The Present and Future
State-of-the-Art Review
The Evolving Future of Instantaneous Wave-Free Ratio and Fractional Flow Reserve

https://doi.org/10.1016/j.jacc.2017.07.770Get rights and content
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Abstract

In this review, the authors reflect upon the role of coronary physiology in the modern management of coronary artery disease. They critically appraise the scientific background of the instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR), from early experimental studies to validation studies against indexes of ischemia, to clinical trials assessing outcome. At this important juncture for the field, the authors make predictions for the future of physiological stenosis assessment, outlining developments for both iFR and FFR in new clinical domains beyond the confines of stable angina. With a focus on the evolving future of iFR and FFR, the authors describe how physiological assessment with iFR may advance its application from simply justifying to guiding revascularization.

Key Words

coronary artery bypass graft
coronary physiology
coronary stenosis
myocardial revascularization
percutaneous coronary intervention

Abbreviations and Acronyms

ACS
acute coronary syndrome
AUC
area under the curve
CABG
coronary artery bypass grafting
CFR
coronary flow reserve
CI
confidence interval
FFR
fractional flow reserve
FFRmyo
myocardial fractional flow reserve
HR
hazard ratio
HSR
hyperemic stenosis resistance
iFR
instantaneous wave-free ratio
MACE
major adverse cardiac events
MI
myocardial infarction
OMT
optimal medical therapy
PCI
percutaneous coronary intervention
PET
positron emission tomography
STEMI
ST-segment elevation myocardial infarction
WFP
wave-free period
WIA
wave intensity analysis

Cited by (0)

Dr. Cook is supported by the Medical Research Council (grant number MR/M018369/1). Dr. Götberg has received an unrestricted research grant from Volcano Corporation; lecture fees from Philips Volcano and Boston Scientific; consulting fees from Boston Scientific; and fees for serving on an advisory board from Medtronic. Dr. Cook has received lecture fees from Philips Volcano. Dr. Sen has attended and conducted teaching sessions supported by Volcano Corporation, St. Jude Medical, Medtronic, Pfizer, and AstraZeneca; and has served on speakers bureaus for Philips and Pfizer. Dr. Nijjer has received lecture fees from Philips Volcano. Dr. Escaned has been a speaker at educational events and a consultant for Abbott, Philips Volcano, and Boston Scientific. Dr. Davies has received research grants from Philips Volcano and AstraZeneca; has received consulting fees from Medtronic, Philips Volcano, and ReCor Medical; and holds patents pertaining to the iFR technology, which is under license to Volcano Corporation. Drs. Götberg and Cook contributed equally to this work.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.

© 2017 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.