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Multicenter Study
. 2022 May 3;11(9):e021490.
doi: 10.1161/JAHA.121.021490. Epub 2022 May 3.

Fractional Flow Reserve Versus Instantaneous Wave-Free Ratio in Assessment of Lesion Hemodynamic Significance and Explanation of their Discrepancies. International, Multicenter and Prospective Trial: The FiGARO Study

Tomas Kovarnik  1 , Matsuo Hitoshi  2 , Ales Kral  1 , Stepan Jerabek  1 , David Zemanek  1 , Yoshiaki Kawase  2 , Hiroyuki Omori  2 , Toru Tanigaki  2 , Jan Pudil  1 , Alexandra Vodzinska  3 , Marian Branny  4 , Roman Stipal  5 , Petr Kala  5 , Jan Mrozek  4 , Martin Porzer  4 , Tomas Grezl  4 , Kamil Novobilsky  6 , Oscar Mendiz  7 , Karel Kopriva  8 , Martin Mates  8 , Martin Chval  9 , Zhi Chen  10 , Pavel Martasek  11 , Ales Linhart  1 ; FiGARO trial investigators
Collaborators, Affiliations
Multicenter Study

Fractional Flow Reserve Versus Instantaneous Wave-Free Ratio in Assessment of Lesion Hemodynamic Significance and Explanation of their Discrepancies. International, Multicenter and Prospective Trial: The FiGARO Study

Tomas Kovarnik et al. J Am Heart Assoc. .

Abstract

Background The FiGARO (FFR versus iFR in Assessment of Hemodynamic Lesion Significance, and an Explanation of Their Discrepancies) trial is a prospective registry searching for predictors of fractional flow reserve/instantaneous wave-free ratio (FFR/iFR) discrepancy. Methods and Results FFR/iFR were analyzed using a Verrata wire, and coronary flow reserve was analyzed using a Combomap machine (both Philips-Volcano). The risk polymorphisms for endothelial nitric oxide synthase and for heme oxygenase-1 were analyzed. In total, 1884 FFR/iFR measurements from 1564 patients were included. The FFR/iFR discrepancy occurred in 393 measurements (20.9%): FFRp (positive)/iFRn (negative) type (264 lesions, 14.0%) and FFRn/iFRp (129 lesions, 6.8%) type. Coronary flow reserve was measured in 343 lesions, correlating better with iFR (R=0.56, P<0.0001) than FFR (R=0.36, P<0.0001). The coronary flow reserve value in FFRp/iFRn lesions (2.24±0.7) was significantly higher compared with both FFRp/iFRp (1.39±0.36), and FFRn/iFRn lesions (1.8±0.64, P<0.0001). Multivariable logistic regression analysis confirmed (1) sex, age, and lesion location in the right coronary artery as predictors for FFRp/iFRn discrepancy; and (2) hemoglobin level, smoking, and renal insufficiency as predictors for FFRn/iFRp discrepancy. The FFRn/iFRp type of discrepancy was significantly more frequent in patients with both risk types of polymorphisms (endothelial nitric oxide synthaser+heme oxygenase-1r): 8 patients (24.2%) compared with FFRp/iFRn type of discrepancy: 2 patients (5.9%), P=0.03. Conclusions Predictors for FFRp/iFRn discrepancy were sex, age, and location in the right coronary artery. Predictors for FFRn/iFRp were hemoglobin level, smoking, and renal insufficiency. The risk type of polymorphism in endothelial nitric oxide synthase and heme oxygenase-1 genes was more frequently found in patients with FFRn/iFRp type of discrepancy. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT03033810.

Keywords: coronary flow reserve; fractional flow reserve; instantaneous wave‐free ratio.

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Figures

Figure 1
Figure 1. A 3‐dimensional image of the ENOS heme domains.
Left panel: the homodimeric structure, alongside heme (pink) and the structural zinc atom (grey). Right panel: the Glu298 (blue) and Asp298 (yellow) represent amino acid residues corresponding to the polymorphic change. ENOS indicates endothelial nitric oxide synthase.
Figure 2
Figure 2. Correlation between FFR and iFR values and histograms for FFR and iFR values.
FFR indicates fractional flow reserve; and iFR, instantaneous wave‐free ratio.
Figure 3
Figure 3. Bland‐Altman plot of difference between FFR and iFR.
FFR indicates fractional flow reserve; and iFR, instantaneous wave‐free ratio.
Figure 4
Figure 4. Correlation between CFR and FFR, and between CFR and iFR.
CFR indicates coronary flow reserve; FFR, fractional flow reserve; and iFR, instantaneous wave‐free ratio.
See this image and copyright information in PMC

Comment in

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