
Background -Although invasive physiologic assessment for coronary stenosis has become a standard practice to guide treatment strategy, coronary circulatory response and changes in invasive physiologic indices, according to different anatomical and hemodynamic lesion severity, have not been fully demonstrated in patients with coronary artery disease. Methods -One hundred fifteen patients with left anterior descending artery stenosis who underwent both (13)N-ammonia positron emission tomography (PET) and invasive physiologic measurement were analyzed...
August 29, 2017: Circulation
https://www.readbyqxmd.com/read/28846545/physiologic-evaluation-of-coronary-lesions-using-instantaneous-wave-free-ratio-ifr-in-patients-with-severe-aortic-stenosis-undergoing-trans-catheter-aortic-valve-implantation
#4
Roberto Scarsini, Gabriele Pesarini, Carlo Zivelonghi, Anna Piccoli, Valeria Ferrero, Mattia Lunardi, Leonardo Gottin, Claudia Zanetti, Giuseppe Faggian, Flavio Ribichini
AIMS: We sought to assess eventual changes in iFR measurements in patients with aortic stenosis (AS) before and after TAVI in coronary lesions with different degree of angiographic severity. METHODS AND RESULTS: The functional relevance of 145 coronary lesions was assessed by on-line iFR and FFR measurement in 66 patients with severe AS before and after TAVI, during the same procedure. The iFR-FFR classification agreement was calculated for pre- and post-TAVI measurements...
August 29, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28835979/-instantaneous-wave-free-ratio-ifr%C3%A2-in-patients-with-coronary-artery-disease
#5
REVIEW
S Baumann, A C Schaefer, A Hohneck, K Mueller, T Becher, M Behnes, M Renker, M Borggrefe, I Akin, D Lossnitzer
Coronary angiography is considered as the gold standard in the morphological representation of coronary artery stenosis. Coronary angiography is often performed without preprocedural non-invasive proof of ischemia and the assessment of the severity of a coronary lesion by morphology is very subjective. Thus, invasive fractional flow reserve (FFR) measurement represents the current standard for estimation of the hemodynamic relevance of coronary artery stenosis and facilitates decision making for percutaneous coronary intervention (PCI) and stenting...
August 23, 2017: Herz
https://www.readbyqxmd.com/read/28789845/discrepancy-between-fractional-flow-reserve-and-instantaneous-wave-free-ratio-clinical-and-angiographic-characteristics
#6
Joo Myung Lee, Eun-Seok Shin, Chang-Wook Nam, Joon-Hyung Doh, Doyeon Hwang, Jonghanne Park, Kyung-Jin Kim, Jinlong Zhang, Bon-Kwon Koo
BACKGROUND: The invasive physiologic index such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) is used in clinical practice to identify ischemia-causing stenosis and to guide treatment strategy. We investigated clinical and angiographic characteristics of lesions with discrepancy between FFR and iFR. METHODS: From the 3V FFR-FRIENDS study, 975 vessels (393 patients) with available pre-intervention FFR and iFR were included in this study...
August 2, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28761673/evaluation-of-intermediate-coronary-stenoses-in-acute-coronary-syndromes-using-pressure-guidewire
#7
REVIEW
Giampaolo Niccoli, Ciro Indolfi, Justin E Davies
Fractional flow reserve (FFR) is increasingly used to guide myocardial revascularisation. However, supporting evidence regarding its use originates from studies that have enrolled mainly patients with stable angina, while patients with acute coronary syndromes (ACS) have not been included. Notably, multifactorial microvascular dysfunction and an increased sympathetic tone in patients with ACS may lead to blunted response to adenosine and false-negative results of FFR due to submaximal hyperaemia. This may raise the possibility of deferring treatment of stenosis that instead would have needed dilatation, thus leaving a residual risk of preventable cardiac events...
