BACKGROUND: Instantaneous wave free ratio (iFR) does not require adenosine, but has a relatively wide intermediate range where functional assessment remains inconclusive. In this pilot study, we sought to enhance iFR through with the use of intracoronary (IC) saline (iFRs) and contrast media (iFRc) and determine whether these techniques correlated well with fractional flow reserve (FFR). METHODS: Patients with coronary artery stenosis (CAS) associated with an iFR in the intermediate zone (≥0.86 and ≤0.93) were prospectively assessed with resting distal coronary pressure/aorta pressure (Pd/Pa), iFR, iFRs, iFRc and FFR. RESULTS: A total of 40 coronary lesions were studied (40 patients). Pearson correlation coefficients for FFR and iFR, FFR and iFRs, FFR and iFRc were respectively: 0.57 (P=0.0002), 0.80 (P<0.0001) and 0.77 (P<0.0001). Receiver-operating characteristic (ROC) curve analysis showed similar area under the curve (AUC) of iFRs and iFR [0.90 (95% CI: 0.76-1) vs. 0.89 (95% CI: 0.79-0.99), P=0.89]. Youden's index established cut-off values of ≤0.90 for iFR (sensitivity =91%, specificity =74%) and ≤0.78 for iFRs (sensitivity =73%, specificity =100%). In contrast, the AUC of iFRc was superior to the AUC of iFR [0.99 (95% CI: 0.98-1), P=0.049]. iFRc showed excellent accuracy and established cut-off values of ≤0.81 in predicting an FFR value of ≤0.80 (sensitivity =100%, specificity =93%). CONCLUSIONS: When iFR is in the intermediate zone, functional assessment of CAS by iFR is enhanced with the use of contrast media but not saline. This pilot study could be hypothesis generating for further study to enhance iFR specificity and sensibility.
BACKGROUND: Instantaneous wave free ratio (iFR) does not require adenosine, but has a relatively wide intermediate range where functional assessment remains inconclusive. In this pilot study, we sought to enhance iFR through with the use of intracoronary (IC) saline (iFRs) and contrast media (iFRc) and determine whether these techniques correlated well with fractional flow reserve (FFR). METHODS: Patients with coronary artery stenosis (CAS) associated with an iFR in the intermediate zone (≥0.86 and ≤0.93) were prospectively assessed with resting distal coronary pressure/aorta pressure (Pd/Pa), iFR, iFRs, iFRc and FFR. RESULTS: A total of 40 coronary lesions were studied (40 patients). Pearson correlation coefficients for FFR and iFR, FFR and iFRs, FFR and iFRc were respectively: 0.57 (P=0.0002), 0.80 (P<0.0001) and 0.77 (P<0.0001). Receiver-operating characteristic (ROC) curve analysis showed similar area under the curve (AUC) of iFRs and iFR [0.90 (95% CI: 0.76-1) vs. 0.89 (95% CI: 0.79-0.99), P=0.89]. Youden's index established cut-off values of ≤0.90 for iFR (sensitivity =91%, specificity =74%) and ≤0.78 for iFRs (sensitivity =73%, specificity =100%). In contrast, the AUC of iFRc was superior to the AUC of iFR [0.99 (95% CI: 0.98-1), P=0.049]. iFRc showed excellent accuracy and established cut-off values of ≤0.81 in predicting an FFR value of ≤0.80 (sensitivity =100%, specificity =93%). CONCLUSIONS: When iFR is in the intermediate zone, functional assessment of CAS by iFR is enhanced with the use of contrast media but not saline. This pilot study could be hypothesis generating for further study to enhance iFR specificity and sensibility.
Authors: Sayan Sen; Javier Escaned; Iqbal S Malik; Ghada W Mikhail; Rodney A Foale; Rafael Mila; Jason Tarkin; Ricardo Petraco; Christopher Broyd; Richard Jabbour; Amarjit Sethi; Christopher S Baker; Micheal Bellamy; Mahmud Al-Bustami; David Hackett; Masood Khan; David Lefroy; Kim H Parker; Alun D Hughes; Darrel P Francis; Carlo Di Mario; Jamil Mayet; Justin E Davies Journal: J Am Coll Cardiol Date: 2011-12-07 Impact factor: 24.094
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Authors: Ricardo Petraco; Javier Escaned; Sayan Sen; Sukhjinder Nijjer; Kaleab N Asrress; Mauro Echavarria-Pinto; Tim Lockie; Muhammed Z Khawaja; Cecilia Cuevas; Nicolas Foin; Christopher Broyd; Rodney A Foale; Nearchos Hadjiloizou; Iqbal S Malik; Ghada W Mikhail; Amarjit Sethi; Raffi Kaprielian; Christopher S Baker; David Lefroy; Michael Bellamy; Mahmud Al-Bustami; Masood A Khan; Alun D Hughes; Darrel P Francis; Jamil Mayet; Carlo Di Mario; Simon Redwood; Justin E Davies Journal: EuroIntervention Date: 2013-05-20 Impact factor: 6.534
Authors: Sayan Sen; Kaleab N Asrress; Sukhjinder Nijjer; Ricardo Petraco; Iqbal S Malik; Rodney A Foale; Ghada W Mikhail; Nicolas Foin; Christopher Broyd; Nearchos Hadjiloizou; Amarjit Sethi; Mahmud Al-Bustami; David Hackett; Masood A Khan; Muhammed Z Khawaja; Christopher S Baker; Michael Bellamy; Kim H Parker; Alun D Hughes; Darrel P Francis; Jamil Mayet; Carlo Di Mario; Javier Escaned; Simon Redwood; Justin E Davies Journal: J Am Coll Cardiol Date: 2013-04-02 Impact factor: 24.094