Comparison of resting distal to aortic coronary pressure with angiography-based quantitative flow ratio

Stähli, Barbara E.; Erbay, Aslihan; Steiner, Julia; Mochmann, Hans‐Christian; Skurk, Carsten; Lauten, Alexander; Landmesser, Ulf; Leistner, David M.

doi:10.1016/j.ijcard.2018.11.093

Cited by 32 publications

(41 citation statements)

References 24 publications

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“…The diagnostic performance of QFR for the identification of hemodynamic significant coronary lesions as defined by FFR ≤0.80 has been demonstrated in the FAVOR studies, [12][13][14] and confirmed in several analyses. [20][21][22][23] The findings of this study, demonstrating the high diag- in prior studies, 10,24 the value of these indices in identifying functional lesion significance remained limited.…”

Section: Quantitative Flow Ratiomentioning

confidence: 64%

Assessment of intermediate coronary lesions by fractional flow reserve and quantitative flow ratio in patients with small‐vessel disease

Erbay

Steiner

Lauten

et al. 2019

Cathet Cardio Intervent

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Background: Quantitative flow ratio (QFR) has recently been introduced as a novel, less-invasive, adenosine-free measure for functional coronary lesion assessment. Whether reference vessel dimensions affect functional lesion assessment is uncertain. Methods: A total of 436 patients with 516 interrogated coronary vessels by means of FFR were included in the study. Patients were dichotomized according to the median reference vessel diameter (group 1: ≤2.8 mm and group 2: >2.8 mm). QFR analyses were performed offline at the institution's core laboratories. Results: Reference vessel diameter was 2.5 [2.3-2.7] mm in group 1 and 3.3 [3.0-3.6] mm in group 2. Diameter stenosis (41.4 [36.4-47.6] % vs. 41.4 [36.4-45.7] %, p = .20) did not differ among groups. Median FFR values were lower in group 1 (0.87 [0.81-0.92]) as compared with group 2 (0.89 [0.84-0.93], p = .001). Consistently, QFR values were lower in group 1 (0.88 [0.82-0.92]) than in group 2 (0.91 [0.85-0.94], p = .001). The proportions of functionally significant coronary lesions as defined by FFR ≤0.80 were 24.1% and 14.2% in groups 1 and 2 (p = .005), and as defined by cQFR ≤0.80 20.4% and 11.8% (p = 0.009), respectively. In ROC analysis for an FFR ≤.80, the AUC was 0.89 (95% CI 0.85-0.93, p < .001) in group 1 and 0.81 (95% CI 0.76-0.86, p < .001) in group 2. Conclusions: These results suggest that QFR measurements are accurate irrespective of the reference vessel diameter. Future studies are needed to elucidate the higher percentage of functionally significant lesions observed in small vessels despite a similar angiographic lesion severity.

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Section: Quantitative Flow Ratiomentioning

confidence: 64%

Assessment of intermediate coronary lesions by fractional flow reserve and quantitative flow ratio in patients with small‐vessel disease

Erbay

Steiner

Lauten

et al. 2019

Cathet Cardio Intervent

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“…The FAVOR II study performed in Europe and Japan confirmed that the precision (absolute difference of QFR-FFR) for QFR with FFR as a reference was not different across strata of FFR values [ 8 ]. Furthermore, Stahli et al found that the diagnostic accuracy of QFR was superior compared to the wave free index distal to aortic coronary pressure (Pd/Pa) using FFR as gold standard [ 24 ]. Comparisons between QFR and single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) revealed a good correlation [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Angiography-based quantitative coronary contrast-flow ratio measurements correlate with myocardial ischemia assessed by stress MRI

Lenk

Schwarzbach

Antoniadis

et al. 2020

Int J Cardiovasc Imaging

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Contrast-flow quantitative flow ratio (cQFR) is a new technology for quantitative evaluation of coronary stenosis using computational fluid dynamics based on angiograms. The aim of this study was to assess the sensitivity and specificity of cQFR to detect myocardial ischemia using stress magnetic resonance imaging (MRI) as a reference standard. Patients who received stress MRI and coronary angiography were selected from the hospital database. Relevant ischemia on stress MRI was defined as a perfusion deficit in ≥ 2 of 16 segments. cQFR was quantitated based on 3-dimensional quantitative coronary angiography using QAngio XA3D1.1 software by two blinded and independent investigators. A cQFR of ≤ 0.80 was considered abnormal. Among 87 patients 230 vessels met the criteria for full analysis by cQFR (88%). In vascular territories with a significant perfusion deficit, cQFR was significantly lower compared to areas with normal perfusion (0.72 (0.62–0.78) vs. 0.96 (0.89–0.99); p < 0.001). The sensitivity of cQFR in detecting significant epicardial stenoses of coronary vessels with documented ischemia in stress MRI was 81% (68–90%), the specificity was 88% (82–92%). Diameter stenoses (DS) and area stenoses (AS) in vessels with positive stress MRI were significantly higher than in vessels without ischemia (DS 59.1% (49.4–68.4%) vs. 34.8% (27.1–46.1%) p < 0.001; AS 75.6% (63.0–85.2%) vs. 45.0% (30.8–63.6%), p < 0.001). The analysis reveals a high correlation between coronary stenosis measured by cQFR and ischemic areas detected by stress MRI. The data set the stage to plan randomized studies assessing cQFR measurements with regard to clinical outcomes.

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“…Cerrato et al [19] Johnson et al [4] Kanaji et al [16] Shiode et al [17] Topcu et al [15] Van Wyk et al [18] Leone et al [5] 0.6 1.0 Sensitivity Q = 14.78, df = 6.00, p = 0.02 Emori et al [22] FAVOR Pilot [9] Stahli et al [30] WIFI II et al [21][25]…”

Section: Combinedmentioning

confidence: 99%

“…Mejia-Renteria et al [26] FAVOR II CHINA [10] Emori et al [24] FAVOR II Europe-Japan [28] Hwang et al [29] Koltowski et al [27] Tie et al [23] Spitaleri et al [21] Yazaki et al [20] Emori et al [22] FAVOR Pilot [9] Stahli et al [30] WIFI II et al [21][25]…”

Section: Combinedmentioning

confidence: 99%

Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses

Zhang

Guo

2020

Journal of Interventional Cardiology

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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.

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Comparison of resting distal to aortic coronary pressure with angiography-based quantitative flow ratio

Cited by 32 publications

References 24 publications

Assessment of intermediate coronary lesions by fractional flow reserve and quantitative flow ratio in patients with small‐vessel disease

Assessment of intermediate coronary lesions by fractional flow reserve and quantitative flow ratio in patients with small‐vessel disease

Angiography-based quantitative coronary contrast-flow ratio measurements correlate with myocardial ischemia assessed by stress MRI

Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses

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