Abstract 14776: Predictors of “Visual-functional Mismatch” in Contemporary Practice -the Characteristics Associating With Mismatch Between Angiographic Stenosis and Hybrid IFR-FFR Strategy
Background: A “hybrid Instantaneous wave-free ratio (IFR) and fractional flow reserve (FFR) strategy” are increasing to evaluate functional severity of coronary intermediate stenosis in clinical setting. Previous studies reported 35-40% of visual-functional mismatches were observed between coronary angiography (CAG) and FFR. We aimed to clarify the relation between angiographic severity and functional severity under hybrid IFR-FFR strategy.
Method and Results: We analyzed 252 patients (340 lesions) undergoing CAG and hybrid IFR-FFR evaluation. First, IFR was measured under resting flow. Relation between IFR and % diameter stenosis (DS) were shown in Figure 1. Additional FFR was examined under hyperemia in 105 lesions with IFR values between 0.86 to 0.93 that is called “adenosine zone”. Figure 2 shows relation between additional FFR and %DS. After hybrid strategy, mismatches were observed in 148 lesions (43.5%, Table.1). Among total lesions, regular-mismatch was observed in 97 lesions (28.5%), whereas reverse-mismatch was seen in 51 lesions (15.0%). Angiographic significant stenosis seemed to be more reliable in patients with diabetes mellitus and lower glomerular filtration rate. Even when CAG indicated %DS ≤ 50%, younger age was associated with functional positive. Non-left anterior descending artery (LAD) lesions had a higher frequency of regular-mismatch (75.3%) than did LAD lesions (23.7%). Reverse-mismatches were identified in 48 (94.1%) LAD lesions but were scarce among non-LAD lesions (3 lesions, 5.9%).
Conclusion: Visual-functional mismatch was observed in hybrid IFR-FFR strategy too. Frequency of mismatch in hybrid strategy tended to be higher compared to previous studies between FFR and % DS. LAD and non-LAD with intermediate coronary artery stenosis had differing features between angiographic characteristics and hybrid IFR - FFR evaluation.
Author Disclosures: Y. Morioka: None. H. Arashi: None. J. Yamaguch: None. H. Kadowaki: None. K. Tanaka: None. R. Itani: None. H. Otsuki: None. K. Shimazaki: None. S. Haruki: None. M. Nakao: None. K. Kamishima: None. K. Jujo: None. Y. Minami: None. H. Ogawa: None. N. Hagiwara: None.
- © 2016 by American Heart Association, Inc.