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Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve

The instantaneous wave-free ratio (iFR) is used for assessing the hemodynamic severity of a lesion, as an alternative to the fractional flow reserve (FFR). We evaluated the relationship between iFR and FFR in detail and the clinical significance of iFR in patients with mild to intermediate coronary...

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Autores principales: Onishi, Kyohei, Watanabe, Heitaro, Kakehi, Kazuyoshi, Ikeda, Tomoyuki, Takase, Toru, Yamaji, Kenji, Ueno, Masafumi, Kobuke, Kazuhiro, Nakazawa, Gaku, Miyazaki, Shunichi, Iwanaga, Yoshitaka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410195/
https://www.ncbi.nlm.nih.gov/pubmed/32760123
http://dx.doi.org/10.1371/journal.pone.0237275
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author Onishi, Kyohei
Watanabe, Heitaro
Kakehi, Kazuyoshi
Ikeda, Tomoyuki
Takase, Toru
Yamaji, Kenji
Ueno, Masafumi
Kobuke, Kazuhiro
Nakazawa, Gaku
Miyazaki, Shunichi
Iwanaga, Yoshitaka
author_facet Onishi, Kyohei
Watanabe, Heitaro
Kakehi, Kazuyoshi
Ikeda, Tomoyuki
Takase, Toru
Yamaji, Kenji
Ueno, Masafumi
Kobuke, Kazuhiro
Nakazawa, Gaku
Miyazaki, Shunichi
Iwanaga, Yoshitaka
author_sort Onishi, Kyohei
collection PubMed
description The instantaneous wave-free ratio (iFR) is used for assessing the hemodynamic severity of a lesion, as an alternative to the fractional flow reserve (FFR). We evaluated the relationship between iFR and FFR in detail and the clinical significance of iFR in patients with mild to intermediate coronary artery stenosis. We recruited consecutive 323 patients (421 lesions) with lesions exhibiting 30% to 80% diameter stenosis on angiography in whom FFR and iFR were measured. In the total lesions, mean diameter stenosis was 48.6% ± 9.0%, and physiological significance, defined by FFR of 0.80 or less or by iFR of 0.92 or less, was observed in 32.5% or 33.5%, respectively. Mismatch between iFR and FFR was observed in 18.1% of the lesions. Clinical factors did not predict FFR value; however, gender, diabetes mellitus, aortic stenosis, anemia, high-sensitivity CRP value, and renal function predicted iFR value. In multivariate logistic analysis after adjustment for FFR value, gender (p < 0.001), diabetes mellitus (p = 0.005), aortic stenosis (p = 0.016), high-sensitivity CRP (p < 0.001), and renal function (p = 0.003) were all independent predictors of iFR value. In Kaplan-Meier analysis, the baseline iFR predicted the subsequent major cardiovascular events (MACE) (hazard ratio, 2.40; 95% CI, 1.16–4.93; p = 0.018) and the results of the iFR-guided strategy for predicting rates of MACE and myocardial infarction/revascularization were superior to those of the FFR-guided strategy. In conclusion, significant clinical factors predicted iFR value, which affected the prognostic capacity. The iFR-guided strategy may be superior in patients with mild to intermediate stenosis.
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spelling pubmed-74101952020-08-13 Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve Onishi, Kyohei Watanabe, Heitaro Kakehi, Kazuyoshi Ikeda, Tomoyuki Takase, Toru Yamaji, Kenji Ueno, Masafumi Kobuke, Kazuhiro Nakazawa, Gaku Miyazaki, Shunichi Iwanaga, Yoshitaka PLoS One Research Article The instantaneous wave-free ratio (iFR) is used for assessing the hemodynamic severity of a lesion, as an alternative to the fractional flow reserve (FFR). We evaluated the relationship between iFR and FFR in detail and the clinical significance of iFR in patients with mild to intermediate coronary artery stenosis. We recruited consecutive 323 patients (421 lesions) with lesions exhibiting 30% to 80% diameter stenosis on angiography in whom FFR and iFR were measured. In the total lesions, mean diameter stenosis was 48.6% ± 9.0%, and physiological significance, defined by FFR of 0.80 or less or by iFR of 0.92 or less, was observed in 32.5% or 33.5%, respectively. Mismatch between iFR and FFR was observed in 18.1% of the lesions. Clinical factors did not predict FFR value; however, gender, diabetes mellitus, aortic stenosis, anemia, high-sensitivity CRP value, and renal function predicted iFR value. In multivariate logistic analysis after adjustment for FFR value, gender (p < 0.001), diabetes mellitus (p = 0.005), aortic stenosis (p = 0.016), high-sensitivity CRP (p < 0.001), and renal function (p = 0.003) were all independent predictors of iFR value. In Kaplan-Meier analysis, the baseline iFR predicted the subsequent major cardiovascular events (MACE) (hazard ratio, 2.40; 95% CI, 1.16–4.93; p = 0.018) and the results of the iFR-guided strategy for predicting rates of MACE and myocardial infarction/revascularization were superior to those of the FFR-guided strategy. In conclusion, significant clinical factors predicted iFR value, which affected the prognostic capacity. The iFR-guided strategy may be superior in patients with mild to intermediate stenosis. Public Library of Science 2020-08-06 /pmc/articles/PMC7410195/ /pubmed/32760123 http://dx.doi.org/10.1371/journal.pone.0237275 Text en © 2020 Onishi et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Onishi, Kyohei
Watanabe, Heitaro
Kakehi, Kazuyoshi
Ikeda, Tomoyuki
Takase, Toru
Yamaji, Kenji
Ueno, Masafumi
Kobuke, Kazuhiro
Nakazawa, Gaku
Miyazaki, Shunichi
Iwanaga, Yoshitaka
Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve
title Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve
title_full Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve
title_fullStr Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve
title_full_unstemmed Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve
title_short Determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: Comparison with those of fractional flow reserve
title_sort determinants and prognostic implications of instantaneous wave-free ratio in patients with mild to intermediate coronary stenosis: comparison with those of fractional flow reserve
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410195/
https://www.ncbi.nlm.nih.gov/pubmed/32760123
http://dx.doi.org/10.1371/journal.pone.0237275
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