51
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Moscarella E, Gragnano F, Cesaro A, Ielasi A, Diana V, Conte M, Schiavo A, Coletta S, Di Maio D, Fimiani F, Calabrò P. Coronary Physiology Assessment for the Diagnosis and Treatment of Coronary Artery Disease. Cardiol Clin 2020; 38:575-588. [DOI: 10.1016/j.ccl.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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52
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Clinical implication of QFR in patients with ST-segment elevation myocardial infarction after drug-eluting stent implantation. Int J Cardiovasc Imaging 2020; 37:755-766. [PMID: 33044717 DOI: 10.1007/s10554-020-02068-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022]
Abstract
The feasibility and prognostic value of quantitative flow ratio (QFR) after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients have not been assessed. The aim of this study was to investigate the prognostic utility of post-PCI QFR to predict outcomes in STEMI and determine the influence of functional results, in both culprit and nonculprit lesions, after PCI. Patients undergoing PCI of culprit lesions and receiving staged procedures of nonculprit lesions after 7 days were enrolled from 2 centers and underwent post-PCI QFR. The primary outcome was the vessel-oriented composite endpoints (VOCEs), defined as vessel-related cardiovascular death, vessel-related myocardial infarction, and target vessel revascularization. Four hundred fifteen vessels (186 culprit lesions and 219 nonculprit lesions) in 186 patients were analyzed. Measured at staged PCI, the post-PCI QFR of culprit lesions was significantly lower than that of nonculprit lesions (0.92 ± 0.10 versus 0.95 ± 0.08, p < 0.001). The multivariable model demonstrated that low post-PCI QFR was an independent predictor of 2-year VOCE (20.8% versus 5.7%; hazard ratio 2.718; 95% CI 1.347-5.486; p = 0.005). In STEMI patients with a low angiography-derived index of microcirculatory resistance (≤ 40U), a good correlation and agreement between post-PCI QFR value of culprit lesions at primary and staged procedures (r = 0.942; mean difference: - 0.0017 [- 0.074 to 0.070]) was identified. In conclusion, culprit lesions suffered from suboptimal functional results more frequently compared to nonculprit lesions after PCI in STEMI patients. Low post-PCI QFR was associated with subsequent adverse clinical outcomes. After stenting, culprit lesions may feasibly be assessed through QFR without significant microvascular dysfunction.
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53
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Mejía-Rentería H, Nombela-Franco L, Paradis JM, Lunardi M, Lee JM, Amat-Santos IJ, Veiga Fernandez G, Kalra A, Bansal EJ, de la Torre Hernandez JM, Rodés-Cabau J, Ribichini FL, Escaned J. Angiography-based quantitative flow ratio versus fractional flow reserve in patients with coronary artery disease and severe aortic stenosis. EUROINTERVENTION 2020; 16:e285-e292. [DOI: 10.4244/eij-d-19-01001] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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54
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Scarsini R, Terentes-Printzios D, De Maria GL, Ribichini F, Banning A. Why, When and How Should Clinicians Use Physiology in Patients with Acute Coronary Syndromes? ACTA ACUST UNITED AC 2020; 15:e05. [PMID: 32577130 PMCID: PMC7301203 DOI: 10.15420/icr.2019.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/13/2020] [Indexed: 12/14/2022]
Abstract
Current data support the use of coronary physiology in patients with acute coronary syndrome (ACS). In patients with ST-elevation MI, the extent of myocardial damage and microvascular dysfunction create a complex conundrum to assimilate when considering clinical management and risk stratification. In this setting, the index of microcirculatory resistance emerged as an accurate tool to identify patients at risk of suboptimal myocardial reperfusion after primary percutaneous coronary intervention who may benefit from novel adjunctive therapies. In the context of non-ST-elevation ACS, coronary physiology should be carefully interpreted and often integrated with intracoronary imaging, especially in cases of ambiguous culprit lesion. Conversely, the functional assessment of bystander coronary disease is favoured by the available evidence, aiming to achieve complete revascularisation. Based on everyday clinical scenarios, the authors illustrate the available evidence and provide recommendations for the functional assessment of infarct-related artery and non-culprit lesions in patients with ACS.
