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

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Authors	KOVARNIK Tomas HITOSHI Matsuo KRAL Ales JERABEK Stepan ZEMANEK David KAWASE Yoshiaki OMORI Hiroyuki TANIGAKI Toru PUDIL Jan VODZINSKA Alexandra BRANNY Marian ŠTÍPAL Roman KALA Petr MROZEK Jan PORZER Martin GREZL Tomas NOVOBILSKY Kamil MENDIZ Oscar KOPRIVA Karel MATES Martin CHVAL Martin CHEN Zhi MARTASEK Pavel LINHART Ales
Year of publication	2022
Type	Article in Periodical
Magazine / Source	Journal of the American Heart Association
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.ahajournals.org/doi/10.1161/JAHA.121.021490
Doi	http://dx.doi.org/10.1161/JAHA.121.021490
Keywords	coronary flow reserve; fractional flow reserve; instantaneous wave-free ratio
Description	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.
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