{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T15:37:55Z","timestamp":1761061075762,"version":"3.41.2"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,7,7]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Although ischemic heart disease has a complex and multilevel origin, the diagnostic approach is mainly focused on focal obstructive disease as assessed by pressure\u2010derived indexes. The prognostic relevance of coronary flow over coronary pressure has been suggested and implies that identification of relevant perfusion abnormalities by invasive physiology techniques is critical for the correct identification of patients who benefit from coronary revascularization. The purpose of this study was to evaluate the diagnostic potential of a sequential approach using pressure\u2010derived indexes instantaneous wave\u2010free ratio (\n              <jats:styled-content style=\"fixed-case\">iFR<\/jats:styled-content>\n              ), fractional flow reserve (\n              <jats:styled-content style=\"fixed-case\">FFR<\/jats:styled-content>\n              ), and coronary flow reserve (\n              <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>\n              ) measurements to determine the number of intermediate lesions associated with flow abnormalities after initial pressure measurements.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A total of 366 intermediate lesions were assessed with simultaneous intracoronary pressure and flow velocity measurements. Contemporary clinical\n              <jats:styled-content style=\"fixed-case\">iFR<\/jats:styled-content>\n              ,\n              <jats:styled-content style=\"fixed-case\">FFR,<\/jats:styled-content>\n              and\n              <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>\n              cut points for myocardial ischemia were applied. A total of 118 (32%) lesions were\n              <jats:styled-content style=\"fixed-case\">FFR<\/jats:styled-content>\n              + and 136 (37%) lesions were\n              <jats:styled-content style=\"fixed-case\">iFR<\/jats:styled-content>\n              +. Subsequent\n              <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>\n              assessment resulted for\n              <jats:styled-content style=\"fixed-case\">FFR<\/jats:styled-content>\n              in a total of 91 (25%)\n              <jats:styled-content style=\"fixed-case\">FFR<\/jats:styled-content>\n              +\/\n              <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>\n              + and for\n              <jats:styled-content style=\"fixed-case\">iFR<\/jats:styled-content>\n              a total of 111 (30%)\n              <jats:styled-content style=\"fixed-case\">iFR<\/jats:styled-content>\n              +\/\n              <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>\n              + lesions. An\n              <jats:styled-content style=\"fixed-case\">iFR<\/jats:styled-content>\n              ,\n              <jats:styled-content style=\"fixed-case\">FFR<\/jats:styled-content>\n              , and invasive flow velocity assessment approach would have yielded 20% of lesions (74 of 366) as ischemic.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Ultimately, 20% of intermediate lesions are associated with flow abnormalities after applying a pressure and flow velocity sequential approach. If\n              <jats:styled-content style=\"fixed-case\">iFR<\/jats:styled-content>\n              is borderline,\n              <jats:styled-content style=\"fixed-case\">FFR<\/jats:styled-content>\n              has limited additional value, in contrast with\n              <jats:styled-content style=\"fixed-case\">CFR<\/jats:styled-content>\n              . These results emphasize the use of coronary physiology in assessing stenosis severity but may also further question the contemporary reputation of a pressure\u2010based approach as a gold standard for the detection of myocardial ischemia in ischemic heart disease.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015559","type":"journal-article","created":{"date-parts":[[2020,6,23]],"date-time":"2020-06-23T09:14:01Z","timestamp":1592903641000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Objective Identification of Intermediate Lesions Inducing Myocardial Ischemia Using Sequential Intracoronary Pressure and Flow Measurements"],"prefix":"10.1161","volume":"9","author":[{"given":"Val\u00e9rie E.","family":"Stegehuis","sequence":"first","affiliation":[{"name":"Department of Interventional Cardiology Amsterdam Cardiovascular Sciences Heart Center Amsterdam UMC\u2013location AMC University of Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilbert W. M.","family":"Wijntjens","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Amsterdam Cardiovascular Sciences Heart Center Amsterdam UMC\u2013location AMC University of Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sukhjinder S.","family":"Nijjer","sequence":"additional","affiliation":[{"name":"Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guus A.","family":"de Waard","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Amsterdam Cardiovascular Sciences Heart Center Amsterdam UMC\u2013location VUmc University of Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim P.","family":"van de Hoef","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Amsterdam Cardiovascular Sciences Heart Center Amsterdam UMC\u2013location AMC University of Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sayan","family":"Sen","sequence":"additional","affiliation":[{"name":"Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Petraco","sequence":"additional","affiliation":[{"name":"Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Echavarr\u00eda\u2010Pinto","sequence":"additional","affiliation":[{"name":"ISSSTE General Hospital and Autonomous University of Quer\u00e9taro Quer\u00e9taro M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martijn","family":"Meuwissen","sequence":"additional","affiliation":[{"name":"Amphia Hospital Breda The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Danad","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Amsterdam Cardiovascular Sciences Heart Center Amsterdam UMC\u2013location VUmc University of Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Knaapen","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Amsterdam Cardiovascular Sciences Heart Center Amsterdam UMC\u2013location VUmc University of Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Escaned","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute Hospital Universitario Clinico San Carlos Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin E.","family":"Davies","sequence":"additional","affiliation":[{"name":"Imperial College London London United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels","family":"van Royen","sequence":"additional","affiliation":[{"name":"Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8666-7129","authenticated-orcid":false,"given":"Jan J.","family":"Piek","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Amsterdam Cardiovascular Sciences Heart Center Amsterdam UMC\u2013location AMC University of Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00057-4"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1408758"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.2.184"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2014.06.022"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.113.001049"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.01.034"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2015.09.002"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1700445"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1616540"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv626"},{"key":"e_1_3_1_12_2","first-page":"e166","article-title":"ACC\/AHA\/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (ACC\/AHA\/SCAI writing committee to update 2001 guidelines for percutaneous coronary intervention)","volume":"113","author":"Smith SC","year":"2006","unstructured":"Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB III, Morrison DA, O'Neil WW, Schaff HV, Whitlow PL, et\u00a0al. 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