Abstract 9916: Evaluation of the Best Cut-off Value of Ischemia in Instantaneous Wave-Free Ratio in Patients With Aortic Valve Stenosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hiroyuki Arashi ◽  
Junichi Yamaguchi ◽  
Tonre Ri ◽  
Eiji Shibahashi ◽  
Ryosuke Itani ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Coronary Stenosis ◽  
Pressure Ratio ◽  
Aortic Valve Area ◽  
Fractional Flow ◽  
Clinical Value ◽  
Flow Reserve ◽  
Significant Difference ◽  
The Mean

Background: Instantaneous wave-free ratio (iFR) is a vasodilator free index calculated using trans-lesional pressure ratio during a specific period of diastole that is called “wave-free period”, and reported to have a good correlation with fractional flow reserve (FFR). In patients with severe aortic valve stenosis (AS), evaluation of intermediate coronary stenosis by FFR using vasodilators is thought to be a contraindication in some situations. Moreover, previous studies reported unique coronary flow pattern during diastolic phase in patients with AS. To date, there is no report claiming the correlation of iFR and FFR in this population. The purpose of the present study was to examine the clinical value of iFR in patients with AS. Method and Results: We examined consecutive 154 patients (with 214 stenosis) whose iFR and FFR were measured simultaneously. The mean age of AS patients (n=10, mean aortic valve area: 0.75 ± 0.42cm2) was higher than non-AS patients (n=144). Other patients’ characteristics are shown in Table 1. The mean iFR value in AS patients was significantly lower than that of non-AS patients, despite no significant difference was observed in the mean FFR value and % diameter stenosis (Table 2). iFR showed a good correlation with FFR in AS patients (Figure 1) and the best cut-off value of iFR in receiver operator curve analysis to predict FFR ≤ 0.8 was 0.73 in AS patients (AUC 0.84, sensitivity 0.8, specificity 0.86, p=0.016; Figure 2), whereas, 0.90 in non-AS patients. Conclusion: The present study demonstrated the good correlation between iFR and FFR in AS patients. Besides, the value below 0.73 of iFR was thought to be a predictor of myocardial ischemia in AS patients, which was lower than standard predictive range of ischemia in iFR. Vasodilator-free assessment by iFR may have potential benefits in evaluating intermediate coronary stenosis in patients with AS.

Fractional flow reserve and instantaneous wave-free ratio discordance in patients with severe aortic valve stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Yamanaka ◽  
K Shishido ◽  
S Yokota ◽  
N Moriyama ◽  
Y Mashimo ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Fractional Flow Reserve ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Aortic Valve Area ◽  
Fractional Flow ◽  
Left Anterior Descending Artery ◽  
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

scholarly journals TCT-516 Instantaneous-wave Free Ratio and Fractional Flow Reserve Comparison in Patients with and Without Severe Aortic Valve Stenosis.

2016 ◽  
Vol 68 (18) ◽  
pp. B208
Author(s):  
Roberto Scarsini ◽  
Gabriele Pesarini ◽  
Carlo Zivelonghi ◽  
Anna Piccoli ◽  
Alessia Gambaro ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve

Combining Baseline Distal-to-Aortic Pressure Ratio and Fractional Flow Reserve in the Assessment of Coronary Stenosis Severity

2015 ◽  
Vol 8 (13) ◽  
pp. 1681-1691 ◽  
Author(s):  
Mauro Echavarría-Pinto ◽  
Tim P. van de Hoef ◽  
Martijn A. van Lavieren ◽  
Sukhjinder Nijjer ◽  
Borja Ibañez ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Pressure Ratio ◽  
Aortic Pressure ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Stenosis Severity

scholarly journals TCT-300 Combining baseline distal-to-aortic pressure ratio and fractional flow reserve in the assessment of coronary stenosis severity

