オオツキ ヒサオ   OOTSUKI Hisao
  大槻 尚男
   所属   医学部 医学科(東京女子医科大学病院)
   職種   特任助教
論文種別 原著
言語種別 英語
査読の有無 査読あり
表題 Hemodynamic and Lesion Characteristics Associated with Discordance between the Instantaneous Wave-Free Ratio and Fractional Flow Reserve.
掲載誌名 正式名:Journal of interventional cardiology
略  称:J Interv Cardiol
ISSNコード:08964327/15408183
掲載区分国外
出版社 Wiley
巻・号・頁 in press頁
著者・共著者 ARASHI Hiroyuki†*, SATOMI Natsuko, ISHIDA Issei, SOONTORNDHADA Kanintorn, EBIHARA Suguru, TANAKA Kazuki, OOTSUKI Hisao, NAKAO Masashi, JUJO Kentaro, YAMAGUCHI Junichi, HAGIWARA Nobuhisa,
発行年月 2019/07/14
概要 BACKGROUND:
The instantaneous wave-free ratio (iFR) is an invasive coronary physiological index that is not inferior to fractional flow reserve- (FFR-) guided revascularization. The indexes of iFR and FFR are similar and closely correlated, but there are a few key differences. Previous studies suggested that patient characteristics and lesion severity could induce discordance between iFR and FFR. This study aimed to clarify the hemodynamics and lesion characteristics that influence discordance between iFR and FFR.

METHODS:
In this retrospective study, we enrolled 225 patients (304 lesions) who underwent clinically indicated invasive coronary angiography and both iFR and FFR examinations between 2012 and 2017. We included only patients who underwent right heart catheterization and had blood pressure and heart rates recorded immediately prior to iFR and FFR.

RESULTS:
Discordance (iFR ≤0.89 and FFR >0.8 or iFR >0.89 and FFR ≤0.8) was observed in 80 lesions (26.3%). The heart rate, rate-pressure product, and cardiac index tended to be higher in the iFR ≤0.89 group than in the iFR >0.89 group. These trends were not seen between the FFR ≤0.8 group and FFR >0.8 group. A multivariate analysis showed that independent predictors of iFR ≤0.89 and FFR >0.8 discordance were female sex and higher rate-pressure product. iFR >0.89 and FFR ≤0.8 discordance was rare in hemodialysis patients.

CONCLUSION:
Even if iFR is functionally significant in intermediate stenosis, additional FFR evaluations should be considered for women, especially those with a high rate-pressure product, to avoid unnecessary percutaneous coronary intervention. If iFR is not functionally significant with intermediate stenosis in hemodialysis patients, then further FFR evaluations are unnecessary.
DOI 10.1155/2019/3765282
PMID 31772528