VERIFY (VERification of Instantaneous Wave-Free Ratio and Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis Severity in EverydaY Practice)

被引：198

作者：

Berry, Colin ^{[1
,2
]}

van 't Veer, Marcel ^{[3
]}

Witt, Nils ^{[4
]}

Kala, Petr ^{[5
,6
]}

Bocek, Otakar ^{[5
,6
]}

Pyxaras, Stylianos A. ^{[7
]}

McClure, John D. ^{[1
]}

Fearon, William F. ^{[8
]}

Barbato, Emanuele ^{[7
]}

Tonino, Pim A. L. ^{[3
]}

De Bruyne, Bernard ^{[7
]}

Pijls, Nico H. J. ^{[3
]}

Oldroyd, Keith G. ^{[2
]}

机构：

[1] Univ Glasgow, Inst Cardiovasc & Med Sci, BHF Glasgow Cardiovasc Res Ctr, Glasgow G12 8TA, Lanark, Scotland

[2] Golden Jubilee Natl Hosp, West Scotland Reg Heart & Lung Ctr, Glasgow, Lanark, Scotland

[3] Catharina Hosp, Eindhoven, Netherlands

[4] Karolinska Inst, Dept Clin Sci & Educ, Div Cardiol, Sodersjukhuset, Stockholm, Sweden

[5] Univ Hosp Brno, Brno, Czech Republic

[6] Masaryk Univ, Brno, Czech Republic

[7] OLV Clin, Cardiovasc Ctr Aalst, Aalst, Belgium

[8] Stanford Univ, Med Ctr, Div Cardiovasc Med, Stanford, CA 94305 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2013年 / 61卷 / 13期

关键词：

adenosine; angina; FFR; hyperemia; iFR; FUNCTIONAL SEVERITY; PRESSURE MEASUREMENTS; PHYSIOLOGICAL-BASIS; TASK-FORCE; FOLLOW-UP; ANGIOGRAPHY; INTERVENTION; HUMANS; ASSOCIATION; VALIDATION;

D O I：

10.1016/j.jacc.2012.09.065

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to compare fractional flow reserve (FFR) with the instantaneous wave-free ratio (iFR) in patients with coronary artery disease and also to determine whether the iFR is independent of hyperemia. Background FFR is a validated index of coronary stenosis severity. FFR-guided percutaneous coronary intervention (PCI) improves clinical outcomes compared to angiographic guidance alone. iFR has been proposed as a new index of stenosis severity that can be measured without adenosine. Methods We conducted a prospective, multicenter, international study of 206 consecutive patients referred for PCI and a retrospective analysis of 500 archived pressure recordings. Aortic and distal coronary pressures were measured in duplicate in patients under resting conditions and during intravenous adenosine infusion at 140 mu g/kg/min. Results Compared to the FFR cut-off value of <= 0.80, the diagnostic accuracy of the iFR value of <= 0.80 was 60% (95% confidence interval [CI]: 53% to 67%) for all vessels studied and 51% (95% CI: 43% to 59%) for those patients with FFR in the range of 0.60 to 0.90. iFR was significantly influenced by the induction of hyperemia: mean +/- SD iFR at rest was 0.82 +/- 0.16 versus 0.64 +/- 0.18 with hyperemia (p < 0.001). Receiver operating characteristics confirmed that the diagnostic accuracy of iFR was similar to resting Pd/Pa and trans-stenotic pressure gradient and significantly inferior to hyperemic iFR. Analysis of our retrospectively acquired dataset showed similar results. Conclusions iFR correlates weakly with FFR and is not independent of hyperemia. iFR cannot be recommended for clinical decision making in patients with coronary artery disease. (Comparison of Fractional Flow Reserve Versus Instant Wave-Free Ratio for Assessment of Coronary Artery Stenosis Severity in Routine Practice; NCT01559493) (J Am Coll Cardiol 2013;61:1421-7) (C) 2013 by the American College of Cardiology Foundation

引用

页码：1421 / 1427

页数：7

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