The impact of tissue Doppler index E/e' ratio on instantaneous wave-free ratio

J Cardiol. 2018 Mar;71(3):237-243. doi: 10.1016/j.jjcc.2017.09.003. Epub 2017 Oct 17.


Background: The instantaneous wave-free ratio (iFR) is a vasodilator-free, invasive pressure wire index of the functional severity of coronary stenosis and is calculated under resting conditions. In a recent study, iFR was found to be more closely linked to coronary flow reserve (CFR) than fractional flow reserve (FFR). E/e' is a surrogate marker of left ventricular (LV) filling pressure and LV diastolic dysfunction. Coronary resting flow was found to be increased in patients with elevated E/e', and higher coronary resting flow was associated with lower CFR. Higher baseline coronary flow induces a greater loss of translesional pressure and may affect iFR. However, no reports have examined the impact of E/e' on iFR. The purpose of this study was to assess the relationship between iFR and E/e' compared with FFR.

Methods and results: We retrospectively examined 103 consecutive patients (142 with stenosis) whose iFR, FFR, and E/e' were measured simultaneously. The mean age, LV mass index, and systolic blood pressure of patients with elevated E/e' were higher than those of patients with normal E/e'. Although no significant differences were observed in mean FFR values and % diameter stenosis, the mean iFR value in patients with elevated E/e' was significantly lower than that in patients with normal E/e'. The iFR was negatively correlated with E/e', while there was no correlation between FFR and E/e'. Multivariate analysis showed that E/e' and % diameter stenosis were independent determinants of iFR.

Conclusion: E/e' ratio affects iFR values. Our results suggest that FFR mainly reflects the functional severity of the epicardial stenosis whereas iFR could potentially be influenced by not only epicardial stenosis but also other factors related to LV filling pressure or LV diastolic dysfunction. Further research is needed to understand the underlying mechanisms that influence the evaluation of iFR in patients with elevated E/e'.

Keywords: E/e′; Fractional flow reserve; Instantaneous wave-free ratio.

MeSH terms

  • Aged
  • Blood Pressure
  • Coronary Angiography / statistics & numerical data*
  • Coronary Stenosis / physiopathology*
  • Echocardiography, Doppler / statistics & numerical data*
  • Female
  • Fractional Flow Reserve, Myocardial / physiology*
  • Humans
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Rest / physiology
  • Retrospective Studies
  • Severity of Illness Index
  • Ventricular Function, Left*