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

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Cook, Christopher M.; Jeremias, Allen; Petraco, Ricardo; Sen, Sayan; Nijjer, Sukhjinder; Shun-Shin, Matthew J.; Ahmed, Yousif; de Waard, Guus; van de Hoef, Tim; Echavarria-Pinto, Mauro; van Lavieren, Martijn; Lamee, Rasha Al; Kikuta, Yuetsu; Shiono, Yasutsugu; Buch, Ashesh; Meuwissen, Martijn; Danad, Ibrahim; Knaapen, Paul; Maehara, Akiko; Koo, Bon-Kwon; Mintz, Gary S.; Escaned, Javier; Stone, Gregg W.; Francis, Darrel P.; Mayet, Jamil; Piek, Jan J.; van Royen, Niels; Davies, Justin E.
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: FFRþ/iFRþ (108 vessels, n 1⁄4 91), FFR–/iFRþ (28 vessels, n 1⁄4 24), FFRþ/iFR– (22 vessels, n 1⁄4 22), FFR–/iFR– (208 vessels, n 1⁄4 154), and an unobstructed vessel group (201 vessels, n 1⁄4 153), in a post hoc analysis of the largest combined pressure and Doppler flow velocity registry (IDEAL [Iberian-Dutch-English] collaborators study). RESULTS FFRdisagreedwithiFRin14%(50of366).Baselineflowvelocitywassimilaracrossall5vesselgroups,includingthe unobstructed vessel group (p 1⁄4 0.34 for variance). In FFRþ/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–/iFRþ discordants, hyperemic flow velocity, and CFR were similar to the FFRþ/iFRþ 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 FFRþ/iFR– demonstrated similar coronary flow characteristics to angiographically unobstructed vessels.
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http://hdl.handle.net/10342/8187
Date
2017-12-26
Citation:
APA:
Cook, Christopher M., & Jeremias, Allen, & Petraco, Ricardo, & Sen, Sayan, & Nijjer, Sukhjinder, & Shun-Shin, Matthew J., & Ahmed, Yousif, & de Waard, Guus, & van de Hoef, Tim, & Echavarria-Pinto, Mauro, & van Lavieren, Martijn, & Lamee, Rasha Al, & Kikuta, Yuetsu, & Shiono, Yasutsugu, & Buch, Ashesh, & Meuwissen, Martijn, & Danad, Ibrahim, & Knaapen, Paul, & Maehara, Akiko, & Koo, Bon-Kwon, & Mintz, Gary S., & Escaned, Javier, & Stone, Gregg W., & Francis, Darrel P., & Mayet, Jamil, & Piek, Jan J., & van Royen, Niels, & Davies, Justin E.. (December 2017). Fractional Flow Reserve/ Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements. JACC: CARDIOVASCULAR INTERVENTIONS, (10:24), p.2514-2524. Retrieved from http://hdl.handle.net/10342/8187

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MLA:
Cook, Christopher M., and Jeremias, Allen, and Petraco, Ricardo, and Sen, Sayan, and Nijjer, Sukhjinder, and Shun-Shin, Matthew J., and Ahmed, Yousif, and de Waard, Guus, and van de Hoef, Tim, and Echavarria-Pinto, Mauro, and van Lavieren, Martijn, and Lamee, Rasha Al, and Kikuta, Yuetsu, and Shiono, Yasutsugu, and Buch, Ashesh, and Meuwissen, Martijn, and Danad, Ibrahim, and Knaapen, Paul, and Maehara, Akiko, and Koo, Bon-Kwon, and Mintz, Gary S., and Escaned, Javier, and Stone, Gregg W., and Francis, Darrel P., and Mayet, Jamil, and Piek, Jan J., and van Royen, Niels, and Davies, Justin E.. "Fractional Flow Reserve/ Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements". JACC: CARDIOVASCULAR INTERVENTIONS. 10:24. (2514-2524.), December 2017. October 23, 2020. http://hdl.handle.net/10342/8187.
Chicago:
Cook, Christopher M. and Jeremias, Allen and Petraco, Ricardo and Sen, Sayan and Nijjer, Sukhjinder and Shun-Shin, Matthew J. and Ahmed, Yousif and de Waard, Guus and van de Hoef, Tim and Echavarria-Pinto, Mauro and van Lavieren, Martijn and Lamee, Rasha Al and Kikuta, Yuetsu and Shiono, Yasutsugu and Buch, Ashesh and Meuwissen, Martijn and Danad, Ibrahim and Knaapen, Paul and Maehara, Akiko and Koo, Bon-Kwon and Mintz, Gary S. and Escaned, Javier and Stone, Gregg W. and Francis, Darrel P. and Mayet, Jamil and Piek, Jan J. and van Royen, Niels and Davies, Justin E., "Fractional Flow Reserve/ Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements," JACC: CARDIOVASCULAR INTERVENTIONS 10, no. 24 (December 2017), http://hdl.handle.net/10342/8187 (accessed October 23, 2020).
AMA:
Cook, Christopher M., Jeremias, Allen, Petraco, Ricardo, Sen, Sayan, Nijjer, Sukhjinder, Shun-Shin, Matthew J., Ahmed, Yousif, de Waard, Guus, van de Hoef, Tim, Echavarria-Pinto, Mauro, van Lavieren, Martijn, Lamee, Rasha Al, Kikuta, Yuetsu, Shiono, Yasutsugu, Buch, Ashesh, Meuwissen, Martijn, Danad, Ibrahim, Knaapen, Paul, Maehara, Akiko, Koo, Bon-Kwon, Mintz, Gary S., Escaned, Javier, Stone, Gregg W., Francis, Darrel P., Mayet, Jamil, Piek, Jan J., van Royen, Niels, Davies, Justin E.. Fractional Flow Reserve/ Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements. JACC: CARDIOVASCULAR INTERVENTIONS. December 2017; 10(24) 2514-2524. http://hdl.handle.net/10342/8187. Accessed October 23, 2020.
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