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Author Notes:

Dr Justin E Davies, International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK; justin.davies@imperial.ac.uk

All authors have contributed to the submitted manuscript. This is summarised as follows: SSN, SS, RP, CB, NF, NH, JED and ADH, JM, were involved in: the conception, design, analysis and interpretation of the data; drafting of the manuscript and revising it critically for intellectual content; final approval of manuscript. RS, RKK, IM, GWM, RAF, ASS, RRK, CSB, MFB, MAK, MAl-B, CDiM and JED were involved in data collection, analysis and interpretation; drafting and revising the manuscript and final approval of the submitted manuscript.

The authors would like to thank the catheter lab staff at the Hammersmith Hospital, London and John Radcliffe Hospital, Oxford for their support. This study would not have been possible without their ongoing commitment to research.

JED and JM hold intellectual property pertaining to this technology, which is under licence to Volcano Corporation. JED is a consultant for Volcano Corporation.

Subject:

Research Funding:

SSN (G1100443) and SS (G1000357) are Medical Research Council fellows. RP (FS/11/46/28861), JED (FS/05/006) and Dr Francis (FS 10/038) are British Heart Foundation fellows. The study also received support from National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London, UK.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • CORONARY PHYSIOLOGY
  • FRACTIONAL FLOW RESERVE
  • ACUTE MYOCARDIAL-INFARCTION
  • MICROVASCULAR RESISTANCE
  • PRESSURE MEASUREMENT
  • INTRAVASCULAR ULTRASOUND
  • INTRACORONARY PRESSURE
  • BALLOON ANGIOPLASTY
  • STENOSIS SEVERITY
  • ARTERY STENOSIS
  • LESION SEVERITY

Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio

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Journal Title:

HEART

Volume:

Volume 99, Number 23

Publisher:

, Pages 1740-1748

Type of Work:

Article | Final Publisher PDF

Abstract:

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 ÄFFR 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 signi ficantly 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.

Copyright information:

Published by the BMJ Publishing Group Limited.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 3.0 Unported License (https://creativecommons.org/licenses/by/3.0/rdf).
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