所属 医学部 医学科（東京女子医科大学病院） 職種 助教
|発表タイトル||Predictors of "Visual-functional Mismatch" in Contemporary Practice -the Characteristics Associating With Mismatch Between Angiographic Stenosis and Hybrid IFR-FFR Strategy|
|会議名||AHA2016 (American Heart Associations Scientific Sessions 2016)|
|主催者||American Heart Associations|
|発表者・共同発表者||◎MORIOKA Yuta, ARASHI Hiroyuki, YAMAGUCHI Junichi, KADOWAKI Hiromu, TANAKA Kazuki, ITANI Ryosuke, OOTSUKI Hisao, SHIMAZAKI Kensuke, HARUKI Shintaro, NAKAO Masashi, KAMISHIMA Kazuho, JUJO Kentaro, MINAMI Yuichiro, OGAWA Hiroshi, HAGIWARA Nobuhisa|
|New Orleans, USA|
Background: A "hybrid Instantaneous wave-free ratio (IFR) and fractional flow reserve (FFR) strategy" are increasing to evaluate functional severity of coronary intermediate stenosis in clinical setting. Previous studies reported 35-40% of visual-functional mismatches were observed between coronary angiography (CAG) and FFR. We aimed to clarify the relation between angiographic severity and functional severity under hybrid IFR-FFR strategy.
Method and Results: We analyzed 252 patients (340 lesions) undergoing CAG and hybrid IFR-FFR evaluation. First, IFR was measured under resting flow. Relation between IFR and % diameter stenosis (DS) were shown in Figure 1. Additional FFR was examined under hyperemia in 105 lesions with IFR values between 0.86 to 0.93 that is called "adenosine zone". Figure 2 shows relation between additional FFR and %DS. After hybrid strategy, mismatches were observed in 148 lesions (43.5%, Table.1). Among total lesions, regular-mismatch was observed in 97 lesions (28.5%), whereas reverse-mismatch was seen in 51 lesions (15.0%). Angiographic significant stenosis seemed to be more reliable in patients with diabetes mellitus and lower glomerular filtration rate. Even when CAG indicated %DS ≤ 50%, younger age was associated with functional positive. Non-left anterior descending artery (LAD) lesions had a higher frequency of regular-mismatch (75.3%) than did LAD lesions (23.7%). Reverse-mismatches were identified in 48 (94.1%) LAD lesions but were scarce among non-LAD lesions (3 lesions, 5.9%).
Conclusion: Visual-functional mismatch was observed in hybrid IFR-FFR strategy too. Frequency of mismatch in hybrid strategy tended to be higher compared to previous studies between FFR and % DS. LAD and non-LAD with intermediate coronary artery stenosis had differing features between angiographic characteristics and hybrid IFR - FFR evaluation.