30
CARDIOVASCULAR
hamburger
 

Why Physiology | Abbott’s Portfolio | Drift | Pressure Ratios Landscape | Clinical Outcomes

Treat the Ischemia, not the Stenosis

Angiography is often used for diagnosing coronary artery disease, but is unable to accurately capture the plaque morphology and eccentricity of an epicardial stenosis. As a result, angiography fails to look beyond the stenosis to objectively understand the extent of ischemia.1

Physiological measurements, also known as hyperemic (FFR) and non-hyperemic pressure ratios (NHPR), are used to evaluate the functional significance of coronary stenosis. Routine adoption of physiology in clinical practice allows the physician to make the right decision for the right patient, at the right time.

 

Watch physician experts discuss the important factors to look for when measuring coronary physiology and explain why technique and the right tools matter.

What are the key trends and takeaways in coronary physiology adoption?
Do we need a clinical outcomes trial for resting indices?
The importance of technique and how it impacts coronary measurements

 

Physiology-Guided Decision Making Leads to Better Outcomes2,3

The benefits of using coronary physiology include:

  • Coronary angiography is not accurate in 34% of cases compared to FFR4
  • FFR-guided PCI reduces MI compared to medical therapy alone5
  • All NHPR, including RFR, have similar outcomes and diagnostic performances3

Abbott’s Coronary Physiology Portfolio

Abbott’s PressureWire™ X Guidewire can measure Resting Full-Cycle Ratio (RFR) and Fractional Flow Reserve (FFR).


 

RFR - RESTING FULL-CYCLE RATIO

RFR scans through diastole and systole for the largest drop in pressure in the entire cardiac cycle.
RFR has been studied in over 3,500 lesions and 2,500 patients3,6-9 and RFR has shown diagnostic equivalence to iFR.10

 


 

FFR - Fractional Flow Reserve

FFR is a ratio of the (Pd) distal to the lesion coronary pressure divided by (Pa) aortic pressure proximal to the stenosis during maximal hyperemia.
FFR measured by the PressureWire™ X Guidewire is a risk stratification tool that helps guide revascularization, as seen in the FAME and FAME 2 trials.11

Screenshot of Quantien software interface


 

MULTIPLE CONNECTION OPTIONS OFFER STRESS FREE CONNECTIVITY

PressureWire™ X Guidewire is the only wire with 4 connection options to eliminate clutter and meet your labs needs.

PressureWire X connection options


 

PRESSUREWIRE™ X GUIDEWIRE

PressureWire™ X Guidewire offers objective decisions with a simplified workflow. The new innovative sensor housing design of PressureWire™ X Guidewire has technology to improve12 measurement accuracy.


 

84% reduced drift with the PressureWire™ X Guidewire with innovative sensor housing design12

Previous Sensor Housing Design

NEW Sensor Housing Design


 

RFR is recognized by the Appropriate Use Criteria with an approved coding recommendation by ACC/SCAI.

Objective Decision Making: Drift Matters

Drift is a phenomenon that affects the accuracy of most pressure measurement devices.13 Accuracy is particularly critical for resting ratios, as clinical decisions from resting ratios are more impacted by drift than FFR.14,15

the effect of drift on stenosis misclassification by physiology index
The distribution of values for FFR, IFR and whole-cycle PD/PA

Compared to the hyperemic state, smaller separation between Pd and Pa at rest means even relatively small amounts of drift can lead to stenosis misclassification compared to FFR. That’s why it critical to detect even the slightest difference of pressure.

Physiological Pressure Ratios Landscape

Physiological pressure ratios landscape

There are several hyperemic and NHPR available to an interventional cardiologist today.

FFR = fractional flow reserve
iFR = instantaneous wave-free ratio (Philips)
RFR = resting full-cycle ratio (Abbott)

Equivalence And Differences In Resting Indices

IRIS-FFR is a large retrospective study (n = 1,506 patients, 1,833 lesions) evaluating outcomes of resting ratios; its median follow-up was 1.1 years. The analysis examined deferred lesion failure (DLF) among 5 resting indices—resting Pd/Pa, iFR, RFR™, dPR and DFR- and concluded that all resting indices had similar outcomes in deferred lesions.14

These results suggest a “class effect” among non-hyperemic pressure ratios. Guidelines and clinical recommendations can therefore be applied in the same manner.14

 

How equivalent are resting (non-hyperemic) indices?

 

  Pd/Pa Full
Cycle Average
Diastolic
Pressure Ratios
RFR
Full Cycle
Accuracy vs. FFR1 85% 83% 84%
Cutoff2 ≤0.91 ≤0.89 ≤0.89
Hyperemia Needed1 No No No
Clinical Decision Making1 Equivalent
Outcomes1 Equivalent
Pullback Sensitivity3 Medium High High

1. Ahn, JM., et al. IRIS-FFR: prognostic performance of five resting pressure-derived indexes of coronary physiology. TCT2018.
2. Kobayashi Y, et al. Agreement of the resting distal to aortic coronary pressure with the instantaneous wave-free ratio. JACC Intv. 2017; 70(17): 2105-13.
3. Nijer, S., et al. The Instantaneous wave-Free Ratio (iFR) pullback: a novel innovation using baseline physiology to optomise coronary angioplasty in tandem lesions. Cardiovascular Revascularization Medicine, 2015.