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Affiliation(s)
- Roberto Scarsini
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals Oxford, UK.,Division of Cardiology, Department of Medicine, University of Verona Verona, Italy
| | | | - Giovanni Luigi De Maria
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals Oxford, UK
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona Verona, Italy
| | - Adrian Banning
- Oxford Heart Centre, NIHR Biomedical Research Centre, Oxford University Hospitals Oxford, UK.,Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford Oxford, UK
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55
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Safi H, Bourantas CV, Ramasamy A, Zanchin T, Bär S, Tufaro V, Jin C, Torii R, Karagiannis A, Reiber JHC, Mathur A, Onuma Y, Windecker S, Lansky A, Maehara A, Serruys PW, Stone P, Baumbach A, Stone GW, Räber L. Predictive value of the QFR in detecting vulnerable plaques in non-flow limiting lesions: a combined analysis of the PROSPECT and IBIS-4 study. Int J Cardiovasc Imaging 2020; 36:993-1002. [PMID: 32152810 DOI: 10.1007/s10554-020-01805-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/22/2020] [Indexed: 01/07/2023]
Abstract
Studies have shown that the quantitative flow ratio (QFR), recently introduced to assess lesion severity from coronary angiography, provides useful prognostic information; however the additive value of this technique over intravascular imaging in detecting lesions that are likely to cause events is yet unclear. We analysed data acquired in the PROSPECT and IBIS-4 studies, in particular the baseline virtual histology-intravascular ultrasound (VH-IVUS) and angiographic data from 17 non-culprit lesions with a presumable vulnerable phenotype (i.e., thin or thick cap fibroatheroma) that caused major adverse cardiac events or required revascularization (MACE) at 5-year follow-up and from a group of 78 vulnerable plaques that remained quiescent. The segments studied by VH-IVUS were identified in coronary angiography and the QFR was estimated. The additive value of 3-dimensional quantitative coronary angiography (3D-QCA) and of the QFR in predicting MACE at 5 year follow-up beyond plaque characteristics was examined. It was found that MACE lesions had a greater plaque burden (PB) and smaller minimum lumen area (MLA) on VH-IVUS, a longer length and a smaller minimum lumen diameter (MLD) on 3D-QCA and a lower QFR compared with lesions that remained quiescent. By univariate analysis MLA, PB, MLD, lesion length on 3D-QCA and QFR were predictors of MACE. In multivariate analysis a low but normal QFR (> 0.80 to < 0.97) was the only independent prediction of MACE (HR 3.53, 95% CI 1.16-10.75; P = 0.027). In non-flow limiting lesions with a vulnerable phenotype, QFR may provide additional prognostic information beyond plaque morphology for predicting MACE throughout 5 years.
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Affiliation(s)
- Hannah Safi
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
| | - Christos V Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK. .,Institute of Cardiovascular Sciences, University College London, London, UK. .,William Harvey Research Institute, Queen Mary University London, London, UK.
| | - Anantharaman Ramasamy
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Thomas Zanchin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Sarah Bär
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Vincenzo Tufaro
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Chongying Jin
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ryo Torii
- Department of Mechanical Engineering, University College London, London, UK
| | - Alexios Karagiannis
- CTU Bern, Institute of Social and Preventive Medicine, Bern University, Bern, Switzerland
| | | | - Anthony Mathur
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Yoshinubo Onuma
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Alexandra Lansky
- Institute of Cardiovascular Sciences, University College London, London, UK.,Division of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Akiko Maehara
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | - Patrick W Serruys
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Peter Stone
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Baumbach
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,William Harvey Research Institute, Queen Mary University London, London, UK
| | - Gregg W Stone
- Department of Cardiology, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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56
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van Diemen PA, Driessen RS, Kooistra RA, Stuijfzand WJ, Raijmakers PG, Boellaard R, Schumacher SP, Bom MJ, Everaars H, de Winter RW, van de Ven PM, Reiber JH, Min JK, Leipsic JA, Knuuti J, Underwood RS, van Rossum AC, Danad I, Knaapen P. Comparison Between the Performance of Quantitative Flow Ratio and Perfusion Imaging for Diagnosing Myocardial Ischemia. JACC Cardiovasc Imaging 2020; 13:1976-1985. [PMID: 32305469 DOI: 10.1016/j.jcmg.2020.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/12/2019] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study compared the performance of the quantitative flow ratio (QFR) with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) myocardial perfusion imaging (MPI) for the diagnosis of fractional flow reserve (FFR)-defined coronary artery disease (CAD). BACKGROUND QFR estimates FFR solely based on cine contrast images acquired during invasive coronary angiography (ICA). Head-to-head studies comparing QFR with noninvasive MPI are lacking. METHODS A total of 208 (624 vessels) patients underwent technetium-99m tetrofosmin SPECT and [15O]H2O PET imaging before ICA in conjunction with FFR measurements. ICA was obtained without using a dedicated QFR acquisition protocol, and QFR computation was attempted in all vessels interrogated by FFR (552 vessels). RESULTS QFR computation succeeded in 286 (52%) vessels. QFR correlated well with invasive FFR overall (R = 0.79; p < 0.001) and in the subset of vessels with an intermediate (30% to 90%) diameter stenosis (R = 0.76; p < 0.001). Overall, per-vessel analysis demonstrated QFR to exhibit a superior sensitivity (70%) in comparison with SPECT (29%; p < 0.001), whereas it was similar to PET (75%; p = 1.000). Specificity of QFR (93%) was higher than PET (79%; p < 0.001) and not different from SPECT (96%; p = 1.000). As such, the accuracy of QFR (88%) was superior to both SPECT (82%; p = 0.010) and PET (78%; p = 0.004). Lastly, the area under the receiver operating characteristics curve of QFR, in the overall sample (0.94) and among vessels with an intermediate lesion (0.90) was higher than SPECT (0.63 and 0.61; p < 0.001 for both) and PET (0.82; p < 0.001 and 0.77; p = 0.002), respectively. CONCLUSIONS In this head-to-head comparative study, QFR exhibited a higher diagnostic value for detecting FFR-defined significant CAD compared with perfusion imaging by SPECT or PET.
