Skip to main content
  • 1264 Accesses

Abstract

The instantaneous wave-free ratio (iFR) is a clinical tool that uses a pressure wire to guide whether a stenosis in a coronary artery is sufficiently severe to benefit from stenting.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Sen S, Escaned J, Malik IS, et al. Development and validation of a new adenosine-independent index of stenosis severity from coronary wave–intensity analysis. J Am Coll Cardiol. 2012;59:1392–402. doi:10.1016/j.jacc.2011.11.003.

    Article  CAS  PubMed  Google Scholar 

  2. Sen S, Asrress KN, Nijjer S, et al. Diagnostic classification of the instantaneous wave-free ratio is equivalent to fractional flow reserve and is not improved with adenosine administration. Results of CLARIFY (Classification Accuracy of Pressure-Only Ratios Against Indices Using Flow Study). J Am Coll Cardiol. 2013;61:1409–20. doi:10.1016/j.jacc.2013.01.034.

    Article  PubMed  Google Scholar 

  3. Nijjer SS, Waard GA de, Sen S, et al. Coronary pressure and flow relationships in humans: phasic analysis of normal and pathological vessels and the implications for stenosis assessment: a report from the Iberian–Dutch–English (IDEAL) collaborators. Eur Heart J. 2015:ehv626. doi:10.1093/eurheartj/ehv626.

  4. Nijjer SS, Sen S, Petraco R, et al. Improvement in coronary haemodynamics after percutaneous coronary intervention: assessment using instantaneous wave-free ratio. Heart. 2013;99:1740–8. doi:10.1136/heartjnl-2013-304387.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Nijjer SS, Sen S, Petraco R, et al. Pre-angioplasty instantaneous wave-free ratio pullback provides virtual intervention and predicts hemodynamic outcome for serial lesions and diffuse coronary artery disease. JACC Cardiovasc Interv. 2014;7:1386–96. doi:10.1016/j.jcin.2014.06.015.

    Article  PubMed  Google Scholar 

  6. Nijjer SS, Sen S, Petraco R, et al. The Instantaneous wave-Free Ratio (iFR) pullback: a novel innovation using baseline physiology to optimise coronary angioplasty in tandem lesions. Cardiovasc Revasc Med. 2015;16:167–71. doi:10.1016/j.carrev.2015.01.006.

    Article  PubMed  Google Scholar 

  7. Curzen N, Rana O, Nicholas Z, et al. Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain? The RIPCORD Study. Circ Cardiovasc Interv. 2014:CIRCINTERVENTIONS.113.000978. doi:10.1161/CIRCINTERVENTIONS.113.000978.

  8. Petraco R, Park JJ, Sen S, et al. Hybrid iFR-FFR decision-making strategy: implications for enhancing universal adoption of physiology-guided coronary revascularisation. EuroIntervention. 2013;8:1157–65. doi:10.4244/EIJV8I10A179.

    Article  PubMed  Google Scholar 

  9. Escaned J, Echavarría-Pinto M, Garcia-Garcia HM, et al. Prospective assessment of the diagnostic accuracy of instantaneous wave-free ratio to assess coronary stenosis relevance: results of ADVISE II international, multicenter study (ADenosine Vasodilator Independent Stenosis Evaluation II). JACC Cardiovasc Interv. 2015;8:824–33. doi:10.1016/j.jcin.2015.01.029.

    Article  PubMed  Google Scholar 

  10. Petraco R, Al-Lamee R, Gotberg M, et al. Real-time use of instantaneous wave-free ratio: results of the ADVISE in-practice: an international, multicenter evaluation of instantaneous wave-free ratio in clinical practice. Am Heart J. 2014;168:739–48. doi:10.1016/j.ahj.2014.06.022.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nam C-W, Mangiacapra F, Entjes R, et al. Functional SYNTAX score for risk assessment in multivessel coronary artery disease. J Am Coll Cardiol. 2011;58:1211–8. doi:10.1016/j.jacc.2011.06.020.

