Fractional Flow Reserve - The Left Main and Coronary Artery Bifurcation Lesion Summit (CBS)

Abstract

Diagnostic Performance of the Instantaneous Wave-Free Ratio: Comparison With Fractional Flow Reserve
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Original Research

2018 Jan;11(1):e004613.

JOURNAL：Circ Cardiovasc Interv.

Article Link

Diagnostic Performance of the Instantaneous Wave-Free Ratio: Comparison With Fractional Flow Reserve

De Rosa S, Polimeni A, Indolfi C et al.

3669

Keywords: acute coronary syndrome; cardiovascular diagnostic technique; coronary artery disease; coronary stenosis; myocardial fractional flow; reserve

ABSTRACT

BACKGROUND - Aim of the present study was to perform a meta-analysis of all available studies comparing the instantaneous wave-free ratio (iFR) with fractional flow reserve (FFR).

METHODS AND RESULTS - Published trials comparing the iFR with FFR were searched for in PubMed, Google Scholar, and Scopus electronic databases. A total of 23 studies were available for the analysis, including 6381 stenoses. First, a meta-analysis of all studies was performed exploring the correlation between FFR and iFR. Interestingly, we found good correlation (0.798 [0.78-0.82]) between the 2 indices (P<0.001). In addition, to evaluate the diagnostic performance of iFR to identify FFR-positive coronary stenoses, we performed an additional meta-analysis, summarizing the results of receiver operating characteristics analyses from individual studies reporting the area under the curve. Summing the results of these studies, we found that iFR has a good diagnostic performance for the identification of FFR-positive stenoses (area under the curve=0.88 [0.86-0.90]; P<0.001). Furthermore, our search results included 5 studies that compared iFR and FFR to a third independent reference standard. Interestingly, no significant differences between iFR and FFR were reported in those studies.

CONCLUSIONS - The present meta-analysis shows that iFR significantly correlates with standard FFR and shows a good diagnostic performance in identifying FFR-positive coronary stenoses. Finally, iFR and FFR have similar diagnostic efficiency for detection of ischemia-inducing stenoses when tested against a third comparator.