Key result
Diffuse LAD disease links to ~83% FFR-/iFR+ discordance while focal disease favors FFR+/iFR- discordance.
Why the study?
The per-vessel level impact of physiological pattern of disease on discordance between FFR and iFR had not been clarified.
Does the physiological pattern of coronary disease affect FFR/iFR discordance differently in the LAD compared to non-LAD vessels?
Does the physiological pattern of coronary disease affect FFR/iFR discordance differently in the LAD compared to non-LAD vessels?
The physiological pattern of coronary disease (diffuse vs. focal) significantly impacts FFR/iFR discordance in the LAD but not in non-LAD vessels.
Disease patterns were associated with FFR/iFR discordance subtypes in LAD; hypothesis-generating for pullback interpretation but should not yet change practice.
BACKGROUND: The per-vessel level impact of physiological pattern of disease on the discordance between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) has not been clarified. METHODS AND RESULTS: Using the AJIP registry, vessels with FFR/iFR discordance (133/671 [19.8%]) were analyzed. In the left anterior descending artery (LAD), physiologically diffuse disease, as assessed by pressure-wire pullback, was associated with FFR-/iFR+ (83.3% [40/48]), while physiologically focal disease was associated with FFR+/iFR- (57.4% [31/54]), significantly (P<0.0001). These differences were not significant in non-LAD (P=0.17). CONCLUSIONS: The impact of physiological pattern of disease on FFR/iFR discordance is more pronounced in the LAD.
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Warisawa et al. (2020) studied this question. Physiologically diffuse disease in the LAD was associated with FFR-/iFR+ discordance (83.3%), while focal disease was associated with FFR+/iFR- discordance (57.4%; P<0.0001).
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