Abstract
Background. Use of the fractional flow reserve (FFR) technique is recommended to evaluate coronary stenosis severity and guide revascularization. However, its high cost, time to administer, and the side effects of adenosine reduce its clinical utility. Two novel adenosine-free indices, contrast-FFR (cFFR) and quantitative flow ratio (QFR), can simplify the functional evaluation of coronary stenosis. This study aimed to analyze the diagnostic performance of cFFR and QFR using FFR as a reference index. Methods. We conducted a systematic review and meta-analysis of observational studies in which cFFR or QFR was compared to FFR. A bivariate model was applied to pool diagnostic parameters. Cochran’s Q test and the I2 index were used to assess heterogeneity and identify the potential source of heterogeneity by metaregression and sensitivity analysis. Results. Overall, 2220 and 3000 coronary lesions from 20 studies were evaluated by cFFR and QFR, respectively. The pooled sensitivity and specificity were 0.87 (95% CI: 0.81, 0.91) and 0.92 (95% CI: 0.88, 0.94) for cFFR and 0.87 (95% CI: 0.82, 0.91) and 0.91 (95% CI: 0.87, 0.93) for QFR, respectively. No statistical significance of sensitivity and specificity for cFFR and QFR were observed in the bivariate analysis (P=0.8406 and 0.4397, resp.). The area under summary receiver-operating curve of cFFR and QFR was 0.95 (95% CI: 0.93, 0.97) for cFFR and 0.95 (95% CI: 0.93, 0.97). Conclusion. Both cFFR and QFR have good diagnostic performance in detecting functional severity of coronary arteries and showed similar diagnostic parameters.
Highlights
Fractional flow reserve (FFR) is the “gold standard” in current clinical practice to evaluate the functional severity of coronary lesions and guide revascularization. ere is solid evidence that using fractional flow reserve (FFR) leads to better clinical outcomes and economic value; it is included in many guidelines and recommended by professional consensus [1]
Contrast is widely used in catheter diagnostics since it can induce submaximal hyperemia of coronary microvasculature. erefore, cFFR obtained by pressure wire after injection of contrast material can be used to evaluate the functional severity of coronary Journal of Interventional Cardiology stenosis [8]. e reported cut-off values of cFFR ranged from 0.82 to 0.85
CFFR was measured in 2220 coronary lesions of 2047 patients and quantitative flow ratio (QFR) was performed in 3000 coronary lesions of 2588 patients. e mean age of patients was 66.4 (±9.0) years and 3303 (71.3%) of the patients were men
Summary
Fractional flow reserve (FFR) is the “gold standard” in current clinical practice to evaluate the functional severity of coronary lesions and guide revascularization. ere is solid evidence that using FFR leads to better clinical outcomes and economic value; it is included in many guidelines and recommended by professional consensus [1]. E contrast-FFR (cFFR) and quantitative flow ratio (QFR) are two novel adenosine-free indices which show superior diagnostic accuracy to other adenosine-free options, including resting distal coronary pressure to aortic pressure ratio (Pd/Pa) and instantaneous wave-free ratio (iFR). It appears that either of these methods may serve as alternatives to FFR since both observational studies and meta-analyses show emerging evidence of cFFR and QFR as effective alternatives to FFR [4,5,6,7]. Two novel adenosine-free indices, contrast-FFR (cFFR) and quantitative flow ratio (QFR), can simplify the functional evaluation of coronary stenosis. Both cFFR and QFR have good diagnostic performance in detecting functional severity of coronary arteries and showed similar diagnostic parameters
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