FUNCTIONAL MEASUREMENT: The iFR® Modality

 

Introduction to the iFR® Modality

instant wave-free Ratio

Overview



Wave Free Period1

The iFR® Modality
  • Volcano’s proprietary instantaneous, trans-lesional pressure ratio measured during the wave-free period.
  • Assesses lesion significance in about five heartbeats without the need for hyperemic agents.
instant wave-Free Ratio:
  • The Instantaneous pressure ratio, across a stenosis during the wave-free period, when resistance is naturally constant and minimized in the cardiac cycle.


 

Physiology Fundamentals


Change in Pressure = Change in Flow x Constant Resistance

△P = △Q x R

Fundamental Equation for relating Pressure and Flow Derived from Poiseuille’s Law for Fluid Dynamics

When Resistance is constant, changes in Pressure are proportional to changes in Flow
  • The FFR modality uses hyperemic agents to achieve a state of constant resistance.
  • The iFR modality uses a period of the cardiac cycle when resistance is naturally constant.


 

Wave Free Period



Pressure, Resistance, and Intensity During the Wave Free Period2

Benefits of the Wave Free Period
  • Noise from compression and suction waves is minimized.
  • Resistance is constant so △P is proportional to △Q (flow).
  • Velocity is higher so better power to discriminate.


 

Case Example



iFR® Modality with Verrata Pressure Guide Wire in Multi-Vessel Disease

Case example from Imperial College, London - February 2014

Downloads

iFR Scout Overview The iFR® Modality Fundamentals Hybrid iFR® / FFR Approach and Cut Points ADVISE II Data Sheet



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1. Escaned J. ADVISE II: A Prospective, Registry Evaluation of iFR vs. FFR. TCT 2013. Lecture conducted from San Francisco, CA.
2. Sen S, et al. Development and validation of a new adenosine-independent index of stenosis severity from coronary wave-intensity analysis: results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) study. J Am Coll Cardiol. 2012 Apr 10;59(15):1392-402.

Simplifying Workflow


The iFR® modality provides a hyperemia-free measurement in as few as five heartbeats



Same Wire, Same System, Fewer Steps


65.1% of patients may be spared from hyperemic agents using a Hybrid iFR® / FFR Approach1


Considerations with Hyperemic Agents:
  • Is the drug stored in the lab or pharmacy?
  • How long does it take to prepare the drug?
  • How much does the drug cost?
  • Do patients experience side effects?
  • Is maximal hyperemia achieved?


 

Downloads

iFR Scout Overview The iFR® Modality Fundamentals Hybrid iFR® / FFR Approach and Cut Points ADVISE II Data Sheet



Need More Information?


Fill out this form and we will get right back to you.
1. The ADVISE II study illustrated a 5.8%, i.e. (17+23)/690, classification discordance between the iFR Hybrid Approach and FFR. Among 477 lesions that would be assessed without hyperemia by the iFR Hybrid Approach, 40 (17+23) were due to classification discordance (iFR Operator’s Manual 505-0101.23).

Providing Choice


One wire, One system, Multi-modality


One wire, One system, Multi-modality
  • Compatible with Volcano pressure guide wires.
  • iFR and FFR modalities are on adjacent tabs in an upgraded Volcano console.
  • Switch back and forth between modalities easily, and effortlessly.
  • Only available from Volcano.


 

An iFR of 0.89 is equivalent to an FFR of 0.801



Fractional Flow Reserve
  • Clinically proven for ischemia detection2.
  • Supported by guidelines worldwide.

The iFR® Modality
  • Volcano’s proprietary instantaneous, trans-lesional pressure ratio measured during the wave-free period.
  • Prospectively tested in the ADVISE II Study.
  • An iFR of 0.89 is equivalent to an FFR of 0.801.


 

The Hybrid iFR® / FFR Approach



Hybrid iFR® / FFR Approach

The Hybrid iFR® / FFR Method in the ADVISE II Study
  • 94.0% match between iFR and FFR using a hybrid approach.3
  • 65.1% of patients may be spared hyperemic agents.4
The Hybrid iFR® / FFR Approach
  • iFR values less than 0.86 are positive.
  • iFR values greater than 0.93 are negative.
  • For iFR values between 0.86 and 0.93, switch to the FFR tab and administer hyperemic agent.