 

When to use FFR vs non-hyperemic index?

 

  Non-Hyperemic FFR
Multi-vessel Disease1 +++ +++
LMCA2 - +++
LAD3 +++ ++
Tandem Lesions4 +++ +
Diffuse Disease5 +++ +
ACS6 +++ ++
DM7 +++ +++
Systolic Dysfunction8 - +++
Post-PCI SB Interrogation9 - +++
Post-PCI Assessment10 - +++

1. Eur Heart J. 2017 Nov 7;38(42):3124-3134. 2. Catheter Cardiovasc Interv. 2015 Jul;86(1):12-8. 3. JACC 2019 Feb 5;73(4):444-453. 4. JACC Int 2014 Dec;7(12):1386-96. 5. Define PCI ACC 2019. 6. JACC Int 2018 Aug 13;11(15):1437-1449. 7. JAMA Cardiol 2019 Jul 17. 8. Eur Heart J. 2019 Aug 16. 9. JACC 2005 Aug16;46(4):633-7. 10. JACC 2014 Oct 21;64(16):1641-54.

Chart courtesy of Ziad Ali, MD.

 

 

ABBOTT'S LEGACY OF LEADERSHIP IN CORONARY PHYSIOLOGY

As a leader in PCI, Abbott also has a rich legacy of supporting research, developing products and advancing technology related to coronary physiology. Abbott’s accomplishments offer interventional cardiologists key data as well as cutting-edge technology.

Abbott's legacy of leadership in coronary physiology

 

 

References

  1. Topol EJ and Nissen SE. Our Preoccupation With Coronary Luminology, CIR. 1995; 92(8): 2333-2342.
  2. Pijls, N., et al JACC Vol. 56, No. 3, 2010
  3. Ahn JM, et al. IRIS FFR: prognostic performance of five resting pressure-derived indexes of coronary physiology. TCT 2018.
  4. Corcoran et al. Fractional Flow Reserve. Int J Cardiovasc Imaging. 2017; 33(7): 961-974.
  5. De Bruyne, B. et al. FFR Guided PCI versus Medical Therapy in Stable Coronary Disease, NEJM. 2012; 367 (11): 991-1001.
  6. Jeremias A, et al. Resting full-cycle ratio (RFR): a novel physiologic index compared to Fractional Flow Reserve (FFR) in assessing the hemodynamic severity of a coronary stenosis: ILUMIEN I + PREDICT. EuroPCR 2018.
  7. Svanerud J, et al. Validation of a novel non-hyperaemic index of coronary artery stenosis severity: the Resting Full-cycle Ratio (VALIDATE RFR) study. EuroIntervention. 2018;14:806-814.
  8. Kumar et al. Re-VALIDATE RFR. CRT 2019.
  9. Lee J-M, et al. Physiological and clinical assessment of resting physiological indexes. Circulation. 2019;139.
  10. Volcano Corp. Verrata‡ guidewire and PrimeWire Prestige‡ Plus guidewire IFUs, Opsens Inc. OptoWire‡ guidewire and OptoWire‡ II guidewire IFUS, ACIST Medical Systems. Navvus‡ Microcatheter IFU, Boston Scientific Corporation. Comet‡ guidewire IFU, PressureWire™ X guidewire IFU.
  11. Tonino PA, et al. Angiographics versus functional severity of coronary artery stenoses in the FAME study: Fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol 2010; 55:2816-21.
  12. Test(s) performed by and data on file at Abbott.
  13. Jeremias, A., et al. A Test in Context: FFR: Accuracy, Prognostic Implications, and Limitations. JACC 2017; 69:2748-58.
  14. Van’t Veer, M, et al. JACC. Comparison of Different Diastolic Resting Indexes to iFR. 70 (25), 2017.
  15. Cook, C. CCI. Quantification of the Effect of Pressure Wire Drift on the Diagnostic Performance of FFR, iFR, & Pd/Pa.
Request Abbott Sales Rep

MAT-2002011 v1.0

DO YOU WISH TO CONTINUE AND EXIT CARDIOVASCULAR.ABBOTT?

CONTENTS OF THE SITE ARE NOT UNDER THE CONTROL OF ABBOTT.

True
accessibility
© 2016 Abbott. All Rights Reserved. Please read the Legal Notice for further details.

Unless otherwise specified, all product and service names appearing in this Internet site are trademarks owned by or licensed to Abbott, its subsidiaries or affiliates. No use of any Abbott trademark, trade name, or trade dress in this site may be made without the prior written authorization of Abbott, except to identify the product or services of the company.

accessibility

DO YOU WISH TO CONTINUE AND EXIT CARDIOVASCULAR.ABBOTT?

CONTENTS OF THE SITE ARE NOT UNDER THE CONTROL OF ABBOTT.