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Lu W, Zhang X, Yan G, Ma G. The Differences of Quantitative Flow Ratio in Coronary Artery Stenosis with or without Atrial Fibrillation. J Interv Cardiol 2023; 2023:7278343. [PMID: 37868769 PMCID: PMC10589068 DOI: 10.1155/2023/7278343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023] Open
Abstract
Quantitative flow ratio (QFR) is a new method for the assessment of the extent of coronary artery stenosis. But it may be obscured by the cardiac remodeling and abnormal blood flow of the coronary artery when encountering atrial fibrillation (AF). The present study aimed to examine the impact of these changed structures and blood flow of coronary arteries on QFR results in AF patients. Methods and Results. We evaluated QFR in 223 patients (112 patients with AF; 111 non-AF patients served as controls) who had undergone percutaneous coronary intervention (PCI) due to severe stenoses in coronary arteries. QFR of the target coronary was determined according to the flow rate of the contrast agent. Results showed that AF patients had significantly higher QFR values than control (0.792 ± 0.118 vs. 0.685 ± 0.167, p < 0.001). We further analyzed local QFR around the stenoses (0.858 ± 0.304 vs. 0.756 ± 0.146, p=0.002), residual QFR (0.958 ± 0.055 vs. 0.929 ± 0.093, p=0.005), and index QFR (0.807 ± 0.108 vs. 0.713 ± 0.152, p < 0.001) in these two groups of patients with and without AF. Further analysis revealed that QFR in AF patients was negatively correlated with coronary flow velocity (R = -0.22, p=0.02) and area of stenosis (R = -0.70, p < 0.001) but positively correlated with the minimum lumen area (MLA) (R = 0.47, p < 0.001). Conclusion. AF patients with coronary artery stenosis have higher QFR values, which are associated with decreased blood flow velocity, smaller stenosis, and larger MLA in AF patients upon cardiac remodeling.
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Affiliation(s)
- Wenbin Lu
- Department of Cardiology, ZhongDa Hospital Affiliated with Southeast University, China
| | - Xiaoguo Zhang
- Department of Cardiology, ZhongDa Hospital Affiliated with Southeast University, China
| | - Gaoliang Yan
- Department of Cardiology, ZhongDa Hospital Affiliated with Southeast University, China
| | - Genshan Ma
- Department of Cardiology, ZhongDa Hospital Affiliated with Southeast University, China
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Li X, Sun S, Luo D, Yang X, Ye J, Guo X, Xu S, Sun B, Zhang Y, Luo J, Zhou Y, Tu S, Dong H. Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound. Front Cardiovasc Med 2022; 9:816387. [PMID: 35355977 PMCID: PMC8959302 DOI: 10.3389/fcvm.2022.816387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background While coronary stent implantation in ST-elevation myocardial infarction (STEMI) can mechanically revascularize culprit epicardial vessels, it might also cause distal embolization. The relationship between geometrical and functional results of stent expansion during the primary percutaneous coronary intervention (pPCI) is unclear. Objective We sought to determine the optimal stent expansion strategy in pPCI using novel angiography-based approaches including angiography-derived quantitative flow ratio (QFR)/microcirculatory resistance (MR) and intravascular ultrasound (IVUS). Methods Post-hoc analysis was performed in patients with acute STEMI and high thrombus burden from our prior multicenter, prospective cohort study (ChiCTR1800019923). Patients aged 18 years or older with STEMI were eligible. IVUS imaging, QFR, and MR were performed during pPCI, while stent expansion was quantified on IVUS images. The patients were divided into three subgroups depending on the degree of stent expansion as follows: overexpansion (>100%), optimal expansion (80%−100%), and underexpansion (<80%). The patients were followed up for 12 months after PCI. The primary endpoint included sudden cardiac death, myocardial infarction, stroke, unexpected hospitalization or unplanned revascularization, and all-cause death. Results A total of 87 patients were enrolled. The average stent expansion degree was 82% (in all patients), 117% (in overexpansion group), 88% (in optimal expansion), and 75% (in under-expansion). QFR, MR, and flow speed increased in all groups after stenting. The overall stent expansion did not affect the final QFR (p = 0.08) or MR (p = 0.09), but it reduced the final flow speed (−0.14 cm/s per 1%, p = 0.02). Under- and overexpansion did not affect final QFR (p = 0.17), MR (p = 0.16), and flow speed (p = 0.10). Multivariable Cox analysis showed that stent expansion was not the risk factor for MACE (hazard ratio, HR = 0.97, p = 0.13); however, stent expansion reduced the risk of MACE (HR = 0.95, p = 0.03) after excluding overexpansion patients. Overexpansion was an independent risk factor for no-reflow (HR = 1.27, p = 0.02) and MACE (HR = 1.45, p = 0.007). Subgroup analysis shows that mild underexpansion of 70%−80% was not a risk factor for MACE (HR = 1.11, p = 0.08) and no-reflow (HR = 1.4, p = 0.08); however, stent expansion <70% increased the risk of MACE (HR = 1.36, p = 0.04). Conclusions Stent expansion does not affect final QFR and MR, but it reduces flow speed in STEMI. Appropriate stent underexpansion of 70–80% does not seem to be associated with short-term prognosis, so it may be tolerable as noninferior compared with optimal expansion. Meanwhile, overexpansion and underexpansion of <70% should be avoided due to the independent risk of MACEs and no-reflow events.
