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      Comparison of FFR, iFR, and QFR assessment in patients with severe aortic stenosis and coronary heart disease

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          Abstract

          Introduction

          Some patients with coronary heart disease are diagnosed with severe aortic stenosis. For further treatment, coronary angiography is performed in these patients. For intermediate lesions, obtaining coronary artery physiological data can facilitate clinical decision-making regarding revascularization.

          Aim

          The study compared the physiological significance of coronary artery stenosis using the fractional flow reserve (FFR) method with instantaneous wave-free pressure ratio (iFR) and quantitative flow ratio (QFR) in patients qualified for aortic valve replacement.

          Material and methods

          Data were collected on patients hospitalized in the years 2019–2020 at the 2 nd Department of Cardiology, University Hospital in Krakow.

          Results

          Twelve patients with severe aortic stenosis and borderline lesions in the coronary artery were qualified for physiological assessment. There were 6 women, whose mean age was 73.8 ±7.5 years. The mean left ventricular ejection fraction was 52 ±15%. The mean aortic valve area was 0.80 ±0.16 cm 2. The left anterior descending artery was assessed in 12 from 13 cases (92%). In comparison to FFR, all iFR measurements were concordant with FFR. The total agreement between QFR and FFR/iFR assessment was 69%.

          Conclusions

          Despite the controversy and uncertainty of some operators regarding the interpretation of the FFR test in patients with severe aortic stenosis, we obtained complete agreement of FFR with iFR assessment. This fact suggests that in patients with severe aortic stenosis the choice of an invasive method to assess the physiological significance of the stenosis in the coronary artery is not crucial – both iFR and FFR allow comparable results.

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          Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses.

          N. H. Pijls, B. De Bruyne, K Peels … (1996)
          The clinical significance of coronary-artery stenoses of moderate severity can be difficult to determine. Myocardial fractional flow reserve (FFR) is a new index of the functional severity of coronary stenoses that is calculated from pressure measurements made during coronary arteriography. We compared this index with the results of noninvasive tests commonly used to detect myocardial ischemia, to determine the usefulness of the index. In 45 consecutive patients with moderate coronary stenosis and chest pain of uncertain origin, we performed bicycle exercise testing, thallium scintigraphy, stress echocardiography with dobutamine, and quantitative coronary arteriography and compared the results with measurements of FFR. In all 21 patients with an FFR of less than 0.75, reversible myocardial ischemia was demonstrated unequivocally on at least one noninvasive test. After coronary angioplasty or bypass surgery was performed, all the positive test results reverted to normal. In contrast, 21 of the 24 patients with an FFR of 0.75 or higher tested negative for reversible myocardial ischemia on all the noninvasive tests. No revascularization procedures were performed in these patients, and none were required during 14 months of follow-up. The sensitivity of FFR in the identification of reversible ischemia was 88 percent, the specificity 100 percent, the positive predictive value 100 percent, the negative predictive value 88 percent, and the accuracy 93 percent. In patients with coronary stenosis of moderate severity, FFR appears to be a useful index of the functional severity of the stenoses and the need for coronary revascularization.
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            Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people

            Eleni Rapsomaniki, Adam Timmis, Julie George … (2014)
            Summary Background The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease. Methods We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalTrials.gov, number NCT01164371. Findings During 5·2 years median follow-up, we recorded 83 098 initial cardiovascular disease presentations. In each age group, the lowest risk for cardiovascular disease was in people with systolic blood pressure of 90–114 mm Hg and diastolic blood pressure of 60–74 mm Hg, with no evidence of a J-shaped increased risk at lower blood pressures. The effect of high blood pressure varied by cardiovascular disease endpoint, from strongly positive to no effect. Associations with high systolic blood pressure were strongest for intracerebral haemorrhage (hazard ratio 1·44 [95% CI 1·32–1·58]), subarachnoid haemorrhage (1·43 [1·25–1·63]), and stable angina (1·41 [1·36–1·46]), and weakest for abdominal aortic aneurysm (1·08 [1·00–1·17]). Compared with diastolic blood pressure, raised systolic blood pressure had a greater effect on angina, myocardial infarction, and peripheral arterial disease, whereas raised diastolic blood pressure had a greater effect on abdominal aortic aneurysm than did raised systolic pressure. Pulse pressure associations were inverse for abdominal aortic aneurysm (HR per 10 mm Hg 0·91 [95% CI 0·86–0·98]) and strongest for peripheral arterial disease (1·23 [1·20–1·27]). People with hypertension (blood pressure ≥140/90 mm Hg or those receiving blood pressure-lowering drugs) had a lifetime risk of overall cardiovascular disease at 30 years of age of 63·3% (95% CI 62·9–63·8) compared with 46·1% (45·5–46·8) for those with normal blood pressure, and developed cardiovascular disease 5·0 years earlier (95% CI 4·8–5·2). Stable and unstable angina accounted for most (43%) of the cardiovascular disease-free years of life lost associated with hypertension from index age 30 years, whereas heart failure and stable angina accounted for the largest proportion (19% each) of years of life lost from index age 80 years. Interpretation The widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range, and that diastolic and systolic associations are concordant, are not supported by the findings of this high-resolution study. Despite modern treatments, the lifetime burden of hypertension is substantial. These findings emphasise the need for new blood pressure-lowering strategies, and will help to inform the design of randomised trials to assess them. Funding Medical Research Council, National Institute for Health Research, and Wellcome Trust.
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              The evolving epidemiology of valvular aortic stenosis. the Tromsø study.

              Gry Eveborn, Henrik Schirmer, Geir Heggelund … (2013)
              To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS).
              Article 0 comments Cited 177 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Postepy Kardiol Interwencyjnej
                Journal ID (iso-abbrev): Postepy Kardiol Interwencyjnej
                Journal ID (publisher-id): PWKI
                Title: Postępy w Kardiologii Interwencyjnej = Advances in Interventional Cardiology
                Publisher: Termedia Publishing House
                ISSN (Print): 1734-9338
                ISSN (Electronic): 1897-4295
                Publication date (Electronic): 19 August 2022
                Publication date (Print): June 2022
                Volume: 18
                Issue: 2
                Pages: 118-121
                Affiliations
                [1 ]KCRI, Krakow, Poland
                [2 ]Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
                [3 ]Department of Bioinformatics and Telemedicine, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
                [4 ]Department of Angiology, University Hospital, Krakow, Poland
                [5 ]2 nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
                Author notes
                Corresponding author: Wojciech Zasada, KCRI, Department of Cardiology, University Hospital, Krakow, Poland. phone: +48 12 400 22 50. e-mail: zasada.wojciech@ 123456gmail.com
                Article
                Publisher ID: 47581
                DOI: 10.5114/aic.2022.118527
                PMC ID: 9421517
                PubMed ID: 36051833
                SO-VID: cd2fbb0a-dce3-44b5-8866-adc7fb8fd95e
                Copyright © Copyright: © 2022 Termedia Sp. z o. o.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                Date received : 12 May 2022
                Date accepted : 02 June 2022
                Categories
                Subject: Original Paper

                Keywords: fractional flow reserve,instantaneous wave-free pressure ratio,quantitative flow ratio,aortic stenosis,coronary heart disease
                Data availability:
                Keywords: fractional flow reserve, instantaneous wave-free pressure ratio, quantitative flow ratio, aortic stenosis, coronary heart disease

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