2017: Open Heart
https://www.readbyqxmd.com/read/28643215/relationship-between-instantaneous-wave-free-ratio-and-fractional-flow-reserve-in-patients-receiving-hemodialysis
#8
Yuta Morioka, Hiroyuki Arashi, Hisao Otsuki, Junichi Yamaguchi, Nobuhisa Hagiwara
Instantaneous wave-free ratio (iFR) is a vasodilator-free index and is reported to have a good correlation with fractional flow reserve (FFR). Hemodialysis patients exhibit left ventricular hypertrophy, reduced arterial compliance, and impaired microcirculation. Such a coronary flow condition in these patients may influence the relationship between iFR and FFR. This study assessed the impact of hemodialysis on the relationship between iFR and FFR. The study enrolled 196 patients with 265 stenoses who underwent assessment via iFR, FFR assessment, and right heart catheterization...
June 22, 2017: Cardiovascular Intervention and Therapeutics
https://www.readbyqxmd.com/read/28612008/hybrid-instantaneous-wave-free-ratio-fractional-flow-reserve-versus-fractional-flow-reserve-in-the-real-world
#9
Kara Shuttleworth, Kristina Smith, Jonathan Watt, Jamie A L Smith, Stephen J Leslie
BACKGROUND: The instantaneous wave-free ratio (iFR) is a novel method to assess the ischemic potential of coronary artery stenoses. Clinical trial data have shown that iFR has acceptable diagnostic agreement with fractional flow reserve (FFR), the reference standard for the functional assessment of coronary stenoses. This study compares iFR measurements with FFR measurements in a real world, single-center setting. METHODS AND RESULTS: Instantaneous wave-free ratio and FFR were measured in 50 coronary artery lesions in 42 patients, with FFR ≤ 0...
2017: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28610962/coronary-physiology-in-patients-with-severe-aortic-stenosis-comparison-between-fractional-flow-reserve-and-instantaneous-wave-free-ratio
#10
Roberto Scarsini, Gabriele Pesarini, Carlo Zivelonghi, Anna Piccoli, Valeria Ferrero, Mattia Lunardi, Marco Barbierato, Francesco Caprioglio, Corrado Vassanelli, Flavio Ribichini
BACKGROUND: The functional assessment of coronary artery disease (CAD) in patients with aortic stenosis (AS) has not been validated so far, and the best strategy to physiologically investigate the relevance of coronary stenosis in this specific setting of patients remains undetermined. The aim of the study is to compare the diagnostic performance of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with severe AS. METHODS: The functional significance of 179 coronary lesions was investigated with on-line iFR and FFR measurements in 85 AS patients and compared with a control group formed by 167 patients (290 lesions) with stable CAD and without AS...
September 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28600102/physiologic-mechanism-of-discordance-between-instantaneous-wave-free-ratio-and-fractional-flow-reserve-insight-from-13-n-ammonium-positron-emission-tomography
#11
Joo Myung Lee, Doyeon Hwang, Jonghanne Park, Yaliang Tong, Bon-Kwon Koo
BACKGROUND: Invasive physiologic indices, such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), are used in clinical practice. We sought to evaluate the physiological mechanism of discordance between iFR and FFR using (13)N-ammonia positron emission tomography (PET)-derived quantitative parameters. METHODS: Data from 113 patients, who underwent both (13)N-ammonia PET and invasive FFR and iFR measurement, were analyzed. Coronary circulatory indices, such as myocardial blood flow (MBF), coronary flow reserve (CFR), microvascular resistance, and trans-stenosis resistance were compared between patients with discordant results (low FFR despite high iFR) and those with concordant abnormal results (low FFR and low iFR), using cut-off values of FFR≤0...
September 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28544741/diagnostic-accuracy-of-a-hybrid-approach-of-instantaneous-wave-free-ratio-and-fractional-flow-reserve-using-high-dose-intracoronary-adenosine-to-characterize-intermediate-coronary-lesions-results-of-the-pals-practical-assessment-of-lesion-severity-prospective
#12
Fernando Rivero, Javier Cuesta, Teresa Bastante, Amparo Benedicto, Marcos García-Guimaraes, Manuel Fuentes-Ferrer, Teresa Alvarado, Fernando Alfonso
OBJECTIVES: We sought to investigate the diagnostic accuracy of instantaneous wave-free ratio (iFR) and high-dose intracoronary adenosine fractional flow reserve (IC-FFR) compared with classical intravenous adenosine fractional flow reserve (IV-FFR) to assess coronary stenosis severity. The usefulness of two hybrid strategies combining iFR and high-dose IC-FFR was also evaluated. BACKGROUND: Physiological assessment of intermediate coronary stenoses to guide revascularization is currently recommended...