2015 ◽  
Vol 66 (15) ◽  
pp. B119
Author(s):  
Mauro Echavarria-Pinto ◽  
Tim P. van de Hoef ◽  
Martijn A. van Lavieren ◽  
Sukhjinder S. Nijjer ◽  
Borja Ibañez ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Pressure Ratio ◽  
Aortic Pressure ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Stenosis Severity

scholarly journals SmartFFR, a New Functional Index of Coronary Stenosis: Comparison With Invasive FFR Data

2021 ◽  
Vol 8 ◽  
Author(s):  
Panagiotis K. Siogkas ◽  
Lampros Lakkas ◽  
Antonis I. Sakellarios ◽  
George Rigas ◽  
Savvas Kyriakidis ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Coronary Stenosis ◽  
Invasive Coronary Angiography ◽  
Rigid Wall ◽  
Site Index ◽  
Computational Time ◽  
Fractional Flow ◽  
Functional Index ◽  
Flow Reserve ◽  
The Mean

Aims: In this study, we evaluate the efficacy of SmartFFR, a new functional index of coronary stenosis severity compared with gold standard invasive measurement of fractional flow reserve (FFR). We also assess the influence of the type of simulation employed on smartFFR (i.e. Fluid Structure Interaction vs. rigid wall assumption).Methods and Results: In a dataset of 167 patients undergoing either computed tomography coronary angiography (CTCA) and invasive coronary angiography or only invasive coronary angiography (ICA), as well as invasive FFR measurement, SmartFFR was computed after the 3D reconstruction of the vessels of interest and the subsequent blood flow simulations. 202 vessels were analyzed with a mean total computational time of seven minutes. SmartFFR was used to process all models reconstructed by either method. The mean FFR value of the examined dataset was 0.846 ± 0.089 with 95% CI for the mean of 0.833–0.858, whereas the mean SmartFFR value was 0.853 ± 0.095 with 95% CI for the mean of 0.84–0.866. SmartFFR was significantly correlated with invasive FFR values (RCCTA = 0.86, pCCTA < 0.0001, RICA = 0.84, pICA < 0.0001, Roverall = 0.833, poverall < 0.0001), showing good agreement as depicted by the Bland-Altman method of analysis. The optimal SmartFFR threshold to diagnose ischemia was ≤0.83 for the overall dataset, ≤0.83 for the CTCA-derived dataset and ≤0.81 for the ICA-derived dataset, as defined by a ROC analysis (AUCoverall = 0.956, p < 0.001, AUCICA = 0.975, p < 0.001, AUCCCTA = 0.952, p < 0.001).Conclusion: SmartFFR is a fast and accurate on-site index of hemodynamic significance of coronary stenosis both at single coronary segment and at two or more branches level simultaneously, which can be applied to all CTCA or ICA sequences of acceptable quality.

Abstract 4693: Osteoporosis Treatment Associated with Decreased Progression of Aortic Stenosis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Adam H Skolnick ◽  
Martin Osranek ◽  
Phillip Formica ◽  
Itzhak Kronzon
Keyword(s):  
Renal Function ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Osteoporosis Treatment ◽  
Aortic Valve Area ◽  
Mineral Density ◽  
Significant Difference ◽  
The Mean ◽  
Statin Use ◽  
Valve Area

A decline in bone mineral density has been reported to be associated with progression of aortic stenosis (AS). We hypothesized that osteoporosis treatment (OT) is associated with decreased progression of AS. We performed a retrospective chart review of patients with mild and moderate aortic stenosis from our echocardiographic database comparing 18 patients on OT (bisphosphonates, calcitonin or estrogen receptor modulators) to 37 patients not on OT. All patients had serial echocardiograms. Patients with mitral stenosis, aortic valve replacement, renal failure, calcium disorders, or LVEF<40% were excluded. Aortic valve area (AVA) was calculated using the continuity equation. There was no significant difference in age (mean of 82 years), gender (76% female), renal function, hypertension, statin use, diabetes or calcium level between the two groups. The mean baseline aortic valve area was 1.33 cm 2 and was not significantly different between the two groups. After a mean of 2.4 ± 1.0 years, the mean annual change in AVA was −0.10 ± 0.18 cm 2 in patients receiving OT and −0.22 ± 0.22 cm 2 in those not on OT (p=0.025). There was a graded association between AS progression rate and OT (Figure ). Age, gender, hypertension, renal function and statin use were not significantly associated with change in AVA. In a relatively small population of patients, osteoporosis treatment is strongly associated with decreased progression of aortic stenosis. This association warrants investigation in a larger, prospective study.

