In vivo validation of resting full-cycle ratio and diastolic pressure ratio: simultaneous measurement with instantaneous wave-free ratio


The diastolic pressure ratio (dPR) and resting full-cycle ratio (RFR) are considered to be almost identical to the instantaneous wave-free ratio (iFR) in the retrospective analysis of pooled data. The aim of this study was to investigate the direct comparison of iFR and these new resting indexes in real world practice. Two pressure wires were inserted and placed in the distal part of the same coronary artery. The measurement of the iFR and the other resting indexes was performed simultaneously. A total of 54 lesions from 23 patients were subject to physiological study. In 49 lesions, iFR and other resting indexes were also measured in hyperemic conditions. The general correlation between iFR and other resting indexes was excellent in both resting and hyperemic conditions (r2 = 0.99; mean difference − 0.001 ± 0.021; p < 0.001; and r2 = 0.99; mean difference − 0.012 ± 0.025; p < 0.001, respectively). This correlation was maintained in various subgroup analyses. A diagnostic change between iFR and other resting indexes occurred in three cases (3%) when a fixed cut-off point (≤ 0.89) was applied. There was no diagnostic change when a hybrid zone (0.86 ≤ iFR ≤ 0.93) was considered. The new resting indexes and iFR showed very high correlation in real world practice. A diagnostic change only occurred in three cases (3%) when a fixed cut-off point (≤ 0.89) was applied.

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  1. 1.

    Davies JE, Sen S, Dehbi HM, Al-Lamee R, Petraco R, Nijjer SS, et al. Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N Engl J Med. 2017;376:1824–34.

    Article  Google Scholar 

  2. 2.

    Escaned J, Collet C, Ryan N, De Maria GL, Walsh S, Sabate M, et al. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J. 2017;38:3124–34.

    Article  Google Scholar 

  3. 3.

    Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg. 2019;55(1):4–90.

    Article  Google Scholar 

  4. 4.

    Lee JM, Choi KH, Park J, Hwang D, Rhee TM, Kim J, et al. Physiological and clinical assessment of resting physiological indexes. Circulation. 2019;139:889–900.

    Article  Google Scholar 

  5. 5.

    Svanerud J, Ahn JM, Jeremias A, Veer M, Gore A, Maehara A, et al. Validation of a novel non-hyperaemic index of coronary artery stenosis severity: the Resting Full-cycle Ratio (VALIDATE RFR) study. EuroIntervention. 2018;14(7):806–14.

    Article  Google Scholar 

  6. 6.

    Beygui F, Lemaitre A, Bignon M, Wain-Hobson J, Briet C, Ardouin P, et al. A head-to-head comparison of three coronary fractional flow reserve measurement technologies: the fractional flow reserve-device study. Catheter Cardiovasc Interv. 2019.

    Article  PubMed  Google Scholar 

  7. 7.

    Jang HJ, Koo BK, Lee HS, Park JB, Kim JH, Seo MK, et al. Safety and efficacy of a novel hyperaemic agent, intracoronary nicorandil, for invasive physiological assessments in the cardiac catheterization laboratory. Eur Heart J. 2013;34:2055–62.

    CAS  Article  Google Scholar 

  8. 8.

    Oi M, Toyofuku M, Matsumura Y, Motohashi Y, Takahashi K, Kawase Y, et al. Utility of nicorandil for the measurement of coronary fractional flow reserve. Cardiovasc Interv Ther. 2014;29:24–30.

    CAS  Article  Google Scholar 

  9. 9.

    Kato D, Takashima H, Waseda K, Kurita A, Kuroda Y, Kosaka T, et al. Feasibility and safety of intracoronary nicorandil infusion as a novel hyperemic agent for fractional flow reserve measurements. Heart Vessels. 2015;30:477–83.

    Article  Google Scholar 

  10. 10.

    Stables RH, Elguindy M, Kemp I, Nicholas Z, Mars C, Mullen L, et al. A randomised controlled trial to compare two coronary pressure wires using simultaneous measurements in human coronary arteries: the COMET trial. EuroIntervention. 2019;14:e1578–e15841584.

    Article  Google Scholar 

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Special thanks go to Shunsuke Imai for his work in collecting and analyzing the study-related data.


This research received no grant from any funding agency in the public, commercial or not-for-profit sectors.

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Correspondence to Yoshiaki Kawase.

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Kawase, Y., Omori, H., Tanigaki, T. et al. In vivo validation of resting full-cycle ratio and diastolic pressure ratio: simultaneous measurement with instantaneous wave-free ratio. Cardiovasc Interv and Ther 36, 74–80 (2021).

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  • Fractional flow reserve
  • Instantaneous wave-free ratio
  • Resting indexes