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.

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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

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