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.
Highlights
Fractional flow reserve (FFR), which enabled analyzing the hemodynamic significance of coronary stenosis, was a real game-changer in the diagnosis and treatment of coronary artery disease (CAD) [1,2]
The quantitative flow ratio (QFR)-negative group was characterized by a higher percentage of patients who had percutaneous coronary interventions (PCI) in the past (34.5% vs. 10.8%, p = 0.016)
We did not find any correlation between vessel QFR and minimal lumen area (MLA), minimal lumen diameter (MLD), plaque volume or plaque burden in the QFR-positive group or the QFR-negative group
Summary
Fractional flow reserve (FFR), which enabled analyzing the hemodynamic significance of coronary stenosis, was a real game-changer in the diagnosis and treatment of coronary artery disease (CAD) [1,2]. Developed quantitative flow ratio (QFR), which computes FFR without the necessity of drug-induced hyperemia or utilization of additional pressure wire [3], is a promising technology with the potential to improve outcomes of percutaneous coronary interventions (PCI). QFR applies fluid dynamics equations and is calculated from three-dimensional quantitative coronary angiography (3D-QCA). It was previously validated and showed high diagnostic accuracy in identifying hemodynamically significant stenosis and the prediction of ≤0.8 FFR [4,5,6]. Besides the fact that IVUS itself is not sufficient to replace the guidance of FFR during PCI, the relationship between
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