 

Downloads

iFR Scout Overview The iFR® Modality Fundamentals Hybrid iFR® / FFR Approach and Cut Points ADVISE II Data Sheet



Need More Information?


Fill out this form and we will get right back to you.
1. 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%. (iFR Operator’s Manual 505-0101.23)
2. Tonino et al. Fractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention. New England Journal of Medicine. 2009; 360, Number 3:213-224.
3. Using the iFR cut points of 0.85 and 0.94 matches best with an FFR ischemic cut-point of 0.80 with a specificity of 90.7% and sensitivity of 96.2%. (iFR Operator’s Manual 505-0101.23)
4. The ADVISE II study illustrated a 5.8%, i.e. (17+23)/690, classification discordance between the iFR Hybrid Approach and FFR. Among 477 lesions that would be assessed without hyperemia by the iFR Hybrid Approach, 40 (17+23) were due to classification discordance.

Building Evidence




Final Manuscript published. Click the logo above to learn more.



Over 4000 patients have been studied with iFR


Numerous prospective iFR studies have been published in peer-reviewed journals


ADVISE HYBRID USEFULNESS VERIFY ADVISE REGISTRY PRE- AND POST- PCI FFR and iFR PET COMPARISON ADVISE in PRACTICE FORECAST AMSTERDAM NON-INVASIVE CLARIFY FLOW VELOCITY SEOUL REGISTRY RESOLVE JUSTIFY CFR ADVISE II

Click on the colored bars to view iFR clinical studies


Downloads

iFR Scout Overview The iFR® Modality Fundamentals Hybrid iFR® / FFR Approach and Cut Points ADVISE II Data Sheet



Need More Information?


Fill out this form and we will get right back to you.

Introduction to the iFR Scout Pullback Technology


iFR Scout pullback technology reveals the physiologic profile of the entire vessel, so when you encounter diffuse disease or serial lesions you can make informed treatment decisions.


This angio shows both focal and diffuse disease.
Which areas are the most physiologically significant?


The iFR Scout pullback shows the most significant gradient is in the mid-vessel lesion with diffuse proximal disease.



 

Make the Shift from Justification to Guidance


Physiology is more than a justification tool. Hyperemia-free iFR Scout pullback technology makes it easier to assess physiology before, during and after your procedure.

iFR Scout Pullback Pre-Intervention


The physician chose to treat the distal two focal lesions with two Drug Eluting Stents.

iFR Scout Pullback Post-Intervention


The iFR Scout pullback demonstrates a Functional Gain from 0.85 to 0.92.



 

iFR Scout Pullback Technology vs FFR Pullback


Benefits of iFR Scout Pullback Technology

  • No hyperemic agent required
  • Simple graphical display of iFR values through the vessel
  • Maps the ischemic contribution of each lesion without the confounding effects observed with FFR pullback1
  • Easily bookmark areas of interest

Limitations of FFR Pullback

  • Requires IV hyperemia
  • Can be difficult to interpret
  • There is an interdependency of pressure gradients in serial lesions1
  • Requires a second FFR pullback after treating the first lesion to assess the “updated” severities of the remaining lesions



 


How to Perform an iFR Scout Pullback




Key New Features


  1. iFR Scout Pullback Assessment reveals the physiologic profile of the entire vessel
  2. Live iFR® and Pd/Pa measurements provide real-time physiologic assessment
  3. Highlighted wave-free period shows where the iFR measurement is being calculated





Downloads

iFR Scout Overview The iFR® Modality Fundamentals Hybrid iFR® / FFR Approach and Cut Points ADVISE II Data Sheet



Need More Information?


Fill out this form and we will get right back to you.
1. Nijjer S, et al. “Pre-Angioplasty Instantaneous Wave-Free Ratio (iFR) Pullback Provides Virtual Intervention and Predicts Hemodynamic Outcome for Serial Lesions and Diffuse Coronary Artery Disease. JACC: Cardiovascular Interventions 2014; 12: 1386-1396.

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