iFR is now recommended by the European Society of Cardiology (ESC)guidelines 8
iFR/FFR to identify hemodynamically relevant coronary lesion(s) in stable patients when evidence of ischemia is not available
FFR-guided PCI in patients with multivessel disease.
Single intermediate lesions
Serial or Tandem lesions
Multi-Vessel disease (MVD)
"The Inclusion of iFR in the guidelines is extremely important as it will increase awareness and help adoption of physiology"
Prof. Giuseppe Tarantini
Department of Cardiac, Thoracic and Vascular Sciences, University of Pudua
The power of choice
Philips provides you with the opportunity to use iFR which is the only clinically validated resting index (recommended by AHA and SCAI) along with FFR. In 2017 Davies et al. and Götberg et al. validated the non-inferiority of iFR compared to FFR .
A physiology index to determine the functional significance of coronary stenosis. FFR is the ratio of the distal pressure compared to the proximal pressure during maximal blood flow (hyperemia), which can be induced by injecting products such as adenosine or papaverine.
iFR provides a hyperemia-free measurement in as few as five heartbeats. Pressure and flow correlate when resistance is consistant P = Q * R. iFR is measured during the wave-free period when resistance is naturally constant.
Curzen N, et al. Does routine pressure wire assessment influence management strategy at coronary angiography for diagnosis of chest pain?: the RIPCORD study. Circ Cardiovasc Interv. 2014. Apr;7(2):248-55. doi:10.1161/ CIRCINTERVENTIONS.113.000978.
Zir LM et al. Interobserver variability in coronary angiography. Circulation. 1976;53:627–632.
Leape L et al. Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularisation procedures. Am Heart J. 2000;139:106–113.
Cameron A et al. Left main coronary artery stenosis: angiographic determination. Circulation. 1983;68:484–489.
Van Belle E, et al. Outcome impact of coronary revascularization strategy reclassification with fractional flow reserve at time of diagnostic angiography: insights from a large French multicenter fractional flow reserve registry. Circulation. 2014;129(2):173–185. doi:10.1161/ CIRCULATIONAHA.113.006646.
Baptista S.B, et al. the POST-IT (POrtuguese Study on The Evaluation of FFR-guided Treatment of coronary disease) prospective multicentre registry. Abstract presented at late-breaking clinical trial session at EuroPCR 2014.
De Bruyne B, Sarma J, Heart. 2008;94(7):949-59.
Neumann, F.-J. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal (2018).
Davies JE, et al., DEFINE-FLAIR: A Multi- Centre, Prospective, International, Randomized, Blinded Comparison of Clinical Outcomes and Cost Efficiencies of iFR and FFR Decision-Making for Physiological Guided Coronary Revascularization. New England Journal of Medicine, epub March 18, 2017
Gotberg M, et al., Instantaneous Wave-Free Ratio Versus Fractional Flow Reserve Guided Intervention (IFR-SWEDEHEART): A Multicenter, Prospective, Registry-Based Randomized Clinical Trial. New England Journal of Medicine, epub March 18, 2017
Patel M. “Cost-effectiveness of instantaneous wave-Free Ratio (iFR) compared with Fractional Flow Reserve (FFR) to guide coronary revascularization decision-making.” Late-breaking Clinical Trial presentation at ACC on March 10, 2018.
An iFR cut-point of 0.89 matches best with an FFR ischemic cut-point of 0.80 with a specificity of 87.8% and sensitivity of 73.0%. (From ADVISE II, and iFR Operator’s Manual 505-0101.23
By clicking on the link, you will be leaving the official Royal Philips Healthcare ("Philips") website. Any links to third-party websites that may appear on this site are provided only for your convenience and in no way represent any affiliation or endorsement of the information provided on those linked websites. Philips makes no representations or warranties of any kind with regard to any third-party websites or the information contained therein.