Author + information
- Received June 2, 2017
- Revision received July 12, 2017
- Accepted July 25, 2017
- Published online September 4, 2017.
- Matthias Götberg, MD, PhDa,∗ (, )
- Christopher M. Cook, MDb,
- Sayan Sen, MD, PhDb,
- Sukhjinder Nijjer, MD, PhDb,
- Javier Escaned, MD, PhDc and
- Justin E. Davies, MD, PhDb
- aDepartment of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
- bHammersmith Hospital, Imperial College London, London, United Kingdom
- cHospital Clínico San Carlos, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Matthias Götberg, Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Getingevägen 4, 22185, Lund, Sweden.
In this review, the authors reflect upon the role of coronary physiology in the modern management of coronary artery disease. They critically appraise the scientific background of the instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR), from early experimental studies to validation studies against indexes of ischemia, to clinical trials assessing outcome. At this important juncture for the field, the authors make predictions for the future of physiological stenosis assessment, outlining developments for both iFR and FFR in new clinical domains beyond the confines of stable angina. With a focus on the evolving future of iFR and FFR, the authors describe how physiological assessment with iFR may advance its application from simply justifying to guiding revascularization.
- coronary artery bypass graft
- coronary physiology
- coronary stenosis
- myocardial revascularization
- percutaneous coronary intervention
Dr. Cook is supported by the Medical Research Council (grant number MR/M018369/1). Dr. Götberg has received an unrestricted research grant from Volcano Corporation; lecture fees from Philips Volcano and Boston Scientific; consulting fees from Boston Scientific; and fees for serving on an advisory board from Medtronic. Dr. Cook has received lecture fees from Philips Volcano. Dr. Sen has attended and conducted teaching sessions supported by Volcano Corporation, St. Jude Medical, Medtronic, Pfizer, and AstraZeneca; and has served on speakers bureaus for Philips and Pfizer. Dr. Nijjer has received lecture fees from Philips Volcano. Dr. Escaned has been a speaker at educational events and a consultant for Abbott, Philips Volcano, and Boston Scientific. Dr. Davies has received research grants from Philips Volcano and AstraZeneca; has received consulting fees from Medtronic, Philips Volcano, and ReCor Medical; and holds patents pertaining to the iFR technology, which is under license to Volcano Corporation. Drs. Götberg and Cook contributed equally to this work.
- Received June 2, 2017.
- Revision received July 12, 2017.
- Accepted July 25, 2017.
- 2017 The Authors
- Central Illustration
- Coronary Physiology in the Pre-FFR Era
- FFR: Introduction and Experimental Validation
- FFR: From the Animal to the Human Model
- FFR and Clinical Outcome Studies
- Fundamentals of iFR
- What Does iFR Actually Measure?
- Can Resting Whole-Cycle Pd/Pa Be Used as an Alternative to iFR?
- iFR Validation
- Early Integration of iFR into Clinical Practice: The Hybrid Strategy
- iFR and Patient Outcome Data
- The Future of Coronary Physiology: From Justification to Guidance
- Pilot Study of the iFR Pullback Study and Virtual PCI Technology
- iFR SCOUT: Fully-Integrated Virtual PCI Planning
- Further New Frontiers for Coronary Physiology