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Coronary Flow Reserve, Fractional Flow Reserve, Instantaneous wave free ratio

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Coronary angiography has been the principle modality for assessing the severity of atherosclerotic coronary artery disease for several decades. However, there is a complex relationship between angiographic coronary stenosis and the presence or absence of myocardial ischemia. Early studies focused on coronary flow reserve (CFR) but more recent work has demonstrated the physiologic accuracy and prognostic value of the fractional flow reserve (FFR) and instantaneous wave free ratio (iFR) for the assessment of coronary artery disease. Although in the new era, "Coronary Flow Reserve in the Instantaneous Wave-Free Ratio/Fractional Flow Reserve Era: Too Valuable to Be Neglected".


Following researches put the discordance between iFR and FFR under the microscope.

October, 2019, "Physiologic Characteristics and Clinical Outcomes of Patients With Discordance Between FFR and iFR" reported that differences in coronary circulatory function were found, especially in the vasodilatory capacity between the low iFR–high FFR and high iFR–low FFR groups. FFR–iFR discordance was not related to an increased risk of POCO among patients with deferred lesions at 5 years.



In the same month, a post hoc analysis "Sex Differences in Instantaneous Wave-Free Ratio or Fractional Flow Reserve–Guided Revascularization Strategy" attempting to better delineate sex-based differences in iFR- and FFR-based revascularization strategies and added further prove that there was no observed difference in 1-year major adverse cardiac event rates (composite of death, nonfatal myocardial infarction, or unplanned revascularization) between men and women or strategy used (iFR or FFR).








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