2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic.
Gifu Heart Center Gifu Japan.
J Am Heart Assoc. 2022 May 3;11(9):e021490. doi: 10.1161/JAHA.121.021490.
Background The FiGARO (FFR versus iFR in Assessment of Hemodynamic Lesion Significance, and an Explanation of Their Discrepancies) trial is a prospective registry searching for predictors of fractional flow reserve/instantaneous wave-free ratio (FFR/iFR) discrepancy. Methods and Results FFR/iFR were analyzed using a Verrata wire, and coronary flow reserve was analyzed using a Combomap machine (both Philips-Volcano). The risk polymorphisms for endothelial nitric oxide synthase and for heme oxygenase-1 were analyzed. In total, 1884 FFR/iFR measurements from 1564 patients were included. The FFR/iFR discrepancy occurred in 393 measurements (20.9%): FFRp (positive)/iFRn (negative) type (264 lesions, 14.0%) and FFRn/iFRp (129 lesions, 6.8%) type. Coronary flow reserve was measured in 343 lesions, correlating better with iFR (R=0.56, <0.0001) than FFR (R=0.36, <0.0001). The coronary flow reserve value in FFRp/iFRn lesions (2.24±0.7) was significantly higher compared with both FFRp/iFRp (1.39±0.36), and FFRn/iFRn lesions (1.8±0.64, <0.0001). Multivariable logistic regression analysis confirmed (1) sex, age, and lesion location in the right coronary artery as predictors for FFRp/iFRn discrepancy; and (2) hemoglobin level, smoking, and renal insufficiency as predictors for FFRn/iFRp discrepancy. The FFRn/iFRp type of discrepancy was significantly more frequent in patients with both risk types of polymorphisms (endothelial nitric oxide synthase+heme oxygenase-1): 8 patients (24.2%) compared with FFRp/iFRn type of discrepancy: 2 patients (5.9%), =0.03. Conclusions Predictors for FFRp/iFRn discrepancy were sex, age, and location in the right coronary artery. Predictors for FFRn/iFRp were hemoglobin level, smoking, and renal insufficiency. The risk type of polymorphism in endothelial nitric oxide synthase and heme oxygenase-1 genes was more frequently found in patients with FFRn/iFRp type of discrepancy. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT03033810.
FiGARO（血流储备分数与瞬时无波比在评估血流动力学意义中的比较及其差异的解释）试验是一项前瞻性注册研究，旨在寻找血流储备分数/瞬时无波比（FFR/iFR）差异的预测因素。
使用 Verrata 导丝分析 FFR/iFR，使用 Combomap 机器（均为飞利浦-火山公司）分析冠状动脉血流储备。分析内皮型一氧化氮合酶和血红素加氧酶-1 的风险多态性。共纳入 1564 例患者的 1884 次 FFR/iFR 测量值。FFR/iFR 差异发生在 393 次测量中（20.9%）：FFRp（阳性）/iFRn（阴性）类型（264 处病变，14.0%）和 FFRn/iFRp 类型（129 处病变，6.8%）。在 343 处病变中测量了冠状动脉血流储备，与 iFR 的相关性更好（R=0.56，<0.0001），而与 FFR 的相关性更好（R=0.36，<0.0001）。FFRp/iFRn 病变的冠状动脉血流储备值（2.24±0.7）明显高于 FFRp/iFRp（1.39±0.36）和 FFRn/iFRn 病变（1.8±0.64，<0.0001）。多变量逻辑回归分析证实：（1）性别、年龄和右冠状动脉病变位置是 FFRp/iFRn 差异的预测因素；（2）血红蛋白水平、吸烟和肾功能不全是 FFRn/iFRp 差异的预测因素。FFRn/iFRp 类型的差异在同时具有两种风险类型多态性（内皮型一氧化氮合酶+血红素加氧酶-1）的患者中更为常见：8 例（24.2%）与 FFRp/iFRn 类型的差异：2 例（5.9%），=0.03。
FFRp/iFRn 差异的预测因素为性别、年龄和右冠状动脉位置。FFRn/iFRp 的预测因素为血红蛋白水平、吸烟和肾功能不全。内皮型一氧化氮合酶和血红素加氧酶-1 基因的风险类型多态性在 FFRn/iFRp 类型差异的患者中更为常见。
