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

Instantaneous wave-free ratio to guide coronary revascularisation: physiological framework, validation and differences from fractional flow reserve



Instantaneous wave-free ratio to guide coronary revascularisation: physiological framework, validation and differences from fractional flow reserve



Eurointervention 13(4): 450-458



Determining the optimal treatment strategy for revascularisation of coronary artery stenosis involves the use of fractional flow reserve (FFR). To improve the low clinical uptake of physiological lesion assessment to guide revascularisation, the instantaneous wave-free period (iFR) was proposed as a simpler alternative to FFR that does not require adenosine administration. iFR is calculated as the ratio of blood pressure distal and proximal to a coronary artery stenosis during the diastolic wave-free period. The wave-free period is a part of the cardiac cycle where generation of new pressure wavefronts does not occur and resting microvascular resistance is relatively minimised. iFR indicates the haemodynamic severity of a stenosis, by assessing the extent to which the epicardial stenosis depletes the microcirculatory, autoregulatory reserve. The introduction of iFR and the potential to assess haemodynamic stenosis severity without the need for administration of potent vasodilators such as adenosine sparked an interesting debate about the fundamentals of human coronary physiology. The outcomes of two randomised clinical trials investigating iFR are pending. These studies are designed to evaluate whether iFR-guided revascularisation is non-inferior to an FFR-guided approach. The purpose of this review article is to discuss the physiological concepts underlying iFR, examine the existing validation studies and discuss the advantages and disadvantages of iFR as compared to FFR.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 059867922

Download citation: RISBibTeXText

PMID: 28191874


Related references

Study of diagnostic efficiencies of pressure indices (rest pd/pa, instantaneous wave free ratio, contrast fractional flow reserve) against fractional flow reserve 0.80 in intermediate coronary lesions. Indian Heart Journal 70: S71-S72, 2018

Differences Between Fractional Flow Reserve and Instantaneous Wave-Free Ratio Clarified by Consideration of a Mathematical Model of Diffuse Coronary Stenosis. Jacc. Cardiovascular Interventions 11(18): 1903-1904, 2018

Revisiting the Optimal Fractional Flow Reserve and Instantaneous Wave-Free Ratio Thresholds for Predicting the Physiological Significance of Coronary Artery Disease. Circulation. Cardiovascular Interventions 11(12): E007041-E007041, 2018

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

Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI. New England Journal of Medicine 376(19): 1813-1823, 2017

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

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

Validation of Resting Diastolic Pressure Ratio Calculated by a Novel Algorithm and Its Correlation With Distal Coronary Artery Pressure to Aortic Pressure, Instantaneous Wave-Free Ratio, and Fractional Flow Reserve. Circulation. Cardiovascular Interventions 11(12): E006911-E006911, 2018

Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio and non-invasive coronary flow reserve. Annales de Cardiologie et d'Angéiologie 65(5): 380-381, 2016

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, 2016

Tctap A-003 Sex Differences in Instantaneous Wave-free Ratio (iFr) or Fractional Flow Reserve (Ffr) Guided Strategy. Journal of the American College of Cardiology 73(15): S1-S2, 2019

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

Go With the Flow When Instantaneous Wave-Free Ratio-Fractional Flow Reserve Discordance Occurs: Indeed, Beware When Relying on Fractional Flow Reserve Alone. Jacc. Cardiovascular Interventions 11(23): 2435-2436, 2018

Hybrid Instantaneous Wave-Free Ratio-Fractional Flow Reserve versus Fractional Flow Reserve in the Real World. Frontiers in Cardiovascular Medicine 4: 35, 2017

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