Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio.
OBJECTIVE: To determine whether the instantaneous wave-free ratio (iFR) can detect improvement in stenosis significance after percutaneous coronary intervention (PCI) and compare this with fractional flow reserve (FFR) and whole cycle Pd/Pa. DESIGN: A prospective observational study was undertaken...
| Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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| Formato: | Journal article |
| Lenguaje: | English |
| Publicado: |
2013
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| _version_ | 1826284405221490688 |
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| author | Nijjer, S Sen, S Petraco, R Sachdeva, R Cuculi, F Escaned, J Broyd, C Foin, N Hadjiloizou, N Foale, R Malik, I Mikhail, G Sethi, A Al-Bustami, M Kaprielian, R Khan, M Baker, C Bellamy, M Hughes, A Mayet, J Kharbanda, R Di Mario, C Davies, J |
| author_facet | Nijjer, S Sen, S Petraco, R Sachdeva, R Cuculi, F Escaned, J Broyd, C Foin, N Hadjiloizou, N Foale, R Malik, I Mikhail, G Sethi, A Al-Bustami, M Kaprielian, R Khan, M Baker, C Bellamy, M Hughes, A Mayet, J Kharbanda, R Di Mario, C Davies, J |
| author_sort | Nijjer, S |
| collection | OXFORD |
| description | OBJECTIVE: To determine whether the instantaneous wave-free ratio (iFR) can detect improvement in stenosis significance after percutaneous coronary intervention (PCI) and compare this with fractional flow reserve (FFR) and whole cycle Pd/Pa. DESIGN: A prospective observational study was undertaken in elective patients scheduled for PCI with FFR ≤ 0.80. Intracoronary pressures were measured at rest and during adenosine-mediated vasodilatation, before and after PCI. iFR, Pd/Pa and FFR values were calculated using the validated fully automated algorithms. SETTING: Coronary catheter laboratories in two UK centres and one in the USA. PATIENTS: 120 coronary stenoses in 112 patients were assessed. The mean age was 63 ± 10 years, while 84% were male; 39% smokers; 33% with diabetes. Mean diameter stenosis was 68 ± 16% by quantitative coronary angiography. RESULTS: Pre-PCI, mean FFR was 0.66 ± 0.14, mean iFR was 0.75 ± 0.21 and mean Pd/Pa 0.83 ± 0.16. PCI increased all indices significantly (FFR 0.89 ± 0.07, p<0.001; iFR 0.94 ± 0.05, p<0.001; Pd/Pa 0.96 ± 0.04, p<0.001). The change in iFR after intervention (0.20 ± 0.21) was similar to ΔFFR 0.22 ± 0.15 (p=0.25). ΔFFR and ΔiFR were significantly larger than resting ΔPd/Pa (0.13 ± 0.16, both p<0.001). Similar incremental changes occurred in patients with a higher prevalence of risk factors for microcirculatory disease such as diabetes and hypertension. CONCLUSIONS: iFR and FFR detect the changes in coronary haemodynamics elicited by PCI. FFR and iFR have a significantly larger dynamic range than resting Pd/Pa. iFR might be used to objectively document improvement in coronary haemodynamics following PCI in a similar manner to FFR. |
| first_indexed | 2024-03-07T01:13:20Z |
| format | Journal article |
| id | oxford-uuid:8dcedb9f-c2e2-4830-8cd4-7686e57aeb1c |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T01:13:20Z |
| publishDate | 2013 |
| record_format | dspace |
| spelling | oxford-uuid:8dcedb9f-c2e2-4830-8cd4-7686e57aeb1c2022-03-26T22:53:33ZImprovement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:8dcedb9f-c2e2-4830-8cd4-7686e57aeb1cEnglishSymplectic Elements at Oxford2013Nijjer, SSen, SPetraco, RSachdeva, RCuculi, FEscaned, JBroyd, CFoin, NHadjiloizou, NFoale, RMalik, IMikhail, GSethi, AAl-Bustami, MKaprielian, RKhan, MBaker, CBellamy, MHughes, AMayet, JKharbanda, RDi Mario, CDavies, J OBJECTIVE: To determine whether the instantaneous wave-free ratio (iFR) can detect improvement in stenosis significance after percutaneous coronary intervention (PCI) and compare this with fractional flow reserve (FFR) and whole cycle Pd/Pa. DESIGN: A prospective observational study was undertaken in elective patients scheduled for PCI with FFR ≤ 0.80. Intracoronary pressures were measured at rest and during adenosine-mediated vasodilatation, before and after PCI. iFR, Pd/Pa and FFR values were calculated using the validated fully automated algorithms. SETTING: Coronary catheter laboratories in two UK centres and one in the USA. PATIENTS: 120 coronary stenoses in 112 patients were assessed. The mean age was 63 ± 10 years, while 84% were male; 39% smokers; 33% with diabetes. Mean diameter stenosis was 68 ± 16% by quantitative coronary angiography. RESULTS: Pre-PCI, mean FFR was 0.66 ± 0.14, mean iFR was 0.75 ± 0.21 and mean Pd/Pa 0.83 ± 0.16. PCI increased all indices significantly (FFR 0.89 ± 0.07, p<0.001; iFR 0.94 ± 0.05, p<0.001; Pd/Pa 0.96 ± 0.04, p<0.001). The change in iFR after intervention (0.20 ± 0.21) was similar to ΔFFR 0.22 ± 0.15 (p=0.25). ΔFFR and ΔiFR were significantly larger than resting ΔPd/Pa (0.13 ± 0.16, both p<0.001). Similar incremental changes occurred in patients with a higher prevalence of risk factors for microcirculatory disease such as diabetes and hypertension. CONCLUSIONS: iFR and FFR detect the changes in coronary haemodynamics elicited by PCI. FFR and iFR have a significantly larger dynamic range than resting Pd/Pa. iFR might be used to objectively document improvement in coronary haemodynamics following PCI in a similar manner to FFR. |
| spellingShingle | Nijjer, S Sen, S Petraco, R Sachdeva, R Cuculi, F Escaned, J Broyd, C Foin, N Hadjiloizou, N Foale, R Malik, I Mikhail, G Sethi, A Al-Bustami, M Kaprielian, R Khan, M Baker, C Bellamy, M Hughes, A Mayet, J Kharbanda, R Di Mario, C Davies, J Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. |
| title | Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. |
| title_full | Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. |
| title_fullStr | Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. |
| title_full_unstemmed | Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. |
| title_short | Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. |
| title_sort | improvement in coronary haemodynamics after percutaneous coronary intervention assessment using instantaneous wave free ratio |
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