Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve: A PRISMA-compliant meta-analysis of randomized studies.
BACKGROUND
The instantaneous wave-free ratio (iFR) is a new vasodilator-free index of coronary stenosis severity. The aim of this meta-analysis is to assess the diagnostic performance of iFR for the evaluation of coronary stenosis severity with fractional flow reserve as standard reference.


METHODS
We searched PubMed, EMBASE, CENTRAL, ProQuest, Web of Science, and International Clinical Trials Registry Platform (ICTRP) for publications concerning the diagnostic value of iFR. We used a random-effects covariate to synthesize the available data of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). Overall test performance was summarized by the summary receiver operating characteristic curve (sROC) and the area under the curve (AUC).


RESULTS
Eight studies with 1611 subjects were included in the meta-analysis. The pooled sensitivity, specificity, LR+, LR-, and DOR for iFR were respectively 73.3% (70.1-76.2%), 86.4% (84.3-88.3%), 5.71 (4.43-7.37), 0.29 (0.22-0.38), and 20.54 (16.11-26.20). The area under the summary receiver operating characteristic curves for iFR was 0.8786. No publication bias was identified.


CONCLUSIONS
The available evidence suggests that iFR may be a new, simple, and promising technology for coronary stenosis physiological assessment.
Department of Cardiology, Xijing Hospital Department of Health Statistics, Faculty of Preventive Medicine Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China.
Wanrong
W
Man
Jianqiang
J
Hu
Zhijing
Z
Zhao
Mingming
M
Zhang
Tingting
T
Wang
Jie
J
Lin
Yu
Y
Duan
Ling
L
Wang
Haichang
H
Wang
Dongdong
D
Sun
Yan
Y
Li
D019540:Area Under Curve; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology*; D003971:Diastole; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index