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Instantaneous wave-free ratio (iFR®) to determine hemodynamically significant coronary stenosis: A comprehensive

Stefan Baumann1, Leonard Chandra2, Elizaveta Skarga2

  • 1First Department of Medicine-Cardiology, University Medical Center Mannheim, Mannheim, Germany and DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim 68167, Baden-Württemberg, Germany. stefan.baumann@umm.de.

World Journal of Cardiology
|January 10, 2019
PubMed

Insights

Instantaneous wave-free ratio (iFR) offers a non-inferior alternative to fractional flow reserve (FFR) for assessing coronary artery stenosis severity. This innovative method avoids vasodilators, simplifying procedures and improving clinical outcomes in cardiology.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Coronary angiography provides morphological assessment of coronary artery stenosis, but severity evaluation is subjective.
  • Fractional flow reserve (FFR) is the current standard for assessing hemodynamic significance, guiding revascularization strategies.
  • FFR use is limited by the need for adenosine and procedure prolongation.

Purpose of the Study:

  • To introduce and evaluate the instantaneous wave-free ratio (iFR) as a novel, simpler method for determining hemodynamic significance of coronary stenosis.
  • To compare the safety and efficacy of iFR with FFR in clinical practice.

Main Methods:

  • iFR measurement at rest without vasodilators.
  • Comparison of iFR and FFR in large clinical trials (SWEDEHEART, DEFINE-FLAIR).
  • Utilizing iFR-pullback to create hemodynamic maps of coronary vessels.

Main Results:

  • iFR demonstrated non-inferiority to FFR regarding periprocedural complications and prognosis.
  • iFR eliminates the need for adenosine administration, shortening procedure time.
  • iFR-pullback enables detailed visualization of hemodynamic changes along the coronary artery.

Conclusions:

  • iFR is a safe and effective alternative to FFR for assessing coronary stenosis.
  • The iFR technique simplifies hemodynamic assessment, potentially increasing its clinical adoption.
  • iFR-pullback offers advanced diagnostic capabilities for coronary artery disease management.

Keywords:
Coronary angiographyCoronary revascularizationCoronary stenosisFractional flow reserveInstantaneous wave-free ratioMyocardial ischemia

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