Author + information
- Received March 21, 2018
- Revision received July 19, 2018
- Accepted July 24, 2018
- Published online August 25, 2018.
- Futoshi Yamanaka, MDa,∗ (, )
- Koki Shishido, MDa,
- Tomoki Ochiai, MDa,
- Noriaki Moriyama, MDa,
- Kazumasa Yamazaki, MDb,
- Ayumu Sugitanic,
- Tomoyuki Tani, MDb,
- Kazuki Tobita, MDa,
- Shingo Mizuno, MDa,
- Yutaka Tanaka, MD, PhDa,
- Masato Murakami, MD, PhDa,
- Saeko Takahashi, MDa,
- Seiji Yamazaki, MDb and
- Shigeru Saito, MDa,b
- aDepartment of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
- bDepartment of Cardiology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- cDepartment of Biometrics, Institute of Biomedical Research, Sapporohigashi Tokushukai Hospital, Sapporo, Japan
- ↵∗Address for correspondence:
Dr. Futoshi Yamanaka, Department of Cardiology, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, Japan.
Objectives This study investigated the diagnostic performance of instantaneous wave-free ratio (iFR) in patients with aortic valve stenosis (AS).
Background The iFR was introduced as a new, nonpharmacologic stress index of coronary stenosis severity. However, the diagnostic performance of iFR has not been sufficiently explored in patients with severe AS.
Methods We analyzed 95 consecutive patients with AS (57 women) demonstrating intermediate coronary artery stenosis (116 vessels), and compared the iFR values with fractional flow reserve (FFR) values and with adenosine-stress myocardial perfusion imaging as indicators of myocardial ischemia.
Results The median value and interquartile range (first quartile [Q1], third quartile [Q3]) of the iFR was 0.86 (Q1 to Q3 range, 0.76 to 0.93), and that of the FFR was 0.84 (Q1 to Q3 range, 0.76 to 0.91). The iFR values correlated well with the FFR values (R = 0.854; p < 0.0001). A receiver operating characteristic analysis demonstrated an optimal cutoff of 0.82 for the iFR to indicate an FFR ≤0.75, with an area under the curve of 0.92. The optimal iFR cutoff value indicating myocardial ischemia on perfusion scintigraphy was 0.82 (area under the curve: 0.84).
Conclusions In patients with severe AS, a good correlation exists between iFR and FFR. Both the iFR and FFR values exhibit good correlation with perfusion scintigraphy–identified myocardial ischemia. The iFR could be a safe diagnostic tool for patients with severe AS. (Clinical Trial Registration: UMIN000024479).
Dr. Saito has a relationship with Medtronic and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 21, 2018.
- Revision received July 19, 2018.
- Accepted July 24, 2018.
- 2018 American College of Cardiology Foundation
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