Abstract
BackgroundBoth quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFRCT) have shown significant correlations with invasive wire-based fractional flow reserve. However, the correlation between QFR and FFRCT is not fully investigated in patients with complex coronary artery disease (CAD). The aim of this study is to investigate the correlation and agreement between QFR and FFRCT in patients with de novo three-vessel disease and/or left main CAD. MethodsThis is a post-hoc sub-analysis of the international, multicenter, and randomized SYNTAX III REVOLUTION trial, in which both invasive coronary angiography and coronary computed tomography angiography were prospectively obtained prior to the heart team discussion. QFR was performed in an independent core laboratory and compared with FFRCT analyzed by HeartFlow™. The correlation and agreement between QFR and FFRCT were assessed per vessel. Furthermore, independent factors of diagnostic discordance between QFR and FFRCT were evaluated. ResultsOut of 223 patients, 40 patients were excluded from this analysis due to the unavailability of FFRCT and/or QFR, and a total of 469 vessels (183 patients) were analyzed. There was a strong correlation between QFR and FFRCT (R = 0.759; p < 0.001), and the Bland-Altman analysis demonstrated a mean difference of −0.005 and a standard deviation of 0.116. An independent predictor of diagnostic concordance between QFR and FFRCT was the lesion location in right coronary artery (RCA) (odds ratio 0.395; 95% confidence interval 0.174–0.894; P = 0.026). ConclusionIn patients with complex CAD, QFR and FFRCT were strongly correlated. The location of the lesion in RCA was associated with the highest diagnostic concordance between QFR and FFRCT.
Highlights
Physiological assessment of coronary artery disease (CAD) has become one of the most important factors in decision making for myocardial revascularization.[1]
Image derived physiological assessment, such as fractional flow reserve derived from computed tomography angiography (FFRCT) and quantitative flow ratio (QFR), has been developed
The present study is a post-hoc analysis of the SYNTAX III REVOLUTION trial (NCT02813473), which has investigated the agreement in decision making between two heart teams on the selection of coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) as modalities of revascularization, using either coronary computed tomography angiography (CCTA) with FFRCT or invasive coronary angiography (ICA), while blinded to the other imaging modality in patients with de novo 3VD and/or left main coronary artery disease (LMCAD).[9]
Summary
Physiological assessment of coronary artery disease (CAD) has become one of the most important factors in decision making for myocardial revascularization.[1]. Image derived physiological assessment, such as fractional flow reserve derived from computed tomography angiography (FFRCT) and quantitative flow ratio (QFR), has been developed. Among patients with complex CAD, the diagnostic performance of QFR to predict binary wire-based ischemia has been demonstrated.[14]. Both quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFRCT) have shown significant correlations with invasive wire-based fractional flow reserve. The correlation between QFR and FFRCT is not fully investigated in patients with complex coronary artery disease (CAD). An independent predictor of diagnostic concordance between QFR and FFRCT was the lesion location in right coronary artery (RCA) (odds ratio 0.395; 95% confidence interval 0.174–0.894; P 1⁄4 0.026).
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