1
|
Gohmann RF, Schug A, Krieghoff C, Seitz P, Majunke N, Buske M, Kaiser F, Schaudt S, Renatus K, Desch S, Leontyev S, Noack T, Kiefer P, Pawelka K, Lücke C, Abdelhafez A, Ebel S, Borger MA, Thiele H, Panknin C, Abdel-Wahab M, Horn M, Gutberlet M. Interrater Variability of ML-Based CT-FFR in Patients without Obstructive CAD before TAVR: Influence of Image Quality, Coronary Artery Calcifications, and Location of Measurement. J Clin Med 2024; 13:5247. [PMID: 39274460 PMCID: PMC11395889 DOI: 10.3390/jcm13175247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/16/2024] Open
Abstract
Objectives: CT-derived fractional flow reserve (CT-FFR) can improve the specificity of coronary CT-angiography (cCTA) for ruling out relevant coronary artery disease (CAD) prior to transcatheter aortic valve replacement (TAVR). However, little is known about the reproducibility of CT-FFR and the influence of diffuse coronary artery calcifications or segment location. The objective was to assess the reliability of machine-learning (ML)-based CT-FFR prior to TAVR in patients without obstructive CAD and to assess the influence of image quality, coronary artery calcium score (CAC), and the location of measurement within the coronary tree. Methods: Patients assessed for TAVR, without obstructive CAD on cCTA were evaluated with ML-based CT-FFR by two observers with differing experience. Differences in absolute values and categorization into hemodynamically relevant CAD (CT-FFR ≤ 0.80) were compared. Results in regard to CAD were also compared against invasive coronary angiography. The influence of segment location, image quality, and CAC was evaluated. Results: Of the screened patients, 109/388 patients did not have obstructive CAD on cCTA and were included. The median (interquartile range) difference of CT-FFR values was -0.005 (-0.09 to 0.04) (p = 0.47). Differences were smaller with high values. Recategorizations were more frequent in distal segments. Diagnostic accuracy of CT-FFR between both observers was comparable (proximal: Δ0.2%; distal: Δ0.5%) but was lower in distal segments (proximal: 98.9%/99.1%; distal: 81.1%/81.6%). Image quality and CAC had no clinically relevant influence on CT-FFR. Conclusions: ML-based CT-FFR evaluation of proximal segments was more reliable. Distal segments with CT-FFR values close to the given threshold were prone to recategorization, even if absolute differences between observers were minimal and independent of image quality or CAC.
Collapse
Affiliation(s)
- Robin F Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Adrian Schug
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Christian Krieghoff
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Patrick Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Nicolas Majunke
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Maria Buske
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Fyn Kaiser
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Sebastian Schaudt
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Katharina Renatus
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Sergey Leontyev
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Konrad Pawelka
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Christian Lücke
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Ahmed Abdelhafez
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | | | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Matthias Horn
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstr. 16-18, 04107 Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
- Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany
| |
Collapse
|
2
|
Zhang S, Wang M, Gan Q, Zhai X, Chen Y, Guan S, Xu X, Wen J, Qu X, Han W. Prognostic Value of Quantitative Flow Ratio Combined with SYNTAX Scores I/II in Multivessel Coronary Artery Disease: A Small-Sample, Single-Center Study. Rev Cardiovasc Med 2024; 25:329. [PMID: 39355580 PMCID: PMC11440452 DOI: 10.31083/j.rcm2509329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 10/03/2024] Open
Abstract
Background A fractional flow reserve (FFR)-fixed-SYNTAX score could decrease the number of high-risk patients. This study explored the prognostic value of non-invasive quantitative flow ratio (QFR)-fixed-SYNTAX I/II scores in multivessel disease patients. Methods This was a single-center, small-sample, observational study. Multivessel coronary disease patients were enrolled and finished a 1-year follow-up. SYNTAX scores I/II and functional SYNTAX scores I/II based on QFR (cut-off value of 0.85) were calculated for all patients. The composite occurrence of cardiac deaths, any myocardial infarction, or ischemia-driven revascularization were analyzed using a different score system. Results A total of 160 patients were stratified into risk groups based on a different scoring system. FSS (functional SYNTAX score) and FSSII (functional SYNTAX score II) reduce the radio of high-risk major adverse cardiovascular events (MACEs), transforming the patients from high-risk to medium- and low-risk. Furthermore, FSSII (hazard ratio (HR): 1.069, 95% CI: 1.025-1.115, p = 0.002) showed a better relationship with MACEs than the other score systems. After recalculating SSII, the survival-free ratio stratified by FSSII decreased from 38.46% to 27.27% in the high-risk group and increased from 84.09% to 86.05% in the low-risk group. Conclusions FSS or FSSII could decrease the number of high-risk patients compared to SYNTAX score (SS) and FSS. SYNTAX II score (SSII) and FSSII showed a better predictive ability than other scoring systems for under-risk stratification.
Collapse
Affiliation(s)
- Shuyi Zhang
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| | - Ming Wang
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| | - Qian Gan
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| | - Xinrong Zhai
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| | - Yang Chen
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| | - Shaofeng Guan
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| | - Xinxin Xu
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| | - Jiasheng Wen
- Department of Cardiology, Kunshan Hospital of Traditional Chinese Medicine, 215300 Kunshan, Jiangsu, China
| | - Xinkai Qu
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| | - Wenzheng Han
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, 200040 Shanghai, China
| |
Collapse
|
3
|
Zhao L, Chen BH, Tang H, Wang YY, Gu ZY, An DA, Wu LM, Xue S. The association between cardiac T2*BOLD and quantitative flow ratio (QFR) in the diagnosis of stenotic coronary arteries in patients with multi-vessel coronary artery disease. LA RADIOLOGIA MEDICA 2024; 129:1184-1196. [PMID: 38997567 DOI: 10.1007/s11547-024-01847-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND T2*BOLD is based on myocardial deoxyhemoglobin content to reflect the state of myocardial oxygenation. Quantitative flow ratio is a tool for assessing coronary blood flow based on invasive coronary angiography. PURPOSE This study aimed to evaluate the correlation between T2*BOLD and QFR in the diagnosis of stenotic coronary arteries in patients with multi-vessel coronary artery disease. METHODS Fifty patients with MVCAD with at least 1 significant coronary artery stenosis (diameter stenosis > 50%) and 21 healthy control subjects underwent coronary angiography combined with QFR measurements and cardiovascular magnetic resonance (CMR). QFR ≤ 0.80 was considered to indicate the presence of hemodynamic obstruction. RESULTS Totally 60 (54%) obstructive vessels had hemodynamic change. Between stenotic coronary arteries (QFR ≤ 0.8) and normal vessels, T2*BOLD showed AUCs of 0.97, 0.69, and 0.91 for left anterior descending (LAD), left circumflex (LCX) and right coronary (RCA) arteries and PI displayed AUCs of 0.89, 0.77 and 0.90 (all p > 0.05, except for LAD). The AUCs of T2*BOLD between stenotic coronary arteries (QFR > 0.8) and normal vessels were 0.86, 0.72, and 0.85 for LAD, LCX and RCA; while, PI showed AUCs of 0.93, 0.86, and 0.88, respectively (p > 0.05). Moreover, T2*BOLD displayed AUCs of 0.96, 0.74, and 0.91 for coronary arteries as before between coronary arteries with stenosis (QFR ≤ 0.8 and > 0.8), but the mean PI of LAD, LCX and RCA showed no significant differences between them. CONCLUSION T2* BOLD and QFR have good correlation in diagnosing stenotic coronary arteries with hemodynamic changes in patients with stable multi-vessel CAD. T2* BOLD is superior to semi-quantitative perfusion imaging in analyzing myocardial ischemia without stress.
Collapse
Affiliation(s)
- Lei Zhao
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Bing-Hua Chen
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Hui Tang
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Yong-Yi Wang
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Zi-Yi Gu
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Dong-Aolei An
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
| | - Song Xue
- Department of Cardiovascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 PuJian Road, Shanghai, 200127, People's Republic of China.
| |
Collapse
|
4
|
Han W, Liang L, Han T, Wang Z, Shi L, Li Y, Chang F, Cao Y, Zhang C, Wu H. Diagnostic performance of the quantitative flow ratio and CT-FFR for coronary lesion-specific ischemia. Sci Rep 2024; 14:16969. [PMID: 39043839 PMCID: PMC11266565 DOI: 10.1038/s41598-024-68212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/22/2024] [Indexed: 07/25/2024] Open
Abstract
Fractional flow reserve (FFR) has become the gold standard for evaluating coronary lesion-specific ischemia. However, FFR is an invasive method that may cause possible complications in the coronary artery and requires expensive equipment, which limits its use. Promising noninvasive diagnostic methods, such as computed tomography angiography-derived FFR (CT-FFR) and the quantitative flow ratio (QFR), have been proposed. In this study, we evaluated the diagnostic performance of the QFR and CT-FFR in predicting coronary lesion-specific ischemia, with the FFR serving as the reference standard. Patients with suspected or known coronary artery disease who underwent coronary CT angiography revealing 30-90% diameter stenosis in the main coronary artery (≥ 2.0 mm reference diameter) were enrolled. The FFR was measured during invasive coronary angiography (within 15 days after coronary CT angiography). An FFR ≤ 0.8 was the reference standard for coronary lesion-specific ischemia. A total of 103 vessels from 92 consecutive patients (aged 59.8 ± 9.2 years; 60.9% were men) were evaluated. The diagnostic performance of a QFR ≤ 0.80 for predicting coronary lesion-specific ischemia demonstrated good diagnostic accuracy, sensitivity, and specificity (92.2%, 87.2%, and 96.4%, respectively), with an area under the receiver operating characteristic curve (AUC) of 0.987 (P < 0.0001). The diagnostic performance of a CT-FFR ≤ 0.80 for predicting coronary lesion-specific ischemia also demonstrated good diagnostic accuracy, sensitivity, and specificity (96.1%, 95.7%, and 96.4%, respectively), with an AUC of 0.967 (P < 0.0001). However, there was no significant difference in the AUC between a QFR ≤ 0.80 and a CT-FFR ≤ 0.80 for predicting coronary lesion-specific ischemia (P = 0.319). There was an excellent correlation between the QFR and FFR (r = 0.856, P < 0.0001). The CT-FFR and FFR also showed a good direct correlation (r = 0.816, P < 0.0001). The QFR and CT-FFR are strongly correlated with the FFR and can provide excellent clinical diagnostic performance for coronary lesion-specific ischemia detection.