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Affiliation(s)
- Pepijn A van Diemen
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Wynand J Stuijfzand
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Department of Radiology, Nuclear Medicine, and PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Department of Radiology, Nuclear Medicine, and PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Stefan P Schumacher
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Michiel J Bom
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Henk Everaars
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - James K Min
- Institute for Cardiovascular Imaging, Weill-Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Jonathan A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Richard S Underwood
- Department of Nuclear Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Albert C van Rossum
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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57
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Lauri FM, Macaya F, Mejía-Rentería H, Goto S, Yeoh J, Nakayama M, Quirós A, Liontou C, Pareek N, Fernández-Ortíz A, Macaya C, MacCarthy P, Escaned J. Angiography-derived functional assessment of non-culprit coronary stenoses in primary percutaneous coronary intervention. EUROINTERVENTION 2020; 15:e1594-e1601. [DOI: 10.4244/eij-d-18-01165] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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58
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Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses. J Interv Cardiol 2020. [DOI: 10.1155/2020/7352150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Use of the fractional flow reserve (FFR) technique is recommended to evaluate coronary stenosis severity and guide revascularization. However, its high cost, time to administer, and the side effects of adenosine reduce its clinical utility. Two novel adenosine-free indices, contrast-FFR (cFFR) and quantitative flow ratio (QFR), can simplify the functional evaluation of coronary stenosis. This study aimed to analyze the diagnostic performance of cFFR and QFR using FFR as a reference index. Methods. We conducted a systematic review and meta-analysis of observational studies in which cFFR or QFR was compared to FFR. A bivariate model was applied to pool diagnostic parameters. Cochran’s Q test and the I2 index were used to assess heterogeneity and identify the potential source of heterogeneity by metaregression and sensitivity analysis. Results. Overall, 2220 and 3000 coronary lesions from 20 studies were evaluated by cFFR and QFR, respectively. The pooled sensitivity and specificity were 0.87 (95% CI: 0.81, 0.91) and 0.92 (95% CI: 0.88, 0.94) for cFFR and 0.87 (95% CI: 0.82, 0.91) and 0.91 (95% CI: 0.87, 0.93) for QFR, respectively. No statistical significance of sensitivity and specificity for cFFR and QFR were observed in the bivariate analysis (P=0.8406 and 0.4397, resp.). The area under summary receiver-operating curve of cFFR and QFR was 0.95 (95% CI: 0.93, 0.97) for cFFR and 0.95 (95% CI: 0.93, 0.97). Conclusion. Both cFFR and QFR have good diagnostic performance in detecting functional severity of coronary arteries and showed similar diagnostic parameters.
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59
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Cortés C, Carrasco‐Moraleja M, Aparisi A, Rodriguez‐Gabella T, Campo A, Gutiérrez H, Julca F, Gómez I, San Román JA, Amat‐Santos IJ. Quantitative flow ratio—Meta‐analysis and systematic review. Catheter Cardiovasc Interv 2020; 97:807-814. [DOI: 10.1002/ccd.28857] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 02/19/2020] [Accepted: 03/07/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Carlos Cortés
- Department of Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
- Department of Cardiology Hospital San Pedro de Logroño Logroño Spain
| | | | - Alvaro Aparisi
- Department of Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | | | - Alberto Campo
- Department of Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | - Hipolito Gutiérrez
- Department of Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | - Fabián Julca
- Department of Cardiology Hospital Clínico Universitario de Valladolid Valladolid Spain
| | - Itziar Gómez
- CIRBERCV Hospital Clínico Universitario de Valladolid Valladolid Spain
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60
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Sheng X, Qiao Z, Ge H, Sun J, He J, Li Z, Ding S, Pu J. Novel application of quantitative flow ratio for predicting microvascular dysfunction after ST-segment-elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 95 Suppl 1:624-632. [PMID: 31912991 DOI: 10.1002/ccd.28718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study evaluated quantitative flow ratio (QFR) to predict microvascular dysfunction (MVD) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND QFR is a novel approach for the rapid computation of fractional flow reserve based on three-dimensional quantitative coronary angiography. We hypothesized that QFR computation could be used to predict MVD after STEMI. METHODS Indexes such as contrast-flow QFR (cQFR), fixed-flow QFR (fQFR), and hyperemic flow velocity (HFV) were calculated in 130 STEMI patients with culprit lesion with ≥50% diameter stenosis and TIMI flow grade 2/3 in the spontaneously recanalized culprit artery on initial angiography. MVD was defined as microvascular obstruction determined by contrast-enhanced cardiac magnetic resonance at a median of 5 days after percutaneous coronary intervention. RESULTS Patients were divided into the MVD group (76/130, 58.5%) and non-MVD group (54/130, 41.5%). Patients with MVD had higher cQFR-fQFR value (0.080 ± 0.058 vs. 0.038 ± 0.039, p < .001) and lower modeled HFV (0.096 ± 0.044 vs. 0.144 ± 0.041 m/s, p < .001). Receiver operator characteristic curve analysis revealed that both the cQFR-fQFR value (area under the curve, AUC = 0.716, p < .001) and modeled HFV (AUC = 0.805, p < .001) had high specificity and positive predictive value to predict MVD. In multivariable logistic analysis, cQFR-fQFR was identified as an independent predictor of MVD (odds ratio = 9.800, p < .001). CONCLUSIONS This proof-of-concept study suggested that QFR computation may be a useful tool to predict MVD after STEMI (Trial Registration:NCT03780335).
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Affiliation(s)
- Xincheng Sheng
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiqing Qiao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiateng Sun
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jie He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Song Ding
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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61
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Comparison of quantitative flow ratio and fractional flow reserve with myocardial perfusion scintigraphy and cardiovascular magnetic resonance as reference standard. A Dan-NICAD substudy. Int J Cardiovasc Imaging 2019; 36:395-402. [PMID: 31745744 PMCID: PMC7080669 DOI: 10.1007/s10554-019-01737-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/15/2019] [Indexed: 12/21/2022]
Abstract
Quantitative flow ratio (QFR) and fractional flow reserve (FFR) have not yet been compared head to head with perfusion imaging as reference for myocardial ischemia. We aimed to compare the diagnostic accuracy of QFR and FFR with myocardial perfusion scintigraphy (MPS) or cardiovascular magnetic resonance (CMR) as reference. This study is a predefined post hoc analysis of the Dan-NICAD study (NCT02264717). Patients with suspected coronary artery disease by coronary computed tomography angiography (CCTA) were randomized 1:1 to MPS or CMR and were referred to invasive coronary angiography with FFR and predefined QFR assessment. Paired data with FFR, QFR and MPS or CMR were available for 232 vessels with stenosis in 176 patients. Perfusion defects were detected in 57 vessel territories (25%). For QFR and FFR the diagnostic accuracy was 61% and 57% (p = 0.18) and area under the receiver operating curve was 0.64 vs. 0.58 (p = 0.22). Stenoses with absolute indication for stenting due to diameter stenosis > 90% by visual estimate were not classified as significant by either QFR or MPS/CMR in 21% (7 of 34) of cases. The diagnostic performance of QFR and FFR was similar but modest with MPS or CMR as reference. Comparable performance levels for QFR and FFR are encouraging for this pressure wire-free diagnostic method.
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62
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Was the Ball Inside or Outside the Court? JACC Cardiovasc Interv 2019; 12:2089-2092. [DOI: 10.1016/j.jcin.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 07/02/2019] [Indexed: 10/25/2022]
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63
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Biscaglia S, Tebaldi M, Brugaletta S, Cerrato E, Erriquez A, Passarini G, Ielasi A, Spitaleri G, Di Girolamo D, Mezzapelle G, Geraci S, Manfrini M, Pavasini R, Barbato E, Campo G. Prognostic Value of QFR Measured Immediately After Successful Stent Implantation. JACC Cardiovasc Interv 2019; 12:2079-2088. [DOI: 10.1016/j.jcin.2019.06.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/16/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022]
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64
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Hamaya R, Hoshino M, Kanno Y, Yamaguchi M, Ohya H, Sumino Y, Kanaji Y, Usui E, Murai T, Lee T, Yonetsu T, Hirao K, Kakuta T. Prognostic implication of three-vessel contrast-flow quantitative flow ratio in patients with stable coronary artery disease. EUROINTERVENTION 2019; 15:180-188. [PMID: 30686781 DOI: 10.4244/eij-d-18-00896] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Contrast-flow quantitative flow ratio (cQFR) is a novel index of the functional severity of coronary stenosis, which can be calculated from three-dimensional quantitative coronary angiography. Previous studies have shown a high correlation between cQFR and fractional flow reserve. This study sought to investigate the prognostic value of the sum of cQFR in three vessels (3V-cQFR) in patients with stable coronary artery disease (CAD). METHODS AND RESULTS A total of 549 patients who underwent invasive coronary angiography and cQFR measurements in three vessels were analysed in the present study. Median cQFR of all cQFR-assessed vessels and 3V-cQFR of each patient were 0.94 (0.85-0.98) and 2.75 (2.62-2.87), respectively. During a median follow-up of 2.2 years, 57 patients experienced MACE. 3V-cQFR could provide prognostic information in the total cohort and among those without undergoing revascularisation as well. In a multivariate analysis, 3V-cQFR, high-sensitivity cardiac troponin-I and previous MI remained as independent predictors for MACE, and conventional angiographic scores did not. CONCLUSIONS 3V-cQFR could discriminate the risk for MACE in patients with stable CAD. 3V-cQFR calculated from routine invasive angiograms was feasible, and the prognostic implication could be more powerful than that of conventional angiographic scores.
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Affiliation(s)
- Rikuta Hamaya
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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65
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Hideo-Kajita A, Garcia-Garcia HM, Shlofmitz E, Campos CM. Update on Coronary Angiography-Based Physiology Technologies. Arq Bras Cardiol 2019; 113:282-285. [PMID: 31365603 PMCID: PMC6777878 DOI: 10.5935/abc.20190140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/21/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alexandre Hideo-Kajita
- MedStar Health Research Institute - Medstar Cardiovascular Research Network (MHRI/MCRN), Hyattsville, Maryland - USA.,MedStar Washington Hospital Center, Washington, District of Columbia - USA
| | - Hector M Garcia-Garcia
- MedStar Health Research Institute - Medstar Cardiovascular Research Network (MHRI/MCRN), Hyattsville, Maryland - USA.,MedStar Washington Hospital Center, Washington, District of Columbia - USA
| | - Evan Shlofmitz
- MedStar Washington Hospital Center, Washington, District of Columbia - USA
| | - Carlos M Campos
- Universidade de São Paulo - Faculdade de Medicina Hospital das Clinicas Instituto do Coração, São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein - Cardiologia Intervencionista, São Paulo, SP - Brazil
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Applicability of quantitative flow ratio for rapid evaluation of intermediate coronary stenosis: comparison with instantaneous wave-free ratio in clinical practice. Int J Cardiovasc Imaging 2019; 35:1963-1969. [DOI: 10.1007/s10554-019-01656-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022]
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67
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Xing Z, Pei J, Huang J, Hu X, Gao S. Diagnostic Performance of QFR for the Evaluation of Intermediate Coronary Artery Stenosis Confirmed by Fractional Flow Reserve. Braz J Cardiovasc Surg 2019; 34:165-172. [PMID: 30916126 PMCID: PMC6436789 DOI: 10.21470/1678-9741-2018-0234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/17/2018] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Quantitative flow ratio (QFR) is a novel method enabling efficient computation of FFR from three-dimensional quantitative coronary angiography (3D QCA) and thrombolysis in myocardial infarction (TIMI) frame counting. We decided to perform a systematic review and quantitative meta-analysis of the literature to determine the correlation between the diagnosis of functionally significant stenosis obtained by QFR versus FFR and to determine the diagnostic accuracy of QFR for intermediate coronary artery stenosis. METHODS We searched PubMed, Embase, and Web of Science for studies concerning the diagnostic performance of QFR. Our meta-analysis was performed using the DerSimonian and Laird random effects model to determine sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). The sROC was used to determine diagnostic test accuracy. RESULTS Nine studies consisting of 1175 vessels in 1047 patients were included in our study. The pooled sensitivity, specificity, LR+, LR-, and DOR for QFR were 0.89 (95% CI: 0.86-0.92), 0.88 (95% CI: 0.86-0.91), 6.86 (95% CI,: 5.22-9.02), 0.14 (95% CI: 0.10-0.21), and 53.05 (95% CI: 29.75-94.58), respectively. The area under the summary receiver operating characteristic (sROC) curve for QFR was 0.94. CONCLUSION QFR is a simple, useful, and noninvasive modality for diagnosis of functional significance of intermediate coronary artery stenosis.
