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

• Published in: Journal of the American College of Cardiology Vol. 61; no. 13; pp. 1421 - 1427
• Main Authors: BERRY, Colin, VAN'T VEER, Marcel, DE BRUYNE, Bernard, PIJLS, Nico H. J, OLDROYD, Keith G, WITT, Nils, KALA, Petr, BOCEK, Otakar, PYXARAS, Stylianos A, MCCLURE, John D, FEARON, William F, BARBATO, Emanuele, TONINO, Pim A. L
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 02.04.2013
• Subjects: Adenosine - administration & dosage; Aged; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary Angiography; Coronary Stenosis - diagnosis; Coronary Stenosis - pathology; Coronary Stenosis - physiopathology; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Fractional Flow Reserve, Myocardial - physiology; Humans; Hyperemia - physiopathology; Infusions, Intravenous; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Myocardial Contraction - physiology; ROC Curve; Severity of Illness Index; Vasodilator Agents - administration & dosage; Human; Reserve; Multicenter study; Coronary artery; Cardiovascular disease; Patient; Verification; Artery stenosis; Arterial disease; Vascular disease; Wave; Professional practice; Ratio; Circulatory system; Cardiology
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2012.09.065

This study sought to compare fractional flow reserve (FFR) with the instantaneous wave-free ratio (iFR) in patients with coronary artery disease and also to determine whether the iFR is independent of hyperemia. FFR is a validated index of coronary stenosis severity. FFR-guided percutaneous coronary intervention (PCI) improves clinical outcomes compared to angiographic guidance alone. iFR has been proposed as a new index of stenosis severity that can be measured without adenosine. We conducted a prospective, multicenter, international study of 206 consecutive patients referred for PCI and a retrospective analysis of 500 archived pressure recordings. Aortic and distal coronary pressures were measured in duplicate in patients under resting conditions and during intravenous adenosine infusion at 140 μg/kg/min. Compared to the FFR cut-off value of ≤0.80, the diagnostic accuracy of the iFR value of ≤0.80 was 60% (95% confidence interval [CI]: 53% to 67%) for all vessels studied and 51% (95% CI: 43% to 59%) for those patients with FFR in the range of 0.60 to 0.90. iFR was significantly influenced by the induction of hyperemia: mean ± SD iFR at rest was 0.82 ± 0.16 versus 0.64 ± 0.18 with hyperemia (p < 0.001). Receiver operating characteristics confirmed that the diagnostic accuracy of iFR was similar to resting Pd/Pa and trans-stenotic pressure gradient and significantly inferior to hyperemic iFR. Analysis of our retrospectively acquired dataset showed similar results. iFR correlates weakly with FFR and is not independent of hyperemia. iFR cannot be recommended for clinical decision making in patients with coronary artery disease.