PT  - JOURNAL ARTICLE
AU  - Nijjer, Sukhjinder S
AU  - Sen, Sayan
AU  - Petraco, Ricardo
AU  - Sachdeva, Rajesh
AU  - Cuculi, Florim
AU  - Escaned, Javier
AU  - Broyd, Christopher
AU  - Foin, Nicolas
AU  - Hadjiloizou, Nearchos
AU  - Foale, Rodney A
AU  - Malik, Iqbal
AU  - Mikhail, Ghada W
AU  - Sethi, Amarjit S
AU  - Al-Bustami, Mahmud
AU  - Kaprielian, Raffi R
AU  - Khan, Masood A
AU  - Baker, Christopher S
AU  - Bellamy, Michael F
AU  - Hughes, Alun D
AU  - Mayet, Jamil
AU  - Kharbanda, Rajesh K
AU  - Di Mario, Carlo
AU  - Davies, Justin E
TI  - Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio
AID  - 10.1136/heartjnl-2013-304387
DP  - 2013 Dec 01
TA  - Heart
PG  - 1740--1748
VI  - 99
IP  - 23
4099  - http://heart.bmj.com/content/99/23/1740.short
4100  - http://heart.bmj.com/content/99/23/1740.full
SO  - Heart2013 Dec 01; 99
AB  - Objective To determine whether the instantaneous wave-free ratio (iFR) can detect improvement in stenosis significance after percutaneous coronary intervention (PCI) and compare this with fractional flow reserve (FFR) and whole cycle Pd/Pa. Design A prospective observational study was undertaken in elective patients scheduled for PCI with FFR ≤0.80. Intracoronary pressures were measured at rest and during adenosine-mediated vasodilatation, before and after PCI. iFR, Pd/Pa and FFR values were calculated using the validated fully automated algorithms. Setting Coronary catheter laboratories in two UK centres and one in the USA. Patients 120 coronary stenoses in 112 patients were assessed. The mean age was 63±10 years, while 84% were male; 39% smokers; 33% with diabetes. Mean diameter stenosis was 68±16% by quantitative coronary angiography. Results Pre-PCI, mean FFR was 0.66±0.14, mean iFR was 0.75±0.21 and mean Pd/Pa 0.83±0.16. PCI increased all indices significantly (FFR 0.89±0.07, p<0.001; iFR 0.94±0.05, p<0.001; Pd/Pa 0.96±0.04, p<0.001). The change in iFR after intervention (0.20±0.21) was similar to ΔFFR 0.22±0.15 (p=0.25). ΔFFR and ΔiFR were significantly larger than resting ΔPd/Pa (0.13±0.16, both p<0.001). Similar incremental changes occurred in patients with a higher prevalence of risk factors for microcirculatory disease such as diabetes and hypertension. Conclusions iFR and FFR detect the changes in coronary haemodynamics elicited by PCI. FFR and iFR have a significantly larger dynamic range than resting Pd/Pa. iFR might be used to objectively document improvement in coronary haemodynamics following PCI in a similar manner to FFR.