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Instantaneous wave free ratio

Stepan Jerabek, Tomas Kovarnik
BACKGROUND: The only indication for coronary revascularization is elimination of ischaemia. Invasive hemodynamic methods (fractional flow reserve - FFR and instantaneous wave-free ratio (iFR) are superior to coronary angiography in detection of lesions causing myocardial ischaemia. Current European guidelines for myocardial revascularization recommend using of FFR for detection of functional assessment of lesions severity in category IA and number of these procedures increases. However, routine usage of these methods requires knowledge of technical requirements and limitations...
February 27, 2018: Acta Cardiologica
Eric Van Belle, Robert Gil, Volker Klauss, Mohammed Balghith, Martijn Meuwissen, Jérôme Clerc, Bernhard Witzenbichler, Miha Cercek, Marios Vlachojannis, Irene Lang, Philippe Commeau, Flavien Vincent, Luca Testa, Wojciech Wasek, Nicolas Debry, Stephan Kische, Gabriele Gabrielli, Gennaro Sardella
OBJECTIVES: This study sought to prospectively assess the impact of routine invasive physiology at the time of angiography on reclassification of therapeutic management of multivessel disease (MVD) patients, and to assess how implementation of instantaneous wave-free ratio (iFR) alters the process. BACKGROUND: Routine invasive physiology in intermediate coronary lesions at the time of diagnostic angiography, primarily in patients with single-vessel disease and using fractional flow reserve (FFR), reclassifies coronary revascularization management in 26% to 44% of patients...
February 26, 2018: JACC. Cardiovascular Interventions
Stefano Benenati, Giovanni Luigi De Maria, Roberto Scarsini, Italo Porto, Adrian P Banning
International guidelines recommend that revascularization for coronary artery disease (CAD) should be guided by evidence of myocardial ischemia. Fractional flow reserve (FFR) and instantaneous free wave ratio (iFR) are the main invasive indices for assessing the ischemic potential of angiographically intermediate coronary stenosis as a large body of evidence supports their routine application. Both indices have been tested and validated in patients with isolated stable CAD, but notably their application outside this specific context is a matter of debate and investigation...
January 31, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Rohit Maini, John Moscona, Paul Katigbak, Camilo Fernandez, Gursukhmandeep Sidhu, Qusai Saleh, Anand Irimpen, Rohan Samson, Thierry LeJemtel
BACKGROUND/PURPOSE: Fractional flow reserve (FFR) remains underutilized due to practical concerns related to the need for hyperemic agents. These concerns have prompted the study of instantaneous wave-free ratio (iFR), a vasodilator-free index of coronary stenosis. Non-inferior cardiovascular outcomes have been demonstrated in two recent randomized clinic trials. We performed this meta-analysis to provide a necessary update of the diagnostic accuracy of iFR referenced to FFR based on the addition of eight more recent studies and 3727 more lesions...
December 27, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Salvatore De Rosa, Alberto Polimeni, Ricardo Petraco, Justin E Davies, Ciro Indolfi
BACKGROUND: Aim of the present study was to perform a meta-analysis of all available studies comparing the instantaneous wave-free ratio (iFR) with fractional flow reserve (FFR). METHODS AND RESULTS: Published trials comparing the iFR with FFR were searched for in PubMed, Google Scholar, and Scopus electronic databases. A total of 23 studies were available for the analysis, including 6381 stenoses. First, a meta-analysis of all studies was performed exploring the correlation between FFR and iFR...
January 2018: Circulation. Cardiovascular Interventions
Guus A de Waard, Christopher M Cook, Niels van Royen, Justin E Davies
For identification of myocardial ischaemia by non-invasive imaging or invasive physiological assessment, administration of a vasodilating or positive inotropic agent is often considered indispensable to exhaust the cardiac compensation mechanisms. Indeed, microcirculatory dilatation is needed for assessment of myocardial perfusion or coronary blood flow. However, three different modalities exist that quantify myocardial ischaemia without recourse to pharmacological stress agents, using either myocardial contrast echocardiography, imaging of myocardial blood volume or invasive coronary pressure measurement with the instantaneous wave-free ratio (iFR)...
December 11, 2017: European Heart Journal
Morton J Kern, Arnold H Seto
No abstract text is available yet for this article.
