1157-41 Lesion severity index, a new nonhyperemic physiologic parameter for the assessment of coronary artery stenosis: A comparison to fractional flow reserve

Abstract Background It has been reported that discordance between fractional flow reserve (FFR) and Instantaneous Wave-Free Ratio (iFR) could occur in up to 20% of cases. However, there are no reports regarding discordance between FFR and iFR in patients with severe aortic valve stenosis (AS). Purpose We aimed to investigate the discordance between FFR and iFR in patients with severe AS. Methods Severe AS was defined as an aortic-valve area of ≤1.0 cm2, a mean aortic-valve gradient of 40mmHg or more, or a peak aortic-jet velocity of 4.0 m/s or more. Intermediate coronary artery stenosis was defined as 30% to 70% stenosis (visual estimation). FFR and iFR were calculated in 4 quadrants based on values of FFR ≤0.8 and iFR ≤0.89 (positive discordance; low FFR and high iFR, negative discordance; high FFR and low iFR). Results We examined consecutive 140 patients (164 intermediate coronary artery stenosis vessels). Mean FFR and iFR ± standard deviation was 0.82±0.09 and 0.82±0.14, respectively. The discordance was observed in 48 vessels (29.3%). In the discordant group, most of cases were negative discordance (45 cases, 93.6%). Binary logistic regression analysis showed that left anterior descending artery (Hazard Ratio 3.80; 1.55 to 9.31, p=0.0036) was independently associated with negative discordance. Conclusions In patients with severe AS, the discordance between FFR and iFR could be observed in 29.3% of the vessels, mostly negative discordance. The left anterior descending artery is an independent predictor for negative discordance. Funding Acknowledgement Type of funding source: None

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Fractional Flow Reserve Measurement for the Physiological Assessment of Coronary Artery Stenosis Severity

JAMA ◽

10.1001/jama.2018.10683 ◽

2018 ◽

Vol 320 (12) ◽

pp. 1275 ◽

Cited By ~ 1

Author(s):

Deepak L. Bhatt

Keyword(s):

Coronary Artery ◽

Fractional Flow Reserve ◽

Coronary Artery Stenosis ◽

Artery Stenosis ◽

Fractional Flow ◽

Flow Reserve ◽

Physiological Assessment ◽

Stenosis Severity

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P5619Correlation between dobutamine stress echocardiography and invasive fractional flow reserve in patients with known moderate coronary artery stenosis

European Heart Journal ◽

10.1093/eurheartj/ehy566.p5619 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

A Ahres ◽

B Jablonkai ◽

A Oze ◽

G Ruboczky ◽

B Nagybaczoni ◽

...

Keyword(s):

Coronary Artery ◽

Fractional Flow Reserve ◽

Stress Echocardiography ◽

Dobutamine Stress Echocardiography ◽

Coronary Artery Stenosis ◽

Dobutamine Stress ◽

Artery Stenosis ◽

Fractional Flow ◽

Flow Reserve

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P5633Diagnostic impact of resting full-cycle ratio as newly developed non-hyperemic indices for physiological lesion assessment

European Heart Journal ◽

10.1093/eurheartj/ehz746.0577 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Takashima ◽

A Suzuki ◽

S Sakurai ◽

H Ando ◽

Y Nakano ◽

...

Keyword(s):

Coronary Artery ◽

Entire Range ◽

Coronary Artery Stenosis ◽

Stable Condition ◽

Artery Stenosis ◽

Lesion Length ◽

Fractional Flow ◽

Gold Standard Method ◽

Flow Reserve ◽

Lesion Severity

Abstract Background Although fractional flow reserve (FFR) is a gold standard method to evaluate functional lesion severity in the catheterization laboratory, the need of hyperemic condition limits the widespread adoption of FFR. Recently, the resting full-cycle ratio (RFR) which was newly developed resting indices was launched. It is unclear whether RFR as resting condition could assess physiological lesion severity of coronary artery stenosis. The aim of this study was to evaluate the diagnostic impact of RFR compared to FFR in entire range of coronary artery stenosis. Method A total of 53 patients with 70 lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis. Results In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.3±0.8mm, 44±12%, 14.6±7.2mm, 0.90±0.11, and 0.83±0.11, respectively. Functional significance was observed in 24 lesions (34%) of all lesions. The RFR showed a significant correlation with FFR (y = 0.800x + 0.239, R = 0.817, p<0.001). The Bland-Altman plot demonstrated a good agreement with a mean difference of 0.07 and a standard deviation of 0.06 between RFR and FFR across entire range of coronary artery stenosis. ROC curve analysis showed an excellent accuracy of RFR cut-off of ≤0.90 in predicting FFR ≤0.80 which had 78% sensitivity and 87% specificity (AUC 0.87, diagnostic accuracy 84%). Conclusion The RFR as newly resting indices is reliable to the assessment of functional lesion severity. This physiology-based approach may be a possible alternative method for FFR measurements in daily practice.

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