scholarly journals Non-randomized comparison between revascularization and deferral for intermediate coronary stenosis with abnormal fractional flow reserve and preserved coronary flow reserve

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Doosup Shin ◽  
Joo Myung Lee ◽  
Seung Hun Lee ◽  
Doyeon Hwang ◽  
Ki Hong Choi ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Fractional Flow Reserve ◽  
International Collaboration ◽  
Coronary Stenosis ◽  
Coronary Flow ◽  
Target Vessel ◽  
Fractional Flow ◽  
Patient Level ◽  
Flow Reserve ◽  
Significant Difference

AbstractLimited data are available regarding comparative prognosis after percutaneous coronary intervention (PCI) versus deferral of revascularization in patients with intermediate stenosis with abnormal fractional flow reserve (FFR) but preserved coronary flow reserve (CFR). From the International Collaboration of Comprehensive Physiologic Assessment Registry (NCT03690713), a total of 330 patients (338 vessels) who had coronary stenosis with FFR ≤ 0.80 but CFR > 2.0 were selected for the current analysis. Patient-level clinical outcome was assessed by major adverse cardiac events (MACE) at 5 years, a composite of all-cause death, target-vessel myocardial infarction (MI), or target-vessel revascularization. Among the study population, 231 patients (233 vessels) underwent PCI and 99 patients (105 vessels) were deferred. During 5 years of follow-up, cumulative incidence of MACE was 13.0% (31 patients) without significant difference between PCI and deferred groups (12.7% vs. 14.0%, adjusted HR 1.301, 95% CI 0.611–2.769, P = 0.495). Multiple sensitivity analyses by propensity score matching and inverse probability weighting also showed no significant difference in patient-level MACE and vessel-specific MI or revascularization. In this hypothesis-generating study, there was no significant difference in clinical outcomes between PCI and deferred groups among patients with intermediate stenosis with FFR ≤ 0.80 but CFR > 2.0. Further study is needed to confirm this finding.Clinical Trial Registration: International Collaboration of Comprehensive Physiologic Assessment Registry (NCT03690713; registration date: 10/01/2018).

P5616Risk stratification of cardiovascular events among patients with functionally non-significant coronary stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Jujo ◽  
K Shimazaki ◽  
Y Furuki ◽  
T Moriyama ◽  
N Shiozaki ◽  
...  
Keyword(s):  
Coronary Stenosis ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Fractional Flow ◽  
Clinical Prognosis ◽  
Flow Reserve ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Significant Coronary Stenosis ◽  
Deferred Group