December 12, 2017: Circulation
Yoshiaki Kawase, Masanori Kawasaki, Jun Kikuchi, Tetsuo Hirata, Syuuichi Okamoto, Toru Tanigaki, Hiroyuki Omori, Hideaki Ota, Munenori Okubo, Hiroki Kamiya, Akihiro Hirakawa, Hitoshi Matsuo
BACKGROUND: Instantaneous wave-free ratio (iFR) has the potential to improve the accuracy of the prediction of the physiological result of percutaneous coronary intervention (PCI). The aim of this study was to evaluate the accuracy of iFR to predict the final physiological results following PCI, and investigate the factors for failed prediction. METHODS: In 73 lesions, iFR pullback recordings were measured and comparisons were made between the predicted improvement following PCI and the observed result...
December 1, 2017: Journal of Cardiology
Troels Thim, Matthias Götberg, Ole Fröbert, Robin Nijveldt, Niels van Royen, Sergio Bravo Baptista, Sasha Koul, Thomas Kellerth, Hans Erik Bøtker, Christian Juhl Terkelsen, Evald Høj Christiansen, Lars Jakobsen, Steen Dalby Kristensen, Michael Maeng
OBJECTIVES: The aim of this study was to examine the level of agreement between acute instantaneous wave-free ratio (iFR) measured across nonculprit stenoses in patients with ST-segment elevation myocardial infarction (STEMI) and iFR measured at a staged follow-up procedure. BACKGROUND: Acute full revascularization of nonculprit stenoses in STEMI is debated and currently guided by angiography. Acute functional assessment of nonculprit stenoses may be considered...
December 26, 2017: JACC. Cardiovascular Interventions
Joo Myung Lee, Eun-Seok Shin, Chang-Wook Nam, Joon-Hyung Doh, Doyeon Hwang, Jonghanne Park, Kyung-Jin Kim, Jinlong Zhang, Chul Ahn, Bon-Kwon Koo
OBJECTIVES: The authors investigated 2-year clinical outcomes according to fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) values in deferred lesions. BACKGROUND: Invasive physiological indices such as FFR or iFR are used in clinical practice to select ischemia-causing stenosis and to guide the treatment strategy for patients with coronary artery disease. METHODS: From the 3V FFR-FRIENDS (3-Vessel Fractional Flow Reserve for the Assessment of Total Stenosis Burden and Its Clinical Impact in Patients With Coronary Artery Disease) study, 821 deferred lesions (n = 374) with both FFR and iFR available were included in this study...
December 26, 2017: JACC. Cardiovascular Interventions
Arnold H Seto
No abstract text is available yet for this article.
December 26, 2017: JACC. Cardiovascular Interventions
Joo Myung Lee, Doyeon Hwang, Jonghanne Park, Yaliang Tong, Bon-Kwon Koo
No abstract text is available yet for this article.
February 15, 2018: International Journal of Cardiology
Carmine Musto, Francesco De Felice, Stefano Rigattieri, Diana Chin, Andrea Marra, Marco Stefano Nazzaro, Alberta Cifarelli, Roberto Violini
BACKGROUND: Functional assessment of non-infarct-related artery lesions during primary percutaneous coronary intervention (PCI) might be useful to avoid revascularization of nonsignificant stenosis and staged procedures, thus reducing hospital stay. We aimed to assess the diagnostic performance of instantaneous wave-free ratio (iFR) as compared with fractional flow reserve (FFR) in this setting. METHODS: In the WAVE study, a prospective, observational, single-center registry (NCT02869906), paired iFR and FFR measurements were performed at the level of non-IRA lesions in patients with ST-segment elevation myocardial infarction both during primary PCI and during staged procedures (5-8 days after)...