Collapse
Affiliation(s)
- Wenqi Han
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Lei Liang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Tuo Han
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710068, Shaanxi, China
| | - Zhenyu Wang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Lei Shi
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Yuan Li
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Fengjun Chang
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Yiwei Cao
- Department of Electrocardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Chunyan Zhang
- Department of Cardiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710068, Shaanxi, China
| | - Haoyu Wu
- Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China.
| |
Collapse
|
5
|
Edrisnia H, Sarkhosh MH, Mohebbi B, Parhizgar SE, Alimohammadi M. Non-invasive fractional flow reserve estimation in coronary arteries using angiographic images. Sci Rep 2024; 14:15640. [PMID: 38977740 PMCID: PMC11231276 DOI: 10.1038/s41598-024-65626-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
Coronary artery disease is the leading global cause of mortality and Fractional Flow Reserve (FFR) is widely regarded as the gold standard for assessing coronary artery stenosis severity. However, due to the limitations of invasive FFR measurements, there is a pressing need for a highly accurate virtual FFR calculation framework. Additionally, it's essential to consider local haemodynamic factors such as time-averaged wall shear stress (TAWSS), which play a critical role in advancement of atherosclerosis. This study introduces an innovative FFR computation method that involves creating five patient-specific geometries from two-dimensional coronary angiography images and conducting numerical simulations using computational fluid dynamics with a three-element Windkessel model boundary condition at the outlet to predict haemodynamic distribution. Furthermore, four distinct boundary condition methodologies are applied to each geometry for comprehensive analysis. Several haemodynamic features, including velocity, pressure, TAWSS, and oscillatory shear index are investigated and compared for each case. Results show that models with average boundary conditions can predict FFR values accurately and observed errors between invasive FFR and virtual FFR are found to be less than 5%.
Collapse
Affiliation(s)
- Hadis Edrisnia
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | | | - Bahram Mohebbi
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ehsan Parhizgar
- Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Mona Alimohammadi
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| |
Collapse
|
6
|
Tian M, Xu B, Chen L, Wu F, Zhang R, Guan C, Xie L, Wang X, Hu S. Quantitative flow ratio and graft outcomes of coronary artery bypass grafting surgery: A retrospective study. J Thorac Cardiovasc Surg 2024; 168:121-132.e10. [PMID: 37084819 DOI: 10.1016/j.jtcvs.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE Quantitative flow ratio (QFR) is a novel noninvasive tool for the functional assessment of coronary stenosis. Whether or not QFR could predict graft outcomes after coronary artery bypass grafting procedure is unknown. This study aimed to investigate the association of QFR value with graft outcomes after coronary artery bypass grafting surgery. METHODS The QFR values were retrospectively obtained from patients receiving coronary artery bypass grafting surgery from 2017 to 2019 in the Graft Patency Between No-Touch Vein Harvesting Technique and Conventional Approach in Coronary Artery Bypass Graft Surgery (PATENCY) trial. QFR calculation was conducted in eligible coronary arteries, defined as those with ≥50% stenosis and a diameter ≥1.5 mm. A threshold of QFR ≤0.80 was considered functionally significant stenosis. The primary outcome was graft occlusion at 12 months evaluated by computed tomography angiography. RESULTS Two thousand twenty-four patients with 7432 grafts (2307 arterial grafts and 5125 vein grafts) were included. For the arterial grafts, the risk of 12-month occlusion was significantly increased in the QFR >0.80 group than in the QFR ≤0.80 group (7.1% vs 2.6%; P = .001; unadjusted model: odds ratio, 3.08; 95% CI, 1.65-5.75; fully adjusted model: odds ratio, 2.67; 95% CI, 1.44-4.97). No significant association was observed in the vein grafts (4.6% vs 4.3%; P = .67; unadjusted model: odds ratio, 1.10; 95% CI, 0.82-1.47; fully adjusted model: odds ratio, 1.12; 95% CI, 0.83-1.51). Results were stable across sensitivity analyses with a QFR threshold of 0.78 and 0.75. CONCLUSIONS Target vessel QFR >0.80 was associated with a significantly higher risk of arterial graft occlusion at 12 months after coronary artery bypass grafting surgery. No significant association was found between target lesion QFR and vein graft occlusion.
Collapse
Affiliation(s)
- Meice Tian
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China
| | - Liang Chen
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Wu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Zhang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changdong Guan
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lihua Xie
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xianqiang Wang
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengshou Hu
- Department of Surgery, National Center for Cardiovascular Disease, China and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
7
|
Chen Z, Zhang J, Cai Y, Zhao H, Wang D, Li C, He Y. Diagnostic performance of angiography-derived fractional flow reserve and CT-derived fractional flow reserve: A systematic review and Bayesian network meta-analysis. J Evid Based Med 2024; 17:119-133. [PMID: 38205918 DOI: 10.1111/jebm.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Accumulating evidence has demonstrated that fractional flow reserves (FFRs) derived from invasive coronary angiograms (CA-FFRs) and coronary computed tomography angiography-derived FFRs (CT-FFRs) are promising alternatives to wire-based FFRs. However, it remains unclear which method has better diagnostic performance. This systematic review and meta-analysis aimed to compare the diagnostic performances of the two approaches. METHODS The Cochrane Library, PubMed, Embase, Medline (Ovid), the Chinese China National Knowledge Infrastructure Database (CNKI), VIP, and WanFang Data databases were searched for relevant studies that included comparisons between CA-FFR and CT-FFR, from their respective database inceptions until January 1, 2023. Studies where both noninvasive FFR (including CA-FFR and CT-FFR) and invasive FFR (as a reference standard) were performed for the diagnosis of ischemic coronary artery disease and were designed as prospective, paired diagnostic studies, were pulled. The diagnostic test accuracy method and Bayesian hierarchical summary receiver operating characteristic (ROC) model for network meta-analysis (NMA) of diagnostic tests (HSROC-NMADT) were both used to perform a meta-analysis on the data. RESULTS Twenty-six studies were included in this NMA. The results from both the diagnostic test accuracy and HSROC-NMADT methods revealed that the diagnostic accuracy of CA-FFR was higher than that of CT-FFR, in terms of sensitivity (Se; 0.86 vs. 0.84), specificity (Sp; 0.90 vs. 0.78), positive predictive value (PPV; 0.83 vs. 0.70), and negative predictive value (NPV; 0.91 vs. 0.89) for the detection of myocardial ischemia. A cumulative ranking curve analysis indicated that CA-FFR had a higher diagnostic accuracy than CT-FFR in the context of this study, with a higher area under the ROC curve (AUC; 0.94 vs. 0.87). CONCLUSIONS Although both of these two commonly used virtual FFR methods showed high levels of diagnostic accuracy, we demonstrated that CA-FFR had a better Se, Sp, PPV, NPV, and AUC than CT-FFR. However, this study provided only indirect comparisions; therefore, larger studies are warranted to directly compare the diagnostic performances of these two approaches.
Collapse
Affiliation(s)
- Zhongxiu Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Junyan Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yujia Cai
- Chinese Evidence-based Medicine Center and MAGIC-China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongsen Zhao
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Chen Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
8
|
Wu X, Wang K, Li G, Wu J, Jiang J, Gao F, Zhu L, Xu Q, Wang X, Xu M, Chen H, Ma L, Han X, Luo N, Tu S, Wang J, Hu X. Diagnostic Performance of Angiography-Derived Quantitative Flow Ratio in Complex Coronary Lesions. Circ Cardiovasc Imaging 2024; 17:e016046. [PMID: 38502735 DOI: 10.1161/circimaging.123.016046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/23/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Quantitative flow ratio derived from computed tomography angiography (CT-QFR) and invasive coronary angiography (Murray law-based quantitative flow ratio [μQFR]) are novel approaches enabling rapid computation of fractional flow reserve without the use of pressure guidewires and vasodilators. However, the feasibility and diagnostic performance of both CT-QFR and μQFR in evaluating complex coronary lesions remain unclear. METHODS Between September 2014 and September 2021, 240 patients with 30% to 90% coronary diameter stenosis who underwent both coronary computed tomography angiography and invasive coronary angiography with fractional flow reserve within 60 days were retrospectively enrolled. The diagnostic performance of CT-QFR and μQFR in detecting functional ischemia among all lesions, especially complex coronary lesions, was analyzed using fractional flow reserve as the reference standard. RESULTS CT-QFR and μQFR analyses were performed on 309 and 289 vessels, respectively. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for CT-QFR in all lesions at the per-vessel level were 91% (with a 95% CI of 84%-96%), 92% (95% CI, 88%-95%), 83% (95% CI, 75%-90%), 96% (95% CI, 93%-98%), and 92% (95% CI, 88%-95%), with values for μQFR of 90% (95% CI, 81%-95%), 97% (95% CI, 93%-99%), 92% (95% CI, 84%-97%), 96% (95% CI, 92%-98%), and 94% (95% CI, 91%-97%), respectively. Among bifurcation, tandem, and moderate-to-severe calcified lesions, the diagnostic values of CT-QFR and μQFR showed great correlation and agreement with those of invasive fractional flow reserve, achieving an area under the receiver operating characteristic curve exceeding 0.9 for each complex lesion at the vessel level. Furthermore, the accuracies of CT-QFR and μQFR in the gray zone were 85% and 84%, respectively. CONCLUSIONS Angiography-derived quantitative flow ratio (CT-QFR and μQFR) demonstrated remarkable diagnostic performance in complex coronary lesions, indicating its pivotal role in the management of patients with coronary artery disease.
