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Real-time use of instantaneous wave-free ratio: Results of the ADVISE in-practice: An international, multicenter evaluation of instantaneous wave-free ratio in clinical practice

Petraco, Ricardo; Al-Lamee, Rasha; Götberg, Matthias LU ; Sharp, Andrew; Hellig, Farrel; Nijjer, Sulthjinder S.; Echavarria-Pinto, Mauro; van de Hoef, Tim P.; Sen, Sayan and Tanaka, Nobuhiro, et al. (2014) In American Heart Journal 168(5). p.739-748
Abstract
Objectives To evaluate the first experience of real-time instantaneous wave-free ratio (iFR) measurement by clinicians. Background The iFR is a new vasodilator-free index of coronary stenosis severity, calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, when distal resistance is lowest and stable. Because all previous studies have calculated iFR offline, the feasibility of real-time iFR measurement has never been assessed. Methods Three hundred ninety-two stenoses with angiographically intermediate stenoses were included in this multicenter international analysis. Instantaneous wave free ratio and fractional flow reserve (FFR) were performed in real time on commercially available consoles. The... (More)
Objectives To evaluate the first experience of real-time instantaneous wave-free ratio (iFR) measurement by clinicians. Background The iFR is a new vasodilator-free index of coronary stenosis severity, calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, when distal resistance is lowest and stable. Because all previous studies have calculated iFR offline, the feasibility of real-time iFR measurement has never been assessed. Methods Three hundred ninety-two stenoses with angiographically intermediate stenoses were included in this multicenter international analysis. Instantaneous wave free ratio and fractional flow reserve (FFR) were performed in real time on commercially available consoles. The classification agreement of coronary stenoses between iFR and FFR was calculated. Results Instantaneous wave-free ratio and FFR maintain a close level of diagnostic agreement when both are measured by clinicians in real time (for a clinical 0.80 FFR cutoff: area under the receiver operating characteristic curve [ROCAUC] 0.87, classification match 80%, and optimal iFR cutoff 0.90; for a ischemic 0.75 FFR cutoff: iFR ROCAUC 0.90, classification match 88%, and optimal iFR cutoff 0.85; if the FFR 0.75-0.80 gray zone is accounted for: ROCAUC 0.93, classification match 92%). When iFR and FFR are evaluated together in a hybrid decision-making strategy, 61% of the population is spared from vasodilator while maintaining a 94% overall agreement with FFR lesion classification. Conclusion When measured in real time, iFR maintains the close relationship to FFR reported in offline studies. These findings confirm the feasibility and reliability of real-time iFR calculation by clinicians. (Less)
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Contribution to journal
publication status
published
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in
American Heart Journal
volume
168
issue
5
pages
739 - 748
publisher
Mosby
external identifiers
  • wos:000344434300017
  • pmid:25440803
  • scopus:84908339420
ISSN
1097-6744
DOI
10.1016/j.ahj.2014.06.022
language
English
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yes
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1763395d-0dc8-4c87-aeba-88d057dae17e (old id 4865238)
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http://www.ncbi.nlm.nih.gov/pubmed/25440803?dopt=Abstract
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2015-01-07 10:32:43
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2017-11-19 03:10:08
@article{1763395d-0dc8-4c87-aeba-88d057dae17e,
  abstract     = {Objectives To evaluate the first experience of real-time instantaneous wave-free ratio (iFR) measurement by clinicians. Background The iFR is a new vasodilator-free index of coronary stenosis severity, calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, when distal resistance is lowest and stable. Because all previous studies have calculated iFR offline, the feasibility of real-time iFR measurement has never been assessed. Methods Three hundred ninety-two stenoses with angiographically intermediate stenoses were included in this multicenter international analysis. Instantaneous wave free ratio and fractional flow reserve (FFR) were performed in real time on commercially available consoles. The classification agreement of coronary stenoses between iFR and FFR was calculated. Results Instantaneous wave-free ratio and FFR maintain a close level of diagnostic agreement when both are measured by clinicians in real time (for a clinical 0.80 FFR cutoff: area under the receiver operating characteristic curve [ROCAUC] 0.87, classification match 80%, and optimal iFR cutoff 0.90; for a ischemic 0.75 FFR cutoff: iFR ROCAUC 0.90, classification match 88%, and optimal iFR cutoff 0.85; if the FFR 0.75-0.80 gray zone is accounted for: ROCAUC 0.93, classification match 92%). When iFR and FFR are evaluated together in a hybrid decision-making strategy, 61% of the population is spared from vasodilator while maintaining a 94% overall agreement with FFR lesion classification. Conclusion When measured in real time, iFR maintains the close relationship to FFR reported in offline studies. These findings confirm the feasibility and reliability of real-time iFR calculation by clinicians.},
  author       = {Petraco, Ricardo and Al-Lamee, Rasha and Götberg, Matthias and Sharp, Andrew and Hellig, Farrel and Nijjer, Sulthjinder S. and Echavarria-Pinto, Mauro and van de Hoef, Tim P. and Sen, Sayan and Tanaka, Nobuhiro and Van Belle, Eric and Bojara, Waldemar and Sakoda, Kunihiro and Mates, Martin and Indolfi, Ciro and De Rosa, Salvatore and Vrints, Christian J. and Haine, Steven and Yokoi, Hiroyoshi and Ribichini, Flavio L. and Meuwissen, Martjin and Matsuo, Hitoshi and Janssens, Luc and Katsumi, Ueno and Di Mario, Carlo and Escaned, Javier and Piek, Jan and Davies, Justin E.},
  issn         = {1097-6744},
  language     = {eng},
  number       = {5},
  pages        = {739--748},
  publisher    = {Mosby},
  series       = {American Heart Journal},
  title        = {Real-time use of instantaneous wave-free ratio: Results of the ADVISE in-practice: An international, multicenter evaluation of instantaneous wave-free ratio in clinical practice},
  url          = {http://dx.doi.org/10.1016/j.ahj.2014.06.022},
  volume       = {168},
  year         = {2014},
}