Joo Myung Lee1, Eun-Seok Shin2, Chang-Wook Nam3, Joon-Hyung Doh4, Doyeon Hwang5, Jonghanne Park5, Kyung-Jin Kim5, Jinlong Zhang5, Bon-Kwon Koo6. 1. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 2. Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea; Division of Cardiology, Dietrich Bonhoeffer Hospital, Academic Teaching Hospital of University of Greifswald, Greifswald, Germany. 3. Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea. 4. Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea. 5. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea. 6. Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea; Institute on Aging, Seoul National University, Seoul, South Korea. Electronic address: bkkoo@snu.ac.kr.
Abstract
BACKGROUND: The invasive physiologic index such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) is used in clinical practice to identify ischemia-causing stenosis and to guide treatment strategy. We investigated clinical and angiographic characteristics of lesions with discrepancy between FFR and iFR. METHODS: From the 3V FFR-FRIENDS study, 975 vessels (393 patients) with available pre-intervention FFR and iFR were included in this study. The vessels were classified according to FFR and iFR into: concordant normal (Group 1 [n=724]: FFR>0.80 and iFR≥0.90); high FFR and low iFR (Group 2 [n=33]: FFR>0.80 and iFR<0.90); low FFR and high iFR (Group 3 [n=82]: FFR≤0.80 and iFR≥0.90); and concordant abnormal (Group 4 [n=136]: FFR≤0.80 and iFR<0.90). RESULTS: Angiographic stenosis severity assessed by percent diameter stenosis, minimum lumen diameter and lesion length was increased from Group 1 to Group 4 (all p<0.001). SYNTAX score increased and FFR decreased proportionally from Group 1 to Group 4 (all p<0.001). In multivariable GEE model, female, diabetes mellitus, smaller reference vessel diameter, and higher %DS were significantly associated with low iFR among high FFR groups (Group 2 discordance). Conversely, males, absence of diabetes mellitus and lower %DS were significantly associated with high iFR among low FFR groups (Group 3 discordance). CONCLUSIONS: Four groups classified according to FFR and iFR were different in clinical and angiographic characteristics, SYNTAX score, and predictors of discordance. The lesions with discordant FFR and iFR may need to be interpreted as a different clinical entity.
BACKGROUND: The invasive physiologic index such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR) is used in clinical practice to identify ischemia-causing stenosis and to guide treatment strategy. We investigated clinical and angiographic characteristics of lesions with discrepancy between FFR and iFR. METHODS: From the 3V FFR-FRIENDS study, 975 vessels (393 patients) with available pre-intervention FFR and iFR were included in this study. The vessels were classified according to FFR and iFR into: concordant normal (Group 1 [n=724]: FFR>0.80 and iFR≥0.90); high FFR and low iFR (Group 2 [n=33]: FFR>0.80 and iFR<0.90); low FFR and high iFR (Group 3 [n=82]: FFR≤0.80 and iFR≥0.90); and concordant abnormal (Group 4 [n=136]: FFR≤0.80 and iFR<0.90). RESULTS: Angiographic stenosis severity assessed by percent diameter stenosis, minimum lumen diameter and lesion length was increased from Group 1 to Group 4 (all p<0.001). SYNTAX score increased and FFR decreased proportionally from Group 1 to Group 4 (all p<0.001). In multivariable GEE model, female, diabetes mellitus, smaller reference vessel diameter, and higher %DS were significantly associated with low iFR among high FFR groups (Group 2 discordance). Conversely, males, absence of diabetes mellitus and lower %DS were significantly associated with high iFR among low FFR groups (Group 3 discordance). CONCLUSIONS: Four groups classified according to FFR and iFR were different in clinical and angiographic characteristics, SYNTAX score, and predictors of discordance. The lesions with discordant FFR and iFR may need to be interpreted as a different clinical entity.
Authors: Hak Seung Lee; Joo Myung Lee; Chang-Wook Nam; Eun-Seok Shin; Joon-Hyung Doh; Neng Dai; Martin K C Ng; Andy S C Yong; Damras Tresukosol; Ajit S Mullasari; Rony Mathew; Praveen Chandra; Kuang-Te Wang; Yundai Chen; Jiyan Chen; Kai-Hang Yiu; Nils P Johnson; Bon-Kwon Koo Journal: Cardiol J Date: 2019-06-21 Impact factor: 2.737
Authors: Tim P van de Hoef; Joo Myung Lee; Mauro Echavarria-Pinto; Bon-Kwon Koo; Hitoshi Matsuo; Manesh R Patel; Justin E Davies; Javier Escaned; Jan J Piek Journal: Nat Rev Cardiol Date: 2020-05-14 Impact factor: 32.419
Authors: Joo Myung Lee; Ki Hong Choi; Bon-Kwon Koo; Hakim-Moulay Dehbi; Joon-Hyung Doh; Chang-Wook Nam; Eun-Seok Shin; Christopher M Cook; Rasha Al-Lamee; Ricardo Petraco; Sayan Sen; Iqbal S Malik; Sukhjinder S Nijjer; Hernán Mejía-Rentería; Eduardo Alegria-Barrero; Ali Alghamdi; John Altman; Sérgio B Baptista; Ravinay Bhindi; Waldemar Bojara; Salvatore Brugaletta; Pedro Canas Silva; Carlo Di Mario; Andrejs Erglis; Robert T Gerber; Olaf Going; Tobias Härle; Farrel Hellig; Ciro Indolfi; Luc Janssens; Allen Jeremias; Rajesh K Kharbanda; Ahmed Khashaba; Yuetsu Kikuta; Florian Krackhardt; Mika Laine; Sam J Lehman; Hitoshi Matsuo; Martijin Meuwissen; Giampaolo Niccoli; Jan J Piek; Flavo Ribichini; Habib Samady; James Sapontis; Arnold H Seto; Murat Sezer; Andrew S P Sharp; Jasvindar Singh; Hiroaki Takashima; Suneel Talwar; Nobuhiro Tanaka; Kare Tang; Eric Van Belle; Niels van Royen; Hugo Vinhas; Christiaan J Vrints; Darren Walters; Hiroyoshi Yokoi; Bruce Samuels; Chris Buller; Manesh R Patel; Patrick Serruys; Javier Escaned; Justin E Davies Journal: JAMA Cardiol Date: 2019-09-01 Impact factor: 14.676
Authors: Tomas Kovarnik; Matsuo Hitoshi; Ales Kral; Stepan Jerabek; David Zemanek; Yoshiaki Kawase; Hiroyuki Omori; Toru Tanigaki; Jan Pudil; Alexandra Vodzinska; Marian Branny; Roman Stipal; Petr Kala; Jan Mrozek; Martin Porzer; Tomas Grezl; Kamil Novobilsky; Oscar Mendiz; Karel Kopriva; Martin Mates; Martin Chval; Zhi Chen; Pavel Martasek; Ales Linhart Journal: J Am Heart Assoc Date: 2022-05-03 Impact factor: 6.106