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Affiliation(s)
- Xida Li
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
- Department of Cardiology, Southern Medical University, Guangzhou, China
| | - Shuo Sun
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Demou Luo
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xing Yang
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Jingguang Ye
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Xiaosheng Guo
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Shenghui Xu
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Boyu Sun
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Youti Zhang
- Department of Cardiology, Guangdong Provincial Jiexi People's Hospital, Jiexi, China
| | - Jianfang Luo
- Department of Cardiology, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shengxian Tu
| | - Haojian Dong
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Haojian Dong
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Terentes-Printzios D, Oikonomou D, Gkini KP, Gardikioti V, Aznaouridis K, Dima I, Tsioufis K, Vlachopoulos C. Angiography-based estimation of coronary physiology: A frame is worth a thousand words. Trends Cardiovasc Med 2021; 32:366-374. [PMID: 34329733 DOI: 10.1016/j.tcm.2021.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/04/2021] [Accepted: 07/21/2021] [Indexed: 02/04/2023]
Abstract
Cumulative evidence has shown that coronary revascularization should be guided by functional significance of coronary lesions. Fractional flow reserve (FFR) is the gold standard for assessment of hemodynamic significance of coronary stenosis and FFR-guided percutaneous coronary intervention has improved clinical outcomes in patients with coronary artery disease. However, limitations of FFR such as increased operational time and cost, requirement of pressure wire and adenosine and technical difficulties have led to significant underutilization of the method in clinical practice. In the last few years, several methods of FFR estimation based on coronary angiography images have emerged to overcome invasive FFR limitations. The common elements of the novel indices include a 3D anatomical reconstruction of coronary vessels by angiographic projections and various approaches to fluid dynamics computation. Angiography-derived FFR methods have shown high diagnostic accuracy compared to invasive FFR. Although there are promising results regarding their prognostic role, large randomized trials evaluating clinical outcomes are lacking. The aim of this review is to present currently available angiography-derived FFR indices and highlight their differences, advantages, disadvantages and potential clinical implications.
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Affiliation(s)
- Dimitrios Terentes-Printzios
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece.
| | - Dimitrios Oikonomou
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantia-Paraskevi Gkini
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Vasiliki Gardikioti
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Ioanna Dima
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, Athens, Greece
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Pagnoni M, Meier D, Candreva A, Maillard L, Adjedj J, Collet C, Mahendiran T, Cook S, Mujcinovic A, Dupré M, Rubimbura V, Roguelov C, Eeckhout E, De Bruyne B, Muller O, Fournier S. Future culprit detection based on angiography-derived FFR. Catheter Cardiovasc Interv 2021; 98:E388-E394. [PMID: 33913606 DOI: 10.1002/ccd.29736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We sought to characterize the hemodynamic impact of mild coronary artery disease (CAD) using quantitative flow ratio (QFR, an angiography-derived fractional flow reserve [FFR]) in a population of patients with only non-significant CAD at baseline that subsequently experienced a myocardial infarction (MI). BACKGROUND The discriminatory value of FFR in patients with mild CAD remains imperfect. METHODS We retrospectively included patients who underwent invasive coronary angiography for an MI, in whom another angiogram had been performed within the previous 5 years. Three-dimensional quantitative coronary angiography, QFR, and lesion length analysis were conducted on lesions responsible for the MI (future culprit lesions, [FCL]) as well as on control lesions (non-culprit lesions, [NCL]). RESULTS Eighty-three FCL and 117 NCL were analyzed in 83 patients: FCL were more severe (median % diameter of stenosis [DS] 39.1% [29.8; 45.7] vs. 29.8% [25.0; 37.2], p < .001), had lower QFR values (0.94 [0.86; 0.98] vs. 0.98 [0.96; 1.00], p < .001) and tended to be longer (15.2 mm [10.0; 27.3] vs. 12.7 mm [9.3; 22.4], p = .070) than NCL. In lesions with an interval < 2 years between baseline angiography and MI, the difference in QFR was more pronounced compared to the lesions with a longer interval (FCL: 0.92 [0.85; 0.97] vs. NCL: 0.98 [0.94; 1.00], p < .001 and FCL: 0.96 [0.88; 1.00] vs. NCL: 0.98 [0.96;1.00], p = .006 respectively) CONCLUSION: Mild coronary stenoses that are subsequently responsible for an MI (FCL) exhibit a higher DS and lower QFR years before the event. Furthermore, FCL with a lower QFR at baseline appear to lead earlier to MI.
