Comparison of Instantaneous Wave-Free Ratio (iFR) and Fractional Flow Reserve (FFR) with respect to Their Sensitivities to Cardiovascular Factors: A Computational Model-Based Study.
Xinyang GeYoujun LiuZhaofang YinShengxian TuYuqi FanYuri VassilevskiSergey SimakovFu-You LiangPublished in: Journal of interventional cardiology (2020)
While coronary revascularization strategies guided by instantaneous wave-free ratio (iFR) are, in general, noninferior to those guided by fractional flow reserve (FFR) with respect to the rate of major adverse cardiac events at one-year follow-up in patients with stable angina or an acute coronary syndrome, the overall accuracy of diagnosis with iFR in large patient cohorts is about 80% compared with the diagnosis with FFR. So far, it remains incompletely understood what factors contribute to the discordant diagnosis between iFR and FFR. In this study, a computational method was used to systemically investigate the respective effects of various cardiovascular factors on FFR and iFR. The results showed that deterioration in aortic valve disease (e.g., regurgitation or stenosis) led to a marked decrease in iFR and a mild increase in FFR given fixed severity of coronary artery stenosis and that increasing coronary microvascular resistance caused a considerable increase in both iFR and FFR, but the degree of increase in iFR was lower than that in FFR. These findings suggest that there is a high probability of discordant diagnosis between iFR and FFR in patients with severe aortic valve disease or coronary microcirculation dysfunction.
Keyphrases
- aortic valve
- coronary artery
- aortic stenosis
- transcatheter aortic valve replacement
- coronary artery disease
- transcatheter aortic valve implantation
- aortic valve replacement
- acute coronary syndrome
- pulmonary artery
- percutaneous coronary intervention
- left ventricular
- case report
- emergency department
- early onset
- heart failure
- coronary artery bypass grafting
- pulmonary hypertension