Diagnostic Performance of Intracoronary Optical Coherence Tomography-Modulated Quantitative Flow Ratio for Assessing Coronary Stenosis

Abstract

BackgroundA novel method for fast computation of Murray law-based quantitative flow ratio (μQFR) from coregistered angiography and optical coherence tomography (OCT) was recently developed. This study aimed to evaluate the diagnostic performance of this OCT-modulated μQFR (OCT-μFR).MethodsPatients who underwent coronary angiography, OCT, and fractional flow reserve (FFR) were retrospectively enrolled. μQFR was computed from a single angiographic projection. Subsequently, OCT image pullback was coregistered with the angiogram, and OCT-μFR was calculated based on the coregistered data. The same cut-off value of 0.80 was used for OCT-μFR, μQFR, and FFR to define ischemia.ResultsA paired comparison of OCT-μFR and μQFR was performed in 269 vessels from 218 patients. The mean FFR was 0.81 ± 0.11, and 45.0% of vessels had an FFR ≤0.80. OCT-μFR showed a better correlation with FFR than μQFR (r = 0.83 vs 0.76, P = .018) and numerically higher diagnostic performance (area under the curve [AUC] = 0.95 vs 0.92, P = .057). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for OCT-μFR to identify ischemia-causing stenosis were 89.3%, 93.2%, 91.5%, 91.4%, 13.2, and 0.1, respectively. In addition, OCT-μFR showed significantly higher diagnostic performance compared with μQFR in vessels with suboptimal angiographic image quality (AUC = 0.93 vs 0.87, P = .028) and tandem lesions (AUC = 0.94 vs 0.87, P = .017).ConclusionsComputation of OCT-μFR was feasible and accurately identified physiologically significant coronary stenosis with simultaneous morphological assessment. In vessels with suboptimal angiographic image quality or tandem lesions, OCT-μFR had a higher diagnostic performance than angiography-based μQFR.