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Predictive factors of discordance between the instantaneous wave‐free ratio and fractional flow reserve
Author(s) -
Dérimay François,
Johnson Nils P.,
Zimmermann Frederik M.,
Adjedj Julien,
Witt Nils,
Hennigan Barry,
Koo BonKwon,
Barbato Emanuele,
Esposito Giovanni,
Trimarco Bruno,
Rioufol Gilles,
Park SeungJung,
Baptista Sérgio Bravo,
Chrysant George S.,
Leone Antonio Maria,
Jeremias Allen,
Berry Colin,
De Bruyne Bernard,
Oldroyd Keith G.,
Pijls Nico H.J.,
Fearon William F.
Publication year - 2019
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28116
Subject(s) - fractional flow reserve , medicine , cardiology , stenosis , cutoff , revascularization , hemodynamics , gold standard (test) , coronary angiography , myocardial infarction , physics , quantum mechanics
Objectives To identify clinical, angiographic and hemodynamic predictors of discordance between instantaneous wave‐free ratio (iFR) and fractional flow reserve (FFR). Background The iFR was found to be non‐inferior to the gold‐standard FFR for guiding coronary revascularization, although it is discordant with FFR in 20% of cases. A better understanding of the causes of discordance may enhance application of these indices. Methods Both FFR and iFR were measured in the prospective multicenter CONTRAST study. Clinical, angiographic and hemodynamic variables were compared between patients with concordant values of FFR and iFR (cutoff ≤0.80 and ≤0.89, respectively). Results Out of the 587 patients included, in 466 patients (79.4%) FFR and iFR agreed: both negative, n = 244 (41.6%), or positive, n = 222 (37.8%). Compared with FFR, iFR was negative discordant (FFR+/iFR‐) in 69 (11.8%) patients and positive discordant (FFR‐/iFR+) in 52 (8.9%) patients. On multivariate regression, stenosis location (left main or proximal left anterior descending) (OR: 3.30[1.68;6.47]), more severe stenosis (OR: 1.77[1.35;2.30]), younger age (OR: 0.93[0.90;0.97]), and slower heart rate (OR: 0.59[0.42;0.75]) were predictors of a negative discordant iFR. Absence of a beta‐blocker (OR: 0.41[0.22;0.78]), older age (OR: 1.04[1.00;1.07]), and less severe stenosis (OR: 0.69[0.53;0.89]) were predictors of a positive discordant iFR. Conclusions During iFR acquisition, stenosis location, stenosis degree, heart rate, age and use of beta blockers influence concordance with FFR and should be taken into account when interpreting iFR.