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

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...

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Published inJournal 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
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Published New York, NY Elsevier 02.04.2013
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Abstract 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.
AbstractList 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.
OBJECTIVESThis 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. BACKGROUNDFFR 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. METHODSWe 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. RESULTSCompared 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. CONCLUSIONSiFR correlates weakly with FFR and is not independent of hyperemia. iFR cannot be recommended for clinical decision making in patients with coronary artery disease.
Author TONINO, Pim A. L
KALA, Petr
BARBATO, Emanuele
DE BRUYNE, Bernard
PYXARAS, Stylianos A
MCCLURE, John D
BERRY, Colin
FEARON, William F
WITT, Nils
VAN'T VEER, Marcel
OLDROYD, Keith G
BOCEK, Otakar
PIJLS, Nico H. J
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Issue 13
Keywords Human
Reserve
Multicenter study
Coronary artery
Cardiovascular disease
Patient
Verification
Artery stenosis
Arterial disease
Vascular disease
Wave
Professional practice
Ratio
Circulatory system
Cardiology
Language English
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PublicationTitle Journal of the American College of Cardiology
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References 23433563 - J Am Coll Cardiol. 2013 Apr 2;61(13):1436-9
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Snippet 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...
OBJECTIVESThis study sought to compare fractional flow reserve (FFR) with the instantaneous wave-free ratio (iFR) in patients with coronary artery disease and...
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StartPage 1421
SubjectTerms 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
Title 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
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