Physiological and Clinical Assessment of Resting Physiological Indexes: Resting Full-Cycle Ratio, Diastolic Pressure Ratio, and Instantaneous Wave-Free Ratio

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Abstract

Recently, resting pressure-derived indexes such as resting full-cycle ratio (RFR) and diastolic pressure ratio (dPR) have been introduced to assess the functional significance of epicardial coronary stenosis. The present study sought to investigate the agreement of RFR or dPR with other pressure-derived indexes (instantaneous wave-free ratio [iFR] or fractional flow reserve), the sensitivity of RFR or dPR for anatomic or hemodynamic stenosis severity, and the prognostic implications of RFR or dPR compared with iFR Methods: RFR and dPR were calculated from resting pressure tracings by an independent core laboratory in 1024 vessels (435 patients). The changes in resting physiological indexes according to diameter stenosis were compared among iFR, RFR, and dPR. Among 115 patients who underwent 13N-ammonia positron emission tomography, the changes in those indexes according to basal and hyperemic stenosis resistance and absolute hyperemic myocardial blood flow were compared. The association between resting physiological indexes and the risk of 2-year vessel-oriented composite outcomes (a composite of cardiac death, vessel-related myocardial infarction, and vessel-related ischemia-driven revascularization) was analyzed among 864 deferred vessels.

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Most cited references 15

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Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI

Justin E. Davies, Sayan Sen, Hakim-Moulay Dehbi … (2017)

Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR.

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Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial.

Lokien X van Nunen, Frederik Zimmermann, Pim Tonino … (2015)

In the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study, fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) improved outcome compared with angiography-guided PCI for up to 2 years of follow-up. The aim in this study was to investigate whether the favourable clinical outcome with the FFR-guided PCI in the FAME study persisted over a 5-year follow-up.

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Validation of a novel non-hyperaemic index of coronary artery stenosis severity: the Resting Full-cycle Ratio (VALIDATE RFR) study

Johan Svanerud, Jung-Min Ahn, Allen Jeremias … (2018)

Randomised controlled trials have reported instantaneous wave-free ratio (iFR) to be non-inferior to fractional flow reserve (FFR) for major adverse cardiovascular events at one year; however, iFR is limited by sensitive landmarking of the pressure waveform, and the assumption that maximal flow and minimal resistance occur during a fixed period of diastole. We sought to validate the resting full-cycle ratio (RFR), a novel non-hyperaemic index of coronary stenosis severity based on unbiased identification of the lowest distal coronary pressure to aortic pressure ratio (Pd/Pa), independent of the ECG, landmark identification, and timing within the cardiac cycle.

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Author and article information

Journal

Title: Circulation

Abbreviated Title: Circulation

Publisher: Ovid Technologies (Wolters Kluwer Health)

ISSN (Print): 0009-7322

ISSN (Electronic): 1524-4539

Publication date Created: February 12 2019

Publication date (Print): February 12 2019

Volume: 139

Issue: 7

Pages: 889-900

Affiliations

[1 ]Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (J.M.L., K.H.C., Y.B.S., J.-Y.H.).

[2 ]Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, South Korea (Jonghanne Park, D.H., T.-M.R., B.-K.K.).

[3 ]Department of Internal Medicine, Naju National Hospital, Ministry of Health and Welfare, South Korea (Jonghanne Park).

[4 ]Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea (Jinhyoung Park).

[5 ]Department of Epidemiology, School of Public Health (J.K.), Seoul National University, South Korea.

[6 ]Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, South Korea (H.Y.K.).

[7 ]Department of Cardiology, Daegu Catholic University Medical Center, South Korea (H.W.J.).

[8 ]Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea (Y.-K.C., H.-J.Y., C.-W.N., S.-H.H.).

[9 ]Division of Cardiology, Ulsan Hospital, South Korea (E.-S.S.).

[10 ]Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, South Korea (E.-S.S.).

[11 ]Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea (J.-H.D.).

[12 ]Institute on Aging (B.-K.K.), Seoul National University, South Korea.

Article

DOI: 10.1161/CIRCULATIONAHA.118.037021

PubMed ID: 30586749

SO-VID: e7ee8592-3de5-4e27-bb93-3561b19ebbc6

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