Shuttleworth Kara, Smith Kristina, Watt Jonathan, Smith Jamie A L, Leslie Stephen J
Cardiac Unit, Raigmore Hospital, Inverness, UK.
Department of Diabetes and Cardiovascular Science, The Centre for Health Science, University of the Highlands and Islands, The Centre for Health Science, Inverness, UK.
Front Cardiovasc Med. 2017 May 30;4:35. doi: 10.3389/fcvm.2017.00035. eCollection 2017.
The instantaneous wave-free ratio (iFR) is a novel method to assess the ischemic potential of coronary artery stenoses. Clinical trial data have shown that iFR has acceptable diagnostic agreement with fractional flow reserve (FFR), the reference standard for the functional assessment of coronary stenoses. This study compares iFR measurements with FFR measurements in a real world, single-center setting.
Instantaneous wave-free ratio and FFR were measured in 50 coronary artery lesions in 42 patients, with FFR ≤ 0.8 classified as functionally significant. An iFR-only technique, using a treatment cut-off value, iFR ≤ 0.89, provided a classification agreement of 84% with FFR ≤ 0.80. Use of a hybrid iFR-FFR technique, incorporating FFR measurement for lesions within the iFR gray zone of 0.86-0.93, would improve classification agreement with FFR to 94%, with diagnosis achieved without the need for hyperemia in 57% patients.
This study in a real-world setting demonstrated good classification agreement between iFR and FFR. Use of a hybrid iFR-FFR technique would achieve high diagnostic accuracy while minimizing adenosine use, compared with routine FFR.
瞬时无波比值（iFR）是评估冠状动脉狭窄缺血潜能的一种新方法。临床试验数据表明，iFR与冠状动脉狭窄功能评估的参考标准——血流储备分数（FFR）具有可接受的诊断一致性。本研究在真实世界的单中心环境中比较了iFR测量值与FFR测量值。
对42例患者的50处冠状动脉病变进行了瞬时无波比值和FFR测量，FFR≤0.8被分类为功能上显著。仅使用iFR技术，采用治疗临界值iFR≤0.89，与FFR≤0.80的分类一致性为84%。使用混合iFR-FFR技术，对处于iFR灰色区域0.86-0.93内的病变进行FFR测量，将与FFR的分类一致性提高到94%，57%的患者无需充血即可完成诊断。
本在真实世界环境中的研究表明iFR与FFR之间具有良好的分类一致性。与常规FFR相比，使用混合iFR-FFR技术可在减少腺苷使用的同时实现高诊断准确性。
