ArticleJACC. Cardiovascular interventions2017
Fractional Flow Reserve/Instantaneous Wave-Free Ratio Discordance in Angiographically Intermediate Coronary Stenoses: An Analysis Using Doppler-Derived Coronary Flow Measurements.
Article in JACC. Cardiovascular interventions, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
59 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Diagnostic Performance of Non-Hyperemic Pressure Ratios Versus Fractional Flow Reserve Stratified by Coronary Artery: A Systematic Review and Meta-Analysis of Individual Patient Data.Journal of the American Heart Association · 2026Pooled it
- Meta-Analysis of Diagnostic Performance of Instantaneous Wave-Free Ratio versus Quantitative Flow Ratio for Detecting the Functional Significance of Coronary Stenosis.BioMed research international · 2019Pooled it
- Clinical Impact of Concordant and Discordant Physiology Parameters Post-Percutaneous Coronary Intervention in the EASY-PREDICT Study.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025Trial
- Comparison of quantitative flow ratio and fractional flow reserve with myocardial perfusion scintigraphy and cardiovascular magnetic resonance as reference standard. A Dan-NICAD substudy.The international journal of cardiovascular imaging · 2020Trial
- Clinical Events After Deferral of LAD Revascularization Following Physiological Coronary Assessment.Journal of the American College of Cardiology · 2019Trial
- Invasive Coronary Physiology in Contemporary Practice: From Lesion Selection to Comprehensive PCI Guidance and Functional Phenotyping.Journal of clinical medicine · 2026Review
- Impact of Epicardial plaQUe Composition and geomeTry on Coronary hEmodynamics and Flow in Patients With Coronary Artery Disease (iEquate).Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2025Observational
- Interpretation of Discordance Between Non-Hyperemic Pressure Ratios and Fractional Flow Reserve: Potential Mechanisms and Clinical Implications.Reviews in cardiovascular medicine · 2025Review
- Coronary Artery Disease and Transcatheter Aortic Valve Replacement.Journal of the Society for Cardiovascular Angiography & Interventions · 2025Review
- A Novel Method for Angiographic Contrast-Based Diagnosis of Stenosis in Coronary Artery Disease: In Vivo and In Vitro Analyses.Diagnostics (Basel, Switzerland) · 2024Article
- Physiological Assessment with iFR prior to FFR Measurement in Left Main Disease.Cardiovascular intervention and therapeutics · 2024Article
- Validation of resting full-cycle ratio and diastolic pressure ratio with [Heart and vessels · 2024Article
- Sex Differences in 5-Year Outcomes After Deferral of Revascularization Following Physiological Coronary Assessment.Circulation reports · 2024Article
- Diagnostic accuracy of diastolic pressure ratio using a pressure microcatheter for intracoronary physiological assessment.Heart and vessels · 2023Observational
- Impact of stenosis resistance and coronary flow capacity on fractional flow reserve and instantaneous wave-free ratio discordance: a combined analysis of DEFINE-FLOW and IDEAL.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2023Article
- Decoding fractional flow reserve/instantaneous wave-free ratio discordance: is flow the answer?Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2023Article
- Invasive physiologic assessment of coronary artery stenosis by resting full-cycle ratio and fractional flow reserve: a prospective observational study.Scientific reports · 2023Observational
- Hyperemic and non-hyperemic indexes in coronary physiology. Causes and implications of discordant results.International journal of cardiology. Heart & vasculature · 2023Article
- Coronary Vascular (DYS) Function and Invasive Physiology Assessment: Insights into Bolus and Continuous Thermodilution Methods.Journal of clinical medicine · 2023Review
- Insufficient adenosine-induced hyperemia is a major determinant of discordance between non-hyperemic pressure ratio and fractional flow reserve.Scientific reports · 2023Article
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28 authors.
Funding
Abstract
objectivesThe study sought to determine the coronary flow characteristics of angiographically intermediate stenoses classified as discordant by fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR).
backgroundDiscordance between FFR and iFR occurs in up to 20% of cases. No comparisons have been reported between the coronary flow characteristics of FFR/iFR discordant and angiographically unobstructed vessels.
methodsBaseline and hyperemic coronary flow velocity and coronary flow reserve (CFR) were compared across 5 vessel groups: FFR+/iFR+ (108 vessels, n = 91), FFR-/iFR+ (28 vessels, n = 24), FFR+/iFR- (22 vessels, n = 22), FFR-/iFR- (208 vessels, n = 154), and an unobstructed vessel group (201 vessels, n = 153), in a post hoc analysis of the largest combined pressure and Doppler flow velocity registry (IDEAL [Iberian-Dutch-English] collaborators study).
resultsFFR disagreed with iFR in 14% (50 of 366). Baseline flow velocity was similar across all 5 vessel groups, including the unobstructed vessel group (p = 0.34 for variance). In FFR+/iFR- discordants, hyperemic flow velocity and CFR were similar to both FFR-/iFR- and unobstructed groups; 37.6 (interquartile range [IQR]: 26.1 to 50.4) cm/s vs. 40.0 [IQR: 29.7 to 52.3] cm/s and 42.2 [IQR: 33.8 to 53.2] cm/s and CFR 2.36 [IQR: 1.93 to 2.81] vs. 2.41 [IQR: 1.84 to 2.94] and 2.50 [IQR: 2.11 to 3.17], respectively (p > 0.05 for all). In FFR-/iFR+ discordants, hyperemic flow velocity, and CFR were similar to the FFR+/iFR+ group; 28.2 (IQR: 20.5 to 39.7) cm/s versus 23.5 (IQR: 16.4 to 34.9) cm/s and CFR 1.44 (IQR: 1.29 to 1.85) versus 1.39 (IQR: 1.06 to 1.88), respectively (p > 0.05 for all).
conclusionsFFR/iFR disagreement was explained by differences in hyperemic coronary flow velocity. Furthermore, coronary stenoses classified as FFR+/iFR- demonstrated similar coronary flow characteristics to angiographically unobstructed vessels.
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