By Drs Justin E Davies, Ricardo Petraco and Sayan Sen

Imperial College London, 2012



Please feel free to browse the following links to improve your understanding of coronary physiology.  The aim of these talks is to expand beyond the scope of the range of topics normally discussed in clinical courses, to aid understanding of how new insights in coronary physiology have origins from the observations of pioneers in the past.










1. Background of coronary flow

            Aim: Understand the mechanisms behind coronary blood flow


2. Mechanisms of coronary flow regulation

            Aim: Understand how coronary flow is regulated by changes in coronary contractility as well as resistance


3. Benefits of the diastolic wave-free period

            Aim: Understand the rationale and benefits of the wave-free period for assessment of coronary stenoses


4. Pressure gradient assessment: an historical perspective  

Aim: Understand the origins of physiological assessment of coronary stenoses


5. New-novel non-hyperaemic indices Basal Stenosis Resistance (BSR) and Instant wave-free ration (iFR)

            Aim: Introduction to two new indices for evaluation of coronary stenosis severity without the need for hyperaemia


6. ADVISE study

            Aim: Understand the rationale, study design, methods and interpretation of the first-in-man evaluation of iFR.


7. ADVISE-Registry

            Aim: Understand the rationale for this study, and interpretation of the results of this real world application of iFR


8.  Using iFR and FFR together in a hybrid assessment approach  

Aim: Potential for application of iFR and FFR in clinical practice


9.  South Korean Prospective study

            Aim: Assessment of iFR in a prospective, independent, blinded study cohort.


10. CLARIFY study

            Aim: Assessment of impact of adenosine administration on diagnostic categoristaion using iFR and FFR.


11. Classification differences between physiological indexes

            Aim: Understand the physiological rationale for differences in classification between different physiological indices


12.  Measuring iFR and potential pitfalls

            Aim: Understand whats needed to measure iFR reliably


13.  iFR clinical trials program





iFR PUBLICATIONS                                                              


ADVISE studySayan Sen

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.


Sen S, Escaned J, Malik IS, Mikhail GW, Foale RA, Mila R, Tarkin J, Petraco R, Broyd C, Jabbour R, Sethi A, Baker CS, Bellamy M, Al-Bustami M, Hackett D, Khan M, Lefroy D, Parker KH, Hughes AD, Francis DP, Di Mario C, Mayet J, Davies JE.


J Am Coll Cardiol. 2012 Apr 10;59(15):1392-402. doi: 10.1016/j.jacc.2011.11.003. Epub 2011 Dec 7.


ADVISE Editorial – Morton Kern

An adenosine-independent index of stenosis severity from coronary wave-intensity analysis: a new paradigm in coronary physiology for the cath lab?

Kern MJ.

J Am Coll Cardiol. 2012 Apr 10;59(15):1403-5. doi: 10.1016/j.jacc.2011.11.006. Epub 2011 Dec 7.


ADVISE-Registry – Ricardo Petraco

Classification performance of instantaneous wave-free ratio (iFR) and fractional flow reserve in a clinical population of intermediate coronary stenoses: results of the ADVISE registry.

Petraco R, Escaned J, Sen S, Nijjer S, Asrress KN, Echavarria-Pinto M, Lockie T, Khawaja MZ, Cuevas C, Foin N, Broyd C, Foale RA, Hadjiloizou N, Malik IS, Mikhail GW, Sethi A, Kaprielian R, Baker CS, Lefroy D, Bellamy M, Al-Bustami M, Khan MA, Hughes AD, Francis DP, Mayet J, Di Mario C, Redwood S, Davies JE.

EuroIntervention. 2012 Aug 25. doi:pii: 20120413-02. [Epub ahead of print]


iFR-FFR Hybrid – Ricardo Petraco

Hybrid iFR-FFR decision-making strategy: implications for enhancing universal adoption of physiology-guided coronary revascularisation

Ricardo Petraco MD*, Jin Joo Park¤, Sayan Sen MBBS*, Sukhjinder Nijjer MBChB*, Iqbal S. Malik MBBS PhD*, Mauro Echavarra-Pinto MD, Kaleab N. Asrress MA BM BCh, Chang-Wook Nam**, Enrico Macas MD, Rodney A Foale MD*, Amarjit Sethi MBBS PhD*, Ghada W. Mikhail MBBS MD*, Raffi Kaprielian MBBS MD*, Christopher S. Baker MBBS PhD*, David Lefroy MB BChir*, Michael Bellamy MBBS MD*, Mahmud Al-Bustami MD*, Masood A. Khan MB BChir MA*, Nieves Gonzalo MD PhD, Alun D. Hughes MBBS PhD*, Darrel P. Francis MB BChir MA MD*, Jamil Mayet MBChB MD MBA*, Carlo Di Mario MD PhD^, Simon Redwood MBBS MD, Javier Escaned MD PhD, Bon-Kwon Koo¤, and Justin E Davies MBBS PhD*. Eurointervention. December 2012 (in press).

Basal Stenosis Resistance – Tim van de Hoef

Diagnostic accuracy of combined intracoronary pressure and flow velocity information during baseline conditions: adenosine-free assessment of functional coronary lesion severity.


van de Hoef TP, Nolte F, Damman P, Delewi R, Bax M, Chamuleau SA, Voskuil M, Siebes M, Tijssen JG, Spaan JA, Piek JJ, Meuwissen M.

Circ Cardiovasc Interv. 2012 Aug 1;5(4):508-14. doi: 10.1161/CIRCINTERVENTIONS.111.965707.







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