Abstract
BackgroundComputational quantitative flow ratio (QFR) based on 3-dimensional quantitative coronary angiography (3D QCA) analysis offers the opportunity to assess the significance of coronary artery disease (CAD) without using an invasive pressure wire or inducing hyperemia. This study aimed to evaluate the diagnostic performance of QFR compared to wire-based fractional flow reserve (FFR) and to validate the previously reported QFR cut-off value of >0.90 to safely rule out functionally significant CAD. MethodsQFR was retrospectively derived from standard-care coronary angiograms. Correlation and agreement of fixed-flow QFR (fQFR) and contrast-flow QFR (cQFR) models with invasive wire-based FFR was calculated. Diagnostic performance of QFR was evaluated at different QFR cut-off values defining significant CAD (FFR ≤ 0.80). Results101 vessels in 96 patients who underwent FFR were studied. Mean FFR was 0.87 ± 0.08 and 21 of 101 (21%) vessels had an FFR ≤ 0.80. Correlation of fQFR and cQFR with FFR was r = 0.71 (p < 0.001) and r = 0.70 (p < 0.001), respectively. Sensitivity and specificity were 57% and 93% for fQFR and 67% and 96% for cQFR at a QFR cut-off value >0.80 defining non-significant CAD, respectively. fQFR > 0.90 was present in 34 (34%) and cQFR > 0.90 in 39 (39%) vessels. For both QFR models, none of the vessels with QFR > 0.90 had an FFR ≤ 0.80. ConclusionsQFR appears to be a safe and effective gatekeeper to wire-based FFR when applying a QFR threshold of >0.90 to rule out significant CAD. Further prospective research is required to establish QFR in the real-life setting of functional CAD assessment in the catheterization laboratory.
Highlights
Coronary artery disease (CAD) is the most common cause of death globally, resulting in 8.9 million deaths annually worldwide [1]
Fifteen additional vessels were excluded after 2 readers reached consensus about inadequateness of acquisitions caused by factors not reflected by the Image Quality Score (IQS)
We observed that computational flow QFR (fQFR) and contrast-flow QFR (cQFR) have good diagnostic performance compared to wire-based fractional flow reserve (FFR), and superior diagnostic performance compared to 3-dimensional quantitative coronary angiography (3D QCA) analysis
Summary
Coronary artery disease (CAD) is the most common cause of death globally, resulting in 8.9 million deaths annually worldwide [1]. Images without introducing an invasive pressure wire in the coronary artery or inducing hyperemia, and showed good agreement of QFR computation models with wire-based FFR [7]. Validation of these first results on QFR analysis is essential in order to prevent inappropriate adjustment of diagnostic strategies based on results of unreproducible studies (Baker, Nature 2016). Computational quantitative flow ratio (QFR) based on 3-dimensional quantitative coronary angiography (3D QCA) analysis offers the opportunity to assess the significance of coronary artery disease (CAD) without using an invasive pressure wire or inducing hyperemia. This study aimed to evaluate the diagnostic performance of QFR compared to wire-based fractional flow reserve (FFR) and to validate the previously reported QFR cut-off value of N0.90 to safely rule out functionally significant CAD. Further prospective research is required to establish QFR in the real-life setting of functional CAD assessment in the catheterization laboratory
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