Discordance between fractional flow reserve and instantaneous wave-free ratio in patients with severe aortic stenosis: A retrospective cohort study. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Yamanaka, Futoshi; Shishido, Koki; Yokota, Shohei; Moriyama, Noriaki; Ochiai, Tomoki; Yamada, Takashi; Hayashi, Takahiro; Miyashita, Hirokazu; Yokoyama, Hiroaki; Yamanaga, Kenshi; Tabata, Noriaki; Yamaguchi, Masashi; Yamagishi, Tamiharu; Matsumoto, Takashi; Tobita, Kazuki; Mizuno, Shingo; Tanaka, Yutaka; Murakami, Masato; Takahashi, Saeko; Saito, Shigeru; Tsujita, Kenichi
• Is Part Of: Journal of cardiology. Volume 81:Issue 2(2023)
• Page Start: 138
• Page End: 143
• Publication Date: 2023-02
• Subjects: Aortic valve stenosis -- Coronary artery disease -- Fractional flow reserve -- Instantaneous wave-free ratio -- Discordance; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2022.08.005
• Languages: English
• ISSNs: 0914-5087

Abstract

Abstract: Background: Discordance between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) occurs in approximately 20 % of cases. However, no studies have reported the discordance in patients with severe aortic stenosis (AS). We aimed to evaluate the diagnostic discordance between FFR and iFR in patients with severe AS. Methods: We examined 140 consecutive patients with severe AS (164 intermediate coronary artery stenosis vessels). FFR and iFR were calculated in four quadrants based on threshold FFR and iFR values of ≤0.8 and ≤0.89, respectively (Group 1: iFR >0.89, FFR >0.80; Group 2: iFR ≤0.89, FFR >0.80; Group 3: iFR >0.89, FFR ≤0.80; and Group 4: iFR ≤0.89, FFR ≤0.80). Concordant groups were Groups 1 and 4, and discordant groups were Groups 2 and 3. Positive and negative discordant groups were Groups 3 and 2, respectively. Results: The median (Q1, Q3) FFR and iFR were 0.84 (0.76, 0.88) and 0.85 (0.76, 0.91), respectively. Discordance was observed in 48 vessels (29.3 %). In the discordant group, negative discordance (Group 2: iFR ≤0.89 and FFR >0.80) was predominant (45 cases, 93.6 %). Multivariate analysis showed that the left anterior descending artery [odds ratio (OR), 3.88; 95 % confidence interval (CI): 1.54–9.79, p = 0.004] and peak velocity ≥5.0 m/s (OR, 3.21; 95%CI: 1.36–7.57, p = 0.008) were independently associated with negative discordance (FFR >0.8 and iFR ≤0.89). Conclusions: In patients with severe AS, discordance between FFR and iFR was predominantly negative and observed in 29.3 % of vessels. The left anterior descending artery and peak velocity ≥5.0 m/s were independently associated with negative discordance. Graphical abstract: Unlabelled Image Highlights: The discordance rate between FFR and iFR was 29.3% in patients with aortic stenosis. Negative discordance (FFR >0.8 and iFR ≤0.89) was dominant in discordant cases. Left anterior descending artery lesions were associated with negative discordance. Peak velocity ≥5.0 m/s was independently associated with negative discordance.