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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

2022; Wiley; Volume: 11; Issue: 9 Linguagem: Inglês

10.1161/jaha.121.021490

2047-9980

Tomáš Kovárník, Hitoshi Matsuo, Aleš Král, Petr Jeřábek, David Zemánek, Yoshiaki Kawase, Hiroyuki Omori, Toru Tanigaki, Jan Pudil, Alexandra Vodzinská, Marian Branny, Roman Štípal, Petr Kala, Jan Mrózek, Martin Porzer, Tomáš Grézl, Kamil Novobílský, Oscar Méndiz, Karel Kopřiva, Martin Mates, Martin Chvál, Zhi Chen, Pavel Martásek, Aleš Linhart, Tomáš Kovárník, Aleš Král, Petr Jeřábek, David Zemánek, Jan Pudil, Jiri Humhal, K Gorican, Michael Padour, Stanislav Šimek, Jan Bělohlávek, Daniel Rob, Michaela Hronová, Aleš Král, Hitoshi Matsuo, Yoshiaki Kawase, Hiroyuki Omori, Toru Tanigaki, Alexandra Vodzinská, J. Černý, Jan Indrak, Miroslav Hudec, Marian Branny, Jan Mrózek, Martin Porzer, Tomáš Grézl, Roman Štípal, Petr Kala, Jan Kaňovský, Otakar Boček, Martin Poloczek, Petr Jeřábek, Kamil Novobílský, Tomas Kolomaznik, Oscar Méndiz, Karel Kopřiva, Martin Mates, F. Holy, Martin Chvál, Zhi Chen, Pavel Martásek, Lubomir Kralik,

Cardiovascular Health and Disease Prevention

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 synthase r +heme oxygenase‐1 r ): 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.