Physiological benefits evaluated by quantitative flow ratio in patients with reduced left ventricular ejection fraction who underwent percutaneous coronary intervention.

Jiaxin Zhong,Mingfang Ye,Yukun Luo,Lianglong Chen,Huang Chen,Long Chen,Qin Chen,Zhen Ye,Yuanming Yan,Jianmin Sun,Juchang Hong

doi:10.1186/s12872-020-01814-5

Abstract

BackgroundTo explore the clinical benefits of revascularization in patients with different levels of left ventricular ejection fraction (LVEF) from the perspective of quantitative flow ratio (QFR).MethodsPatients who underwent successful percutaneous coronary intervention (PCI) and one-year angiographic follow-up were retrospectively screened and computed by QFR analysis. Based on their LVEF, 301 eligible patients were classified into reduced LVEF (≤ 50%, n = 48) and normal LVEF (> 50%, n = 253) groups. Pre-PCI QFR, post-PCI QFR, follow-up QFR, late lumen loss (LLL), LVEF and major adverse cardiovascular and cerebrovascular events (MACCEs) at one year were compared between groups.ResultsThe reduced LVEF group had a lower mean pre-PCI QFR than the normal LVEF group (0.67 ± 0.16 vs. 0.73 ± 0.15, p = 0.004), but no significant difference was found in the post-PCI or one-year follow-up QFR. No association was found between LVEF and QFR at pre-PCI or follow-up. The reduced LVEF group had greater increases in QFR (0.27 ± 0.18 vs. 0.22 ± 0.15, p = 0.043) and LVEF (6.05 ± 9.45% vs. − 0.37 ± 8.11%, p < 0.001) than the normal LVEF group. The LLL results showed no difference between the two groups, indicating a similar degree of restenosis. The reduced LVEF group had a higher incidence of MACCEs (14.6% vs. 4.3%, p = 0.016), which was mainly due to the higher risk of heart failure (6.3% vs. 0%, p = 0.004).ConclusionCompared to the corresponding normal LVEF patients, patients with reduced LVEF who underwent successful PCI were reported to have greater increases in QFR and LVEF, a similar degree of restenosis, and a higher incidence of MACCEs due to a higher risk of heart failure. It seems that patients with reduced LVEF gain more coronary benefits from successful revascularization from the perspective of flow physiology evaluations.

Highlights

To explore the clinical benefits of revascularization in patients with different levels of left ventricular ejection fraction (LVEF) from the perspective of quantitative flow ratio (QFR)
After excluding patients based on the predefined criteria (Fig. 1), 301 patients were enrolled in the final analysis and were divided into a reduced LVEF group (n = 48) and a normal LVEF group (n = 253) according to a threshold of 50% of the pre-percutaneous coronary intervention (PCI) LVEF value (Fig. 1)
The reduced LVEF (rLVEF) group had a higher incidence of diabetes (50.0% vs. 30.4%, p = 0.008) and a similar incidence of prediabetes

Summary

Introduction

To explore the clinical benefits of revascularization in patients with different levels of left ventricular ejection fraction (LVEF) from the perspective of quantitative flow ratio (QFR). The frequency of percutaneous coronary intervention (PCI) in patients diagnosed with coronary artery disease (CAD) is significantly increasing due to the. Considering the impact of myocardial ischaemia, myocardial stunning, myocardial hibernation and the presence of scars, patients with reduced left ventricular ejection fraction (LVEF) may be likely to develop complicated conditions. The consideration of long-term benefits still makes it controversial whether such patients should undergo revascularization in clinical practice. FFR assessments are still largely under-utilized in clinical practice due to concerns regarding prolonged procedural time, increased costs and potential complications caused by pressure-wire instrumentation [7]

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