Collapse
Affiliation(s)
- Xianpeng Wu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Kan Wang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Guohua Li
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Jie Wu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, Jinhua People's Hospital, Jinhua, China (J. Wu)
| | - Jun Jiang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Feng Gao
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Lingjun Zhu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Qiyuan Xu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Xinhong Wang
- Department of Radiology (X. Wang, M.X.), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengxi Xu
- Department of Radiology (X. Wang, M.X.), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Chen
- Department of Cardiology (H.C., L.M.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Longhui Ma
- Department of Cardiology (H.C., L.M.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xianjun Han
- Department of Radiology (X. Han, N.L.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Nan Luo
- Department of Radiology (X. Han, N.L.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (S.T.)
| | - Jian'an Wang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Xinyang Hu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| |
Collapse
|
9
|
Fezzi S, Pighi M, Del Sole PA, Scarsini R, Mammone C, Zanforlin R, Ferrero V, Lunardi M, Tavella D, Pesarini G, Ribichini FL. Long-term intracoronary imaging and physiological measurements of bioresorbable scaffolds and untreated atherosclerotic plaques. Int J Cardiol 2024; 394:131341. [PMID: 37678431 DOI: 10.1016/j.ijcard.2023.131341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Bioresorbable scaffolds (BRS) provide the prospect of restoring the anatomic and physiologic characteristics of the vascular wall. OBJECTIVE This study sought to examine the long-term outcomes of BRS-based coronary intervention in a young population with diffuse and severe coronary atherosclerotic disease (CAD) and to compare the long-term evolution of treated segments versus the natural progression of untreated non-flow limiting stenoses. METHODS Observational, single-center cohort study that prospectively included patients that underwent percutaneous coronary intervention with implantation of ABSORB BRS (Abbott Vascular). The clinical endpoint was the incidence of device-oriented composite endpoint (DoCE) up to 5 years follow-up. A subgroup of patients with baseline intracoronary imaging assessment of long lesions and/or multivessel disease underwent elective angiographic (70 patients, 129 lesions) and intracoronary imaging (55 patients, 102 lesions) follow-up. Paired intravascular ultrasound (IVUS) and quantitative flow reserve (QFR) were analyzed. RESULTS Between 2012 and 2017, 159 patients (mean age 54.0 ± 11.1) with native CAD were treated with BRS on 247 lesions. Patients were mainly at their first cardiac event, mostly acute coronary syndromes (86.5%). At the median follow-up time of 56 months [41-65], DoCE occurred in 15/159 (9.4%) patients, while non-target vessel-oriented composite endpoint occurred in 16 patients (10.4%). A significant atherosclerotic progression was detected on residual non-flow limiting plaques as per IVUS and QFR assessment, while no significant change was detected in the treated segment. CONCLUSIONS Mild-to-moderate asymptomatic CAD progressed significantly at 5-year despite OMT. BRS-treated segments had a less aggressive progression at 5-year despite more severe and symptomatic CAD at baseline.
Collapse
Affiliation(s)
- Simone Fezzi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy; The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, University of Galway, Galway, Ireland
| | - Michele Pighi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Paolo Alberto Del Sole
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Concetta Mammone
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Roberto Zanforlin
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Valeria Ferrero
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Domenico Tavella
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Gabriele Pesarini
- Division of Cardiology, Department of Medicine, Verona University Hospital, Verona, Italy
| | | |
Collapse
|
10
|
Kotoku N, Ninomiya K, Ding D, O'Leary N, Tobe A, Miyashita K, Masuda S, Kageyama S, Garg S, Leipsic JA, Mushtaq S, Andreini D, Tanaka K, de Mey J, Wijns W, Tu S, Piazza N, Onuma Y, Serruys PW. Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters. Int J Cardiovasc Imaging 2024; 40:195-206. [PMID: 37870715 PMCID: PMC10774209 DOI: 10.1007/s10554-023-02974-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
Murray law-based quantitative flow ratio (µQFR) assesses fractional flow reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised in suboptimal angiographic projections. FFRCT is a well-validated non-invasive method measuring FFR from coronary computed tomographic angiography (CCTA). We evaluated the feasibility of µQFR in left main (LM) bifurcations, the impact of the optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance with FFRCT. In 300 patients with three-vessel disease, the values of FFRCT and µQFR were compared at distal LM, proximal left anterior descending artery (pLAD) and circumflex artery (pLCX). The optimal viewing angle of LM bifurcation was defined on CCTA by 3-dimensional coordinates and converted into a 2-dimensional fluoroscopic view. The best fluoroscopic projection was considered the closest angulation to the optimal viewing angle on CCTA. µQFR was successfully computed in 805 projections. In the best projections, µQFR sensitivity was 88.2% (95% CI 76.1-95.6) and 84.8% (71.1-93.7), and specificity was 96.8% (93.8-98.6) and 97.2% (94.4-98.9), in pLAD and pLCX, respectively, with regard to FFRCT. The AUC of µQFR for predicting FFRCT ≤ 0.80 tended to be improved using the best versus suboptimal projections (0.94 vs. 0.89 [p = 0.048] in pLAD; 0.94 vs. 0.88 [p = 0.075] in pLCX). Computation of µQFR in LM bifurcations using a single angiographic view showed high feasibility from post-hoc analysis of coronary angiograms obtained for clinical purposes. The fluoroscopic viewing angle influences the diagnostic performance of physiological assessment using a single angiographic view.
Collapse
Affiliation(s)
- Nozomi Kotoku
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Neil O'Leary
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Akihiro Tobe
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kotaro Miyashita
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Saima Mushtaq
- Departments of Cardiovascular Imaging and Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland.
| |
Collapse
|
11
|
Luo D, Wu H, Zhou W, Zhang J, Jin X, Xu C, Huang B, Yang J, Jiang H, Chen J. Angio-based coronary functional assessment predicts 30-day new-onset heart failure after acute myocardial infarction. ESC Heart Fail 2023; 10:2914-2926. [PMID: 37455355 PMCID: PMC10567646 DOI: 10.1002/ehf2.14452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/10/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
AIMS Suboptimal perfusion leading to heart failure (HF) often occurs after ST-segment elevation myocardial infarction (STEMI), despite restoration of epicardial coronary flow in primary percutaneous coronary intervention (PPCI) era. We determined the clinical implications of angio-based coronary functional assessment in evaluation of suboptimal perfusion and further outcomes among STEMI patients after successful PPCI. METHODS AND RESULTS In this study, STEMI patients in the Chinese STEMI PPCI registry trial (NCT04996901) who achieved post-PPCI thrombolysis in myocardial infarction grade 3 flow were retrospectively screened. Post-procedural quantitative flow ratio (QFR), angio-based microvascular resistance (AMR), and coronary flow velocity (CFV) of the infarct-related artery were calculated. QFR and AMR measure epicardial stenosis severity and microvascular resistance, respectively. QFR+ was defined as QFR < 0.90 while QFR- was QFR ≥ 0.90. AMR+ was defined as AMR ≥ 250 mmHg*s/m while AMR- was AMR < 250 mmHg*s/m. The primary outcome was 30-day new-onset HF. The Kaplan-Meier curves were used to establish the associations between QFR, AMR, CFV, and HF incidences. The relationship between CFV and combined QFR and AMR indices was further assessed. Independent predictors were determined using Cox regression analysis. The receiver-operating characteristic curve was used to assess discriminant ability to predict HF. A total of 942 patients (mean age was 57.8 ± 11.7 years and 84.6% were men) were enrolled. Among them, 129 patients had new-onset HF episodes. Patients in the QFR-/AMR- group had a low risk of HF compared with those in the QFR+/AMR+ group (10.5% vs. 27.3%, P = 0.027). A higher CFV ≥ 17.4 cm/s was associated with low HF incidences as compared with CFV < 17.4 cm/s (10.3% vs. 16.8%, P = 0.005), whereas isolated QFR or AMR did not reveal any marked differences in HF incidences (P = 0.150 and 0.079, respectively). The highest and lowest medians of CFV were observed in the QFR-/AMR- and QFR+/AMR+ groups, respectively. CFV correlated well with the QFR/AMR ratio (adjusted R2 = 1, P < 0.001) and post-PPCI CFV was found to be an independent predictor of post-STEMI HF (adjusted hazard ratio: 0.61, 95% confidence interval: 0.41-0.90, P = 0.012). The area under curve estimate of the multivariable regression model was 0.749. CONCLUSIONS CFV is an integrated coronary physiological assessment approach that incorporates epicardial and microcirculatory contributions. Patients with post-PPCI CFV < 17.4 cm/s were strongly associated with a high risk for post-STEMI HF, even achieving thrombolysis in myocardial infarction grade 3 flow. The immediate angio-based coronary functional assessment is a feasible tool for evaluating suboptimal perfusion and risk stratification.
