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iFR pressure wire

Joo Myung Lee, Joon Hyung Doh, Chang Wook Nam, Eun Seok Shin, Bon Kwon Koo
The presence of myocardial ischemia is the most important prognostic factor in patients with coronary artery disease, and ischemia-directed revascularization has been a standard of care. Fractional flow reserve (FFR) is an invasive method used to detect the functionally significant epicardial coronary stenosis, and FFR-guided revascularization strategy has been proven to be superior to angiography-guided strategy. Recently, a hyperemia-free index, instantaneous wave free ratio (iFR), was developed and showed its non-inferiority for clinical outcomes compared with FFR-guided strategy...
March 2018: Korean Circulation Journal
Roberto Scarsini, Gabriele Pesarini, Mattia Lunardi, Anna Piccoli, Claudia Zanetti, Rosaria Cantone, Michele Bellamoli, Valeria Ferrero, Leonardo Gottin, Giuseppe Faggian, Flavio Ribichini
BACKGROUND: The complexity of coronary physiology in presence of severe aortic stenosis (AS) raises concerns about the reliability of pressure-derived indexes in this clinical setting. Furthermore, neither fractional flow reserve (FFR) nor instantaneous wave-free period (iFR) has been validated in AS. Combining iFR and FFR in a tailored decision-making strategy may help to increase simplicity, accuracy and safety of physiology-guided revascularization in AS. METHODS: In this prospective observational study iFR and FFR were measured before and after TAVI during the same procedure in patients with severe AS and concomitant coronary artery disease (CAD)...
October 3, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
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...
March 2018: Journal of Cardiology
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...
December 2017: Journal of Interventional Cardiology
Giuseppe Gargiulo, Eugenio Stabile, Marco Ferrone, Emanuele Barbato, Frederik M Zimmermann, Julien Adjedj, Barry Hennigan, Mitsuaki Matsumura, Nils P Johnson, William F Fearon, Allen Jeremias, Bruno Trimarco, Giovanni Esposito
BACKGROUND: Adenosine-free coronary pressure wire metrics have been proposed to test the functional significance of coronary artery lesions, but it is unexplored whether their diagnostic performance might be altered in patients with diabetes. METHODS: We performed a post-hoc analysis of the CONTRAST study, which prospectively enrolled an international cohort of patients undergoing routine fractional flow reserve (FFR) assessment for standard indications. Paired, repeated measurements of all physiology metrics (Pd/Pa, iFR, contrast-based FFR, and FFR) were made...
January 13, 2017: Cardiovascular Diabetology
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
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
Sukhjinder S Nijjer, Sayan Sen, Ricardo Petraco, Jamil Mayet, Darrel P Francis, Justin E R Davies
Coronary intervention is increasingly performed in complex disease with tandem and diffuse disease. Pressure wires enable detailed assessment of the physiological significance of a stenosis but in the presence of tandem disease, predicting the impact of a stenting a given stenosis can be difficult and is impeded by flow interaction between stenoses under hyperemia. In this review, we consider the physiological difficulties posed by flow interaction under hyperemia and consider alternative approaches such as assessment under baseline conditions...
April 2015: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Sukhjinder S Nijjer, Sayan Sen, Ricardo Petraco, Justin Er Davies
Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes...
2015: Circulation Journal: Official Journal of the Japanese Circulation Society
Sukhjinder S Nijjer, Sayan Sen, Ricardo Petraco, Javier Escaned, Mauro Echavarria-Pinto, Christopher Broyd, Rasha Al-Lamee, Nicolas Foin, Rodney A Foale, Iqbal S Malik, Ghada W Mikhail, Amarjit S Sethi, Mahmud Al-Bustami, Raffi R Kaprielian, Masood A Khan, Christopher S Baker, Michael F Bellamy, Alun D Hughes, Jamil Mayet, Darrel P Francis, Carlo Di Mario, Justin E R Davies
OBJECTIVES: The aim of this study was to perform hemodynamic mapping of the entire vessel using motorized pullback of a pressure guidewire with continuous instantaneous wave-free ratio (iFR) measurement. BACKGROUND: Serial stenoses or diffuse vessel narrowing hamper pressure wire-guided management of coronary stenoses. Characterization of functional relevance of individual stenoses or narrowed segments constitutes an unmet need in ischemia-driven percutaneous revascularization...
December 2014: JACC. Cardiovascular Interventions
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