Physiological Disease Pattern as Assessed by Pullback Pressure Gradient Index in Vessels With FFR/iFR Discordance (JACC Cardiovascular Interventions April 2025)-Article: Physiological Disease Pattern as Assessed by Pullback Pressure Gradient Index in Vessels With FFR/iFR Discordance

Article: Physiological Disease Pattern as Assessed by Pullback Pressure Gradient Index in Vessels With FFR/iFR Discordance

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The study investigated the discordance between fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) in coronary artery disease (CAD) by focusing on the physiological disease pattern, using the pull back pressure gradient index (PPGi). Conducted on 355 patients with 390 coronary vessels showing 40%-90% stenosis, the study aimed to evaluate CAD's physiological pattern in FFR and iFR discordance, classifying vessels into four groups based on FFR and iFR readings. The study found discordance in 16.7% of cases, with two main discordant groups: those with FFR-/iFR+ and FFR+/iFR-. <br /><br />The findings highlighted that the physiological pattern of CAD, as characterized by PPGi, significantly influences FFR/iFR discordance. FFR+/iFR- was associated mainly with focal disease, while FFR-/iFR+ correlated with diffuse disease. This suggests that the pattern of CAD (focal vs. diffuse) is a critical factor in the discordance between these two diagnostic indices. Focal diseases tend to have significant pressure drops over focal lesions, easily relieved by stenting, whereas diffuse patterns show steady pressure loss due to longitudinal frictional components. The study emphasizes that discordance does not generally correlate with poor clinical outcomes, though it significantly influences the decision-making process in diagnostic assessment and potential revascularization treatments.<br /><br />While PPGi provides a quantitative approach to assess CAD, the study also noted limitations such as the absence of intracoronary flow velocity data and intravascular imaging which could further enhance understanding of CAD patterns and their impact on FFR/iFR discordance. Ultimately, the study advocates for future research to explore how these discordant measurements can better predict clinical outcomes and inform therapeutic decisions in CAD management.

Keywords

fractional flow reserve

instantaneous wave-free ratio

coronary artery disease

pull back pressure gradient index

FFR/iFR discordance

focal disease

diffuse disease

stenosis

revascularization

clinical outcomes