May 22, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28381739/a-comparison-between-the-instantaneous-wave-free-ratio-and-resting-distal-coronary-artery-pressure-aortic-pressure-and-the-fractional-flow-reserve-the-diagnostic-accuracy-can-be-improved-by-the-use-of-both-indices
#13
COMPARATIVE STUDY
Nobuo Shiode, Tomokazu Okimoto, Hiromichi Tamekiyo, Tomoharu Kawase, Kenichi Yamane, Yuzo Kagawa, Yuto Fujii, Yusuke Ueda, Naoya Hironobe, Yasuko Kato, Yasuhiko Hayashi
Objectives The fractional flow reserve (FFR) is an index of the severity of coronary stenosis that has been clinically validated in several studies. The instantaneous wave-free ratio (iFR) and the resting distal coronary artery pressure/aortic pressure (Pd/Pa) are nonhyperemic pressure-derived indices of the severity of stenosis. This study sought to examine the diagnostic accuracy of the iFR and resting Pd/Pa with respect to hyperemic FFR. Methods Following an intracoronary injection of papaverine, the iFR, resting Pd/Pa, and FFR were continuously measured in 123 lesions in 103 patients with stable coronary disease...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28365268/diagnostic-performance-of-resting-and-hyperemic-invasive-physiological-indices-to-define-myocardial-ischemia-validation-with-13-n-ammonia-positron-emission-tomography
#14
Doyeon Hwang, Ki-Hyun Jeon, Joo Myung Lee, Jonghanne Park, Chee Hae Kim, Yaliang Tong, Jinlong Zhang, Ji-In Bang, Minseok Suh, Jin Chul Paeng, Sang-Hoon Na, Gi Jeong Cheon, Christopher M Cook, Justin E Davies, Bon-Kwon Koo
OBJECTIVES: The authors sought to compare the diagnostic performance of fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and resting distal coronary artery pressure/aortic pressure (Pd/Pa) using (13)N-ammonia positron emission tomography (PET). BACKGROUND: The diagnostic performance of invasive physiological indices was reported to be different according to the reference to define the presence of myocardial ischemia. METHODS: A total of 115 consecutive patients with left anterior descending artery stenosis who underwent both (13)N-ammonia PET and invasive physiological measurement were included...
March 24, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28365266/effect-of-coronary-anatomy-and-hydrostatic-pressure-on-intracoronary-indices-of-stenosis%C3%A2-severity
#15
Tobias Härle, Mareike Luz, Sven Meyer, Kay Kronberg, Britta Nickau, Javier Escaned, Justin Davies, Albrecht Elsässer
OBJECTIVES: The authors sought to analyze height differences within the coronary artery tree in patients in a supine position and to quantify the impact of hydrostatic pressure on intracoronary pressure measurements in vitro. BACKGROUND: Although pressure equalization of the pressure sensor and the systemic pressure at the catheter tip is mandatory in intracoronary pressure measurements, subsequent measurements may be influenced by hydrostatic pressure related to the coronary anatomy in the supine position...
