Related Experiment Video

Updated: Jan 8, 2026

Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
13:07

Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression

Published on: January 15, 2022

4.3K

Angiographic phenotypes predict FFR/iFR discordance in severe aortic stenosis: A cluster analysis

Artur Dziewierz1, Barbara Zdzierak1, Łukasz Rzeszutko1

  • 12(nd) Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.

Cardiovascular Revascularization Medicine : Including Molecular Interventions
|December 12, 2025
PubMed

Insights

In severe aortic stenosis, high percent diameter stenosis lesions predict FFR/iFR discordance. Unsupervised clustering identified "High %DS / Intermediate Length" lesions as the primary drivers of physiological discordance.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Assessing coronary artery disease in severe aortic stenosis (AS) is challenging due to altered hemodynamics.
  • Discordance between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) is common in AS.
  • The role of angiographic lesion characteristics in predicting this discordance is not well understood.

Purpose of the Study:

  • To identify angiographic predictors of FFR/iFR discordance in severe AS.
  • To define distinct angiographic lesion phenotypes using unsupervised machine learning.
  • To understand the impact of lesion characteristics on physiological measurements in AS.

Main Methods:

  • Prospective registry of 221 patients with severe AS and 401 intermediate coronary lesions.
  • Quantitative coronary angiography to measure percent diameter stenosis (%DS) and lesion length (LL).
  • FFR and iFR measurements were performed; K-means clustering analyzed %DS and LL to identify phenotypes.

Main Results:

  • FFR/iFR discordance occurred in 7.5% of lesions, exclusively as FFR-negative/iFR-positive.
  • Higher %DS was the sole independent angiographic predictor of discordance (OR 1.35).
  • Three phenotypes were identified: High %DS/Intermediate LL (16.5% discordance), Low %DS/Short-Intermediate LL (2.7% discordance), and Intermediate %DS/Long LL (9.0% discordance).

Conclusions:

  • FFR/iFR discordance in severe AS presents as FFR-negative/iFR-positive.
  • "High %DS / Intermediate Length" lesions are the primary drivers of physiological discordance.
  • These findings identify cases where iFR may overestimate lesion severity in the context of AS-related hemodynamics.
Abstract

Keywords:
Aortic stenosisCluster analysisCoronary microvascular dysfunctionFractional flow reserveInstantaneous wave-free ratio

More Related Videos

A Rat Model of Pressure Overload Induced Moderate Remodeling and Systolic Dysfunction as Opposed to Overt Systolic Heart Failure07:13

A Rat Model of Pressure Overload Induced Moderate Remodeling and Systolic Dysfunction as Opposed to Overt Systolic Heart Failure

Published on: April 30, 2020

6.8K
Author Spotlight: Development of a Minimally Invasive Large-Animal Model for Reliable and Reproducible Cardiovascular Research06:51

Author Spotlight: Development of a Minimally Invasive Large-Animal Model for Reliable and Reproducible Cardiovascular Research

Published on: October 20, 2023

1.6K

Related Concept Videos

Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
375
Mitral Stenosis II: Clinical features and Diagnostic Tests01:23

Mitral Stenosis II: Clinical features and Diagnostic Tests

Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
194
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
443
Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
429
Acute Coronary Syndrome III: Diagnostic Studies01:30

Acute Coronary Syndrome III: Diagnostic Studies

Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
197