November 2017: American Heart Journal
Rasha Al-Lamee, David Thompson, Hakim-Moulay Dehbi, Sayan Sen, Kare Tang, John Davies, Thomas Keeble, Michael Mielewczik, Raffi Kaprielian, Iqbal S Malik, Sukhjinder S Nijjer, Ricardo Petraco, Christopher Cook, Yousif Ahmad, James Howard, Christopher Baker, Andrew Sharp, Robert Gerber, Suneel Talwar, Ravi Assomull, Jamil Mayet, Roland Wensel, David Collier, Matthew Shun-Shin, Simon A Thom, Justin E Davies, Darrel P Francis
BACKGROUND: Symptomatic relief is the primary goal of percutaneous coronary intervention (PCI) in stable angina and is commonly observed clinically. However, there is no evidence from blinded, placebo-controlled randomised trials to show its efficacy. METHODS: ORBITA is a blinded, multicentre randomised trial of PCI versus a placebo procedure for angina relief that was done at five study sites in the UK. We enrolled patients with severe (≥70%) single-vessel stenoses...
November 1, 2017: Lancet
Tobias Härle, Mareike Luz, Sven Meyer, Felix Vahldiek, Pim van der Harst, Randy van Dijk, Daan Ties, Javier Escaned, Justin Davies, Albrecht Elsässer
BACKGROUND: An influence of hydrostatic pressure on intracoronary indices of stenosis severity in vitro was recently reported. We sought to analyze the influence of hydrostatic pressure, caused by the height difference between the distal and proximal pressure sensor after guidewire positioning in the interrogated vessel, on intracoronary pressure measurements in vivo. METHODS AND RESULTS: In 30 coronary stenoses, intracoronary pressure measurements were performed in supine, left, and right lateral patient position...
November 2, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Hiroyuki Arashi, Junichi Yamaguchi, Tonre Ri, Hisao Otsuki, Masashi Nakao, Kazuho Kamishima, Kentaro Jujo, Yuichiro Minami, Hiroshi Ogawa, Nobuhisa Hagiwara
BACKGROUND: The instantaneous wave-free ratio (iFR) is a vasodilator-free, invasive pressure wire index of the functional severity of coronary stenosis and is calculated under resting conditions. In a recent study, iFR was found to be more closely linked to coronary flow reserve (CFR) than fractional flow reserve (FFR). E/e' is a surrogate marker of left ventricular (LV) filling pressure and LV diastolic dysfunction. Coronary resting flow was found to be increased in patients with elevated E/e', and higher coronary resting flow was associated with lower CFR...
October 17, 2017: Journal of Cardiology
Joo Myung Lee, Jonghanne Park, Doyeon Hwang, Chee Hae Kim, Ki Hong Choi, Tae-Min Rhee, Yaliang Tong, Jin Joo Park, Eun-Seok Shin, Chang-Wook Nam, Joon-Hyung Doh, Bon-Kwon Koo
BACKGROUND: Instantaneous wave-free ratio (iFR) has been used in clinical practice to identify functionally significant stenosis and to guide treatment strategy. However, there are limited clinical data regarding another resting pressure-derived index, resting distal to aortic coronary pressure (Pd/Pa), and similarities and differences between resting Pd/Pa and iFR. OBJECTIVES: The authors investigated the changes in resting Pd/Pa and iFR according to anatomic and hemodynamic stenosis severity and their prognostic implications...
October 24, 2017: Journal of the American College of Cardiology
Yuhei Kobayashi, Nils P Johnson, Frederik M Zimmermann, Nils Witt, Colin Berry, Allen Jeremias, Bon-Kwon Koo, Giovanni Esposito, Gilles Rioufol, Seung-Jung Park, Takeshi Nishi, Dong-Hyun Choi, Keith G Oldroyd, Emanuele Barbato, Nico H J Pijls, Bernard De Bruyne, William F Fearon
BACKGROUND: Recently, 2 randomized controlled trials showed that the instantaneous wave-free ratio (iFR), a resting coronary physiological index, is noninferior to fractional flow reserve for guiding revascularization. The resting distal to aortic coronary pressure (Pd/Pa) measured at rest is another adenosine-free index widely available in the cardiac catheterization laboratory; however, little is known about the agreement of Pd/Pa using iFR as a reference standard. OBJECTIVES: The goal of this study was to investigate the agreement of Pd/Pa with iFR...
October 24, 2017: Journal of the American College of Cardiology
Deepak L Bhatt
New England Journal of Medicine, Volume 377, Issue 16, Page 1595-1599, October 2017.
October 19, 2017: New England Journal of Medicine
Justin E Davies, Sayan Sen, Javier Escaned
No abstract text is available yet for this article.
October 19, 2017: New England Journal of Medicine
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