+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio, and non-invasive coronary flow reserve



Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio, and non-invasive coronary flow reserve



International Journal of Cardiovascular Imaging 33(7): 999-1007



To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50-70 % diameter stenosis), were prospectively studied. IFR was calculated as a trans-lesion pressure ratio during the wave-free period in diastole; FFR as distal pressure divided by mean aortic pressure during maximal hyperemia (using 180 μg intracoronary adenosine); and CFR as hyperemic peak LAD flow velocity divided by baseline flow velocity using intravenous adenosine (140 μg/kg/min over 2 min). The mean values of IFR, FFR, and CFR were 0.88 ± 0.07, 0.81 ± 0.09, and 2.4 ± 0.6 respectively. A significant correlation was found between CFR and FFR (r = 0. 68), FFR and IFR (r = 0.6), and between CFR and IFR (r = 0.5) (all, p < 0.01). Using a ROC curve analysis, the best cut-off to detect a significant lesion based on FFR assessment (FFR ≤ 0.8, n = 31) was IFR ≤ 0.88 with a sensitivity (Se) of 74 %, specificity (Sp) of 73 %, AUC 0.81 ± 0.04, accuracy 72 %; and CFR ≤ 2 with a Se = 77 %, Sp = 89 %, AUC 0.88 ± 0.04, accuracy 85 % (all, p < 0.001). In stable patients with LAD stenosis of IS, non-invasive CFR is a useful tool to detect a significant lesion based on FFR. Furthermore, there was a better correlation between CFR and FFR than between CFR and IFR, and a trend to a better diagnostic performance for CFR versus IFR.

(PDF emailed within 0-6 h: $19.90)

Accession: 057243724

Download citation: RISBibTeXText

PMID: 27752796

DOI: 10.1007/s10554-016-1000-3


Related references

Comparison between non-invasive coronary flow reserve and fractional flow reserve to assess the functional significance of left anterior descending artery stenosis of intermediate severity. Journal of the American Society of Echocardiography 24(4): 374-381, 2011

VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice): a multicenter study in consecutive patients. Journal of the American College of Cardiology 61(13): 1421-1427, 2013

TCT-163 Physiologic Assessment of Intermediate Coronary Artery Stenosis by Intravascular Ultrasound Radiofrequency Signal Analysis of Blood Speckles: A Comparison with Fractional Flow Reserve and Instantaneous Wave-Free Ratio. Journal of the American College of Cardiology 66(15): B59-B60, 2015

Fractional flow reserve and instantaneous wave-free ratio for the physiological assessment of coronary artery stenosis in the catheterization laboratory: Practical tips. Annales de Cardiologie et d'Angeiologie 66(1): 32-41, 2016

Non-invasive instantaneous wave-free ratio using coronary CT angiography: diagnostic performance for evaluation of ischaemia-causing coronary stenosis confirmed by invasive fractional flow reserve. Clinical Radiology 73(11): 983.E15-983.E22, 2018

Diagnostic performance of on-site computed CT-fractional flow reserve based on fluid structure interactions: comparison with invasive fractional flow reserve and instantaneous wave-free ratio. European Heart Journal Cardiovascular Imaging 2018, 2018

Reconciling poststenotic pressure with hyperemic flow: comparing coronary flow reserve, instantaneous wave-free ratio, and fractional flow reserve. Circulation. Cardiovascular Interventions 7(4): 432-434, 2015

Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery. Circulation. Cardiovascular Interventions 9(8), 2018

Coronary Flow Reserve in the Instantaneous Wave-Free Ratio/Fractional Flow Reserve Era: Too Valuable to Be Neglected. Jacc. Cardiovascular Interventions 11(15): 1434-1436, 2018

Evaluation of left anterior descending coronary artery stenosis of intermediate severity using transthoracic coronary flow reserve and dobutamine stress echocardiography. Journal of the American Society of Echocardiography 18(12): 1233-1240, 2005

Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements. Jacc. Cardiovascular Interventions 10(24): 2514-2524, 2017

Quantitative flow ratio and instantaneous wave-free ratio for the assessment of the functional severity of intermediate coronary artery stenosis. Coronary Artery Disease 29(8): 611-617, 2018

Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve: A PRISMA-compliant meta-analysis of randomized studies. Medicine 95(36): E4774, 2017

Diagnostic accuracy of a hybrid approach of instantaneous wave-free ratio and fractional flow reserve using high-dose intracoronary adenosine to characterize intermediate coronary lesions: Results of the PALS (Practical Assessment of Lesion Severity) prospective study. Catheterization and Cardiovascular Interventions 90(7): 1070-1076, 2017

Discordance Between Resting and Hyperemic Indices of Coronary Stenosis Severity: The VERIFY 2 Study (A Comparative Study of Resting Coronary Pressure Gradient, Instantaneous Wave-Free Ratio and Fractional Flow Reserve in an Unselected Population Referred for Invasive Angiography). Circulation. Cardiovascular Interventions 9(11), 2017