Introducing the

iFR modality
(instant wave-Free Ratio)

Philips Volcano’s proprietary technology that is the only resting index with over 4000 patients studied.

Introduction to the iFR modality instant wave-Free Ratio

iFR modality overview

iFR modality wave-free ratio graph

The iFR modality

  • Philips Volcano’s proprietary instantaneous, trans-lesional pressure ratio measured during the wave-free period
  • Assesses lesion significance in about five heartbeats without the need for hyperemic agents

 

Instant wave-Free Ratio:

  • The instantaneous pressure ratio, across a stenosis during the wave-free period, when resistance is naturally constant and minimized in the cardiac cycle
Wave-free period1

Physiology fundamentals

ifr modality physiology fundamentals

When resistance is constant, changes in pressure are proportional to changes in flow

  • The FFR modality uses hyperemic agents to achieve a state of constant resistance.
  • The iFR modality uses a period of the cardiac cycle when resistance is naturally constant.

Wave-free period

iFR wave-free period graph

Benefits of the wave-free period

  • Noise from compression and suction waves is minimized.
  • Resistance is constant so △P is proportional to △Q (flow).
  • Velocity is higher so better power to discriminate.
Pressure, resistance, and intensity during the wave-free period2

Case example: iFR modality with Verrata Pressure Guide Wire in multi-vessel disease

iFR clinical case

Imperial College, London - February 2014

Simplifying workflow

The iFR modality provides a hyperemia-free measurement in as few as five heartbeats

iFR modality demo screen

Same wire, same system, fewer steps

iFR workflow

Hybrid iFR/FFR approach  

 

94.0% match to FFR3

65.1% of patients may be free of hyperemic agents4

iFR modality hybrid approach

The hybrid iFR / FFR method in the ADVISE II study

  • iFR values less than 0.86 are positive
  • iFR values greater than 0.93 are negative
  • For iFR values between 0.86 and 0.93, switch to the FFR tab and administer hyperemic agent

Providing choice

The Verrata Pressure Guide Wire

Verrata pressure guide wire

One wire, one system, multi-modality

 

  • Compatible with Philips Volcano consoles
  • iFR and FFR modalities are on adjacent tabs in an upgraded Philips Volcano console
  • Switch back and forth between modalities easily, and effortlessly
  • Only available from Philips Volcano

An iFR of 0.89 is equivalent to an FFR of 0.805

iFR modality FFR screen

Fractional flow reserve

 

  • Clinically proven for ischemia detection.6
  • Supported by guidelines worldwide.
iFR modality iFR screen

The iFR modality

 

  • Philips Volcano’s proprietary instantaneous, trans-lesional pressure ratio measured during the wave-free period.
  • Prospectively tested in the ADVISE II Study.
  • An iFR of 0.89 is equivalent to an FFR of 0.80.5

Building evidence

ADVISE II study logo

Over 4000 patients have been studied with iFR and numerous prospective iFR studies have been published in peer-reviewed journals.

iFR clinical progress

Clinical articles

  1. Escaned J. ADVISE II: A Prospective, Registry Evaluation of iFR vs. FFR. TCT 2013. Lecture conducted from San Francisco, CA.
  2. Sen S, et al. Development and validation of a new adenosine-independent index of stenosis severity from coronary wave-intensity analysis: results of the ADVISE (ADenosine Vasodilator Independent Stenosis Evaluation) study. J Am Coll Cardiol. 2012 Apr 10;59(15):1392-402.
  3. Using the iFR cut points of 0.85 and 0.94 matches best with an FFR ischemic cut-point of 0.80 with a specificity of 90.7% and sensitivity of 96.2%. (iFR Operator’s Manual 505-0101.23
  4. The ADVISE II study illustrated a 5.8%, i.e. (17+23)/690, classification discordance between the iFR Hybrid Approach and FFR. Among 477 lesions that would be assessed without hyperemia by the iFR Hybrid Approach, 40 (17+23) were due to classification discordance.
  5. An iFR cut-point of 0.89 matches best with an FFR ischemic cut-point of 0.80 with a specificity of 87.8% and sensitivity of 73.0%. (iFR Operator’s Manual 505-0101.23)
  6. Tonino et al. Fractional Flow Reserve Versus Angiography for Guiding Percutaneous Coronary Intervention. New England Journal of Medicine. 2009; 360, Number 3:213-224.