Fractional Flow Reserve Versus Instantaneous Wave‐Free Ratio in Assessment of Lesion Hemodynamic Significance and Explanation of their Discrepancies. International, Multicenter and Prospective Trial: The FiGARO Study
Authors: Kovarnik Tomas , Hitoshi Matsuo , Kral Ales , Jerabek Stepan , Zemanek David , Kawase Yoshiaki , Omori Hiroyuki , Tanigaki Toru , Pudil Jan , Vodzinska Alexandra , Branny Marian , Stipal Roman , Kala Petr , Mrozek Jan , Porzer Martin , Grezl Tomas , Novobilsky Kamil , Mendiz Oscar , Kopriva Karel , Mates Martin , Chval Martin , Chen Zhi , Martasek Pavel , Linhart Ales , Kovarnik Tomas , Kral Ales , Jerabek Stepan , Zemanek David , Pudil Jan , Humhal Jiri , Gorican Karel , Padour Michael , Šimek Stanislav , Belohlavek Jan , Rob Daniel , Hronova Michaela , Kral Ales , Hitoshi Matsuo , Kawase Yoshiaki , Omori Hiroyuki , Tanigaki Toru , Vodzinska Alexandra , Cerny Jindrich , Indrak Jan , Hudec Miroslav , Branny Marian , Mrozek Jan , Porzer Martin , Grezl Tomas , Stipal Roman , Kala Petr , Kanovsky Jan , Bocek Otakar , Poloczek Martin , Jerabek Petr , Novobilsky Kamil , Kolomaznik Tomas , Mendiz Oscar , Kopriva Karel , Mates Martin , Holy Frantisek , Chval Martin , Chen Zhi , Martasek Pavel , Kralik Lubomir 
Published: May 2022

Background
The FiGARO (FFR versus iFR in Assessment of Hemodynamic Lesion Significance, and an Explanation of Their Discrepancies) trial is a prospective registry searching for predictors of fractional flow reserve/instantaneous wave‐free ratio (FFR/iFR) discrepancy.

Methods and Results

FFR/iFR were analyzed using a Verrata wire, and coronary flow reserve was analyzed using a Combomap machine (both Philips‐Volcano). The risk polymorphisms for endothelial nitric oxide synthase and for heme oxygenase‐1 were analyzed. In total, 1884 FFR/iFR measurements from 1564 patients were included. The FFR/iFR discrepancy occurred in 393 measurements (20.9%): FFRp (positive)/iFRn (negative) type (264 lesions, 14.0%) and FFRn/iFRp (129 lesions, 6.8%) type. Coronary flow reserve was measured in 343 lesions, correlating better with iFR (R=0.56,
P
<0.0001) than FFR (R=0.36,
P
<0.0001). The coronary flow reserve value in FFRp/iFRn lesions (2.24±0.7) was significantly higher compared with both FFRp/iFRp (1.39±0.36), and FFRn/iFRn lesions (1.8±0.64,
P
<0.0001). Multivariable logistic regression analysis confirmed (1) sex, age, and lesion location in the right coronary artery as predictors for FFRp/iFRn discrepancy; and (2) hemoglobin level, smoking, and renal insufficiency as predictors for FFRn/iFRp discrepancy. The FFRn/iFRp type of discrepancy was significantly more frequent in patients with both risk types of polymorphisms (endothelial nitric oxide synthase
r
+heme oxygenase‐1
r
): 8 patients (24.2%) compared with FFRp/iFRn type of discrepancy: 2 patients (5.9%),
P
=0.03.

Conclusions
Predictors for FFRp/iFRn discrepancy were sex, age, and location in the right coronary artery. Predictors for FFRn/iFRp were hemoglobin level, smoking, and renal insufficiency. The risk type of polymorphism in endothelial nitric oxide synthase and heme oxygenase‐1 genes was more frequently found in patients with FFRn/iFRp type of discrepancy.

Registration

URL:
https://clinicaltrials.gov
; Unique identifier: NCT03033810.