Real-time use of instantaneous wave-free ratio: results of the ADVISE in-practice: an international, multicenter evaluation of instantaneous wave-free ratio in clinical practice

2.50
Hdl Handle:
http://hdl.handle.net/11287/593871
Title:
Real-time use of instantaneous wave-free ratio: results of the ADVISE in-practice: an international, multicenter evaluation of instantaneous wave-free ratio in clinical practice
Authors:
Petraco, R.; Al-Lamee, R.; Gotberg, M.; Sharp, Andrew; Hellig, F.; Nijjer, S. S.; Echavarria-Pinto, M.; van de Hoef, T. P.; Sen, S.; Tanaka, N.; Van Belle, E.; Bojara, W.; Sakoda, K.; Mates, M.; Indolfi, C.; De Rosa, S.; Vrints, C. J.; Haine, S.; Yokoi, H.; Ribichini, F. L.; Meuwissen, M.; Matsuo, H.; Janssens, L.; Katsumi, U.; Di Mario, C.; Escaned, J.; Piek, J.; Davies, J. E.
Abstract:
OBJECTIVES: To evaluate the first experience of real-time instantaneous wave-free ratio (iFR) measurement by clinicians. BACKGROUND: The iFR is a new vasodilator-free index of coronary stenosis severity, calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, when distal resistance is lowest and stable. Because all previous studies have calculated iFR offline, the feasibility of real-time iFR measurement has never been assessed. METHODS: Three hundred ninety-two stenoses with angiographically intermediate stenoses were included in this multicenter international analysis. Instantaneous wave-free ratio and fractional flow reserve (FFR) were performed in real time on commercially available consoles. The classification agreement of coronary stenoses between iFR and FFR was calculated. RESULTS: Instantaneous wave-free ratio and FFR maintain a close level of diagnostic agreement when both are measured by clinicians in real time (for a clinical 0.80 FFR cutoff: area under the receiver operating characteristic curve [ROC(AUC)] 0.87, classification match 80%, and optimal iFR cutoff 0.90; for a ischemic 0.75 FFR cutoff: iFR ROC(AUC) 0.90, classification match 88%, and optimal iFR cutoff 0.85; if the FFR 0.75-0.80 gray zone is accounted for: ROC(AUC) 0.93, classification match 92%). When iFR and FFR are evaluated together in a hybrid decision-making strategy, 61% of the population is spared from vasodilator while maintaining a 94% overall agreement with FFR lesion classification. CONCLUSION: When measured in real time, iFR maintains the close relationship to FFR reported in offline studies. These findings confirm the feasibility and reliability of real-time iFR calculation by clinicians.
Citation:
Am Heart J. 2014 Nov;168(5):739-48.
Publisher:
Elsevier
Journal:
American heart journal
Issue Date:
1-Nov-2014
URI:
http://hdl.handle.net/11287/593871
DOI:
10.1016/j.ahj.2014.06.022
PubMed ID:
25440803
Additional Links:
http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(14)00407-4
Note:
This article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.
Type:
Journal Article; Multicenter Study
Language:
eng
ISSN:
1097-6744
Appears in Collections:
2014 RD&E publications; Cardiology

Full metadata record

DC FieldValue Language
dc.contributor.authorPetraco, R.en
dc.contributor.authorAl-Lamee, R.en
dc.contributor.authorGotberg, M.en
dc.contributor.authorSharp, Andrewen
dc.contributor.authorHellig, F.en
dc.contributor.authorNijjer, S. S.en
dc.contributor.authorEchavarria-Pinto, M.en
dc.contributor.authorvan de Hoef, T. P.en
dc.contributor.authorSen, S.en
dc.contributor.authorTanaka, N.en
dc.contributor.authorVan Belle, E.en
dc.contributor.authorBojara, W.en
dc.contributor.authorSakoda, K.en
dc.contributor.authorMates, M.en
dc.contributor.authorIndolfi, C.en
dc.contributor.authorDe Rosa, S.en
dc.contributor.authorVrints, C. J.en
dc.contributor.authorHaine, S.en
dc.contributor.authorYokoi, H.en
dc.contributor.authorRibichini, F. L.en
dc.contributor.authorMeuwissen, M.en
dc.contributor.authorMatsuo, H.en
dc.contributor.authorJanssens, L.en
dc.contributor.authorKatsumi, U.en
dc.contributor.authorDi Mario, C.en
dc.contributor.authorEscaned, J.en
dc.contributor.authorPiek, J.en
dc.contributor.authorDavies, J. E.en
dc.date.accessioned2016-01-19T12:36:05Zen
dc.date.available2016-01-19T12:36:05Zen
dc.date.issued2014-11-01en
dc.identifier.citationAm Heart J. 2014 Nov;168(5):739-48.en
dc.identifier.issn1097-6744en
dc.identifier.pmid25440803en
dc.identifier.doi10.1016/j.ahj.2014.06.022en
dc.identifier.urihttp://hdl.handle.net/11287/593871en
dc.description.abstractOBJECTIVES: To evaluate the first experience of real-time instantaneous wave-free ratio (iFR) measurement by clinicians. BACKGROUND: The iFR is a new vasodilator-free index of coronary stenosis severity, calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, when distal resistance is lowest and stable. Because all previous studies have calculated iFR offline, the feasibility of real-time iFR measurement has never been assessed. METHODS: Three hundred ninety-two stenoses with angiographically intermediate stenoses were included in this multicenter international analysis. Instantaneous wave-free ratio and fractional flow reserve (FFR) were performed in real time on commercially available consoles. The classification agreement of coronary stenoses between iFR and FFR was calculated. RESULTS: Instantaneous wave-free ratio and FFR maintain a close level of diagnostic agreement when both are measured by clinicians in real time (for a clinical 0.80 FFR cutoff: area under the receiver operating characteristic curve [ROC(AUC)] 0.87, classification match 80%, and optimal iFR cutoff 0.90; for a ischemic 0.75 FFR cutoff: iFR ROC(AUC) 0.90, classification match 88%, and optimal iFR cutoff 0.85; if the FFR 0.75-0.80 gray zone is accounted for: ROC(AUC) 0.93, classification match 92%). When iFR and FFR are evaluated together in a hybrid decision-making strategy, 61% of the population is spared from vasodilator while maintaining a 94% overall agreement with FFR lesion classification. CONCLUSION: When measured in real time, iFR maintains the close relationship to FFR reported in offline studies. These findings confirm the feasibility and reliability of real-time iFR calculation by clinicians.en
dc.language.isoengen
dc.publisherElsevieren
dc.relation.urlhttp://linkinghub.elsevier.com/retrieve/pii/S0002-8703(14)00407-4en
dc.titleReal-time use of instantaneous wave-free ratio: results of the ADVISE in-practice: an international, multicenter evaluation of instantaneous wave-free ratio in clinical practiceen
dc.typeJournal Articleen
dc.typeMulticenter Studyen
dc.identifier.journalAmerican heart journalen
dc.description.noteThis article is available via Open Access. Please click on the 'Additional Link' above to access the full-text.en

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