Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry

Ricardo Petraco; Javier Escaned; Sayan Sen; Sukhjinder Nijjer; Kaleab N. Asrress; Mauro Echavania-Pinto; Tim Lockie; Muhammed Z. Khawaja; Cecilia Cuevas; Nicolas Foin; Christopher Broyd; Rodney A. Foale; Nearchos Hadjiloizou; Iqbal S. Malik; Ghada W. Mikhail; Amarjit Sethi; Raffi Kaprielian; Christopher S. Baker; David Lefroy; Michael Bellamy; Mahmud Al-Bustami; Masood A. Khan; Alun D. Hughes; Darrel P. Francis; Jamil Mayet; Carlo Di Mario; Simon Redwood; Justin E. Davies

doi:10.4244/EIJV9I1A14

Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry

Ricardo Petraco^*, Javier Escaned, Sayan Sen, Sukhjinder Nijjer, Kaleab N. Asrress, Mauro Echavania-Pinto, Tim Lockie, Muhammed Z. Khawaja, Cecilia Cuevas, Nicolas Foin, Christopher Broyd, Rodney A. Foale, Nearchos Hadjiloizou, Iqbal S. Malik, Ghada W. Mikhail, Amarjit Sethi, Raffi Kaprielian, Christopher S. Baker, David Lefroy, Michael BellamyMahmud Al-Bustami, Masood A. Khan, Alun D. Hughes, Darrel P. Francis, Jamil Mayet, Carlo Di Mario, Simon Redwood, Justin E. Davies

^*Corresponding author for this work

Cardiovascular Sciences

Research output: Contribution to journal › Article › peer-review

155 Citations (Scopus)

Abstract

Aims: To evaluate the classification agreement between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with angiographic intermediate coronary stenoses.

Methods and results: Three hundred and twelve patients (339 stenoses) with angiographically intermediate stenoses were included in this international clinical registry. The iFR was calculated using fully automated algorithms. The receiver operating characteristic (ROC) curve was used to identify the iFR optimal cut-point corresponding to FFR 0.8. The classification agreement of coronary stenoses as significant or non-significant was established between iFR and FFR and between repeated FFR measurements for each 0.05 quantile of FFR values, from 0.2 to 1. Close agreement was observed between iFR and FFR (area under ROC curve= 86%). The optimal iFR cut-off (for an FFR of 0.80) was 0.89. After adjustment for the intrinsic variability of FFR, the classification agreement (accuracy) between iFR and FFR was 94%. Amongst the stenoses classified as non-significant by iFR (>0.89) and as significant by FFR (

Conclusions: In a population of intermediate coronary stenoses, the classification agreement between iFR and FFR is excellent and similar to that of repeated FFR measurements in the same sample. Vasodilator-independent assessment of intermediate stenosis seems applicable and may foster adoption of coronary physiology in the catheterisation laboratory.

Original language	English
Pages (from-to)	91-101
Number of pages	11
Journal	Eurointervention
Volume	9
Issue number	1
DOIs	https://doi.org/10.4244/EIJV9I1A14
Publication status	Published - May 2013

Keywords

coronary stenosis
instantaneous wave-free ratio
fractional flow reserve
adenosine
ARTERY-DISEASE
PRESSURE
REPRODUCIBILITY
INTERVENTION
ANGIOGRAPHY
ASSOCIATION
VALIDATION
CARDIOLOGY
SEVERITY
HUMANS

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Petraco, R., Escaned, J., Sen, S., Nijjer, S., Asrress, K. N., Echavania-Pinto, M., Lockie, T., Khawaja, M. Z., Cuevas, C., Foin, N., Broyd, C., Foale, R. A., Hadjiloizou, N., Malik, I. S., Mikhail, G. W., Sethi, A., Kaprielian, R., Baker, C. S., Lefroy, D., ... Davies, J. E. (2013). Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry. Eurointervention, 9(1), 91-101. https://doi.org/10.4244/EIJV9I1A14

@article{520056cc7e1a4e29954540327de66198,

title = "Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry",

abstract = "Aims: To evaluate the classification agreement between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with angiographic intermediate coronary stenoses.Methods and results: Three hundred and twelve patients (339 stenoses) with angiographically intermediate stenoses were included in this international clinical registry. The iFR was calculated using fully automated algorithms. The receiver operating characteristic (ROC) curve was used to identify the iFR optimal cut-point corresponding to FFR 0.8. The classification agreement of coronary stenoses as significant or non-significant was established between iFR and FFR and between repeated FFR measurements for each 0.05 quantile of FFR values, from 0.2 to 1. Close agreement was observed between iFR and FFR (area under ROC curve= 86%). The optimal iFR cut-off (for an FFR of 0.80) was 0.89. After adjustment for the intrinsic variability of FFR, the classification agreement (accuracy) between iFR and FFR was 94%. Amongst the stenoses classified as non-significant by iFR (>0.89) and as significant by FFR (Conclusions: In a population of intermediate coronary stenoses, the classification agreement between iFR and FFR is excellent and similar to that of repeated FFR measurements in the same sample. Vasodilator-independent assessment of intermediate stenosis seems applicable and may foster adoption of coronary physiology in the catheterisation laboratory.",

keywords = "coronary stenosis, instantaneous wave-free ratio, fractional flow reserve, adenosine, ARTERY-DISEASE, PRESSURE, REPRODUCIBILITY, INTERVENTION, ANGIOGRAPHY, ASSOCIATION, VALIDATION, CARDIOLOGY, SEVERITY, HUMANS",