Collapse
Affiliation(s)
- Da Luo
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Research Institute of Wuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Hui Wu
- Institute of Cardiovascular DiseaseChina Three Gorges UniversityYichangChina
- Department of CardiologyYichang Central People's HospitalYichangChina
| | - Wenjie Zhou
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Research Institute of Wuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Jing Zhang
- Institute of Cardiovascular DiseaseChina Three Gorges UniversityYichangChina
- Department of CardiologyYichang Central People's HospitalYichangChina
| | - Xing Jin
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Research Institute of Wuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Changwu Xu
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Research Institute of Wuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Bing Huang
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Research Institute of Wuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Jian Yang
- Institute of Cardiovascular DiseaseChina Three Gorges UniversityYichangChina
- Department of CardiologyYichang Central People's HospitalYichangChina
| | - Hong Jiang
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Research Institute of Wuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| | - Jing Chen
- Department of CardiologyRenmin Hospital of Wuhan UniversityWuhanChina
- Cardiovascular Research Institute of Wuhan UniversityWuhanChina
- Hubei Key Laboratory of CardiologyWuhanChina
| |
Collapse
|
12
|
Zhu Y, Zhou G, Yang L, Liu K, Xie Y, Yang WY, Dai Q. Predictive value of intravascular ultrasound for the function of intermediate coronary lesions. BMC Cardiovasc Disord 2023; 23:457. [PMID: 37710160 PMCID: PMC10500773 DOI: 10.1186/s12872-023-03489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/01/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Intravascular ultrasound (IVUS) can provide detailed coronary anatomic parameters. The purpose of our study was to evaluate the parameters measured by IVUS for the prediction of intermediate coronary lesions function by referencing quantitative fraction ratio (QFR) ≤ 0.80 (vs. > 0.80). METHODS Eighty four cases with 92 intermediate coronary lesions in vessels with a diameter ≥ 2.50 mm were enrolled. Paired assessment of IVUS and cQFR was available, and vessels with cQFR ≤ 0.8 were considered the positive reference standard. Logistic regression was used to select model variables by a maximum partial likelihood estimation test and receiver operating characteristic curve (ROC) analysis to evaluate the diagnostic value of different indices. RESULTS Plaque burden (PB) and lesion length (LL) of IVUS were independent risk factors for the function of coronary lesions. The predictive probability P was derived from the combined PB and LL model. The area under the curve (AUC) of PB, (minimum lumen area) MLA, and LL and the predicted probability P are 0.789,0.732,0731, and 0.863, respectively (P < 0.01). The AUC of the predicted probability P was the biggest among them; the prediction accuracy of cQFR ≤ 0.8 was 84.8%, and the sensitivity of the diagnostic model was 0.826, specificity was 0. 725, and P < 0.01. CONCLUSION PB and LL of IVUS were independent risk factors influencing the function of intermediate coronary lesions. The model combining the PB and LL may predict coronary artery function better than any other single parameter.
Collapse
Affiliation(s)
- Yajuan Zhu
- Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, No.100, Haining Rd, Hongkou District, Shanghai, 200080, China
| | - Guowei Zhou
- Department of Cardiology, Shanghai General Hospital of Shanghai Jiao Tong University School of Medicine, No.100, Haining Rd, Hongkou District, Shanghai, 200080, China
| | - Lei Yang
- Department of Emergency, Shanghai General Hospital of Shanghai Jiao Tong University School of Medicine, No.100, Haining Rd, Hongkou District, Shanghai, 200080, China
| | - Keng Liu
- Menghai County People's Hospital, Xishuangbanna, Yunnan Province, China
| | - Yuning Xie
- School of Oral Medicine, Nanjing Medical University, No.1, Shanghai RD, Nanjing City, Jiangsu Province, China
| | - Wen-Yi Yang
- Department of Cardiology, Shanghai General Hospital of Shanghai Jiao Tong University School of Medicine, No.100, Haining Rd, Hongkou District, Shanghai, 200080, China.
| | - Qiuyan Dai
- Department of Cardiology, Shanghai General Hospital of Nanjing Medical University, No.100, Haining Rd, Hongkou District, Shanghai, 200080, China.
| |
Collapse
|
13
|
Guan X, Song D, Li C, Hu Y, Leng X, Sheng X, Bao L, Pan Y, Dong L, Jiang J, Xiang J, Jiang W. Functional Assessment of Coronary Artery Stenosis from Coronary Angiography and Computed Tomography: Angio-FFR vs. CT-FFR. J Cardiovasc Transl Res 2023; 16:905-915. [PMID: 36913125 DOI: 10.1007/s12265-023-10361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023]
Abstract
This study was designed to compare the diagnostic performance of angio-FFR and CT-FFR for detecting hemodynamically significant coronary stenosis. Angio-FFR and CT-FFR were measured in 110 patients (139 vessels) with stable coronary disease using invasive FFR as the reference standard. On per-patient basis, angio-FFR was highly correlated with FFR (r =0.78, p <0.001), while the correlation was moderate between CT-FFR and FFR (r =0.68, p <0.001). Diagnostic accuracy, sensitivity, and specificity for angio-FFR were 94.6%, 91.4%, and 96.0%, respectively; and those of CT-FFR were 91.8%, 91.4%, and 92%, respectively. Bland-Altman analysis showed that angio-FFR had a larger average difference and a smaller root mean squared deviation than CT-FFR compared with FFR (-0.014±0.056 vs. 0.0003±0.072). Angio-FFR had a slightly higher AUC than that of CT-FFR (0.946 vs. 0.935, p =0.750). Angio-FFR and CT-FFR computed from coronary images could be accurate and efficient computational tools for detecting lesion-specific ischemia of coronary artery stenosis. Angio-FFR and CT-FFR calculated based on the two types of images can both accurately diagnose functional ischemia of coronary stenosis. CT-FFR can act as a gatekeeper to the catheter room, assisting doctors in determining whether patients need to be screened by coronary angiography. Angio-FFR can be used in the catheter room to determine the functional significant stenosis for helping decision-making in revascularization.
Collapse
Affiliation(s)
- Xueqiang Guan
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dan Song
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Changling Li
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yumeng Hu
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | | | - Xiaosheng Sheng
- Department of Cardiology, Jinhua People's Hospital, Jinhua, China
| | - Lifang Bao
- Department of Electrophysiology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Yibin Pan
- Department of Cardiology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Liang Dong
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Wenbing Jiang
- Department of Cardiology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China.
| |
Collapse
|
14
|
Huang W, Zhang J, Yang L, Hu Y, Leng X, Liu Y, Jin H, Tang Y, Wang J, Liu X, Guo Y, Ye C, Feng Y, Xiang J, Tang L, Du C. Accuracy of intravascular ultrasound-derived virtual fractional flow reserve (FFR) and FFR derived from computed tomography for functional assessment of coronary artery disease. Biomed Eng Online 2023; 22:64. [PMID: 37370077 PMCID: PMC10303302 DOI: 10.1186/s12938-023-01122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Coronary computed tomography-derived fractional flow reserve (CT-FFR) and intravascular ultrasound-derived fractional flow reserve (IVUS-FFR) are two functional assessment methods for coronary stenoses. However, the calculation algorithms for these methods differ significantly. This study aimed to compare the diagnostic performance of CT-FFR and IVUS-FFR using invasive fractional flow reserve (FFR) as the reference standard. METHODS Six hundred and seventy patients (698 lesions) with known or suspected coronary artery disease were screened for this retrospective analysis between January 2020 and July 2021. A total of 40 patients (41 lesions) underwent intravascular ultrasound (IVUS) and FFR evaluations within six months after completing coronary CT angiography were included. Two novel CFD-based models (AccuFFRct and AccuFFRivus) were used to compute the CT-FFR and IVUS-FFR values, respectively. The invasive FFR ≤ 0.80 was used as the reference standard for evaluating the diagnostic performance of CT-FFR and IVUS-FFR. RESULTS Both AccuFFRivus and AccuFFRct demonstrated a strong correlation with invasive FFR (R = 0.7913, P < 0.0001; and R = 0.6296, P < 0.0001), and both methods showed good agreement with FFR. The area under the receiver operating characteristic curve was 0.960 (P < 0.001) for AccuFFRivus and 0.897 (P < 0.001) for AccuFFRct in predicting FFR ≤ 0.80. FFR ≤ 0.80 were predicted with high sensitivity (96.6%), specificity (85.7%), and the Youden index (0.823) using the same cutoff value of 0.80 for AccuFFRivus. A good diagnostic performance (sensitivity 89.7%, specificity 85.7%, and Youden index 0.754) was also demonstrated by AccuFFRct. CONCLUSIONS AccuFFRivus, computed from IVUS images, exhibited a high diagnostic performance for detecting myocardial ischemia. It demonstrated better diagnostic power than AccuFFRct, and could serve as an accurate computational tool for ischemia diagnosis and assist in clinical decision-making.
Collapse
Affiliation(s)
- Wenhao Huang
- Department of Medicine, The Second College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jingyuan Zhang
- Department of Medicine, The Second College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lin Yang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yumeng Hu
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | | | - Yajun Liu
- Department of Medicine, The Second College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongfeng Jin
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Yiming Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Jiangting Wang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Xiaowei Liu
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Yitao Guo
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Chen Ye
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Yue Feng
- Department of Radiology, Zhejiang Hospital, Hangzhou, China
| | | | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China.
| | - Changqing Du
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China.
| |
Collapse
|
15
|
de Oliveira Laterza Ribeiro M, Correia VM, Herling de Oliveira LL, Soares PR, Scudeler TL. Evolving Diagnostic and Management Advances in Coronary Heart Disease. Life (Basel) 2023; 13:951. [PMID: 37109480 PMCID: PMC10143565 DOI: 10.3390/life13040951] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
Despite considerable improvement in diagnostic modalities and therapeutic options over the last few decades, the global burden of ischemic heart disease is steadily rising, remaining a major cause of death worldwide. Thus, new strategies are needed to lessen cardiovascular events. Researchers in different areas such as biotechnology and tissue engineering have developed novel therapeutic strategies such as stem cells, nanotechnology, and robotic surgery, among others (3D printing and drugs). In addition, advances in bioengineering have led to the emergence of new diagnostic and prognostic techniques, such as quantitative flow ratio (QFR), and biomarkers for atherosclerosis. In this review, we explore novel diagnostic invasive and noninvasive modalities that allow a more detailed characterization of coronary disease. We delve into new technological revascularization procedures and pharmacological agents that target several residual cardiovascular risks, including inflammatory, thrombotic, and metabolic pathways.
