Impact of Stenosis Resistance and Coronary Flow Capacity on Fractional Flow Reserve and Instantaneous Wave-free Ratio Discordance: A combined Analysis of DEFINE-FLOW and IDEAL

Overview

Journal Neth Heart J

Specialty Cardiology & Vascular Diseases

Date 2023 Aug 18

PMID 37594612

Authors

Valerie Stegehuis

Coen Boerhout

Yuetsu Kikuta

Maribel Cambero-Madera

Niels van Royen

Hitoshi Matsuo

Masafumi Nakayama

Guus de Waard

Paul Knaapen

Sukhjinder Nijjer

Ricardo Petraco

Maria Siebes

Justin Davies

Javier Escaned

Tim van de Hoef

Jan Piek

Affiliations

Soon will be listed here.

Abstract

Background: The pressure-derived parameters fractional flow reserve (FFR) and the emerging instantaneous wave-free ratio (iFR) are the most widely applied invasive coronary physiology indices to guide revascularisation. However, approximately 15-20% of intermediate stenoses show discordant FFR and iFR, and therapeutical consensus is lacking.

Aims: We sought to associate hyperaemic stenosis resistance index, coronary flow reserve (CFR) and coronary flow capacity (CFC) to FFR/iFR discordance.

Methods: We assessed pressure and flow measurements of 647 intermediate lesions (593 patients) of two multi-centre international studies.

Results: FFR and iFR were discordant in 15% of all lesions (97 out of 647). FFR+/iFR- lesions had similar hyperaemic average peak velocity (hAPV), CFR and CFC as FFR-/iFR- lesions, whereas FFR-/iFR+ lesions had similar hAPV, CFR and CFC as FFR+/iFR+ lesions (p > 0.05 for all). FFR+/iFR- lesions were associated with lower baseline stenosis resistance, but not hyperaemic stenosis resistance, compared with FFR-/iFR+ lesions (p < 0.001).

Conclusions: Discordance with FFR+/iFR- is characterised by maximal flow values, CFR, and CFC patterns similar to FFR-/iFR- concordance that justifies conservative therapy. Discordance with FFR-/iFR+ on the other hand, is characterised by low flow values, CFR, and CFC patterns similar to iFR+/FFR+ concordance that may benefit from percutaneous coronary intervention.

Citing Articles

Decoding fractional flow reserve/instantaneous wave-free ratio discordance: is flow the answer?.

van Nunen L, Damman P Neth Heart J. 2023; 31(11):413-414.

PMID: 37816971 PMC: 10602989. DOI: 10.1007/s12471-023-01822-y.

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