author = "Ricardo Petraco and Javier Escaned and Sayan Sen and Sukhjinder Nijjer and Asrress, {Kaleab N.} and Mauro Echavania-Pinto and Tim Lockie and Khawaja, {Muhammed Z.} and Cecilia Cuevas and Nicolas Foin and Christopher Broyd and Foale, {Rodney A.} and Nearchos Hadjiloizou and Malik, {Iqbal S.} and Mikhail, {Ghada W.} and Amarjit Sethi and Raffi Kaprielian and Baker, {Christopher S.} and David Lefroy and Michael Bellamy and Mahmud Al-Bustami and Khan, {Masood A.} and Hughes, {Alun D.} and Francis, {Darrel P.} and Jamil Mayet and {Di Mario}, Carlo and Simon Redwood and Davies, {Justin E.}",

year = "2013",

month = may,

doi = "10.4244/EIJV9I1A14",

language = "English",

volume = "9",

pages = "91--101",

journal = "Eurointervention",

issn = "1774-024X",

publisher = "EuroPCR",

number = "1",

}

Petraco, R, Escaned, J, Sen, S, Nijjer, S, Asrress, KN, Echavania-Pinto, M, Lockie, T , Khawaja, MZ, Cuevas, C, Foin, N, Broyd, C, Foale, RA, Hadjiloizou, N, Malik, IS, Mikhail, GW, Sethi, A, Kaprielian, R, Baker, CS, Lefroy, D, Bellamy, M, Al-Bustami, M, Khan, MA, Hughes, AD, Francis, DP, Mayet, J, Di Mario, C, Redwood, S & Davies, JE 2013, 'Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry', Eurointervention, vol. 9, no. 1, pp. 91-101. https://doi.org/10.4244/EIJV9I1A14

TY - JOUR

T1 - Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry

AU - Petraco, Ricardo

AU - Escaned, Javier

AU - Sen, Sayan

AU - Nijjer, Sukhjinder

AU - Asrress, Kaleab N.

AU - Echavania-Pinto, Mauro

AU - Lockie, Tim

AU - Khawaja, Muhammed Z.

AU - Cuevas, Cecilia

AU - Foin, Nicolas

AU - Broyd, Christopher

AU - Foale, Rodney A.

AU - Hadjiloizou, Nearchos

AU - Malik, Iqbal S.

AU - Mikhail, Ghada W.

AU - Sethi, Amarjit

AU - Kaprielian, Raffi

AU - Baker, Christopher S.

AU - Lefroy, David

AU - Bellamy, Michael

AU - Al-Bustami, Mahmud

AU - Khan, Masood A.

AU - Hughes, Alun D.

AU - Francis, Darrel P.

AU - Mayet, Jamil

AU - Di Mario, Carlo

AU - Redwood, Simon

AU - Davies, Justin E.

PY - 2013/5

Y1 - 2013/5

N2 - Aims: To evaluate the classification agreement between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with angiographic intermediate coronary stenoses.Methods and results: Three hundred and twelve patients (339 stenoses) with angiographically intermediate stenoses were included in this international clinical registry. The iFR was calculated using fully automated algorithms. The receiver operating characteristic (ROC) curve was used to identify the iFR optimal cut-point corresponding to FFR 0.8. The classification agreement of coronary stenoses as significant or non-significant was established between iFR and FFR and between repeated FFR measurements for each 0.05 quantile of FFR values, from 0.2 to 1. Close agreement was observed between iFR and FFR (area under ROC curve= 86%). The optimal iFR cut-off (for an FFR of 0.80) was 0.89. After adjustment for the intrinsic variability of FFR, the classification agreement (accuracy) between iFR and FFR was 94%. Amongst the stenoses classified as non-significant by iFR (>0.89) and as significant by FFR (Conclusions: In a population of intermediate coronary stenoses, the classification agreement between iFR and FFR is excellent and similar to that of repeated FFR measurements in the same sample. Vasodilator-independent assessment of intermediate stenosis seems applicable and may foster adoption of coronary physiology in the catheterisation laboratory.

AB - Aims: To evaluate the classification agreement between instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with angiographic intermediate coronary stenoses.Methods and results: Three hundred and twelve patients (339 stenoses) with angiographically intermediate stenoses were included in this international clinical registry. The iFR was calculated using fully automated algorithms. The receiver operating characteristic (ROC) curve was used to identify the iFR optimal cut-point corresponding to FFR 0.8. The classification agreement of coronary stenoses as significant or non-significant was established between iFR and FFR and between repeated FFR measurements for each 0.05 quantile of FFR values, from 0.2 to 1. Close agreement was observed between iFR and FFR (area under ROC curve= 86%). The optimal iFR cut-off (for an FFR of 0.80) was 0.89. After adjustment for the intrinsic variability of FFR, the classification agreement (accuracy) between iFR and FFR was 94%. Amongst the stenoses classified as non-significant by iFR (>0.89) and as significant by FFR (Conclusions: In a population of intermediate coronary stenoses, the classification agreement between iFR and FFR is excellent and similar to that of repeated FFR measurements in the same sample. Vasodilator-independent assessment of intermediate stenosis seems applicable and may foster adoption of coronary physiology in the catheterisation laboratory.

KW - coronary stenosis

KW - instantaneous wave-free ratio

KW - fractional flow reserve

KW - adenosine

KW - ARTERY-DISEASE

KW - PRESSURE

KW - REPRODUCIBILITY

KW - INTERVENTION

KW - ANGIOGRAPHY

KW - ASSOCIATION

KW - VALIDATION

KW - CARDIOLOGY

KW - SEVERITY

KW - HUMANS

U2 - 10.4244/EIJV9I1A14

DO - 10.4244/EIJV9I1A14

M3 - Article

SN - 1774-024X

VL - 9

SP - 91

EP - 101

JO - Eurointervention

JF - Eurointervention

IS - 1

ER -

Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry

Abstract

Keywords

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