Reliability of Instantaneous Wave-Free Ratio (iFR) for the Evaluation of Left Main Coronary Artery Lesions

Journal of Clinical Medicine
Salvatore De RosaCiro Indolfi

Abstract

The assessment of the left main coronary artery (LMCA) by coronary angiography has several limitations. The fractional flow reserve (FFR) is useful for the functional evaluation of LMCA stenoses. The instantaneous wave-free ratio (iFR), a resting index, was developed to simplify functional coronary assessment. However, its performance for LMCA stenoses has yet to be explored. The iFR was measured at rest, and the FFR was measured under maximal hyperemia. We calculated that a sample size of 90 lesions would have provided 90% power at a 5% significance level to detect an Area Under the Curve (AUC) < 0.7 for the iFR to identify FFR-positive stenoses. A total of 91 measurements were performed on angiographically intermediate LMCA stenoses at three centers. The comparison between the iFR and the FFR showed a significant correlation (r = 0.67, p < 0.001). At receiver operating characteristic (ROC) analysis, the iFR revealed a good diagnostic performance when compared to the FFR (AUC = 0.84; p < 0.001). A classification agreement between the iFR and the FFR was recorded in 81% of cases. The left ventricular ejection fraction (LVEF) was an independent predictor of the discrepancy between the FFR and iFR values (p = 0.040). The present ...Continue Reading

References

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Jan 13, 2018·Circulation. Cardiovascular Interventions·Salvatore De RosaCiro Indolfi

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Citations

May 16, 2020·Nature Reviews. Cardiology·Tim P van de HoefJan J Piek
Feb 10, 2020·Current Cardiology Reports·Harsha S NagarajaraoTimir K Paul
Feb 26, 2021·Journal of Interventional Cardiology·Peter KayaertSteven Haine

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Methods Mentioned

BETA
coronary artery bypass

Clinical Trials Mentioned

NCT01881555
NCT03767621

Software Mentioned

SPSS

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