Αναζήτηση όρων
Physiology
Αναζήτηση όρων
| Recommendations | Class | Level |
| iFR/FFR to identify hemodynamically relevant coronary lesion(s) in stable patients when evidence of ischemia is not available | I | A |
| FFR-guided PCI in patients with multivessel disease. | IIa | B |
"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
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 .
FFR = Distal Coronary Pressure (Pd)
(During maximal hyperemia)
iFR = Distal Coronary Pressure (Pd)
(During wave-free period)
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
Present a case with discordant iFR / FFR measurements and provide an explanation to the difference
Enrich your knowledge of coronary physiology and present a case study (10 slides or more) in which you present the patient and their symptoms, the FFR and iFR measurements and the explanation for the discordance.
Win a free EuroPCR visit*
EuroPCR, 21-24 May 2019, Paris
*TRIP: includes entry fees for full stay at EuroPCR, 4 nights of accommodation (excl. travel costs to Paris) and the chance to present your case on the Philips Booth
1. The promoter of this competition is Volcano Europe SPRL/BVBA (Philips).
2. Entry to the competition is open only to fellows of interventional cardiology excluding physicians who have ongoing contracts with Philips.
3. By entering the competition you agree to be bound by these terms and conditions. 4. To enter, send the case presentation of minimal 10 slides to the assigned email address.
5. Entries should be submitted by 12am on Friday 1 February 2019.
6. Only one entry per person is permitted.
7. Philips reserves the right to disqualify or reject any entry we believe to be in conflict with our competition or not made in good faith or on other reasonable grounds.
8. Cash alternatives are not offered in respect of any prizes.
9. Philips clinical board will choose a winner and the results are final.
10. Notification shall be sent to competition participants by email no later than February 22nd.
11. Prizes must be claimed within 4 weeks of the date of notification. All rights to prizes not claimed within this period shall be lost. Prize winners may need to verify their proper identity before claiming prizes. Prizes are personal and not transferrable. 12. Prize winners may be required to participate in publicity without additional compensation. The winner’s appearance at EuroPCR may be filmed and the material may be used by Philips for scientific and commercial purposes globally.
13. All submissions become Philips property and may be used by Philips for scientific and commercial purposes.
14. No correspondence, except for notification of prizes, shall be entered into.
15. Philips may cancel or amend the terms of this competition at any time by publishing notice of the relevant details.
16. Philips shall not be liable for any delay or failure to perform.
17. These terms and conditions will be interpreted in accordance with the laws of Belgium.
18. Philips will use your personal data provided to administer this competition and for the purposes stated herein.
In a diseased vessel with serial lesions, pressure drops under hyperemic conditions may be altered by local flow conditions and serial lesions interplay, underestimating gradient across individual stenosis.
Serial lesions interplay is less present at rest thanks to the stability of resting coronary flow across the wide range of lesion severities1&2.
iFR pullback can predict the hemodynamic consequences of stenting specific stenoses and thereby may facilitate the intervention and stenting strategy3&4.
1. Gould KL. Pressure-flow characteristics of coronary stenoses in unsedated dogs at rest andduring coronary vasodilation. Circ Res 1978;43: 242–53.
2. Uren NG, Melin JA, De Bruyne B, Wijns W, Baudhuin T, Camici PG. Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med 1994;330: 1782–8.
3. Nijjer SS, Sen S, Petraco R, et al. Pre-angioplasty instantaneous wave-free ratio pullback provides virtual intervention and predicts hemodynamic outcome for serial lesions and diffuse coronary artery disease. J Am Coll Cardiol Intv 2014;7:1386–96.
4. Kikuta et al, iFR GRADIENT Registry J Am Coll Cardiol Intv 2018;11:757–67
Using iFR shows a 5min reduction on procedure time
The use of iFR is associated with a shorter procedural time than the use of FFR in the DEFINE FLAIR study (40.5 minutes vs. 45.0 minutes, P = 0.001)1. The timesavings gained with iFR optimize cathlab resources.
Researchers found that an iFR-guided strategy offers an average cost savings of $896 per patient compared to an FFR-guided strategy, while delivering consistent patient outcomes2.
1. Davies JE, et al., Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI. N Engl J Med. 2017 May 11;376(19):1824-1834.
2. 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.
9. Van de Hoef TP et al. Circ Cardiovasc Interv. 2012;5:508-14;
10. Sen S et al. J Am Coll Cardiol. 2013;61:1409-20; 3. Van de Hoef TP et al. EuroIntervention. 2015;11:914-25;
11. Sen S et al. J Am Coll Cardiol. 2013;62:566;
12. Petraco R et al. Circ. Int. 2014;7:492-502;
13. de Waard G et al. J Am Coll Cardiol. 2014;63:A1692.
DEFINE FLAIR and iFR Swedeheart furthered physiology adoption with hyperemia-free measurements (iFR) and showed positive clinical outcomes, decreased patient discomfort and decreased procedural time.9,11 These results have spurred new interest in resting indices and looking ahead at what is next for physiology.
Sen
Sen
Present a case with discordant iFR / FFR measurements and provide an explanation
Enrich your knowledge of coronary physiology and present a case study (10 slides or more) in which you describe the patient the FFR and iFR measurements and the explanation for the discordance.
Win a free EuroPCR visit*
EuroPCR, 21-24 May 2019, Paris
*TRIP: includes entry fees for full stay at EuroPCR, 4 nights of accommodation (excl. travel costs to Paris) and the chance to present your case on the Philips Booth
1. The promoter of this competition is Volcano Europe SPRL/BVBA (Philips).
2. Entry to the competition is open only to fellows of interventional cardiology excluding physicians who have ongoing contracts with Philips.
3. By entering the competition you agree to be bound by these terms and conditions.
4. To enter, send the case presentation of minimal 10 slides to ve_veweb@philips.com.
5. By accepting this prize, you are agreeing to present the case during EuroPCR in publicity without additional compensation. The winner’s appearance at EuroPCR may be filmed and the material may be used by Philips for scientific and commercial purposes globally.
6. Entries should be submitted by 12 am on Friday 1 February 2019.
7. Only one entry per person is permitted.
8. Philips reserves the right to disqualify or reject any entry we believe to be in conflict with our
9. Cash alternatives are not offered in respect of any prizes.
10. Philipsclinical board will choose a winner and the results are final.
11.
12. Prizes must be claimed within 4 weeks of the date of notification. All rights to prizes not claimed within this period shall be lost. Prize winners may need to verify their proper identity before claiming prizes. Prizes are personal and not transferrable.
13. All submissions become Philips property and may be used by Philips for scientific and commercial purposes.
14. No correspondence, except for notification of prizes, shall be entered into.
15. Philips may cancel or amend the terms of this competition at any time by publishing notice of the relevant details.
16. Philips shall not be liable for any delay or failure to perform.
17. These terms and conditions will be interpreted in accordance with the laws of
Belgium.
18. Philips will use your personal data provided to administer this competition and for the purposes stated herein.
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