Abstract Introduction Deferral of percutaneous coronary intervention (PCI) of a functionally non-significant stenosis is associated with a favorable long-term clinical prognosis. However, to date, there has been limited evidence to stratify the risk for the development of cardiovascular (CV) adverse events in patients who were deferred of PCI due to a greater fractional flow reserve (FFR) than 0.80 at the target lesion. Purpose We aimed to stratify the risk of CV events in patients with functionally significant and non-significant coronary stenosis. Methods This observational study included 458 patients who were proven angiographically intermediate coronary stenoses and were measured FFR, of whom 298 deferred patients with FFR>0.80 and 160 intervened patients with FFR<0.80. The primary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE) including any death, non-fatal myocardial infarction, hospitalization due to heart failure, ischemic stroke and any unplanned revascularization. ROC curve for MACCE indicated the cut-off point of FFR as 0.85 and 0.76 in deferred patients and intervened patients, respectively. Results During the observation period, 27 MACCE (9.1%) in the Deferred group, and 33 MACCE (20.6%) in Intervened group were occurred. Kaplan-Meier curves showed a higher MACCE rate in the Intervened group than Deferred group (hazard ratio (HR): 2.19, 95% confidence interval (CI): 1.29–3.71, Figure A). However, even among patients in the Deferred group, the population with “intermediate” FFR (0.81–0.85) had a significantly higher MACCE rate than those with higher FFR (>0.85) (HR 2.55, 95% CI 1.14–5.69, Figure B). This rate was comparable to that of the Intervened group at the remote phase (at 4-year: 32.0% vs. 35.8%). Conversely, in the Intervened group, there was no statistically significant difference in MACCE rate between patients with higher FFR (0.76–0.80) and those with lower FFR (<0.76) (Log-rank: p=0.21, Figure C). Conclusion The population with relatively low FFR in patients who were deferred PCI by FFR>0.80 had comparable MACCE rate to patients with FFR<0.80. Close observation after the FFR evaluation should be considered in those population.

Influence of heart rate on fractional flow reserve, pressure drop coefficient, and lesion flow coefficient for epicardial coronary stenosis in a porcine model

2011 ◽  
Vol 300 (1) ◽  
pp. H382-H387 ◽  
Author(s):  
Kranthi K. Kolli ◽  
R. K. Banerjee ◽  
Srikara V. Peelukhana ◽  
T. A. Helmy ◽  
M. A. Leesar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pressure Drop ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Flow Coefficient ◽  
Fractional Flow ◽  
Mean Values ◽  
Flow Reserve ◽  
The Mean ◽  
Lesion Flow Coefficient

A limitation in the use of invasive coronary diagnostic indexes is that fluctuations in hemodynamic factors such as heart rate (HR), blood pressure, and contractility may alter resting or hyperemic flow measurements and may introduce uncertainties in the interpretation of these indexes. In this study, we focused on the effect of fluctuations in HR and area stenosis (AS) on diagnostic indexes. We hypothesized that the pressure drop coefficient (CDPe, ratio of transstenotic pressure drop and distal dynamic pressure), lesion flow coefficient (LFC, square root of ratio of limiting value CDP and CDP at site of stenosis) derived from fluid dynamics principles, and fractional flow reserve (FFR, ratio of average distal and proximal pressures) are independent of HR and can significantly differentiate between the severity of stenosis. Cardiac catheterization was performed on 11 Yorkshire pigs. Simultaneous measurements of distal coronary arterial pressure and flow were performed using a dual sensor-tipped guidewire for HR < 120 and HR > 120 beats/min, in the presence of epicardial coronary lesions of <50% AS and >50% AS. The mean values of FFR, CDPe, and LFC were significantly different ( P < 0.05) for lesions of <50% AS and >50% AS (0.88 ± 0.04, 0.76 ± 0.04; 62 ± 30, 151 ± 35, and 0.10 ± 0.02 and 0.16 ± 0.01, respectively). The mean values of FFR and CDPe were not significantly different ( P > 0.05) for variable HR conditions of HR < 120 and HR > 120 beats/min (FFR, 0.81 ± 0.04 and 0.82 ± 0.04; and CDPe, 95 ± 33 and 118 ± 36). The mean values of LFC do somewhat vary with HR (0.14 ± 0.01 and 0.12 ± 0.02). In conclusion, fluctuations in HR have no significant influence on the measured values of CDPe and FFR but have a marginal influence on the measured values of LFC. However, all three parameters can significantly differentiate between stenosis severities. These results suggest that the diagnostic parameters can be potentially used in a better assessment of coronary stenosis severity under a clinical setting.

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