Physiology

    Guide PCI with coronary physiology

    Please filled in the information below and we will get in touch with you for the next step of the competition.

    Kontaktinformation

    * Detta fält är obligatoriskt
    *

    Kontaktuppgifter

    *
    *
    *

    Företagsinformation

    *
    *
    *
    *
    *

    Kommunikationsdetaljer

    Genom att specifiera anledningen till att du kontaktar oss, kan vi ge dig en bättre service
    *
    *

    Are you using physiology?

    Yes

    No

    iFR is now recommended by the European Society of Cardiology (ESC) guidelines 8

    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
    Single intermediate lesions
    Diffuse disease
    Bifurcation lesions
    Serial or Tandem lesions
    Multi-Vessel disease (MVD)
    Post-PCI assessment
    video
    Play video

       

    "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 .

    coronary pressure

    FFR = Distal Coronary Pressure (Pd)

    Promixal Coronary Pressure (Pa)

    (During maximal hyperemia)

    Distal Coronary Pressure

    iFR = Distal Coronary Pressure (Pd)

    Promixal Coronary Pressure (Pa)

    (During wave-free period)

    FFR

    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

    iFR

    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.

    Diagram treat and defer

    Spot the difference Quiz

    Spot the difference

    Spot the difference Quiz

    Which lesion is significant?

    LAD

    Spela

    Doctor figure

    LCX

    Spela

    LAD
    LCX

    Spot the difference Quiz

    What are the steps needed for a FFR pullback?
    option 1
    option 2
    option 3
    Option 1
    Option 2
    Option 3

    Spot the difference Quiz

    What are the steps needed for a iFR pullback?

    option 1
    option 2
    option 3
    Option 1
    Option 2
    Option 3

    Spot the difference Quiz

    What are the differences between iFR and FFR pullback?

    iFR

    ifr

    FFR

    ffr
    option 1, 2 and 3
    Option 1
    Option 2
    Option 3

    Spot the difference Quiz

    How much time saving do you have with iFR?
    1 minute
    5 minutes
    1 minute
    5 minutes

    Spot the difference Quiz

    How often do we find a mismatch for iFR/FFR?

    mismatch for ifr/ffr
    10%
    20%
    50%

    Spot the difference Quiz

    Make your own iFR / FFR case study!

    make your own ifr/ffr case study

    Make you own iFR/FFR case study!


    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.
     

    • Competition will run from 5 October, 2018 to 31 January, 2019
    • Philips clinical board will choose a winner and communicate before 22 February all participants of the outcomes
    • Admission to competition only for fellows

     

    Win a free EuroPCR visit*

    EuroPCR, 21-24 May 2019, Paris
     

    • 1st Prize – Registration & accommodation to EuroPCR 2019 and a chance to present your case in training village / forum
    • 2nd Prize – Registration to EuroPCR 2019

     

    *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.

    Visa flerVisa färre
    Submit your case

    Spot the difference Quiz

    Answer

    ifr 0.75
    Doctor figure with info
    ifr 1
    1. Neumann, F.-J. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal (2018).
    Go to next question

    Spot the difference Quiz

    Answer

    option 1
    • Prepare hyperemic agent (not possible under IC)
    • Prepare, insert and advance the wire
    • “NORMALIZE” (Pd/Pa should equal 1.00)
    • Place pressure sensor distal to lesion
    • Install infusion pump
    • Administer hyperemic agent
    • Wait for steady state hyperemic effect (normally 1-2min)
    • Press Pullback
    • Slowly pull wire proximal through vessel to the guide catheter
    • Press Stop
    • Review
    All the 11 steps are key for a successful FFR pullback
    Go to next question

    Spot the difference Quiz

    Answer

    Option 3
    • Prepare, insert and advance the wire
    • “NORMALIZE” (Pd/Pa should equal 1.00)
    • Place pressure sensor distal to lesion
    • Press Pullback
    • Slowly pull wire proximal through vessel to the guide catheter
    • Press Stop
    • Review
    iFR pullback has a simpler workflow with only 7 steps
    Go to next question

    Spot the difference Quiz

    Answer

    iFR pullback

    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

    Go to next question

    Spot the difference Quiz

    Answer

    Using iFR

       

    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.

    Go to next question

    Spot the difference Quiz

    Answer

    ifr
    accuracy ifr

    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.

    Make your own study

    Please filled in the information below and we will get in touch with you for the next step of the competition.

    Kontaktinformation

    * Detta fält är obligatoriskt
    *

    Kontaktuppgifter

    *
    *
    *

    Företagsinformation

    *
    *
    *
    *
    *

    Kommunikationsdetaljer

    Genom att specifiera anledningen till att du kontaktar oss, kan vi ge dig en bättre service
    *
    *
    **No matching rule found. Please select another answer

    Proven outcomes

     

    • Validated in more than 4,500 patients9,10
    • Consistent outcomes as with FFR
    • 0.89 cut-point backed by data9,10,12
    europcr 2018 web graphics char

    Superior value

     

    • 10% Cost saving per patient11
    • 10% reduction in procedure time
    • 90% reduction in patient discomfort9
  • 10% Cost saving per patient
  • 10% reduction in procedure time
  • 90% reduction in patient discomfort1
  • 10% Cost saving per patient
  • 10% reduction in procedure time
  • 90% reduction in patient discomfort1
  • europcr 2018 web graphics cluster

       

    Advantages of iFR

     

    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.

     

    ifr-thumb
    Play video

    Be sure with iFR guidance

    In-depth information for lesion specific ischemia
    ifr scout

    iFR Scout

     

    • Provides beat-by-beat pressure measurements across the entire vessel, artery by artery
    • Establishes the physiological significance of each vessel and/or individual lesion (focal or diffuse)
    • Provides a clear view of the functional gain from treating
    • Facilitates multiple assessments before, during and after the procedure (without the need for hyperemia)
    ifr co reg

    iFR Co-Registration

     

    • Visualization of pressure gradients to facilitate stent planning on SyncVision system
    • Provides mapping of physiology information into the anatomy image
    • Allows length measurement to be made on to the angiogram
    • Seamless integration into your PCI
    • Provides iFR estimated value post-stenting allowing for virtual stenting functionality
    iFR study

    Make your own iFR/FFR case study!

     

    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 describe the patient the FFR and iFR measurements and the explanation for the discordance.
     

    • Competition will run from 5 October, 2018 to 31 January, 2019
    • Philips clinical board will choose a winner and communicate before 22 February all participants of the outcomes
    • Admission to competition only for fellows

     

    Win a free EuroPCR visit*

    EuroPCR, 21-24 May 2019, Paris

    • 1st Prize – Registration & accommodation to EuroPCR 2019 and a chance to present your case in training village / forum
    • 2nd Prize – Registration to EuroPCR 2019

     

    *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.

    Terms and conditionsVisa färre

    References

    1. 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.
    2. Zir LM et al. Interobserver variability in coronary angiography. Circulation. 1976;53:627–632.
    3. 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.
    4. Cameron A et al. Left main coronary artery stenosis: angiographic determination. Circulation. 1983;68:484–489.
    5. 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.
    6. 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.
    7. De Bruyne B, Sarma J, Heart. 2008;94(7):949-59.
    8. Neumann, F.-J. et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European heart journal (2018).
    9. 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
    10. 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
    11. 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.  
    12. 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