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Comparison of Diagnostic Values of Instantaneous Wave-Free R atio and Fractional Flow R eserve With Noninvasive Methods for Evaluating Myocardial Ischemia in Assessment of the Functional Significance of Intermediate Coronary Stenoses in Patients With Chronic Ischemic Heart Disease

Darenskiy D. I., Gramovich V. V., Zharova E. A., Ansheles A. A., Sergienko V. B., Mitroshkin M. G., Atanesyan R. V., Matchin Y. G.
Institute of Cardiology of Russian Cardiology Scientific and Production Complex, Moscow, Russia

Keywords: instantaneous wave-free ratio; fractional flow reserve; stress-echo; SPECT

DOI: 10.18087/cardio.2017.8.10012

Objective. To compare the diagnostic accuracy of instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) with noninvasive methods in assessment of the functional significance of moderate coronary stenoses in patients with chronic ischemic heart disease (IHD). Methods. We included in this study 50 patients with chronic or suspected IHD and moderate coronary stenoses (50–70%; 74 stenoses). Values of iFR and FFR were determined within 10 days after noninvasive stress tests (combination of stress-echo and SPECT). The values of iFR and FFR were compared with the results of noninvasive methods by ROC-analysis. Coronary artery stenosis was considered functionally important if at least one of noninvasive tests (stress-echo or SPECT) demonstrated positive result. Results. The results of noninvasive stress-tests were positive in 14 patients (28%). ROC area under the curve (AUC) for iFR – 0.961±0.019 (95%CI 0.888–0.992). The best cut-off point for iFR is 0.92 (sensitivity 100, specificity 84%). ROC AUC for FFR – 0.893±0.041 (95%CI 0.79–0.96). The best cut-off point for FFR is 0.81 (sensitivity 100% and specificity 69%). There was no significant difference between iFR and FFR ROC-curves (р=0.0845). Conclusion. The values of iFR and FFR have equivalent agreement with the results of noninvasive tests commonly used to detect myocardial ischemia in patients with moderate coronary stenoses.
  1. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2014;35 (37):2541–2619. doi: 10.1093/eurheartj/ehu278.
  2. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J 2013;34 (38):2949–3003. doi: 10.1093/eurheartj/eht296.
  3. Tonino P., Fearon W., De Bruyne B. et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 2010;55 (25):2816–2821. doi:10.1016/j.jacc.2009.11.096.
  4. Pijls N.H., Pim A.L., William F. Fearon et al. Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis. 5-Year Follow-Up of the DEFER Study. J Am Coll Cardiol 2007;49 (21):2105–2111. doi:10.1016/j.jacc.2007.01.087.
  5. Belenkov Yu. N., Savtchenko A. P., Danilov N. M. et al. First Experience of the Use of Sirolimus Covered Stents Output in the Treatment of Ischemic Heart Disease. Kardiologiia 2004;44 (3):9–14. Russian (Беленков Ю. Н., Савченко А. П., Данилов Н. М. и др. Первый опыт применения сиролимуспокрытых стентов Cypher в лечении ишемической болезни сердца. Кардиология 2004;44 (3):9–14).
  6. Lotfi A., Jeremias A., Fearon W. et al. Expert consensus statement on the use of fractional flow reserve, intravascular ultrasound, and optical coherence tomography. Cathet Cardiovasc Intervent 2014;83 (4):509–518. doi: 10.1002/ccd.25222.
  7. De Bruyne B., Pijls N.H., Barbato E. et al. Intracoronary and Intravenous Adenosine 5’-Triphosphate, Adenosine, Papaverine, and Contrast Medium to Assess Fractional Flow Reserve in Humans. Circulation 2003;107 (14):1877–1883. doi: 10.1161/01.CIR.0000061950.24940.88.
  8. Dattilo P.B., Prasad A., Honeycutt E. et al. Contemporary patterns of fractional flow reserve and intravascular ultrasound use among patients undergoing percutaneous coronary intervention in the United States: insights from the National Cardiovascular Data Registry. J Am Coll Cardiol 2012;60 (22):2337–2339. doi: 10.1016/j.jacc.2012.08.990.
  9. Puymirat E., Muller O., Sharif F. et al. Fractional flow reserve: Concepts, applications and use in France in 2010. Arch Cardiovasc Dis 2010;103 (11–12):615–622. doi: 10.1016/j.acvd.2010.10.006.
