Endothelial dysfunction assessed by digital tonometry and discrepancy between fraction flow reserve and instantaneous wave free ratio

Stepan Jerabek, David Zemanek, Jan Pudil, Kristyna Bayerova, Ales Kral, Karel Kopriva, Yoshiaki Kawase, Hiroyuki Omori, Toru Tanigaki, Zhi Chen, Alexandra Vodzinska, Marian Branny, Hitoshi Matsuo, Martin Mates, Milan Sonka, Tomas Kovarnik

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: We tested whether the level of endothelial dysfunction assessed by digital tonometry, and expressed as reactive hyperemia index (RHI), is related to occurrences of a discrepancy between fractional flow reserve (FFR) and the instantaneous wave free ratio (iFR) (ClinicalTrials.gov identifier: NCT03033810). Methods: We examined patients with coronary stenosis in the range of 40–70%, assessed by both FFR and iFR (system Philips-Volcano) for stable angina. We included consecutive patients with FFR and iFR in one native coronary artery, and who had had no previous intervention. Results: We included 138 patients. Out of those, 24 patients (17.4%) had a negative FFR (with an FFR value >0.8) and positive iFR (with a iFR value ≤0.89)–designated the FFRn/iFRp discrepancy group, and 22 patients (15.9%) had a positive FFR (≤0.8) and negative iFR (>0.89)–designated the FFRp/iFRn discrepancy. RHI was higher in the discrepancy groups compared the group without discrepancy (1.73 ± 0.79 vs. 1.48 ± 0.50, p = 0.025). However, this finding was not confirmed in multivariant logistic regression analyses. Patients with any type of discrepancy differed from the agreement group by having a higher occurrence of diabetes mellitus [9 patients (21.4%) vs. 36 patients (39.6%), p = 0.029], active smoking (23 patients or 54.8% vs. 26 patients or 28.6%, p = 0.003) and lower use of calcium channel blockers (9 patients, 21.4%, vs. 43 patients, 46.7%, p = 0.004). Conclusion: The presence of endothelial dysfunction can be associated with a discrepancy in FFR/iFR. However, RHI correlated with risk factors of atherosclerosis, not with FFR or iFR.

Original languageEnglish
Pages (from-to)323-328
Number of pages6
JournalActa Cardiologica
Issue number4
StatePublished - 3 Jul 2020
Externally publishedYes


  • Coronary disease
  • endothelial cells
  • fractional flow reserve


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