Collapse
Affiliation(s)
| | | | | | | | - Thiago Luis Scudeler
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| |
Collapse
|
16
|
Dutta U, Sinha A, Demir OM, Ellis H, Rahman H, Perera D. Coronary Slow Flow Is Not Diagnostic of Microvascular Dysfunction in Patients With Angina and Unobstructed Coronary Arteries. J Am Heart Assoc 2022; 12:e027664. [PMID: 36565193 PMCID: PMC9973578 DOI: 10.1161/jaha.122.027664] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Guidelines recommend that coronary slow flow phenomenon (CSFP), defined as corrected thrombolysis in myocardial infarction frame count (CTFC) >$$ > $$27, can diagnose coronary microvascular dysfunction (CMD) in patients with angina and nonobstructed coronary arteries. CSFP has also historically been regarded as a sign of coronary endothelial dysfunction (CED). We sought to validate the utility of CTFC, as a binary classifier of CSFP and as a continuous variable, to diagnose CMD and CED. Methods and Results Patients with angina and nonobstructed coronary arteries had simultaneous coronary pressure and flow velocity measured using a dual sensor-tipped guidewire during rest, adenosine-mediated hyperemia, and intracoronary acetylcholine infusion. CMD was defined as the inability to augment coronary blood flow in response to adenosine (coronary flow reserve <2.5) and CED in response to acetylcholine (acetylcholine flow reserve ≤1.5); 152 patients underwent assessment using adenosine, of whom 82 underwent further acetylcholine testing. Forty-six patients (30%) had CSFP, associated with lower flow velocity and higher microvascular resistance as compared with controls (16.5±$$ \pm $$6.9 versus 20.2±$$ \pm $$6.9 cm/s; P=0.001 and 6.26±$$ \pm $$1.83 versus 5.36±$$ \pm $$1.83 mm Hg/cm/s; P=0.009, respectively). However, as a diagnostic test, CSFP had poor sensitivity and specificity for both CMD (26.7% and 65.2%) and CED (21.1% and 56.0%). Furthermore, on receiver operating characteristics analyses, CTFC could not predict CMD or CED (area under the curve, 0.41 [95% CI, 0.32%-0.50%] and 0.36 [95% CI, 0.23%-0.49%], respectively). Conclusions In patients with angina and nonobstructed coronary arteries, CSFP and CTFC are not diagnostic of CMD or CED. Guidelines supporting the use of CTFC in the diagnosis of CMD should be revisited.
Collapse
Affiliation(s)
- Utkarsh Dutta
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Aish Sinha
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Ozan M. Demir
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Howard Ellis
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Haseeb Rahman
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| | - Divaka Perera
- School of Cardiovascular Medicine and SciencesBritish Heart Foundation Centre of Excellence and National Institute for Health Research Biomedical Research Centre, King’s College LondonLondonUK
| |
Collapse
|
17
|
Yu B, Mo Y, Hu X, Wang W, Liu J, Jin J, Lun Z, Luo Bu CR, Dong H, Zhou Y. Triglyceride-glucose index is associated with quantitative flow ratio in patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention. Front Cardiovasc Med 2022; 9:1002030. [PMID: 36158820 PMCID: PMC9493184 DOI: 10.3389/fcvm.2022.1002030] [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: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022] Open
Abstract
Background The triglyceride-glucose (TyG) index is a novel marker representing the degree of insulin resistance (IR) and is closely related to cardiovascular diseases. However, the association between the TyG index and vascular function in patients with acute ST-elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) remains unknown. Materials and methods This study was a post hoc analysis of a multicenter, prospective cohort study. In this study, patients with STEMI who underwent PCI were included, and coronary angiography data were analyzed by Quantitative coronary angiography (QCA) and quantitative flow ratio (QFR). In addition, the TyG index was calculated as follows: Ln [fasting triglyceride (mg/dl) × fasting blood glucose (mg/dl) × 1/2]. According to the post-PCI QFR, patients were divided into two groups: post-PCI QFR ≤ 0.92 group and post-PCI QFR > 0.92 group. Construction of logistic regression model to explore the relationship between the TyG index and post-PCI QFR. Results A total of 241 STEMI patients were included in this study. Compared with patients in the post-PCI QFR > 0.92 group, the TyG index was higher in the post-PCI QFR ≤ 0.92 group. Logistic regression model showed that after adjusting for other confounding factors, the TyG index was positively correlated with the risk of post-PCI QFR ≤ 0.92 (OR = 1.697, 95% CI 1.171–2.460, P = 0.005). Restricted cubic splines showed the cutoff value of TyG index associated with post-PCI QFR ≤ 0.92 risk was 9.75. Conclusion The TyG index was associated with the risk of post-PCI QFR ≤ 0.92 in STEMI patients. The risk of post-PCI QFR ≤ 0.92 increased when the TyG index exceeded 9.75.
Collapse
Affiliation(s)
- Bingyan Yu
- School of Medicine, South China University of Technology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuhao Mo
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiangming Hu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weimian Wang
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jieliang Liu
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Junguo Jin
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ziheng Lun
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Haojian Dong
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Haojian Dong,
| | - Yingling Zhou
- School of Medicine, South China University of Technology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Yingling Zhou,
| |
Collapse
|
18
|
Miyata K, Asano T, Saito A, Abe K, Tanigaki T, Hoshino M, Kobayashi T, Takaoka Y, Kanie T, Yamasaki M, Yoshino K, Wakabayashi N, Ouchi K, Kodama H, Shiina Y, Tamaki R, Nishihata Y, Masuda K, Suzuki T, Nonaka H, Emori H, Katagiri Y, Miyazaki Y, Sotomi Y, Yasunaga M, Kogame N, Kuramitsu S, Reiber JHC, Okamura T, Higuchi Y, Kakuta T, Misumi H, Komiyama N, Matsuo H, Tanabe K. Heart Team risk assessment with angiography-derived fractional flow reserve determining the optimal revascularization strategy in patients with multivessel disease: Trial design and rationale for the DECISION QFR randomized trial. Clin Cardiol 2022; 45:605-613. [PMID: 35362109 PMCID: PMC9175249 DOI: 10.1002/clc.23821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
In patients with multivessel disease (MVD), functional information on lesions improves the prognostic capability of the SYNTAX score. Quantitative flow ratio (QFR®) is an angiography-derived fractional flow reserve (FFR) that does not require a pressure wire or pharmacological hyperemia. We aimed to investigate the feasibility of QFR-based patient information in Heart Teams' discussions to determine the optimal revascularization strategy for patients with MVD. We hypothesized that there is an acceptable agreement between treatment recommendations based on the QFR approach and recommendation based on the FFR approach. The DECISION QFR study is a prospective, multicenter, randomized controlled trial that will include patients with MVD who require revascularization. Two Heart Teams comprising cardiologists and cardiac surgeons will be randomized to select a revascularization strategy (percutaneous coronary intervention or coronary artery bypass graft) according to patient information either based on QFR or on FFR. All 260 patients will be assessed by both teams with reference to the anatomical and functional SYNTAX score/SYNTAX score II 2020 derived from the allocated physiological index (QFR or FFR). The primary endpoint of the trial is the level of agreement between the treatment recommendations of both teams, assessed using Cohen's κ. As of March 2022, the patient enrollment has been completed and 230 patients have been discussed in both Heart Teams. The current trial will indicate the usefulness of QFR, which enables a wireless multivessel physiological interrogation, in the discussions of Heart Teams to determine the optimal revascularization strategy for MVD.