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Affiliation(s)
- Mattia Pagnoni
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - David Meier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Luc Maillard
- Department of Cardiology, GCS ES Axium Rambot, Aix en Provence, France
| | - Julien Adjedj
- Department of Cardiology, Arnault Tzank Institute, Saint Laurent Du Var, France
| | - Carlos Collet
- Cardiovascular Center, OLV Ziekenhuis, Aalst, Belgium
| | - Thabo Mahendiran
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Cook
- Department of Cardiology, HFR Fribourg, Fribourg, Switzerland
| | - Alma Mujcinovic
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Marion Dupré
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Vladimir Rubimbura
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Christan Roguelov
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard De Bruyne
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Cardiovascular Center, OLV Ziekenhuis, Aalst, Belgium
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.,Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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Milzi A, Dettori R, Burgmaier K, Marx N, Reith S, Burgmaier M. Quantitative Flow Ratio Is Related to Intraluminal Coronary Stenosis Parameters as Assessed with Optical Coherence Tomography. J Clin Med 2021; 10:jcm10091856. [PMID: 33923243 PMCID: PMC8123110 DOI: 10.3390/jcm10091856] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Quantitative flow ratio (QFR) is a novel method for assessing hemodynamic relevance of a coronary lesion based on angiographic projections without the need of a pressure wire. Various studies demonstrated that QFR consistently related to fractional flow reserve (FFR); however, it is still unclear to what extent QFR reflects intraluminal stenosis parameters. Given that optical coherence tomography (OCT) is currently the gold standard to assess intraluminal stenosis parameters, we investigated the relationship between OCT-derived lesion geometry and QFR. Methods: We determined QFR in 97 lesions from 87 patients who underwent coronary angiography and OCT due to stable angina. QFR was measured with proprietary software and compared with OCT-based assessment of intraluminal stenosis parameters as well as lesion morphology. Results: Mean QFR was 0.79 ± 0.10. QFR demonstrated a consistent association with FFR (r = 0.834, p < 0.001). Interestingly, QFR was associated with OCT-derived parameters such as minimal lumen area (MLA, r = 0.390, p = 0.015), percent area stenosis (r = 0.412, p < 0.001), minimal lumen diameter (MLD, r = 0.395, p < 0.001), and percent diameter stenosis (r = 0.400, p < 0.001). Both minimal luminal area (ROC = 0.734, optimal cut-off 1.75 mm2) and minimal luminal diameter (ROC = 0.714, optimal cut-off 1.59 mm) presented a good diagnostic accuracy in diagnosing hemodynamic relevance (QFR ≤ 0.80). There was no significant association between QFR and anatomic features of plaque vulnerability. Conclusion: OCT-derived intraluminal stenosis parameters are related to QFR values and predict hemodynamic lesion relevance. The data supports the validity of QFR as 3D-vessel reconstruction method to assess coronary physiology without the need of a pressure wire.
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Affiliation(s)
- Andrea Milzi
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52074 Aachen, Germany; (R.D.); (N.M.); (S.R.); (M.B.)
- Correspondence: ; Tel.: +49-241-80-36098; Fax: +49-241-80-33-36304
| | - Rosalia Dettori
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52074 Aachen, Germany; (R.D.); (N.M.); (S.R.); (M.B.)
| | - Kathrin Burgmaier
- Department of Pediatrics, University Hospital Cologne, D-50441 Cologne, Germany;
| | - Nikolaus Marx
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52074 Aachen, Germany; (R.D.); (N.M.); (S.R.); (M.B.)
| | - Sebastian Reith
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52074 Aachen, Germany; (R.D.); (N.M.); (S.R.); (M.B.)
| | - Mathias Burgmaier
- Department of Cardiology, University Hospital of the RWTH Aachen, D-52074 Aachen, Germany; (R.D.); (N.M.); (S.R.); (M.B.)
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