March 24, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28317458/use-of-the-instantaneous-wave-free-ratio-or-fractional-flow-reserve-in-pci
#16
RANDOMIZED CONTROLLED TRIAL
Justin E Davies, Sayan Sen, Hakim-Moulay Dehbi, Rasha Al-Lamee, Ricardo Petraco, Sukhjinder S Nijjer, Ravinay Bhindi, Sam J Lehman, Darren Walters, James Sapontis, Luc Janssens, Christiaan J Vrints, Ahmed Khashaba, Mika Laine, Eric Van Belle, Florian Krackhardt, Waldemar Bojara, Olaf Going, Tobias Härle, Ciro Indolfi, Giampaolo Niccoli, Flavo Ribichini, Nobuhiro Tanaka, Hiroyoshi Yokoi, Hiroaki Takashima, Yuetsu Kikuta, Andrejs Erglis, Hugo Vinhas, Pedro Canas Silva, Sérgio B Baptista, Ali Alghamdi, Farrel Hellig, Bon-Kwon Koo, Chang-Wook Nam, Eun-Seok Shin, Joon-Hyung Doh, Salvatore Brugaletta, Eduardo Alegria-Barrero, Martijin Meuwissen, Jan J Piek, Niels van Royen, Murat Sezer, Carlo Di Mario, Robert T Gerber, Iqbal S Malik, Andrew S P Sharp, Suneel Talwar, Kare Tang, Habib Samady, John Altman, Arnold H Seto, Jasvindar Singh, Allen Jeremias, Hitoshi Matsuo, Rajesh K Kharbanda, Manesh R Patel, Patrick Serruys, Javier Escaned
BACKGROUND: Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. METHODS: We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization...
May 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28317438/instantaneous-wave-free-ratio-versus-fractional-flow-reserve-to-guide-pci
#17
RANDOMIZED CONTROLLED TRIAL
Matthias Götberg, Evald H Christiansen, Ingibjörg J Gudmundsdottir, Lennart Sandhall, Mikael Danielewicz, Lars Jakobsen, Sven-Erik Olsson, Patrik Öhagen, Hans Olsson, Elmir Omerovic, Fredrik Calais, Pontus Lindroos, Michael Maeng, Tim Tödt, Dimitrios Venetsanos, Stefan K James, Amra Kåregren, Margareta Nilsson, Jörg Carlsson, Dario Hauer, Jens Jensen, Ann-Charlotte Karlsson, Georgios Panayi, David Erlinge, Ole Fröbert
BACKGROUND: The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. METHODS: We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment...
May 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28191874/instantaneous-wave-free-ratio-to-guide-coronary-revascularisation-physiological-framework-validation-and-differences-from-fractional-flow-reserve
#18
Guus A de Waard, Carlo Di Mario, Amir Lerman, Patrick W Serruys, Niels van Royen
Determining the optimal treatment strategy for revascularisation of coronary artery stenosis involves the use of fractional flow reserve (FFR). To improve the low clinical uptake of physiological lesion assessment to guide revascularisation, the instantaneous wave-free period (iFR) was proposed as a simpler alternative to FFR that does not require adenosine administration. iFR is calculated as the ratio of blood pressure distal and proximal to a coronary artery stenosis during the diastolic wave-free period...
July 20, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28160376/fractional-flow-reserve-and-resting-indices-for-coronary-physiologic-assessment-practical-guide-tips-and-tricks
#19
Fabien Picard, Michele Pighi, Hung Q Ly
Physiologic assessment using fractional flow reserve (FFR) to guide percutaneous coronary interventions (PCI) has been demonstrated to improve clinical outcomes, compared to angiography-guided PCI. Recently, resting indices such as resting Pd/Pa, "instantaneous wave-free ratio", and contrast medium induced FFR have been evaluated for the assessment of the functional consequences of coronary lesions. Herein, we review and discuss the use of FFR and other indices for the functional assessment of coronary lesions...
February 4, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28121952/instantaneous-wave-free-ratio-derived-from-coronary-computed-tomography-angiography-in-evaluation-of-ischemia-causing-coronary-stenosis-feasibility-and-initial-clinical-research
#20
Yue Ma, Hui Liu, Yang Hou, Aike Qiao, Yingying Hou, Qingqing Yang, Qiyong Guo
The instantaneous wave-free ratio (iFR) closely related to fractional flow reserve (FFR) is a adenosine-independent physiologic index of coronary stenosis severity. We sought to evaluate whether iFR derived from coronary computed tomographic angiography (iFRCT) can be used as a novel noninvasive method for diagnosis of ischemia-causing coronary stenosis.We retrospectively enrolled 33 patients (47 lesions) with coronary artery disease (CAD) and examined with coronary computed tomographic angiography (CTA), invasive coronary angiography (ICA), and FFR...
January 2017: Medicine (Baltimore)
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