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OPTICAL COHERENCE TOMOGRAPHY DERIVED MEASURES OF PLAQUE VULNERABILITY IN OBESE PATIENTS WITH CORONARY ARTERY DISEASE
A1507 JACC April 1, 2014 Volume 63, Issue 12
Stable Ischemic Heart Disease Prognostic Insights into the Utilisation of Instantaneous Wave-Free Ratio (iFR) to Guide Coronary Revascularisation: Results of the JUSTIFY-CFR Study, a Comparison of Pressure-Only Indices against Coronary Flow Reserve Moderated Poster Contributions Hall C Saturday, March 29, 2014, 10:00 a.m.-10:15 a.m.
Session Title: Stable Ischemic Heart Disease: Imaging and Lesion Assessment Abstract Category: 25. Stable Ischemic Heart Disease: Clinical Presentation Number: 1131M-365A Authors: Ricardo Petraco da Cunha, Tim van de Hoef, Sukhjinder Nijjer, Sayan Sen, Martijn A. van Lavieren, Rodney Foale, Martijn Meuwissen, Christopher Broyd, Mauro Echavarria-Pinto, Nicolas Foin, Iqbal Malik, Ghada Mikhail, Alun Hughes, Darrel Francis, Jamil Mayet, Carlo Di Mario, Javier Escaned, Jan Piek, Justin Davies, Imperial College, London, United Kingdom, Academic Medical Centre, Amsterdam, The Netherlands Background: The prognostic value of coronary flow reserve (CFR) has been extensively demonstrated in patients with coronary disease. Whilst fractional flow reserve (FFR) is superior to angiography to guide revascularisation, in 30% of patients FFR disagrees with CFR. We evaluated whether the baseline instantaneous wave-free ratio (iFR) could provide an improved pressure-only estimation of CFR. Methods: Pressure and flow velocity were measured in 216 stenoses. The diagnostic agreement between pressure-only indices (iFR and FFR) and coronary flow velocity reserve (CFVR) was evaluated. Results: Across the whole spectrum of stenosis severities baseline iFR was superior to baseline Pd/Pa and hyperaemic FFR as a pressure-only estimation of underlying CFVR (iFR ROC 0.82 vs Pd/Pa ROC 0.77 vs FFR ROC 0.72, p<0.05 for both, for a CFVR of 2). This improved agreement between iFR and CFVR held true for different CFVR cut-offs and was particularly marked within the 0.6 - 0.9 FFR stenoses range (Table 1). The agreement between iFR with CFVR was significantly lower when iFR was calculated during hyperaemia (iFRa) (iFR ROC 0.82 vs iFRa ROC 0.74, p<0.001), suggesting that hyperaemia is a confounder between pressure-only indices and the underlying CFVR. Conclusion: When compared to FFR, iFR provides a better pressure-only estimation of underlying CFR, particularly within the intermediate 0.6 - 0.9 FFR range. This suggests iFR could be used as a functional index of stenosis severity, independently from its agreement with FFR.
Stable Ischemic Heart Disease Prognostic Insights into the Utilisation of Instantaneous Wave-Free Ratio (iFR) to Guide Coronary Revascularisation: Results of the JUSTIFY-CFR Study, a Comparison of Pressure-Only Indices against Coronary Flow Reserve Moderated Poster Contributions Hall C Saturday, March 29, 2014, 10:00 a.m.-10:15 a.m.
Session Title: Stable Ischemic Heart Disease: Imaging and Lesion Assessment Abstract Category: 25. Stable Ischemic Heart Disease: Clinical Presentation Number: 1131M-365A Authors: Ricardo Petraco da Cunha, Tim van de Hoef, Sukhjinder Nijjer, Sayan Sen, Martijn A. van Lavieren, Rodney Foale, Martijn Meuwissen, Christopher Broyd, Mauro Echavarria-Pinto, Nicolas Foin, Iqbal Malik, Ghada Mikhail, Alun Hughes, Darrel Francis, Jamil Mayet, Carlo Di Mario, Javier Escaned, Jan Piek, Justin Davies, Imperial College, London, United Kingdom, Academic Medical Centre, Amsterdam, The Netherlands Background: The prognostic value of coronary flow reserve (CFR) has been extensively demonstrated in patients with coronary disease. Whilst fractional flow reserve (FFR) is superior to angiography to guide revascularisation, in 30% of patients FFR disagrees with CFR. We evaluated whether the baseline instantaneous wave-free ratio (iFR) could provide an improved pressure-only estimation of CFR. Methods: Pressure and flow velocity were measured in 216 stenoses. The diagnostic agreement between pressure-only indices (iFR and FFR) and coronary flow velocity reserve (CFVR) was evaluated. Results: Across the whole spectrum of stenosis severities baseline iFR was superior to baseline Pd/Pa and hyperaemic FFR as a pressure-only estimation of underlying CFVR (iFR ROC 0.82 vs Pd/Pa ROC 0.77 vs FFR ROC 0.72, p<0.05 for both, for a CFVR of 2). This improved agreement between iFR and CFVR held true for different CFVR cut-offs and was particularly marked within the 0.6 - 0.9 FFR stenoses range (Table 1). The agreement between iFR with CFVR was significantly lower when iFR was calculated during hyperaemia (iFRa) (iFR ROC 0.82 vs iFRa ROC 0.74, p<0.001), suggesting that hyperaemia is a confounder between pressure-only indices and the underlying CFVR. Conclusion: When compared to FFR, iFR provides a better pressure-only estimation of underlying CFR, particularly within the intermediate 0.6 - 0.9 FFR range. This suggests iFR could be used as a functional index of stenosis severity, independently from its agreement with FFR.