Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease

Nijjer, Sukhjinder; Sen, Sayan; Petraco, Ricardo; Escaned, Javier; Echavarría‐Pinto, Mauro; Broyd, Christopher; Al‐Lamee, Rasha; Foin, Nicolas; Foale, Rodney A.; Malik, Iqbal; Mikhail, Ghada; Sethi, Amarjit Singh; Al-Bustami, Mahmud; Kaprielian, Raffi; Khan, Masood; Baker, Christopher; Bellamy, Michael; Hughes, Alun D.; Mayet, Jamil; Francis, Dárrel P.; Mario, Carlo Di; Davies, Justin E.

doi:10.1016/j.jcin.2014.06.015

Cited by 117 publications

(97 citation statements)

References 30 publications

(21 reference statements)

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“…During the assessment of eligibility, further 6 studies were excluded. 8,[30][31][32][33][34] Finally, a total of 23 studies were available for the analysis, 7,[9][10][11][12][13][14][15][16][17][18][19][20][21]28,29,[35][36][37][38][39][40][41] including 6381 stenoses. The study selection procedure is reported in details in Figure 1 while the Table summarizes the most relevant characteristics of the selected studies.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Performance of the Instantaneous Wave-Free Ratio

Rosa

Polimeni

Petraco

et al. 2018

Circ: Cardiovascular Interventions

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Background— Aim of the present study was to perform a meta-analysis of all available studies comparing the instantaneous wave-free ratio (iFR) with fractional flow reserve (FFR). Methods and Results— Published trials comparing the iFR with FFR were searched for in PubMed, Google Scholar, and Scopus electronic databases. A total of 23 studies were available for the analysis, including 6381 stenoses. First, a meta-analysis of all studies was performed exploring the correlation between FFR and iFR. Interestingly, we found good correlation (0.798 [0.78–0.82]) between the 2 indices ( P <0.001). In addition, to evaluate the diagnostic performance of iFR to identify FFR-positive coronary stenoses, we performed an additional meta-analysis, summarizing the results of receiver operating characteristics analyses from individual studies reporting the area under the curve. Summing the results of these studies, we found that iFR has a good diagnostic performance for the identification of FFR-positive stenoses (area under the curve=0.88 [0.86–0.90]; P <0.001). Furthermore, our search results included 5 studies that compared iFR and FFR to a third independent reference standard. Interestingly, no significant differences between iFR and FFR were reported in those studies. Conclusions— The present meta-analysis shows that iFR significantly correlates with standard FFR and shows a good diagnostic performance in identifying FFR-positive coronary stenoses. Finally, iFR and FFR have similar diagnostic efficiency for detection of ischemia-inducing stenoses when tested against a third comparator.

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Section: Resultsmentioning

confidence: 99%

Diagnostic Performance of the Instantaneous Wave-Free Ratio

Rosa

Polimeni

Petraco

et al. 2018

Circ: Cardiovascular Interventions

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“…Computer 'Virtual-PCI' algorithms can 'remove' a stenosis on an iFR-Pullback trace (Figure 8) and then compute the residual gradients to estimate an expected post-PCI iFR, 76 under the assumption that any intervention is perfect without any residual gradient in the treated segment. 72 In the first iFR-Pullback study, realworld post-PCI iFR values could be predicted with high accuracy and without a significant systematic bias. 72 The predicted value could provide a target physiological value for the real-world intervention.…”

Section: Discussionmentioning

confidence: 99%

“…72 In the first iFR-Pullback study, realworld post-PCI iFR values could be predicted with high accuracy and without a significant systematic bias. 72 The predicted value could provide a target physiological value for the real-world intervention. The process could also permit the evaluation of the potential physiological benefit of multiple different 'virtual' stenting strategies.…”

Section: Discussionmentioning

confidence: 99%

Advances in Coronary Physiology

Nijjer

Sen

Petraco

et al. 2015

Circ J

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Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting. (Circ J 2015; 79: 1172 -1184

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“…34 The ADVISE II trial recommends that at an iFR value of <0.86, PCI should be performed, and at an iFR value of >0.94, pharmacological therapy should be initiated. 35,36 The undergoing DEFINE REAL trial, which has enrolled over 3,000 patients, aims to follow-up the predictive capacity of iFR in determining the effort-induced ischemia in comparison with FFR, which is still considered gold-standard for the evaluation of functional significance of coronary atherosclerotic lesions. 37 Moreover, the DE-FINE FLAIR trial (NCT02053038) will randomize 2,500 patients to evaluate FFR-guided PCI versus iFR-guided PCI.…”

Section: Determination Of Instantaneous Wave-free Ratio (Ifr)mentioning

confidence: 99%

Invasive FFR — Current Applications and New Developments

Chițu¹,

Raț²,

Opincariu

et al. 2016

Journal of Interdisciplinary Medicine

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Myocardial ischemia caused by coronary atherosclerosis is the main cause of cardiovascular mortality, which is the first cause of death in developed countries. Inducible myocardial ischemia is a negative prognostic factor for coronary artery disease patients, and it represents a major risk stratification marker for predicting mortality. The evolution of these patients depends largely on the extension of the ischemic myocardial mass and the severity of the inducible ischemia. Most patients do not show angiographically significant coronary stenosis. Therefore, such patients do not undergo coronary revascularization therapies, even though they present functional stenoses that trigger myocardial ischemia under stress conditions, which subsequently lead to a high risk for major adverse cardiovascular events. We performed a review that aims to pinpoint invasive techniques used for evaluating the functional impact of a coronary lesion that is considered non-significant upon angiographic examination, but which triggers episodes of myocardial ischemia under stress conditions, and to describe the functional markers that show the highest specificity for predicting ischemic risk, in order to recommend invasive coronary revascularization.Keywords: invasive fractional flow reserve, inducible myocardial ischemia, functional significance of coronary stenosis REVIEWCARDIOLOGY // IMAGING

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Pre-Angioplasty Instantaneous Wave-Free Ratio Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease

Cited by 117 publications

References 30 publications

Diagnostic Performance of the Instantaneous Wave-Free Ratio

Diagnostic Performance of the Instantaneous Wave-Free Ratio

Advances in Coronary Physiology

Invasive FFR — Current Applications and New Developments

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