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Role of intravascular ultrasound in patients with acute myocardial infarction undergoing percutaneous coronary intervention Feasibility of Coronary Access and Aortic Valve Reintervention in Low-Risk TAVR Patients Comparison of newer generation self-expandable vs. balloon-expandable valves in transcatheter aortic valve implantation: the randomized SOLVE-TAVI trial The Year in Cardiovascular Medicine 2020: Valvular Heart Disease: Discussing the Year in Cardiovascular Medicine for 2020 in the field of valvular heart disease is Professor Helmut Baumgartner and Dr Javier Bermejo. Mark Nicholls reports Mechanisms of in-stent restenosis after drug-eluting stent implantation: intravascular ultrasound analysis Risk of Coronary Obstruction and Feasibility of Coronary Access After Repeat Transcatheter Aortic Valve Replacement With the Self-Expanding Evolut Valve: A Computed Tomography Simulation Study Impact of myocardial fibrosis on left ventricular remodelling, recovery, and outcome after transcatheter aortic valve implantation in different haemodynamic subtypes of severe aortic stenosis Association of Effective Regurgitation Orifice Area to Left Ventricular End-Diastolic Volume Ratio With Transcatheter Mitral Valve Repair OutcomesA Secondary Analysis of the COAPT Trial 3-Year Outcomes of the ULTIMATE Trial Comparing Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation Baseline Characteristics and Risk Profiles of Participants in the ISCHEMIA Randomized Clinical Trial
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Original Research2017 Dec;30(6):564-569.

JOURNAL：J Interv Cardiol. Article Link

Diagnostic accuracy of instantaneous wave free-ratio in clinical practice

Ding WY, Nair S, Appleby C. Keywords: fractional flow reserve; functional testing; instantaneous wave-free ratio; pressure wire studies

ABSTRACT


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 0.92 (0.87-0.95) and 0.83 (0.76-0.89), respectively. Pearson's correlation coefficient was 0.75 (P < 0.001). Bland-Altman plot showed a mean difference between iFR and FFR that remained consistent throughout the range of values. The optimal iFR cutoff was 0.91-sensitivity 80%, specificity 82% with ROC area under curve of 89%. Using the Hybrid iFR-FFR strategy, we demonstrated high accuracy of iFR results-sensitivity 95%, specificity 96%, PPV 95%, and NPV 96%. In addition, this method would have avoided adenosine in 56% of patients. Mean follow-up period was 17.2 (±3.4) months. All-cause mortality was 3.2% (np = 5) and repeat intervention was required in six lesions (2.6%).


CONCLUSIONS - This study demonstrates that iFR is a valuable adjunct to FFR using the Hybrid iFR-FFR strategy in a real-world population. The use of adenosine may be avoided in about half the cases.


© 2017, Wiley Periodicals, Inc.

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