Angiography‐derived functional assessment of left main coronary stenoses

Abstract

Objectives: We aimed to evaluate the diagnostic accuracy of quantitative flow ratio (QFR) in left main (LM) coronary stenoses, using Fractional Flow Reserve (FFR) as reference.Background: QFR has demonstrated a high accuracy in determining the functional relevance of coronary stenoses in non-LM. However, there is an important paucity of data regarding its diagnostic value in the specific anatomical subset of LM disease.Methods: This is a retrospective, observational, multicenter, international, and blinded study including patients with LM stenoses. Cases with significant ostial LM disease were excluded. QFR was calculated from conventional angiograms at blinded fashion with respect to FFR.Results: Sixty-seven patients with LM stenoses were analyzed. Overall, LM had intermediate severity, both from angiographic (diameter stenosis [%DS] 43.8 ± 11.1%) and functional perspective (FFR 0.756 ± 0.105). Mean QFR was 0.733 ± 0.159. Correlation between QFR and FFR was moderate (r = 0.590). Positive and negative predictive value, sensitivity and specificity were 85.4%, 64%, 85.4%, and 69.6% respectively. Classification agreement of QFR and FFR in terms of functional stenosis severity was 78.1%. Area under the receiver operating characteristics of QFR using FFR as reference was 0.82 [95% confidence interval [CI], 0.71−0.93], and significantly better than angiographic evaluation including %DS (area under the receiver-operating characteristic curve [AUC] 0.45 [95% CI, 0.32−0.58], p < 0.001) and minimum lumen diameter (AUC 0.60 [95% CI, 0.47−0.74], p < 0.001).

Imaging-Based FFR: How Many Steps Toward Replacement for Wire-Based FFR on A Journey of A Thousand Miles

“…3 Forth, the clinical applicability for the left main disease, which is one of the most complex coronary lesions and potentially life-threatening disease entity even in contemporary practice, 10 was not assessed in the current analysis and data for this subset are limited. 11 Finally, it still remains debatable whether the accuracy of imaging-based FFR is satisfactory or not in predicting post-percutaneous coronary intervention physiological outcomes, which is also of great interest in this field. 12,13 In conclusion, this novel work by Wu et al 9 deserves praise as an important step in the field of imagingbased FFR for the analysis tailored to contemporary practice where we naturally encounter complex coronary lesions.…”