  10. Nakayama M., Saito A., Kitazawa H. et al. Papaverine-induced polymorphic ventricular tachycardia in relation to QTU and giant T-U waves in four cases. Intern Med 2012;51 (4):351–356. doi: 10.2169/internalmedicine.51.6567.
  11. Sen S., Escaned J., Malik I. et al. Development and Validation of a New Adenosine-Independent Index of Stenosis Severity From Coronary Wave – Intensity Analysis. J Am Coll Cardiol 2012;59 (15):1392–1402. doi: 10.1016/j.jacc.2011.11.003.
  12. Sen S., Asrress K.N., Nijjer S. et al. Diagnostic Classification of the Instantaneous Wave-Free Ratio Is Equivalent to Fractional Flow Reserve and Is Not Improved With Adenosine Administration. J Am Coll Cardiol 2013;61 (13):1409–1420. doi:10.1016/j.jacc.2013.01.034.
  13. Escaned J., Echavarría-Pinto M., Garcia-Garcia H.M. et al. Prospective Assessment of the Diagnostic Accuracy of Instantaneous Wave-Free Ratio to Assess Coronary Stenosis Relevance: Results of ADVISE II International, Multicenter Study (ADenosine Vasodilator Independent Stenosis Evaluation II). JACC Cardiovasc Interv 2015;8 (6):824–833. doi: 10.1016/j.jcin.2015.01.029.
  14. Fletcher G.F., Ades P.A., Kligfield P. et al. Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association. Circulation 2013;128 (8):873–934. doi: 10.1161/CIR.0b013e31829b5b44.
  15. Sicari R., Nihoyannopoulos P., Evangelista A. et al. Stress Echocardiography Expert Consensus Statement – Executive Summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J 2009:30 (3):278–289. doi: 10.1093/eurheartj/ehn492
  16. Sergienko V. B., Ansheles A. A., Shulgin D. N. et al. Methodical recommendations Perfusion scintigraphy and OECT of the myocardium. Kardiologicheskij Vestnik 2015;10 (2):6–21. Russian (Сергиенко В. Б., Аншелес А. А., Шульгин Д. Н. и др. Методические рекомендации перфузионная сцинтиграфия и ОФЭКТ миокарда. Кардиологический вестник 2015;10 (2):6–21).
  17. Ansheles A. A., Shulgin D. N., Solomyany V. V., Sergienko V. B. Comparison of stress-test, single-photon emission computed tomography, and coronarography results in IHD patients. Kardiologicheskij Vestnik 2012;7 (2):10–16. Russian (Аншелес А. А., Шульгин Д. Н., Соломяный В. В., Сергиенко В. Б. Сопоставление результатов нагрузочных проб, данных однофотонной эмиссионной компьютерной томографии миокарда и коронарографии у больных ишемической болезнью сердца. Кардиологический вестник 2012;7 (2):10–16).
  18. Hachamovitch R., Hayes S.W., Friedman J.D. et al. Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD. J Am Coll Cardiol 2004;43 (2):200–208. doi: 10.1016/j.jacc.2003.07.043.
  19. Jeremias A., Maehara A., Généreux P. et al. Multicenter Core Laboratory Comparison of the Instantaneous Wave-Free Ratio and Resting Pd/Pa with Fractional Flow Reserve: The RESOLVE Study. J Am Coll Cardiol 2014;63 (13):1253–1261. doi: 10.1016/j.jacc.2013.09.060.
  20. Matchin Y., Gramovich V., Darenskiy D. et al. Method of instantaneous wave-free ratio in comparison with fractional flow reserve in assessment of the physiological significance of intermediate coronary stenosis. Kardiologicheskij Vestnik 2015;10 (1):38–43. Russian (Матчин Ю. Г., Грамович В. В., Даренский Д. И. и др. Использование метода моментального резерва кровотока в сравнении с фракционным резервом кровотока при оценке физиологической значимости пограничных коронарных стенозов. Кардиологический вестник 2015;10 (1):38–43).
  21. Pijls N.H., De Bruyne B., Peels K. et al. Measurement of Fractional Flow Reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 1996;334 (26):1703–1708. doi: 10.1056/NEJM199606273342604.
Darenskiy D. I., Gramovich V. V., Zharova E. A., Ansheles A. A., Sergienko V. B., Mitroshkin M. G., Atanesyan R. V., Matchin Y. G. Comparison of Diagnostic Values of Instantaneous Wave-Free Ratio and Fractional Flow Reserve With Noninvasive Methods for Evaluating Myocardial Ischemia in Assessment of the Functional Significance of Intermediate Coronary Stenoses in Patients With Chronic Ischemic Heart Disease. Kardiologiia. 2017;57(8):11–19.

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