Fractional flow reserve and instantaneous wave-free ratio discordance in patients with severe aortic valve stenosis. (25th November 2020)

• Record Type: Journal Article
• Authors: Yamanaka, F; Shishido, K; Yokota, S; Moriyama, N; Mashimo, Y; Hayashi, T; Miyashita, H; Yokoyama, H; Tobita, K; Mizuno, S; Tanaka, Y; Murakami, M; Takahashi, S; Tsujita, K; Saito, S
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Coronary Circulation, Flow, and Flow Reserve; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.1276
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: It has been reported that discordance between fractional flow reserve (FFR) and Instantaneous Wave-Free Ratio (iFR) could occur in up to 20% of cases. However, there are no reports regarding discordance between FFR and iFR in patients with severe aortic valve stenosis (AS). Purpose: We aimed to investigate the discordance between FFR and iFR in patients with severe AS. Methods: Severe AS was defined as an aortic-valve area of ≤1.0 cm 2, a mean aortic-valve gradient of 40mmHg or more, or a peak aortic-jet velocity of 4.0 m/s or more. Intermediate coronary artery stenosis was defined as 30% to 70% stenosis (visual estimation). FFR and iFR were calculated in 4 quadrants based on values of FFR ≤0.8 and iFR ≤0.89 (positive discordance; low FFR and high iFR, negative discordance; high FFR and low iFR). Results: We examined consecutive 140 patients (164 intermediate coronary artery stenosis vessels). Mean FFR and iFR ± standard deviation was 0.82±0.09 and 0.82±0.14, respectively. The discordance was observed in 48 vessels (29.3%). In the discordant group, most of cases were negative discordance (45 cases, 93.6%). Binary logistic regression analysis showed that left anterior descending artery (Hazard Ratio 3.80; 1.55 to 9.31, p=0.0036) was independently associated with negative discordance. Conclusions: In patients with severe AS, the discordance between FFR and iFR could be observed in 29.3% of the vessels, mostly negative discordance. The left anterior descending artery is an independent predictor for negative discordance. Funding Acknowledgement: Type of funding source: None