    Article  PubMed  Google Scholar 

  12. Jeremias A, Maehara A, Généreux P, et al. Multicenter core laboratory comparison of the instantaneous wave-free ratio and resting Pd/Pa with fractional flow reserve: the RESOLVE study. J Am Coll Cardiol. 2014;63:1253–61. doi:10.1016/j.jacc.2013.09.060.

    Article  PubMed  Google Scholar 

  13. Indolfi C, Mongiardo A, Spaccarotella C, et al. The instantaneous wave-free ratio (iFR) for evaluation of non-culprit lesions in patients with acute coronary syndrome and multivessel disease. Int J Cardiol. 2014;178C:46–54. doi:10.1016/j.ijcard.2014.03.210.

    Google Scholar 

  14. Layland J, Oldroyd KG, Curzen N, et al. Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS–NSTEMI randomized trial. Eur Heart J. 2014:ehu338. doi:10.1093/eurheartj/ehu338.

  15. BARI 2D Investigators. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360:2503–15. doi:10.1056/NEJMoa0805796.

  16. Kapur A, Hall RJ, Malik IS, et al. Randomized comparison of percutaneous coronary intervention with coronary artery bypass grafting in diabetic patients: 1-year results of the CARDia (coronary artery revascularization in diabetes) trial. J Am Coll Cardiol. 2010;55:432–40. doi:10.1016/j.jacc.2009.10.014.

    Article  PubMed  Google Scholar 

  17. Serruys PW, Morice M-C, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961–72.

    Article  CAS  PubMed  Google Scholar 

  18. Farkouh ME, Domanski M, Sleeper LA, et al. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367:2375–84. doi:10.1056/NEJMoa1211585.

    Article  CAS  PubMed  Google Scholar 

  19. Tonino PAL, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24. doi:10.1056/NEJMoa0807611.

    Article  CAS  PubMed  Google Scholar 

  20. Van Belle EV, Rioufol G, Pouillot C, et al. Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography insights from a large french multicenter fractional flow reserve registry. Circulation. 2014;129:173–85. doi:10.1161/CIRCULATIONAHA.113.006646.

    Article  PubMed  Google Scholar 

  21. Botman CJ, Schonberger J, Koolen S, et al. Does stenosis severity of native vessels influence bypass graft patency? A prospective fractional flow reserve–guided study. Ann Thorac Surg. 2007;83:2093–7. doi:10.1016/j.athoracsur.2007.01.027.

    Article  PubMed  Google Scholar 

  22. Bech GJ, Pijls NH, De Bruyne B, et al. Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty. Circulation. 1999;99:883–8.

    Article  CAS  PubMed  Google Scholar 

  23. Pijls NHJ, Klauss V, Siebert U, et al. Coronary pressure measurement after stenting predicts adverse events at follow-up: a multicenter registry. Circulation. 2002;105:2950–4.

    Article  PubMed  Google Scholar 

  24. Danson E, Hansen P, Sen S, et al. Assessment, treatment, and prognostic implications of CAD in patients undergoing TAVI. Nat Rev Cardiol. Published Online First: 11 February 2016. doi:10.1038/nrcardio.2016.9.

  25. Rajappan K, Rimoldi OE, Dutka DP, et al. Mechanisms of coronary microcirculatory dysfunction in patients with aortic stenosis and angiographically normal coronary arteries. Circulation. 2002;105:470–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag London

About this chapter

Cite this chapter

Nijjer, S., Davies, J. (2017). Application of iFR in Clinical Scenarios. In: Escaned, J., Davies, J. (eds) Physiological Assessment of Coronary Stenoses and the Microcirculation. Springer, London. https://doi.org/10.1007/978-1-4471-5245-3_17

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-5245-3_17

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5244-6

  • Online ISBN: 978-1-4471-5245-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics