Association between fractional flow reserve, instantaneous wave-free ratio and dobutamine stress echocardiography in patients with stable coronary artery disease.
March 20, 2018 –
The association between fractional flow reserve (FFR) and dobutamine stress echocardiography(DSE) in real-world stable angina patients is scant and controversial whereas no such comparison exists with instantaneous wave-free ratio (iFR). The current retrospective study aimed to investigate the associations among these modalities in patients with stable coronary artery disease (CAD) and intermediate coronary lesions.
Methods and results
We studied 62 consecutive stable angina patients who underwent DSE and subsequently coronary angiography with FFR (in all 62) and iFR (in 46/62 patients) assessment of intermediate single-vessel lesions between 2014 and 2015. Using receiver operating characteristic (ROC) curves we sought to identify the optimal FFR and iFR cut-off points with the highest discriminative power to predict
the DSE result. The kappa coefficient was used to assess the agreement between FFR, iFR and DSE. Themean age of the study cohort was 63.5±12 years and 35 (56.5%) were males. Thirteen (21%) lesions were adjudicated as causing reversible ischaemia on DSE. Using ROC (FFR predicting DSE result), the area under the curve was 0.952 (95% CI: 0.902 to 1), whereas for iFR it was 0.743 (95% CI: 0.560 to 0.927), pAUC comparison=0.03. The optimal FFR cut-off point predicting positive DSE was 0.80. There was strong agreement between DSE and FFR (kappa 0.682, p<0.001). There was only modest agreement between iFR and DSE (kappa 0.258, p=0.068) using a cut-off value of 0.9.
In patients referred for evaluation of stable CAD, there was good agreement between DSE and FFR (87%) but less so with iFR (71.7%).
Authors: Vasileios F. Panoulas1,2,3*, MD, PhD; Kalliopi Keramida1, MD; Olga Boletti1, MD; Michail I. Papafaklis1, MD, PhD; Dimitris Flessas1, MD; Maria Petropoulou1, MD; Petros Nihoyannopoulos1,2, MD
1. Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; 2. Division of Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom; 3. Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
This paper also includes supplementary data published online at: http://www.pcronline.com/eurointervention/131st_issue/318