BACKGROUND: The functional assessment of coronary artery disease (CAD) in patients with aortic stenosis (AS) has not been validated so far, and the best strategy to physiologically investigate the relevance of coronary stenosis in this specific setting of patients remains undetermined. The aim of the study is to compare the diagnostic performance of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with severe AS. METHODS: The functional significance of 179 coronary lesions was investigated with on-line iFR and FFR measurements in 85 AS patients and compared with a control group formed by 167 patients (290 lesions) with stable CAD and without AS. The iFR-FFR diagnostic agreement has been tested using the conventional 0.80 FFR cut-off. RESULTS: The correlation between iFR and FFR was similar between AS and CAD patients, as well as the area under the curve at ROC curve analysis (0.97 vs 0.96, p=0.88). However, using the standard iFR 0.89 threshold, the diagnostic accuracy of iFR was significantly lower in AS compared with CAD (76.3% vs 86.1%, p=0.009). According to ROC analysis, the best iFR cut-off in predicting FFR≤0.8 was lower in AS (0.83, J=0.82) compared with CAD (0.89, J=0.81). Using the ROC derived cut-off of 0.83, the iFR accuracy increased significantly (91.3%, p=0.003) while maintaining an elevated negative predictive value (95.5%). CONCLUSIONS: In the presence of severe AS, conventional iFR cut-off had lower diagnostic agreement with FFR classification of coronary lesions compared to stable CAD patients. AS seems to influence iFR cut-off ischemic thresholds and deserves further comparative studies.
BACKGROUND: The functional assessment of coronary artery disease (CAD) in patients with aortic stenosis (AS) has not been validated so far, and the best strategy to physiologically investigate the relevance of coronary stenosis in this specific setting of patients remains undetermined. The aim of the study is to compare the diagnostic performance of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with severe AS. METHODS: The functional significance of 179 coronary lesions was investigated with on-line iFR and FFR measurements in 85 AS patients and compared with a control group formed by 167 patients (290 lesions) with stable CAD and without AS. The iFR-FFR diagnostic agreement has been tested using the conventional 0.80 FFR cut-off. RESULTS: The correlation between iFR and FFR was similar between AS and CAD patients, as well as the area under the curve at ROC curve analysis (0.97 vs 0.96, p=0.88). However, using the standard iFR 0.89 threshold, the diagnostic accuracy of iFR was significantly lower in AS compared with CAD (76.3% vs 86.1%, p=0.009). According to ROC analysis, the best iFR cut-off in predicting FFR≤0.8 was lower in AS (0.83, J=0.82) compared with CAD (0.89, J=0.81). Using the ROC derived cut-off of 0.83, the iFR accuracy increased significantly (91.3%, p=0.003) while maintaining an elevated negative predictive value (95.5%). CONCLUSIONS: In the presence of severe AS, conventional iFR cut-off had lower diagnostic agreement with FFR classification of coronary lesions compared to stable CAD patients. AS seems to influence iFR cut-off ischemic thresholds and deserves further comparative studies.
Authors: Roberto Scarsini; Giovanni L De Maria; Giuseppe Di Gioia; Rafail A Kotronias; Cristina Aurigemma; Giuseppe Zimbardo; Francesco Burzotta; Antonio M Leone; Gabriele Pesarini; Carlo Trani; Filippo Crea; Rajesh K Kharbanda; Bernard De Bruyne; Emanuele Barbato; Adrian Banning; Flavio Ribichini Journal: J Cardiovasc Transl Res Date: 2019-05-22 Impact factor: 4.132
Authors: Jeroen Vendrik; Yousif Ahmad; Ashkan Eftekhari; James P Howard; Gilbert W M Wijntjens; Valerie E Stegehuis; Christopher Cook; Christian J Terkelsen; Evald H Christiansen; Karel T Koch; Jan J Piek; Sayan Sen; Jan Baan Journal: J Am Heart Assoc Date: 2020-02-27 Impact factor: 5.501
Authors: Roberto Scarsini; Dimitrios Terentes-Printzios; Giovanni Luigi De Maria; Flavio Ribichini; Adrian Banning Journal: Interv Cardiol Date: 2020-06-04
Authors: Yousif Ahmad; Matthias Götberg; Christopher Cook; James P Howard; Iqbal Malik; Ghada Mikhail; Angela Frame; Ricardo Petraco; Christopher Rajkumar; Ozan Demir; Juan F Iglesias; Ravinay Bhindi; Sasha Koul; Nearchos Hadjiloizou; Robert Gerber; Punit Ramrakha; Neil Ruparelia; Nilesh Sutaria; Gajen Kanaganayagam; Ben Ariff; Michael Fertleman; Jon Anderson; Andrew Chukwuemeka; Darrel Francis; Jamil Mayet; Patrick Serruys; Justin Davies; Sayan Sen Journal: JACC Cardiovasc Interv Date: 2018-08-25 Impact factor: 11.195
Authors: Hannah Z R McConkey; Michael Marber; Amedeo Chiribiri; Philippe Pibarot; Simon R Redwood; Bernard D Prendergast Journal: Circ Cardiovasc Interv Date: 2019-08-16 Impact factor: 6.546