Collapse
Affiliation(s)
- Kotaro Miyata
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Taku Asano
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Akira Saito
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Toru Tanigaki
- Department of Cardiovascular MedicineGifu Heart CenterGifuJapan
| | - Masahiro Hoshino
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | | | - Yoshimitsu Takaoka
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Takayoshi Kanie
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Manabu Yamasaki
- Department of Cardiovascular Surgery, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Kunihiko Yoshino
- Department of Cardiovascular Surgery, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Naoki Wakabayashi
- Department of Radiology, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Koki Ouchi
- Department of Radiology, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Hiroyuki Kodama
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Yumi Shiina
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Rihito Tamaki
- Department of Cardiovascular Surgery, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Yosuke Nishihata
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Keita Masuda
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Hideaki Nonaka
- Division of CardiologyMitsui Memorial HospitalTokyoJapan
| | - Hiroki Emori
- Department of Cardiovascular MedicineWakayama Medical UniversityWakayamaJapan
| | - Yuki Katagiri
- Department of Cardiovascular MedicineSapporo Higashi Tokushukai HospitalSapporoJapan
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical ScienceYamaguchi University Graduate School of MedicineYamaguchiJapan
| | - Yohei Sotomi
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | | | - Norihiro Kogame
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterMeguroTokyoJapan
| | | | - Johan H. C. Reiber
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical ScienceYamaguchi University Graduate School of MedicineYamaguchiJapan
| | | | - Tsunekazu Kakuta
- Division of Cardiovascular MedicineTsuchiura Kyodo General HospitalIbarakiJapan
| | - Hiroyasu Misumi
- Department of Cardiovascular Surgery, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke's International HospitalSt. Luke's International UniversityTokyoJapan
| | - Hitoshi Matsuo
- Department of Cardiovascular MedicineGifu Heart CenterGifuJapan
| | - Kengo Tanabe
- Division of CardiologyMitsui Memorial HospitalTokyoJapan
| | | |
Collapse
|
19
|
Kawashima H, Kogame N, Ono M, Hara H, Takahashi K, Reiber JH, Thomsen B, de Winter RJ, Tanaka K, La Meir M, de Mey J, Schneider U, Doenst T, Teichgräber U, Wijns W, Mushtaq S, Pompilio G, Bartorelli AL, Andreini D, Serruys PW, Onuma Y. Diagnostic Concordance and Discordance Between Angiography-Based Quantitative Flow Ratio and Fractional Flow Reserve Derived from Computed Tomography in Complex Coronary Artery Disease. J Cardiovasc Comput Tomogr 2022; 16:336-342. [DOI: 10.1016/j.jcct.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 12/24/2022]
|
20
|
FFRCT and QFR: Ready to be Used in Clinical Decision Making? J Cardiovasc Comput Tomogr 2022; 16:343-344. [DOI: 10.1016/j.jcct.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
|
21
|
Freitas SA, Nienow D, da Costa CA, Ramos GDO. Functional Coronary Artery Assessment: a Systematic Literature Review. Wien Klin Wochenschr 2021; 134:302-318. [PMID: 34870740 DOI: 10.1007/s00508-021-01970-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022]
Abstract
Cardiovascular diseases represent the number one cause of death in the world, including the most common disorders in the heart's health, namely coronary artery disease (CAD). CAD is mainly caused by fat accumulated in the arteries' internal walls, creating an atherosclerotic plaque that impacts the blood flow functional behavior. Anatomical plaque characteristics are essential but not sufficient for a complete functional assessment of CAD. In fact, plaque analysis and visual inspection alone have proven insufficient to determine the lesion severity and hemodynamic repercussion. Furthermore, the fractional flow reserve (FFR) exam, which is considered the gold standard for stenosis functional impair determination, is invasive and contains several limitations. Such a panorama evidences the need for new techniques applied to image exams to improve CAD functional assessment. In this article, we perform a systematic literature review on emerging methods determining CAD significance, thus delivering a unique base for comparing these methods, qualitatively and quantitatively. Our goal is to guide further studies with evidence from the most promising methods, highlighting the benefits from both areas. We summarize benchmarks, metrics for evaluation, and challenges already faced, thus shedding light on the requirements for a valid, meaningful, and accepted technique for functional assessment evaluation. We create a base of comparison based on quantitative and qualitative indicators and highlight the most relevant geometrical metrics that correlate with lesion significance. Finally, we point out future benchmarks based on recent literature.
Collapse
Affiliation(s)
- Samuel A Freitas
- Software Innovation Laboratory, Graduate Program in Applied Computing, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Débora Nienow
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Cristiano A da Costa
- Software Innovation Laboratory, Graduate Program in Applied Computing, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Gabriel de O Ramos
- Software Innovation Laboratory, Graduate Program in Applied Computing, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.
| |
Collapse
|
22
|
Gohmann RF, Pawelka K, Seitz P, Majunke N, Heiser L, Renatus K, Desch S, Lauten P, Holzhey D, Noack T, Wilde J, Kiefer P, Krieghoff C, Lücke C, Gottschling S, Ebel S, Borger MA, Thiele H, Panknin C, Horn M, Abdel-Wahab M, Gutberlet M. Combined Coronary CT-Angiography and TAVR Planning for Ruling Out Significant Coronary Artery Disease: Added Value of Machine-Learning-Based CT-FFR. JACC Cardiovasc Imaging 2021; 15:476-486. [PMID: 34801449 DOI: 10.1016/j.jcmg.2021.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To analyze the ability of machine-learning (ML)-based computed tomography (CT)-derived fractional flow reserve (CT-FFR) to further improve the diagnostic performance of coronary CT angiography (cCTA) for ruling out significant coronary artery disease (CAD) during pre-transcatheter aortic valve replacement (TAVR) evaluation in patients with a high pre-test probability for CAD. BACKGROUND CAD is a frequent comorbidity in patients undergoing TAVR. Current guidelines recommend its assessment before TAVR. If significant CAD can be excluded on cCTA, invasive coronary angiography (ICA) may be avoided. Although cCTA is a very sensitive test, it is limited by relatively low specificity and positive predictive value, particularly in high-risk patients. METHODS Overall, 460 patients (79.6 ± 7.4 years) undergoing pre-TAVR CT were included and examined with an electrocardiogram-gated CT scan of the heart and high-pitch scan of the vascular access route. Images were evaluated for significant CAD. Patients routinely underwent ICA (388/460), which was omitted at the discretion of the local Heart Team if CAD could be effectively ruled out on cCTA (72/460). CT examinations in which CAD could not be ruled out (CAD+) (n = 272) underwent additional ML-based CT-FFR. RESULTS ML-based CT-FFR was successfully performed in 79.4% (216/272) of all CAD+ patients and correctly reclassified 17 patients as CAD negative. CT-FFR was not feasible in 20.6% because of reduced image quality (37/56) or anatomic variants (19/56). Sensitivity, specificity, positive predictive value, and negative predictive value were 94.9%, 52.0%, 52.2%, and 94.9%, respectively. The additional evaluation with ML-based CT-FFR increased accuracy by Δ+3.4% (CAD+: Δ+6.0%) and raised the total number of examinations negative for CAD to 43.9% (202/460). CONCLUSIONS ML-based CT-FFR may further improve the diagnostic performance of cCTA by correctly reclassifying a considerable proportion of patients with morphological signs of obstructive CAD on cCTA during pre-TAVR evaluation. Thereby, CT-FFR has the potential to further reduce the need for ICA in this challenging elderly group of patients before TAVR.
Collapse
Affiliation(s)
- Robin F Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany; Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Konrad Pawelka
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany; Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Patrick Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Linda Heiser
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Katharina Renatus
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany; Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lauten
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - David Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Johannes Wilde
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Krieghoff
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Sebastian Gottschling
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany; Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| | | | - Matthias Horn
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany; Medical Faculty, University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig, Germany
| |
Collapse
|
23
|
Wang R, Kawashima H, Hara H, Gao C, Ono M, Takahashi K, Tu S, Soliman O, Garg S, van Geuns RJ, Tao L, Wijns W, Onuma Y, Serruys PW. Comparison of Clinically Adjudicated Versus Flow-Based Adjudication of Revascularization Events in Randomized Controlled Trials. Circ Cardiovasc Qual Outcomes 2021; 14:e008055. [PMID: 34666500 DOI: 10.1161/circoutcomes.121.008055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In clinical trials, the optimal method of adjudicating revascularization events as clinically or nonclinically indicated (CI) is to use an independent Clinical Events Committee (CEC). However, the Academic Research Consortium-2 currently recommends using physiological assessment. The level of agreement between these methods of adjudication remains unknown. METHODS Data for all CEC adjudicated revascularization events among the 3457 patients followed-up for 2-years in the TALENT trial, and 3-years in the DESSOLVE III, PIONEER, and SYNTAX II trial were collected and readjudicated according to a quantitative flow ratio (QFR) analysis of the revascularized vessels, by an independent core lab blinded to the results of the conventional CEC adjudication. The κ statistic was used to assess the level of agreement between the 2 methods. RESULTS In total, 351 CEC-adjudicated repeat revascularization events occurred, with retrospective QFR analysis successfully performed in 212 (60.4%). According to QFR analysis, 104 events (QFR ≤0.80) were adjudicated as CI revascularizations and 108 (QFR >0.80) were not. The agreement between CEC and QFR based adjudication was just fair (κ=0.335). Between the 2 methods of adjudication, there was a disagreement of 26.4% and 7.1% in CI and non-CI revascularization, respectively. Overall, the concordance and discordance rates were 66.5% and 33.5%, respectively. CONCLUSIONS In this event-level analysis, QFR based adjudication had a relatively low agreement with CEC adjudication with respect to whether revascularization events were CI or not. CEC adjudication appears to overestimate CI revascularization as compared with QFR adjudication. Direct comparison between these 2 strategies in terms of revascularization adjudication is warranted in future trials. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: TALENT trial: NCT02870140, DESSOLVE III trial: NCT02385279, SYNTAX II: NCT02015832, and PIONEER trial: NCT02236975.
Collapse
Affiliation(s)
- Rutao Wang
- Department of Cardiology, Xijing hospital, Xi'an, China (R.W., C.G., L.T.).,Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.).,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (R.W., C.G., R.J.v.G.)
| | - Hideyuki Kawashima
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.).,Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands (H.K., H.H., M.O., K.T.)
| | - Hironori Hara
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.).,Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands (H.K., H.H., M.O., K.T.)
| | - Chao Gao
- Department of Cardiology, Xijing hospital, Xi'an, China (R.W., C.G., L.T.).,Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.).,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (R.W., C.G., R.J.v.G.)
| | - Masafumi Ono
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.).,Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands (H.K., H.H., M.O., K.T.)
| | - Kuniaki Takahashi
- Department of Cardiology, Amsterdam Universities Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands (H.K., H.H., M.O., K.T.)
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T.)
| | - Osama Soliman
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.)
| | - Scot Garg
- East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom (S.G.)
| | - Robert Jan van Geuns
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (R.W., C.G., R.J.v.G.)
| | - Ling Tao
- Department of Cardiology, Xijing hospital, Xi'an, China (R.W., C.G., L.T.)
| | - William Wijns
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.).,The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and Curam, National University of Ireland, Galway (NUIG), Ireland (W.W.)
