Revaiah Pruthvi C, Tsai Tsung-Ying, Chinhenzva Albert, Miyashita Kotaro, Tobe Akihiro, Oshima Asahi, Ferraz-Costa Gonçalo, Garg Scot, Biscaglia Simone, Patel Manesh, Collet Carlos, Akasaka Takashi, Escaned Javier, Onuma Yoshinobu, Serruys Patrick W
CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland.
CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland; Department of Cardiology, Unidade Local de Saúde de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Coimbra Institute for Clinical and Biomedical Research, Coimbra, Portugal.
JACC Cardiovasc Interv. 2025 Apr 14;18(7):823-834. doi: 10.1016/j.jcin.2024.12.017. Epub 2025 Feb 19.
Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are discordant in approximately 20% of cases, and it is unclear whether this is influenced by the physiological pattern of coronary artery disease (CAD). The pull back pressure gradient index (PPGi) can objectively characterize the physiological pattern of CADs.
The aim of this study was to evaluate whether PPGi differed in discordant groups (FFR+/iFR- vs FFR-/iFR+).
The study enrolled 355 patients (390 vessels) with chronic coronary syndrome who had ≥1 epicardial coronary artery lesion with 40% to 90% diameter stenosis by visual assessment on invasive coronary angiography and had analyzable FFR, iFR, and PPGi derived from quantitative flow ratio. Cutoffs for hemodynamic significance were FFR ≤0.80 and iFR ≤0.89. Vessels were classified as FFR+/iFR+ (n = 103 [26.4%]), FFR-/iFR+ (n = 27 [6.9%]), FFR+/iFR- (n = 38 [9.7%]), and FFR-/iFR- (n = 222 [57%]) groups.
Median FFR, iFR, and quantitative flow ratio were 0.84 (Q1-Q3: 0.77-0.90), 0.92 (Q1-Q3: 0.88-0.97), and 0.83 (Q1-Q3: 0.73-0.90), respectively. FFR disagreed with iFR in 16.7% of cases (65 of 390). The median PPGi was 0.75 (Q1-Q3: 0.67-0.85). The physiological pattern of CAD was classified according to the PPGi as predominantly physiologically focal (PPGi ≥0.75) in 209 of 390 vessels (53.6%) or diffuse (PPGi < 0.75) in 181 of 390 vessels (46.4%). The median PPGi was significantly lower in FFR-/iFR+ vs FFR+/iFR- vessels (0.65 [Q1-Q3: 0.60-0.69] vs 0.82 [Q1-Q3: 0.75-0.85]; P < 0.001). Predominantly physiologically focal disease was significantly associated with FFR+/iFR- (76.3% [29 of 38]), while predominantly physiologically diffuse disease was significantly associated with FFR-/iFR+ (96.3% [26 of 27] [P < 0.001] for pattern of CAD between FFR+/iFR- and FFR-/iFR+ groups).
The physiological pattern of CAD is an important influencing factor in FFR/iFR discordance. (Radiographic Imaging Validation and Evaluation for Angio iFR [REVEAL iFR]; NCT03857503).
血流储备分数（FFR）和瞬时无波比值（iFR）在大约20%的病例中不一致，目前尚不清楚这是否受冠状动脉疾病（CAD）生理模式的影响。回撤压力梯度指数（PPGi）能够客观地描述CAD的生理模式。
本研究旨在评估PPGi在不一致组（FFR+/iFR-与FFR-/iFR+）中是否存在差异。
本研究纳入了355例慢性冠状动脉综合征患者（390支血管），这些患者经有创冠状动脉造影视觉评估显示至少有1支心外膜冠状动脉病变，直径狭窄40%至90%，且具有可分析的FFR、iFR和源自定量血流比值的PPGi。血流动力学意义的截断值为FFR≤0.80和iFR≤0.89。血管被分为FFR+/iFR+组（n = 103 [26.4%]）、FFR-/iFR+组（n = 27 [6.9%]）、FFR+/iFR-组（n = 38 [9.7%]）和FFR-/iFR-组（n = 222 [57%]）。
FFR、iFR和定量血流比值的中位数分别为0.84（四分位间距：0.77 - 0.90）、0.92（四分位间距：0.88 - 0.97）和0.83（四分位间距：0.73 - 0.90）。FFR与iFR在16.7%的病例（390例中的65例）中不一致。PPGi的中位数为0.75（四分位间距：0.67 - 0.85）。根据PPGi，CAD的生理模式在390支血管中的209支（53.6%）被分类为主要生理性局灶性（PPGi≥0.75），在390支血管中的181支（46.4%）被分类为弥漫性（PPGi < 0.75）。FFR-/iFR+血管中的PPGi中位数显著低于FFR+/iFR-血管（0.65 [四分位间距：0.60 - 0.69] 对0.82 [四分位间距：0.75 - 0.85]；P < 0.001）。主要生理性局灶性疾病与FFR+/iFR-显著相关（76.3% [38例中的29例]），而主要生理性弥漫性疾病与FFR-/iFR+显著相关（96.3% [27例中的26例] [FFR+/iFR-和FFR-/iFR+组之间CAD模式的P < 0.001]）。
CAD的生理模式是FFR/iFR不一致的一个重要影响因素。（血管iFR的影像学验证与评估[REVEAL iFR]；NCT03857503）
