Fractional Flow Reserve/ Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements

ECU Author/Contributor (non-ECU co-authors, if there are any, appear on document)

Christopher M.,Jeremias,Allen,Petraco,Ricardo,Sen,Sayan,Nijjer Cook (Creator)

Institution

East Carolina University (ECU )

Web Site: http://www.ecu.edu/lib/

Abstract: OBJECTIVES The study sought to determine the coronary flow characteristics of angiographically intermediate stenoses classified as discordant by fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).BACKGROUND Discordance between FFR and iFR occurs in up to 20% of cases. No comparisons have been reported between the coronary flow characteristics of FFR/iFR discordant and angiographically unobstructed vessels.METHODS Baseline and hyperemic coronary flow velocity and coronary flow reserve (CFR) were comparedacross 5 vessel groups: FFRþ/iFRþ (108 vessels, n 1⁄4 91), FFR--/iFRþ (28 vessels, n 1⁄4 24), FFRþ/iFR-- (22 vessels, n 1⁄4 22), FFR--/iFR-- (208 vessels, n 1⁄4 154), and an unobstructed vessel group (201 vessels, n 1⁄4 153), in a post hoc analysis of the largest combined pressure and Doppler flow velocity registry (IDEAL [Iberian-Dutch-English] collaborators study).RESULTS FFRdisagreedwithiFRin14%(50of366).Baselineflowvelocitywassimilaracrossall5vesselgroups,includingthe unobstructed vessel group (p 1⁄4 0.34 for variance). In FFRþ/iFR-- discordants, hyperemic flow velocity and CFR were similar to both FFR--/iFR-- and unobstructed groups; 37.6 (interquartile range [IQR]: 26.1 to 50.4) cm/s vs. 40.0 [IQR: 29.7 to 52.3] cm/s and 42.2 [IQR: 33.8 to 53.2] cm/s and CFR 2.36 [IQR: 1.93 to 2.81] vs. 2.41 [IQR: 1.84 to 2.94] and 2.50 [IQR: 2.11 to 3.17], respectively (p > 0.05 for all). In FFR--/iFRþ discordants, hyperemic flow velocity, and CFR were similar to the FFRþ/iFRþ group;28.2 (IQR: 20.5 to 39.7) cm/s versus 23.5 (IQR: 16.4 to 34.9) cm/s and CFR 1.44 (IQR: 1.29 to 1.85) versus 1.39 (IQR: 1.06 to 1.88), respectively (p > 0.05 for all).CONCLUSIONS FFR/iFR disagreement was explained by differences in hyperemic coronary flow velocity. Furthermore, coronary stenoses classified as FFRþ/iFR-- demonstrated similar coronary flow characteristics to angiographically unobstructed vessels.

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Language: English

Date: 2017

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