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Affiliation(s)
- Zhenhua Xing
- Department of Cardiology, Second Xiangya Hospital, Changsha, China
| | - Junyu Pei
- Department of Cardiology, Second Xiangya Hospital, Changsha, China
| | - Jiabing Huang
- Department of Cardiology, Second Xiangya Hospital, Changsha, China
| | - Xinqun Hu
- Department of Cardiology, Second Xiangya Hospital, Changsha, China
| | - Shan Gao
- Department of Geriatrics, Second Xiangya Hospital,Changsha, China
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Meta-Analysis of Diagnostic Performance of Instantaneous Wave-Free Ratio versus Quantitative Flow Ratio for Detecting the Functional Significance of Coronary Stenosis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5828931. [PMID: 31119175 PMCID: PMC6500690 DOI: 10.1155/2019/5828931] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/24/2019] [Accepted: 04/03/2019] [Indexed: 01/10/2023]
Abstract
Background Fractional flow reserve (FFR), as a functional measurement of coronary stenosis, is recommended for guiding revascularization in intermediate coronary lesions. However, it still remains underutilized for potential reasons including time consumption, costs, or contraindications associated with adenosine administration. Here we performed this meta-analysis to assess the diagnostic performance of two adenosine-free indices, instantaneous wave free-ratio (iFR), and quantitative flow ratio (QFR) in evaluating coronary stenosis severity with FFR as the reference standard. Methods PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to include relevant studies with the diagnostic accuracy of iFR or QFR referenced to FFR. A bivariate model was applied to pool diagnostic parameters. We used Cochran's Q test and I2 index to assess heterogeneity and identify the potential source of heterogeneity by meta-regression. Results A total of 8213 lesions from 28 studies (19 for iFR and 9 for QFR) were included in this meta-analysis. The pooled sensitivity and specificity were 0.79 (95% CI, 0.75 to 0.83) and 0.85 (95% CI, 0.82 to 0.87) for iFR and 0.90 (95% CI, 0.84 to 0.93) and 0.88 (95% CI, 0.86 to 0.90) for QFR, respectively. Significantly higher sensitivity and specificity were observed in the bivariate analysis for QFR than for iFR (P < 0.001 for both). The area under summary receiver-operating curve of iFR and QFR was 0.89 (95% CI, 0.86 to 0.92) and 0.92 (95% CI, 0.89 to 0.94). Conclusion Evidence suggests that both of the two indices have good performance in detecting functional ischemia of coronary arteries and QFR might be a promising method without requiring the pressure wire. Further application of QFR may potentially provide important information to clinicians in the assessment of coronary lesions.
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Affiliation(s)
- Roberto Ferrari
- Centro Cardiologico Universitario and LTTA Centre, University Hospital of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Rita Pavasini
- Centro Cardiologico Universitario and LTTA Centre, University Hospital of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
| | - Cristina Balla
- Centro Cardiologico Universitario and LTTA Centre, University Hospital of Ferrara, Ferrara, Italy.,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola, Italy
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70
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Zaleska M, Kołtowski Ł, Maksym J, Tomaniak M, Opolski M, Kochman J. Alternative methods for functional assessment of intermediate coronary lesions. Cardiol J 2019; 27:825-835. [PMID: 30912574 DOI: 10.5603/cj.a2019.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/27/2018] [Accepted: 01/21/2019] [Indexed: 01/10/2023] Open
Abstract
Wire-based fractional flow reserve (FFR) is a diagnostic tool used to evaluate the ischemic burden of coronary lesions. Large-scale studies have shown that FFR-guided revascularization is associated with better clinical outcomes. However, wide adoption of this technology is limited due to the considerable cost, additional time needed for set-up and performance of the measurement as well as the invasiveness of the procedure which requires pressure wire placement across the lesion into the distal segment of the coronary artery. To overcome these limitations new, promising, and less-/non-invasive methods were developed. These methods are based on computational fluid dynamics analysis and three-dimensional lumen reconstruction. The aim of this paper is to review scientific evidence supporting the clinical safety and efficacy of these techniques, such as instantaneous wave-free ratio, quantitative flow ratio and FFR calculated from computed tomographic angiography.
