Diagnostic Classification of the Instantaneous Wave-Free Ratio Is Equivalent to Fractional Flow Reserve and Is Not Improved With Adenosine Administration
Diagnostic Classification of the Instantaneous Wave-Free Ratio Is Equivalent to Fractional Flow Reserve and Is Not Improved With Adenosine Administration
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DOI：
10.1016/j.jacc.2013.01.034
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发表时间：
2013-04-02
影响因子：
24
通讯作者：
Davies, Justin E.
中科院分区：
文献类型：
--
作者：
Sen, Sayan;Asrress, Kaleab N.;Davies, Justin E.
目的：本研究旨在确定是否需要腺苷给药来评估冠状动脉狭窄。瞬时无波比（iFR）是一种无血管扩张剂、仅限压力的冠状动脉狭窄血流动力学严重程度的测量方法，在诊断分类上与分数血流储备（FFR）相当。在本研究中，我们使用充血性狭窄阻力（hyperemic stenosis resistance， HSR），一种压力和血流联合指标，作为判定iFR和FFR不一致时哪个指标最能代表狭窄的血流动力学意义的仲裁指标。然后，我们测试给药腺苷是否显著提高iFR的诊断性能。方法测定51只血管在静息状态和腺苷介导的充血状态下狭窄远端冠状动脉内压和血流速度。使用自动算法计算iFR（静息和腺苷给药[iFRa]期间）、FFR、HSR、基线和充血微血管阻力。结果当iFR和FFR不一致时（4例，占研究人群的7.7%），50%的病例中HSR与iFR一致，50%的病例中FFR一致。微血管阻力大小的差异不影响诊断分类；iFR、iFRa和FFR与HSR同样具有良好的诊断一致性（曲线下受者工作特征面积0.93 iFR vs 0.94 iFRa和0.96 FFR, p = 0.48）。结论iFR和FFR与HSR对冠状动脉狭窄严重程度的分级具有相当的一致性。通过给药腺苷进一步降低耐药并没有改善诊断分类，这表明iFR可以作为FFR的无腺苷替代品。[J]; journal of nurses training; 2013; (1):1 - 4 . [C] 2013
Objectives This study sought to determine if adenosine administration is required for the pressure-only assessment of coronary stenoses.Background The instantaneous wave-free ratio (iFR) is a vasodilator-free pressure-only measure of the hemodynamic severity of a coronary stenosis comparable to fractional flow reserve (FFR) in diagnostic categorization. In this study, we used hyperemic stenosis resistance (HSR), a combined pressure-and-flow index, as an arbiter to determine when iFR and FFR disagree which index is most representative of the hemodynamic significance of the stenosis. We then test whether administering adenosine significantly improves diagnostic performance of iFR.Methods In 51 vessels, intracoronary pressure and flow velocity was measured distal to the stenosis at rest and during adenosine-mediated hyperemia. The iFR (at rest and during adenosine administration [iFRa]), FFR, HSR, baseline, and hyperemic microvascular resistance were calculated using automated algorithms.Results When iFR and FFR disagreed (4 cases, or 7.7% of the study population), HSR agreed with iFR in 50% of cases and with FFR in 50% of cases. Differences in magnitude of microvascular resistance did not influence diagnostic categorization; iFR, iFRa, and FFR had equally good diagnostic agreement with HSR (receiver-operating characteristic area under the curve 0.93 iFR vs. 0.94 iFRa and 0.96 FFR, p = 0.48).Conclusions iFR and FFR had equivalent agreement with classification of coronary stenosis severity by HSR. Further reduction in resistance by the administration of adenosine did not improve diagnostic categorization, indicating that iFR can be used as an adenosine-free alternative to FFR. (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study [CLARIFY]; NCT01118481) (J Am Coll Cardiol 2013;61:1409-20) (C) 2013 by the American College of Cardiology Foundation