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.)
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (R.W., H.K., H.H., C.G., M.O., O.S., W.W., Y.O., P.W.S.).,NHLI, Imperial College London, United Kingdom (P.W.S.)
| |
Collapse
|
24
|
Duarte A, Llewellyn A, Walker R, Schmitt L, Wright K, Walker S, Rothery C, Simmonds M. Non-invasive imaging software to assess the functional significance of coronary stenoses: a systematic review and economic evaluation. Health Technol Assess 2021; 25:1-230. [PMID: 34588097 DOI: 10.3310/hta25560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND QAngio® XA 3D/QFR® (three-dimensional/quantitative flow ratio) imaging software (Medis Medical Imaging Systems BV, Leiden, the Netherlands) and CAAS® vFFR® (vessel fractional flow reserve) imaging software (Pie Medical Imaging BV, Maastricht, the Netherlands) are non-invasive technologies to assess the functional significance of coronary stenoses, which can be alternatives to invasive fractional flow reserve assessment. OBJECTIVES The objectives were to determine the clinical effectiveness and cost-effectiveness of QAngio XA 3D/QFR and CAAS vFFR. METHODS We performed a systematic review of all evidence on QAngio XA 3D/QFR and CAAS vFFR, including diagnostic accuracy, clinical effectiveness, implementation and economic analyses. We searched MEDLINE and other databases to January 2020 for studies where either technology was used and compared with fractional flow reserve in patients with intermediate stenosis. The risk of bias was assessed with quality assessment of diagnostic accuracy studies. Meta-analyses of diagnostic accuracy were performed. Clinical and implementation outcomes were synthesised narratively. A simulation study investigated the clinical impact of using QAngio XA 3D/QFR. We developed a de novo decision-analytic model to estimate the cost-effectiveness of QAngio XA 3D/QFR and CAAS vFFR relative to invasive fractional flow reserve or invasive coronary angiography alone. Scenario analyses were undertaken to explore the robustness of the results to variation in the sources of data used to populate the model and alternative assumptions. RESULTS Thirty-nine studies (5440 patients) of QAngio XA 3D/QFR and three studies (500 patients) of CAAS vFFR were included. QAngio XA 3D/QFR had good diagnostic accuracy to predict functionally significant fractional flow reserve (≤ 0.80 cut-off point); contrast-flow quantitative flow ratio had a sensitivity of 85% (95% confidence interval 78% to 90%) and a specificity of 91% (95% confidence interval 85% to 95%). A total of 95% of quantitative flow ratio measurements were within 0.14 of the fractional flow reserve. Data on the diagnostic accuracy of CAAS vFFR were limited and a full meta-analysis was not feasible. There were very few data on clinical and implementation outcomes. The simulation found that quantitative flow ratio slightly increased the revascularisation rate when compared with fractional flow reserve, from 40.2% to 42.0%. Quantitative flow ratio and fractional flow reserve resulted in similar numbers of subsequent coronary events. The base-case cost-effectiveness results showed that the test strategy with the highest net benefit was invasive coronary angiography with confirmatory fractional flow reserve. The next best strategies were QAngio XA 3D/QFR and CAAS vFFR (without fractional flow reserve). However, the difference in net benefit between this best strategy and the next best was small, ranging from 0.007 to 0.012 quality-adjusted life-years (or equivalently £140-240) per patient diagnosed at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year. LIMITATIONS Diagnostic accuracy evidence on CAAS vFFR, and evidence on the clinical impact of QAngio XA 3D/QFR, were limited. CONCLUSIONS Quantitative flow ratio as measured by QAngio XA 3D/QFR has good agreement and diagnostic accuracy compared with fractional flow reserve and is preferable to standard invasive coronary angiography alone. It appears to have very similar cost-effectiveness to fractional flow reserve and, therefore, pending further evidence on general clinical benefits and specific subgroups, could be a reasonable alternative. The clinical effectiveness and cost-effectiveness of CAAS vFFR are uncertain. Randomised controlled trial evidence evaluating the effect of quantitative flow ratio on clinical and patient-centred outcomes is needed. FUTURE WORK Studies are required to assess the diagnostic accuracy and clinical feasibility of CAAS vFFR. Large ongoing randomised trials will hopefully inform the clinical value of QAngio XA 3D/QFR. STUDY REGISTRATION This study is registered as PROSPERO CRD42019154575. FUNDING This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 56. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Ana Duarte
- Centre for Health Economics, University of York, York, UK
| | - Alexis Llewellyn
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Ruth Walker
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Kath Wright
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Claire Rothery
- Centre for Health Economics, University of York, York, UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York, UK
| |
Collapse
|
25
|
Yonetsu T, Kakuta T. Coronary lesion significance: Back to the angiogram, or beyond? Trends Cardiovasc Med 2021; 32:375-377. [PMID: 34407448 DOI: 10.1016/j.tcm.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsunekazu Kakuta
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
| |
Collapse
|
26
|
Zuo W, Sun R, Zhang X, Qu Y, Ji Z, Su Y, Zhang R, Ma G. The Association Between Quantitative Flow Ratio and Intravascular Imaging-defined Vulnerable Plaque Characteristics in Patients With Stable Angina and Non-ST-segment Elevation Acute Coronary Syndrome. Front Cardiovasc Med 2021; 8:690262. [PMID: 34277736 PMCID: PMC8278311 DOI: 10.3389/fcvm.2021.690262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to examine whether quantitative flow ratio (QFR), an angiography-based computation of fractional flow reserve, was associated with intravascular imaging-defined vulnerable plaque features, such as thin cap fibroatheroma (TCFA) in patients with stable angina, and non-ST-segment elevation acute coronary syndrome. Methods: Patients undergoing optical coherence tomography (OCT) or intravascular ultrasound (IVUS) examinations were identified from two prospective studies and their interrogated vessels were assessed with QFR. Lesions in the OCT cohort were classified into tertiles: QFR-T1 (QFR ≤ 0.85), QFR-T2 (0.85 < QFR ≤ 0.93), and QFR-T3 (QFR > 0.93). Lesions in the IVUS cohort were classified dichotomously as low or high QFR groups. Results: This post-hoc analysis included 132 lesions (83 for OCT and 49 for IVUS) from 126 patients. The prevalence of OCT-TCFA was significantly higher in QFR-T1 (50%) than in QFR-T2 (14%) and QFR-T3 (19%) (p = 0.003 and 0.018, respectively). Overall significant differences were also observed among tertiles in maximum lipid arc, thinnest fibrous cap thickness, and minimal lumen area (p = 0.017, 0.040, and <0.001, respectively). Thrombus was more prevalent in QFR-T1 (39%) than in QFR-T2 (3%), and QFR-T3 (12%) (p = 0.001 and 0.020, respectively). In the multivariable analysis, QFR ≤ 0.80 remained as a significant determinant of OCT-TCFA regardless of the presence of NSTE-ACS and the level of low-density lipoprotein cholesterol (adjusted OR: 4.387, 95% CI 1.297-14.839, p = 0.017). The diagnostic accuracy of QFR was moderate in identifying lesions with OCT-TCFA (area under the curve: 0.72, 95% CI 0.58-0.86, p = 0.003). In the IVUS cohort, significant differences were found between two groups in minimal lumen area and plaque burden but not in the distribution of virtual histology (VH)-TCFA (p = 0.025, 0.036, and 1.000, respectively). Conclusions: Lower QFR was related to OCT-defined plaque vulnerability in angiographically mild-to-intermediate lesions. The QFR might be a useful tool for ruling out high-risk plaques without using any pressure wire or vasodilator.
Collapse
Affiliation(s)
- Wenjie Zuo
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Renhua Sun
- Department of Cardiology, The First People's Hospital of Yancheng, Yancheng, China
| | - Xiaoguo Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yangyang Qu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhenjun Ji
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yamin Su
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Rui Zhang
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|
27
|
Performance of Integrated Near-Infrared Spectroscopy and Intravascular Ultrasound (NIRS-IVUS) System against Quantitative Flow Ratio (QFR). Diagnostics (Basel) 2021; 11:diagnostics11071148. [PMID: 34201889 PMCID: PMC8305529 DOI: 10.3390/diagnostics11071148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Quantitative flow ratio (QFR) is a new opportunity to analyze functional stenosis during invasive coronary angiography. Together with a well-known intravascular ultrasound (IVUS) and a new player in the field, near-infrared spectroscopy (NIRS), it is gaining a lot of interest. The aim of the study was to compare QFR results with integrated IVUS-NIRS results acquired simultaneously in the same coronary lesion. We retrospectively enrolled 66 patients in whom 66 coronary lesions were assessed by NIRS-IVUS and QFR. Lesions were divided into two groups based on QFR results as QFR-positive group (QFR ≤ 0.8) or QFR-negative group (QFR > 0.8). Based on ROC curve analysis, the best cut-off values of minimal lumen area (MLA), minimal lumen diameter (MLD) and percent diameter stenosis for predicting QFR ≤ 80 were 2.4 (AUC 0.733, 95%CI 0.61, 0.834), 1.6 (AUC 0.768, 95%CI 0.634, 0.872) and 59.5 (AUC 0.918, 95%CI 0.824, 0.971), respectively. In QFR-positive lesions, the maxLCBI4mm was significantly higher than in QFR-negative lesions (450.12 ± 251.0 vs. 329.47 ± 191.14, p = 0.046). The major finding of the present study is that values of IVUS-MLA, IVUS-MLD and percent diameter stenosis show a good efficiency in predicting QFR ≤ 0.80. Moreover, QFR-positive lesions are characterized by higher maxLCBI4mm as compared to the QFR-negative group.
