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Comparative analysis of fractional flow reserve and instantaneous wave-free ratio : results of a five-year registry

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dc.contributor.authorMenezes, Miguel Nobre
dc.contributor.authorFrancisco, Ana Rita G.
dc.contributor.authorCarrilho-Ferreira, Pedro
dc.contributor.authorJorge, Cláudia
dc.contributor.authorTorres, Diogo
dc.contributor.authorCardoso, Pedro
dc.contributor.authorDuarte, José António
dc.contributor.authorCosta, José Marques da
dc.contributor.authorOliveira, Eduardo Infante de
dc.contributor.authorPinto, Fausto J.
dc.contributor.authorSilva, Pedro Canas da
dc.date.accessioned2018-07-18T13:51:15Z
dc.date.available2018-07-18T13:51:15Z
dc.date.issued2018
dc.description© 2018 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved.pt_PT
dc.description.abstractIntroduction and Objective: Assessment of coronary lesions by the instantaneous wave free ratio (iFR) has generated significant debate. We aimed to assess the diagnostic performance of iFR and its impact on the decision to use fractional flow reserve (FFR) and on procedural characteristics. Methods: In this single-center registry of patients undergoing functional assessment of coronary lesions, FFR was used as a reference for assessing the diagnostic performance of iFR. An iFR value <0.86 was considered positive and a value >0.93 was considered negative. Results: Functional testing was undertaken of 402 lesions, of which 154 were assessed with both techniques, 222 with FFR only, and 26 with iFR only. Using a cut-off of ≤0.80 for iFR, the area underthe curve was 0.73 (95% CI 0.65-0.81), with an optimal value of ≤0.91. FFR was undertaken in 93 out of 94 lesions with an inconclusive iFR and was performed in 69.1% of the remaining iFR-tested lesions. Concordance between iFR and FFR was 87% (chi-square=22.43; p<0.001). Notwithstanding, there were four out of 13 cases (30.7%) of positive iFR with negative FFR and three out of 42 (7.1%) cases of negative iFR and positive FFR. This difference was significant (p=0.026). iFR had no impact on procedure time, fluoroscopy time or radiation dose. Conclusion: iFR had a reasonable diagnostic performance. Operators often chose to perform FFR despite conclusive iFR results. iFR and FFR were highly concordant, but a non-negligible proportion of lesions classified as ischemic by iFR were classified as non-ischemic by FFR. iFR had no impact on procedural characteristics.pt_PT
dc.description.abstractIntrodução e objetivos: A avaliação de lesões coronárias pelo instantaneous wave free ratio (iFR) tem gerado debate. Pretendeu-se analisar o desempenho diagnóstico do iFR e o seu impacto na decisão de utilizar o fractional flow reserve (FFR) e nas características do procedimento. Métodos: Registo unicêntrico de doentes submetidos a avaliação funcional de lesões coronárias. O desempenho do iFR foi aferido utilizando o FFR como referência. Valores de iFR < 0,86 e > 0,93 foram considerados positivos e negativos, respetivamente. Resultados: avaliaram-se 402 lesões, em 154 casos com ambas as técnicas, em 222 apenas com FFR e 26 apenas com iFR. Utilizando um limiar de FFR ≤ 0,80, a área sob a curva foi de 0,73 (95% IC 0,65-0,81) - valor ótimo de iFR ≤ 0,91. Efetuou-se FFR em 93 de 94 lesões inconclusivas por iFR e em 69,1% dos restantes casos aferidos com iFR. O iFR e o FFR foram concordantes em 87% dos casos (X2=22,43; p<0,001). Não obstante, verificaram-se 4 em 13 casos (30,7%) de iFR positivo e FFR negativo, e 3 em 42 casos (7,1%) de iFR negativo e FFR positivo. Esta diferença foi estatisticamente significativa (p=0,026). O iFR não teve impacto na duração, dose/tempo de radiação do procedimento. Conclusões: O desempenho diagnóstico do iFR foi razoável. Os operadores habitualmente efetuaram FFR apesar de valores conclusivos de iFR. Verificou-se elevada concordância, mas com uma proporção não negligenciável de lesões classificadas como isquémicas por iFR e não isquémicas por FFR. O iFR não teve impacto nas características do procedimento.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationRev Port Cardiol. 2018;37(6):511-520pt_PT
dc.identifier.doi10.1016/j.repc.2017.11.011pt_PT
dc.identifier.issn2174-2049
dc.identifier.urihttp://hdl.handle.net/10451/34231
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/revista-portuguesa-de-cardiologiapt_PT
dc.subjectInstantaneous wave-free ratiopt_PT
dc.subjectFractional flow reservept_PT
dc.subjectInvasive functional assessment of coronary lesionspt_PT
dc.titleComparative analysis of fractional flow reserve and instantaneous wave-free ratio : results of a five-year registrypt_PT
dc.title.alternativeAnálise comparativa do fractional flow reserve (FFR) e do instantaneous wave-free ratio (iFR) : resultados de um registo de 5 anospt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage520pt_PT
oaire.citation.issue6pt_PT
oaire.citation.startPage511pt_PT
oaire.citation.titleRevista Portuguesa de Cardiologia (English Edition)pt_PT
oaire.citation.volume37pt_PT
person.familyNameCarrilho-Ferreira
person.familyNamePinto
person.givenNamePedro
person.givenNameFausto J.
person.identifier1308889
person.identifier.ciencia-idC311-AEDD-6DBB
person.identifier.orcid0000-0003-2008-1496
person.identifier.orcid0000-0002-8034-4529
person.identifier.ridG-9363-2015
person.identifier.scopus-author-id7102740158
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublicationadd7664c-b062-4d11-be74-e8802d7c4258
relation.isAuthorOfPublication5f44176f-69f5-482c-83cd-ab94425a6ec3
relation.isAuthorOfPublication.latestForDiscoveryadd7664c-b062-4d11-be74-e8802d7c4258

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