title: Head-to-head comparison of basal stenosis resistance index, instantaneous wave-free ratio, and fractional flow reserve: diagnostic accuracy for stenosis-specific myocardial ischaemia.
abstract: OBJECTIVE
  We sought to compare the diagnostic accuracy of basal stenosis resistance index (BSR), instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) for stenosis-specific myocardial ischaemia identified by means of a combined reference standard of myocardial perfusion scintigraphy and the hyperaemic stenosis resistance index.
  
  
  RESULTS
  BSR and FFR were determined for 299 coronary stenoses, iFR was determined for 85 coronary stenoses (iFR cohort). The discriminative value for stenosis-specific myocardial ischaemia was compared by means of the area under the receiver operating characteristic (ROC) curves (AUC). Classification agreement with the reference standard was determined according to ROC curve-derived ischaemic cut-off values, as well as according to clinical cut-off values, equivalent to the 0.80 FFR cut-off. Across all stenoses, the discriminative value of BSR and FFR was equivalent (AUC: 0.90 and 0.91, respectively, p=0.46). In the iFR cohort, the discriminative value was equivalent for BSR, iFR, and FFR (AUC: 0.88, 0.84, and 0.88, respectively; p≥0.20 for all). At both ischaemic as well as clinical cut-off values, classification agreement with the reference standard was equivalent for BSR and FFR across all stenoses, as well as for BSR, iFR, and FFR in the iFR cohort.
  
  
  CONCLUSIONS
  BSR, iFR, and FFR have equivalent diagnostic accuracy for the detection of ischaemia-generating coronary stenoses.
authors.affiliation: AMC Heart Center, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Tim P
authors.initials: TP
authors.lastname: van de Hoef
authors.forename: Martijn
authors.initials: M
authors.lastname: Meuwissen
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Sayan
authors.initials: S
authors.lastname: Sen
authors.forename: Ricardo
authors.initials: R
authors.lastname: Petraco
authors.forename: Martijn A
authors.initials: MA
authors.lastname: van Lavieren
authors.forename: Mauro
authors.initials: M
authors.lastname: Echavarria-Pinto
authors.forename: Froukje
authors.initials: F
authors.lastname: Nolte
authors.forename: Sukhjinder
authors.initials: S
authors.lastname: Nijjer
authors.forename: Steven A J
authors.initials: SA
authors.lastname: Chamuleau
authors.forename: Michiel
authors.initials: M
authors.lastname: Voskuil
authors.forename: Berthe L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
authors.forename: José P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: Jos A E
authors.initials: JA
authors.lastname: Spaan
authors.forename: Maria
authors.initials: M
authors.lastname: Siebes
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Justin E
authors.initials: JE
authors.lastname: Davies
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
mesh_terms: D000241:Adenosine / Q000008:administration & dosage; D000368:Aged; D019540:Area Under Curve; D006328:Cardiac Catheterization; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016002:Discriminant Analysis; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014655:Vascular Resistance; D014665:Vasodilator Agents / Q000008:administration & dosage
chemical_list: D014665:Vasodilator Agents; D000241:Adenosine