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Change in Kidney Function and 2-Year Mortality After Transcatheter Aortic Valve Replacement Prognostic Value of Intravascular Ultrasound in Patients With Coronary Artery Disease Conceptual Framework for Addressing Residual Atherosclerotic Cardiovascular Disease Risk in the Era of Precision Medicine Coronary calcium as a predictor of coronary events in four racial or ethnic groups A risk score to predict postdischarge bleeding among acute coronary syndrome patients undergoing percutaneous coronary intervention: BRIC-ACS study Infective endocarditis after transcatheter aortic valve implantation: a nationwide study Percutaneous Coronary Intervention of Left Main Disease: Pre- and Post-EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) Era Computed tomography angiography-derived extracellular volume fraction predicts early recovery of left ventricular systolic function after transcatheter aortic valve replacement Randomized Evaluation of TriGuard 3 Cerebral Embolic Protection After Transcatheter Aortic Valve Replacement: REFLECT II Extracellular Myocardial Volume in Patients With Aortic Stenosis
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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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