Collapse
|
28
|
Al-Lamee R, Rajkumar CA, Ganesananthan S, Jeremias A. Optimising physiological endpoints of percutaneous coronary intervention. EUROINTERVENTION 2021; 16:e1470-e1483. [PMID: 33792544 PMCID: PMC9753914 DOI: 10.4244/eij-d-20-00988] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Invasive coronary physiology to select patients for coronary revascularisation has become established in contemporary guidelines for the management of stable coronary artery disease. Compared to revascularisation based on angiography alone, the use of coronary physiology has been shown to improve clinical outcomes and cost efficiency. However, recent data from randomised controlled trials have cast doubt upon the value of ischaemia testing to select patients for revascularisation. Importantly, 20-40% of patients have persistence or recurrence of angina after angiographically successful percutaneous coronary intervention (PCI). This state-of-the-art review is focused on the transitioning role of invasive coronary physiology from its use as a dichotomous test for ischaemia with fixed cut-points, towards its utility for real-time guidance of PCI to optimise physiological results. We summarise the contemporary evidence base for ischaemia testing in stable coronary artery disease, examine emerging indices which allow advanced physiological guidance of PCI, and discuss the rationale and evidence base for post-PCI physiological assessments to assess the success of revascularisation.
Collapse
Affiliation(s)
- Rasha Al-Lamee
- National Heart and Lung Institute, Imperial College London, 2nd Floor, B Block, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom
| | - Christopher A. Rajkumar
- National Heart and Lung Institute, Imperial College London, London, United Kingdom,Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Allen Jeremias
- Department of Cardiology, St. Francis Hospital, The Heart Center, Roslyn, NY, USA
| |
Collapse
|
29
|
Yu W, Tanigaki T, Ding D, Wu P, Du H, Ling L, Huang B, Li G, Yang W, Zhang S, Yan F, Okubo M, Xu B, Matsuo H, Wijns W, Tu S. Accuracy of Intravascular Ultrasound-Based Fractional Flow Reserve in Identifying Hemodynamic Significance of Coronary Stenosis. Circ Cardiovasc Interv 2021; 14:e009840. [PMID: 33541105 DOI: 10.1161/circinterventions.120.009840] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasonic flow ratio (UFR) is a novel method for fast computation of fractional flow reserve (FFR) from intravascular ultrasound images. The objective of this study is to evaluate the diagnostic performance of UFR using wire-based FFR as the reference. METHODS Post hoc computation of UFR was performed in consecutive patients with both intravascular ultrasound and FFR measurement in a core lab while the analysts were blinded to FFR. RESULTS A total of 167 paired comparisons between UFR and FFR from 94 patients were obtained. Median FFR was 0.80 (interquartile range, 0.68-0.89) and 50.3% had a FFR≤0.80. Median UFR was 0.81 (interquartile range, 0.69-0.91), and UFR showed strong correlation with FFR (r=0.87; P<0.001). The area under the curve was higher for UFR than intravascular ultrasound-derived minimal lumen area (0.97 versus 0.89, P<0.001). The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for UFR to identify FFR≤0.80 was 92% (95% CI, 87-96), 91% (95% CI, 82-96), 96% (95% CI, 90-99), 96% (95% CI, 89-99), 91% (95% CI, 93-96), 25.0 (95% CI, 8.2-76.2), and 0.10 (95% CI, 0.05-0.20), respectively. The agreement between UFR and FFR was independent of lesion locations (P=0.48), prior myocardial infarction (P=0.29), and imaging catheters (P=0.22). Intraobserver and interobserver variability of UFR analysis was 0.00±0.03 and 0.01±0.03, respectively. Median UFR analysis time was 102 (interquartile range, 87-122) seconds. CONCLUSIONS UFR had a strong correlation and good agreement with FFR. The fast computational time and excellent analysis reproducibility of UFR bears the potential of a wider adoption of integration of coronary imaging and physiology in the catheterization laboratory.
Collapse
Affiliation(s)
- Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (T.T., M.O., H.M.)
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway (D.D., W.W.)
| | - Peng Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Haiyan Du
- School of Biomedical Engineering, Southern Medical University, China (H.D., W.Y.)
| | - Li Ling
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Biao Huang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Guanyu Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Wei Yang
- School of Biomedical Engineering, Southern Medical University, China (H.D., W.Y.)
| | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Fuhua Yan
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, China (F.Y.)
| | - Munenori Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (T.T., M.O., H.M.)
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (B.X.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (B.X.)
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (T.T., M.O., H.M.)
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway (D.D., W.W.)
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| |
Collapse
|
30
|
Emori H, Kubo T, Shiono Y, Ino Y, Shimamura K, Terada K, Nishi T, Higashioka D, Takahata M, Wada T, Kashiwagi M, Khalifa AKM, Tanaka A, Hozumi T, Tu S, Akasaka T. Comparison of Optical Flow Ratio and Fractional Flow Ratio in Stent-Treated Arteries Immediately After Percutaneous Coronary Intervention. Circ J 2020; 84:2253-2258. [DOI: 10.1253/circj.cj-20-0661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kosei Terada
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takahiro Nishi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | | | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| |
Collapse
|
31
|
Comparison of plaque distribution and wire-free functional assessment in patients with stable angina and non-ST elevation myocardial infarction: an optical coherence tomography and quantitative flow ratio study. Coron Artery Dis 2020; 32:131-137. [PMID: 32826449 DOI: 10.1097/mca.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data comparing plaque characteristics and wire-free physiological assessment in the target vessel in patients with stable angina versus acute coronary syndrome are sparse. Therefore, we investigated the difference in plaque distribution between stable angina and non-ST-elevation myocardial infarction (NSTEMI) and explored the relationship between target vessel vulnerability by optical coherence tomography (OCT) and wire-free functional assessment with quantitative flow ratio (QFR). METHODS Patients with stable angina (n = 25) and NSTEMI (n = 24) were in the final prospective study cohort from the DECODE study (ClinicalTrials.gov, NCT02335086). All 5480 OCT frames in the region of interest were analyzed to study plaque morphology in the target vessel. QFR was analyzed from baseline coronary angiography before percutaneous coronary intervention. Vulnerable vessel score (VVS) was calculated from each plaque, and vessel QFR was then compared. RESULTS Out of all frames, thin-cap fibroatheroma was common with NSTEMI compared to stable angina (10.9 versus 6.3%, P < 0.01), while fibrous plaque was more commonly seen with stable angina compared to NSTEMI (19.7 versus 14.4%, P < 0.01). Calcified plaque was similar in both clinical settings (approximately 6%). Regression analysis showed that segments with normal vessel walls were located significantly farther from the other plaque types. Longitudinal distances for plaque-type in NSTEMI were numerically greater than those for stable angina; however, the mean difference was less than 10 mm. The VVS had a significant inverse linear correlation with QFR (r = -0.34, P = 0.009). CONCLUSIONS The plaque distribution by OCT between stable angina and NSTEMI was similar. Target vessel vulnerability was greater in patients with lower QFR value.
Collapse
|
32
|
|
33
|
Waliszewski M, Rosenberg M, Rittger H, Breul V, Krackhardt F. Endpoint selection for noninferiority percutaneous coronary intervention trials: a methodological description. Ther Adv Cardiovasc Dis 2020; 14:1753944720911329. [PMID: 32168991 PMCID: PMC7074513 DOI: 10.1177/1753944720911329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The objective of this review is to provide a practical update on endpoint selection for noninferiority (NI) studies in percutaneous coronary intervention studies. Methods: A PubMed search was conducted for predefined terms to explore the use of NI designs and intrapatient comparisons to determine their current importance. Sample size calculations for the most frequently used endpoints with NI hypotheses were done to increase statistical awareness. Results: Reported NI trials, with the most frequently chosen clinical endpoint of major adverse cardiac events (MACE), had NI margins ranging from 1.66% to 5.00%, resulting in patient populations of 400–1500 per treatment group. Clinical study endpoints comprising of MACE complemented with rates of bleeding complications and stent thrombosis (ST) are suggested to conduct a statistically and clinically meaningful NI trial. Study designs with surrogate endpoints amenable to intrapatient randomizations, are a very attractive option to reduce the number of necessary patients by about half. Comparative clinical endpoint studies with MACE and ST/bleeding rates to study a shortened dual antiplatelet therapy (DAPT) in coronary stent trials are feasible, whereas ST as the sole primary endpoint is not useful. Conclusions: Expanded composite clinical endpoints (MACE complemented by ST and bleeding rates and intrapatient randomization for selected surrogate endpoints) may be suitable tools to meet future needs in device approval, recertification and reimbursement.
Collapse
Affiliation(s)
- Matthias Waliszewski
- B. Braun Melsungen AG, Medical Scientific Affairs, Sieversufer 8, Berlin, 12359, Germany.,Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Mark Rosenberg
- Klinikum Aschaffenburg-Alzenau, Medizinische Klinik 1, Aschaffenburg, Germany
| | | | - Viktor Breul
- Medical Scientific Affairs, Aesculap AG, Tuttlingen, Germany
| | - Florian Krackhardt
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| |
Collapse
|
34
|
Evaluating the Diagnostic Performance of Noninvasive Testing and the Perils of Inclusion Bias. JACC Cardiovasc Interv 2020; 13:656-657. [DOI: 10.1016/j.jcin.2019.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022]
|
35
|
Reply. JACC Cardiovasc Interv 2020; 13:657. [DOI: 10.1016/j.jcin.2020.01.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 11/23/2022]
|
36
|
|