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Affiliation(s)
- Martyna Zaleska
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
| | - Łukasz Kołtowski
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland.
| | - Jakub Maksym
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
| | - Mariusz Tomaniak
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
| | - Maksymilian Opolski
- Department of Interventional Cardiology and Angiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Janusz Kochman
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
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Sejr‐Hansen M, Westra J, Thim T, Christiansen EH, Eftekhari A, Kristensen SD, Jakobsen L, Götberg M, Frøbert O, Hoeven NW, Holm NR, Maeng M. Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST‐segment elevation myocardial infarction—An iSTEMI substudy. Catheter Cardiovasc Interv 2019; 94:686-692. [DOI: 10.1002/ccd.28208] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/26/2019] [Accepted: 03/16/2019] [Indexed: 11/10/2022]
Affiliation(s)
| | - Jelmer Westra
- Department of CardiologyAarhus University Hospital Aarhus Denmark
| | - Troels Thim
- Department of CardiologyAarhus University Hospital Aarhus Denmark
| | | | - Ashkan Eftekhari
- Department of CardiologyAarhus University Hospital Aarhus Denmark
| | | | - Lars Jakobsen
- Department of CardiologyAarhus University Hospital Aarhus Denmark
| | - Matthias Götberg
- Department of CardiologyLund University, Skane University Hospital Lund Sweden
| | - Ole Frøbert
- Department of CardiologyUniversitetssjukhuset Örebro Örebro Sweden
| | - Nina W. Hoeven
- Department of CardiologyAmsterdam UMC, Vrije Universiteit Amsterdam Amsterdam Netherlands
| | | | - Michael Maeng
- Department of CardiologyAarhus University Hospital Aarhus Denmark
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72
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Cesaro A, Gragnano F, Di Girolamo D, Moscarella E, Diana V, Pariggiano I, Alfieri A, Perrotta R, Golino P, Cesaro F, Mercone G, Campo G, Calabrò P. Functional assessment of coronary stenosis: an overview of available techniques. Is quantitative flow ratio a step to the future? Expert Rev Cardiovasc Ther 2018; 16:951-962. [DOI: 10.1080/14779072.2018.1540303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Arturo Cesaro
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Felice Gragnano
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Domenico Di Girolamo
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Elisabetta Moscarella
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Diana
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ivana Pariggiano
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alfonso Alfieri
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Rocco Perrotta
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Pasquale Golino
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Francesco Cesaro
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Giuseppe Mercone
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Paolo Calabrò
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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73
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Chang Y, Chen L, Westra J, Sun Z, Guan C, Zhang Y, Ding D, Xu B, Tu S. Reproducibility of quantitative flow ratio: An inter-core laboratory variability study. Cardiol J 2018; 27:230-237. [PMID: 30234896 DOI: 10.5603/cj.a2018.0105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel approach to derive fractional flow reserve (FFR) from coronary angiography. This study sought to evaluate the reproducibility of QFR when analyzed in independent core laboratories. METHODS All interrogated vessels in the FAVOR II China Study were separately analyzed using the AngioPlus system (Pulse medical imaging technology, Shanghai) by two independent core laboratories, following the same standard operation procedures. The analysts were blinded to the FFR values and online QFR values. For each interrogated vessel, two identical angiographic image runs were used by two core laboratories for QFR computation. In both core laboratories QFR was successfully obtained in 330 of 332 vessels, in which FFR was available in 328 vessels. Thus, 328 vessels ended in the present statistical analysis. RESULTS The mean difference in contrast-flow QFR between the two core laboratories was 0.004 ± 0.03 (p = 0.040), which was slightly smaller than that between the online analysis and the two core laboratories (0.01 ± 0.05, p < 0.001 and 0.01 ± 0.05, p = 0.038). The mean difference of QFR with re-spect to FFR were comparable between the two core laboratories (0.002 ± 0.06, p = 0.609, and 0.002 ± 0.06, p = 0.531). Receiver operating characteristic curve analysis showed that diagnostic accuracies of QFR analyzed by the two core laboratories were both excellent (area under the curve: 0.970 vs. 0.963, p = 0.142), when using FFR as the reference standard. CONCLUSIONS The present study showed good inter-core laboratory reproducibility of QFR in assessing functionally-significant stenosis. It suggests that QFR analyses can be carried out in different core labo-ratories if, and only if, highly standardized conditions are maintained.
