中尾 優
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Language English
Title Predictors of "Visual-functional Mismatch" in Contemporary Practice -the Characteristics Associating With Mismatch Between Angiographic Stenosis and Hybrid IFR-FFR Strategy
Conference AHA2016 (American Heart Associations Scientific Sessions 2016)
Promoters American Heart Associations
Conference Type International society and overseas society
Presentation Type Poster notice
Lecture Type General
Publisher and common publisher◎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
Date 2016/11/14
Venue
(city and name of the country)
New Orleans, USA
Summary Abstract

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.