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

Christopher M. Cook, Allen Jeremias, Ricardo Petraco, Sayan Sen, Sukhjinder Nijjer, Matthew J. Shun-Shin, Yousif Ahmad, Guus de Waard, Tim van de Hoef, Mauro Echavarria-Pinto, Martijn van Lavieren, Rasha Al Lamee, Yuetsu Kikuta, Yasutsugu Shiono, Ashesh Buch, Martijn Meuwissen, Ibrahim Danad, Paul Knaapen, Akiko Maehara, Bon Kwon KooGary S. Mintz, Javier Escaned, Gregg W. Stone, Darrel P. Francis, Jamil Mayet, Jan J. Piek, Niels van Royen, Justin E. Davies

Research output: Contribution to journalArticlepeer-review

102 Scopus citations

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 compared across 5 vessel groups: FFR+/iFR+ (108 vessels, n = 91), FFR–/iFR+ (28 vessels, n = 24), FFR+/iFR– (22 vessels, n = 22), FFR–/iFR– (208 vessels, n = 154), and an unobstructed vessel group (201 vessels, n = 153), in a post hoc analysis of the largest combined pressure and Doppler flow velocity registry (IDEAL [Iberian-Dutch-English] collaborators study). Results FFR disagreed with iFR in 14% (50 of 366). Baseline flow velocity was similar across all 5 vessel groups, including the unobstructed vessel group (p = 0.34 for variance). In FFR+/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–/iFR+ discordants, hyperemic flow velocity, and CFR were similar to the FFR+/iFR+ 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 FFR+/iFR– demonstrated similar coronary flow characteristics to angiographically unobstructed vessels.

Original languageEnglish
Pages (from-to)2514-2524
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume10
Issue number24
DOIs
StatePublished - 26 Dec 2017
Externally publishedYes

Keywords

  • CFR
  • FFR
  • coronary flow reserve
  • coronary physiology
  • fractional flow reserve
  • iFR
  • instantaneous wave-free ratio

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