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@article{Cook:2017:10.1016/j.jcin.2017.09.021,
author = {Cook, CM and Jeremias, A and Petraco, R and Sen, S and Nijjer, S and Shun-Shin, MJ and Ahmad, Y and de, Waard G and van, de Hoef T and Echavarria-Pinto, M and van, Lavieren M and Al, Lamee R and Kikuta, Y and Shiono, Y and Buch, A and Meuwissen, M and Danad, I and Knaapen, P and Maehara, A and Koo, B-K and Mintz, GS and Escaned, J and Stone, GW and Francis, DP and Mayet, J and Piek, JJ and van, Royen N and Davies, JE},
doi = {10.1016/j.jcin.2017.09.021},
journal = {JACC: Cardiovascular Interventions},
pages = {2514--2524},
title = {Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements},
url = {http://dx.doi.org/10.1016/j.jcin.2017.09.021},
volume = {10},
year = {2017}
}

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TY  - JOUR
AB  - ObjectivesThe study sought to determine the coronary flow characteristics of angiographically intermediate stenoses classified as discordant by fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).BackgroundDiscordance between FFR and iFR occurs in up to 20% of cases. No comparisons have been reported between the coronary flow characteristics of FFR/iFR discordant and angiographically unobstructed vessels.MethodsBaseline and hyperemic coronary flow velocity and coronary flow reserve (CFR) were compared across 5 vessel groups: FFR+/iFR+ (108 vessels, n = 91), FFR–/iFR+ (28 vessels, n = 24), FFR+/iFR– (22 vessels, n = 22), FFR–/iFR– (208 vessels, n = 154), and an unobstructed vessel group (201 vessels, n = 153), in a post hoc analysis of the largest combined pressure and Doppler flow velocity registry (IDEAL [Iberian-Dutch-English] collaborators study).ResultsFFR disagreed with iFR in 14% (50 of 366). Baseline flow velocity was similar across all 5 vessel groups, including the unobstructed vessel group (p = 0.34 for variance). In FFR+/iFR– discordants, hyperemic flow velocity and CFR were similar to both FFR–/iFR– and unobstructed groups; 37.6 (interquartile range [IQR]: 26.1 to 50.4) cm/s vs. 40.0 [IQR: 29.7 to 52.3] cm/s and 42.2 [IQR: 33.8 to 53.2] cm/s and CFR 2.36 [IQR: 1.93 to 2.81] vs. 2.41 [IQR: 1.84 to 2.94] and 2.50 [IQR: 2.11 to 3.17], respectively (p > 0.05 for all). In FFR–/iFR+ discordants, hyperemic flow velocity, and CFR were similar to the FFR+/iFR+ group; 28.2 (IQR: 20.5 to 39.7) cm/s versus 23.5 (IQR: 16.4 to 34.9) cm/s and CFR 1.44 (IQR: 1.29 to 1.85) versus 1.39 (IQR: 1.06 to 1.88), respectively (p > 0.05 for all).ConclusionsFFR/iFR disagreement was explained by differences in hyperemic coronary flow velocity. Furthermore, coronary stenoses classified as FFR+/iFR– demonstrated similar coronary flow characteristics to angiographically unobstructed vessels.
AU  - Cook,CM
AU  - Jeremias,A
AU  - Petraco,R
AU  - Sen,S
AU  - Nijjer,S
AU  - Shun-Shin,MJ
AU  - Ahmad,Y
AU  - de,Waard G
AU  - van,de Hoef T
AU  - Echavarria-Pinto,M
AU  - van,Lavieren M
AU  - Al,Lamee R
AU  - Kikuta,Y
AU  - Shiono,Y
AU  - Buch,A
AU  - Meuwissen,M
AU  - Danad,I
AU  - Knaapen,P
AU  - Maehara,A
AU  - Koo,B-K
AU  - Mintz,GS
AU  - Escaned,J
AU  - Stone,GW
AU  - Francis,DP
AU  - Mayet,J
AU  - Piek,JJ
AU  - van,Royen N
AU  - Davies,JE
DO  - 10.1016/j.jcin.2017.09.021
EP  - 2524
PY  - 2017///
SN  - 1936-8798
SP  - 2514
TI  - Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements
T2  - JACC: Cardiovascular Interventions
UR  - http://dx.doi.org/10.1016/j.jcin.2017.09.021
UR  - http://hdl.handle.net/10044/1/51260
VL  - 10
ER  -

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