Diagnostic performance of instantaneous wave-free ratio for the evaluation of coronary stenosis severity confirmed by fractional flow reserve

Wanrong Man, Jianqiang Hu, Zhijing Zhao, Mingming Zhang, Tingting Wang, Jie Lin, Yu Duan, Ling Wang, Haichang Wang, Dongdong Sun, Yan Li
2016 Medicine  
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
more » ... iate to synthesize the available data of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LRÀ), 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+, LRÀ, 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. Conclusion: The available evidence suggests that iFR may be a new, simple, and promising technology for coronary stenosis physiological assessment. Abbreviations: AUC = area under the sROC curve, CABG = coronary artery bypass grafting, CAD = coronary artery disease, DOR = diagnostic odds ratio, DTA = diagnostic test accuracy, FFR = fractional flow reserve, FN = false negative, FP = false positive, iFR = instantaneous wave-free ratio, LRÀ = negative likelihood ratio, LR+ = positive likelihood ratio, PCI = percutaneous coronary intervention, sROC = summary receiver operating characteristic curve, TN = true negative, TP = true positive.
doi:10.1097/md.0000000000004774 pmid:27603377 pmcid:PMC5023900 fatcat:jyqabojqefcixhucyfciamm2fy