Roberto Scarsini1, Rosaria Cantone2, Gabriele Venturi2, Giovanni Luigi De Maria3, Andrea Variola4, Paolo Braggio5, Mattia Lunardi2, Gabriele Pesarini2, Marco Ferdeghini5, Anna Piccoli6, Mauro Feola7, Rajesh K Kharbanda3, Adrian P Banning3, Flavio Ribichini8. 1. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy; Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom. 2. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy. 3. Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom. 4. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy; Division of Nuclear Cardiology, Department of Nuclear Medicine, University of Verona, Verona, Italy. 5. Division of Nuclear Cardiology, Department of Nuclear Medicine, University of Verona, Verona, Italy. 6. Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, United Kingdom; Biomolecular Medicine PhD Program, University of Verona, Verona, Italy. 7. Division of Cardiology, Ospedale Mondovì, Cuneo, Italy. 8. Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy. Electronic address: flavio.ribichini@univr.it.
Abstract
BACKGROUND: Aortic stenosis (AS) is frequently associated with coronary artery disease (CAD). However, the best tool to functionally assess CAD in AS remains undetermined. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) have never been validated in AS. METHODS: FFR, iFR and stress single photon emission computed tomography (SPECT) were performed in a consecutive series of 28 patients with severe AS and 41 borderline coronary lesions during the work-up for valve replacement. RESULTS: Both FFR and iFR were correlated with an abnormal SPECT. At ROC analysis, FFR yielded an AUC = 0.91 with negative predictive value (NPV) = 95% in detecting ischemia according to SPECT. iFR showed significant worse agreement with myocardial perfusion imaging compared to FFR (59% vs 85%, p = 0.014). Specifically, a significant larger proportion of false positive measurements (negative SPECT and iFR < 0.89) was observed using iFR vs FFR: 39% vs 12%, p = 0.011. Using a pre-specified 0.82 cut-off, the iFR agreement with SPECT increased to 73%. CONCLUSIONS: FFR yielded a good correlation with SPECT and a high NPV in detecting ischemia-provoking lesions. iFR diagnostic metrics were inferior compared with FFR and improved adopting a lower ischemic threshold.
BACKGROUND:Aortic stenosis (AS) is frequently associated with coronary artery disease (CAD). However, the best tool to functionally assess CAD in AS remains undetermined. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) have never been validated in AS. METHODS: FFR, iFR and stress single photon emission computed tomography (SPECT) were performed in a consecutive series of 28 patients with severe AS and 41 borderline coronary lesions during the work-up for valve replacement. RESULTS: Both FFR and iFR were correlated with an abnormal SPECT. At ROC analysis, FFR yielded an AUC = 0.91 with negative predictive value (NPV) = 95% in detecting ischemia according to SPECT. iFR showed significant worse agreement with myocardial perfusion imaging compared to FFR (59% vs 85%, p = 0.014). Specifically, a significant larger proportion of false positive measurements (negative SPECT and iFR < 0.89) was observed using iFR vs FFR: 39% vs 12%, p = 0.011. Using a pre-specified 0.82 cut-off, the iFR agreement with SPECT increased to 73%. CONCLUSIONS: FFR yielded a good correlation with SPECT and a high NPV in detecting ischemia-provoking lesions. iFR diagnostic metrics were inferior compared with FFR and improved adopting a lower ischemic threshold.
Authors: Cameron Dowling; Michael Michail; Jun Michael Zhang; Andrea Comella; Udit Thakur; Robert Gooley; Liam McCormick; Adam J Brown; Dennis T L Wong Journal: Cardiovasc Diagn Ther Date: 2022-06
Authors: Roberto Scarsini; Dimitrios Terentes-Printzios; Giovanni Luigi De Maria; Flavio Ribichini; Adrian Banning Journal: Interv Cardiol Date: 2020-06-04