Comparison between instantaneous wave-free ratio versus morphometric assessments by intracoronary imaging
Anatomical measurements obtained by intracoronary imaging devices are reported to correlate significantly with fractional flow reserve (FFR). Instantaneous wave-free ratio (iFR) is a nonhyperemic index of stenosis severity with discordant reports regarding its accuracy in relation to FFR. There is no information on the correlation of iFR with measurements derived from intracoronary imaging devices. The purpose of this study was to assess the relationship among iFR, intravascular ultrasound (IVUS), and optical frequency domain imaging (OFDI) parameters. Eighty lesions in 72 patients who underwent elective angiography and had intermediate lesions were enrolled. All lesions were assessed by iFR, FFR, IVUS, and OFDI. iFR was ≤ 0.89 in 21 (26%) lesions and FFR was ≤ 0.80 in 41 (51%) lesions. iFR correlated significantly with both IVUS-derived minimum lumen area (MLA) (r = 0.375, p = 0.003) and OFDI-derived MLA (r = 0.357, p = 0.005). FFR also correlated significantly with both IVUS-derived MLA (r = 0.472, p < 0.001) and OFDI-derived MLA (r = 0.445, p < 0.001). Among the lesions with FFR ≤ 0.80, iFR > 0.89 (mismatch) was observed in 20 lesions. There was no lesion with iFR ≤ 0.89 (reverse mismatch) among the lesions with FFR > 0.80. The lesion location among three major coronary vessels was related with the discrepancy between iFR and FFR (p = 0.007). In conclusion, iFR and FFR showed a significant correlation with IVUS and OFDI measurements. The discrepancy of iFR and FFR was associated with the lesion locations.
KeywordsInstantaneous wave-free ratio Fractional flow reserve Intravascular ultrasound Optical frequency domain imaging
This research was funded by JSPS KAKENHI Grant number JP26461079, Terumo Corporation, AstraZeneca, GOODMAN, and MSD.
Compliance with ethical standards
Conflict of interest
KM has received remuneration for lectures from Philips japan and St. Jude Medical Japan. KH has received remuneration for lectures from Daiichi-Sankyo and Boston Scientific Japan; has received research grants from AstraZeneca, MSD, Solve, Biosensors Japan, Teijin Parma, Terumo, Mochida Pharmaceutical, Goodman, Medtronic Japan, and St. Jude Medical Japan. KT has received research grants from AstraZeneca, Ono, Tsumura, Daiichi-Sankyo, Novartis, Astellas, MSD, Pfizer, Research Institute for Production Development, Takeda, Kyowa Hakko Kirin., Chugai Pharmaceutical, Mochida, and Mitsubishi Tanabe. Honoraria from Mochida, Pfizer, Research Institute for Production Development, Sumitomo Dainippon Pharma and Kyowa Hakko Kirin. KK has received remuneration for lectures from AstraZeneca, Toa Eiyo, MSD, Bayer and Daiichi-Sankyo; has received research grants from Toa Eiyo, Bayer, MSD, Astellas, AstraZeneca, Sanofi, Eli Lilly Japan, Research Institute for Production Development, Pfizer, Shionogi, Kowa, Daiichi-Sankyo, Mitsubishi-Tanabe, Nihon Boehringer-Ingelheim, Takeda, Otsuka, and Ono. All other authors report no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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