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Affiliation(s)
- Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Liwei Chen
- Department of Cardiology, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Zhongwei Sun
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Changdong Guan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yimin Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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Westra J, Andersen BK, Campo G, Matsuo H, Koltowski L, Eftekhari A, Liu T, Di Serafino L, Di Girolamo D, Escaned J, Nef H, Naber C, Barbierato M, Tu S, Neghabat O, Madsen M, Tebaldi M, Tanigaki T, Kochman J, Somi S, Esposito G, Mercone G, Mejia-Renteria H, Ronco F, Bøtker HE, Wijns W, Christiansen EH, Holm NR. Diagnostic Performance of In-Procedure Angiography-Derived Quantitative Flow Reserve Compared to Pressure-Derived Fractional Flow Reserve: The FAVOR II Europe-Japan Study. J Am Heart Assoc 2018; 7:JAHA.118.009603. [PMID: 29980523 PMCID: PMC6064860 DOI: 10.1161/jaha.118.009603] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Quantitative flow ratio (QFR) is a novel modality for physiological lesion assessment based on 3‐dimensional vessel reconstructions and contrast flow velocity estimates. We evaluated the value of online QFR during routine invasive coronary angiography for procedural feasibility, diagnostic performance, and agreement with pressure‐wire–derived fractional flow reserve (FFR) as a gold standard in an international multicenter study. Methods and Results FAVOR II E‐J (Functional Assessment by Various Flow Reconstructions II Europe‐Japan) was a prospective, observational, investigator‐initiated study. Patients with stable angina pectoris were enrolled in 11 international centers. FFR and online QFR computation were performed in all eligible lesions. An independent core lab performed 2‐dimensional quantitative coronary angiography (2D‐QCA) analysis of all lesions assessed with QFR and FFR. The primary comparison was sensitivity and specificity of QFR compared with 2D‐QCA using FFR as a reference standard. A total of 329 patients were enrolled. Paired assessment of FFR, QFR, and 2D‐QCA was available for 317 lesions. Mean FFR, QFR, and percent diameter stenosis were 0.83±0.09, 0.82±10, and 45±10%, respectively. FFR was ≤0.80 in 104 (33%) lesions. Sensitivity and specificity by QFR was significantly higher than by 2D‐QCA (sensitivity, 86.5% (78.4–92.4) versus 44.2% (34.5–54.3); P<0.001; specificity, 86.9% (81.6–91.1) versus 76.5% (70.3–82.0); P=0.002). Area under the receiver curve was significantly higher for QFR compared with 2D‐QCA (area under the receiver curve, 0.92 [0.89–0.96] versus 0.64 [0.57–0.70]; P<0.001). Median time to QFR was significantly lower than median time to FFR (time to QFR, 5.0 minutes [interquartile range, –6.1] versus time to FFR, 7.0 minutes [interquartile range, 5.0–10.0]; P<0.001). Conclusions Online computation of QFR in the catheterization laboratory is clinically feasible and is superior to angiographic assessment for evaluation of intermediary coronary artery stenosis using FFR as a reference standard. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02959814.
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Affiliation(s)
- Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu City, Japan
| | - Lukasz Koltowski
- Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Tommy Liu
- Department of Cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Luigi Di Serafino
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University, Madrid, Spain
| | - Holger Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | | | - Marco Barbierato
- Emodinamica Aziendale AULSS 3 Serenissima, Ospedale Dell'Angelo, Mestre, Italy
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Morten Madsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Skejby, Denmark
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu City, Japan
| | - Janusz Kochman
- Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
| | - Samer Somi
- Department of Cardiology, Hagaziekenhuis, The Hague, The Netherlands
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Federico Ronco
- Emodinamica Aziendale AULSS 3 Serenissima, Ospedale Dell'Angelo, Mestre, Italy
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, Galway, Ireland
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Clinical outcomes of complete revascularization using either angiography-guided or fractional flow reserve-guided drug-eluting stent implantation in non-culprit vessels in ST elevation myocardial infarction patients: insights from a study based on a systematic review and meta-analysis. Int J Cardiovasc Imaging 2018; 34:1349-1364. [DOI: 10.1007/s10554-018-1362-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 04/20/2018] [Indexed: 12/31/2022]
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