Diagnostic accuracy of angiography-based quantitative flow ratio in patients with left main disease

López-Palop, Ramón; Carrillo, Pilar; Leithold, Gunnar; Frutos, Araceli; Pinar, Eduardo; Freites, Alfonso

doi:10.1016/j.rec.2020.09.031

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…A strong correlation between invasive FFR and FFR CT has been previously reported in prospective trials [ 27 – 30 ], whereas greater AUC for QFR (QAngio XA 3D version 1.0.28.4, Medis Medical Imaging System) than that for FFR CT has been also reported [ 31 ]. For LMCAD, there is no firm evidence to support the use of QFR (Medis Medical Imaging System), and in fact, the manufacturer does not recommend the QFR analysis on LM [ 32 ]. Therefore, we investigated the impact of optimal fluoroscopic angle on the correlation between µQFR—2D imaging physiological assessment and FFR CT —3D imaging physiological assessment in one of the most challenging lesion geometry, LM bifurcation.…”

Section: Limitationsmentioning

confidence: 99%

Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

Kotoku,

Ninomiya,

Ding

et al. 2023

Int J Cardiovasc Imaging

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Murray law-based quantitative flow ratio (µQFR) assesses fractional flow reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised in suboptimal angiographic projections. FFRCT is a well-validated non-invasive method measuring FFR from coronary computed tomographic angiography (CCTA). We evaluated the feasibility of µQFR in left main (LM) bifurcations, the impact of the optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance with FFRCT. In 300 patients with three-vessel disease, the values of FFRCT and µQFR were compared at distal LM, proximal left anterior descending artery (pLAD) and circumflex artery (pLCX). The optimal viewing angle of LM bifurcation was defined on CCTA by 3-dimensional coordinates and converted into a 2-dimensional fluoroscopic view. The best fluoroscopic projection was considered the closest angulation to the optimal viewing angle on CCTA. µQFR was successfully computed in 805 projections. In the best projections, µQFR sensitivity was 88.2% (95% CI 76.1–95.6) and 84.8% (71.1–93.7), and specificity was 96.8% (93.8–98.6) and 97.2% (94.4–98.9), in pLAD and pLCX, respectively, with regard to FFRCT. The AUC of µQFR for predicting FFRCT ≤ 0.80 tended to be improved using the best versus suboptimal projections (0.94 vs. 0.89 [p = 0.048] in pLAD; 0.94 vs. 0.88 [p = 0.075] in pLCX). Computation of µQFR in LM bifurcations using a single angiographic view showed high feasibility from post-hoc analysis of coronary angiograms obtained for clinical purposes. The fluoroscopic viewing angle influences the diagnostic performance of physiological assessment using a single angiographic view.

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Section: Limitationsmentioning

confidence: 99%

Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

Kotoku,

Ninomiya,

Ding

et al. 2023

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

show abstract

“…Recently, Spanish scholars compared QFR and FFR findings in LMCA and found that retrospective QFR determination could be performed in more than 80% of LMCA lesions, with >85% agreement, which was higher than that obtained by angiography. 24 Moreover, the QFR-based functional synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score was applicable in prognostication and revascularization strategy choices in patients with LMCA disease. 25 Hyperemic flow estimation and geometric reconstruction are fundamental differences between QFR and UFR.…”

Section: Angiographic and Ultrasound Characteristics Are Shown In Tablementioning

confidence: 99%

Diagnostic performance of intravascular ultrasound‐based fractional flow reserve versus angiography‐based quantitative flow ratio measurements for evaluating left main coronary artery stenosis

Sui

Yang

et al. 2022

Cathet Cardio Intervent

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Objectives We compared the diagnostic performance of the ultrasonic flow ratio (UFR) and quantitative flow ratio (QFR) for left main coronary artery (LMCA) stenosis. Background Evaluation of LMCA stenosis remains challenging because of its complex pathogenesis and severity. Computing QFR allows rapid determination of fractional flow reserve (FFR) from coronary angiograms. A novel intravascular ultrasound (IVUS)‐based FFR (UFR) allows rapid FFR computation from IVUS images. Neither of the computational approaches required a pressure wire or hyperemia induction. Previous studies have validated the good diagnostic accuracy of QFR and UFR in identifying hemodynamically significant coronary stenosis using FFR as the reference standard. Methods This retrospective observational study enrolled consecutive patients with intermediate‐grade LMCA stenosis who underwent IVUS evaluation. UFR and QFR of all LMCA stenosis patients were assessed, their correlation and agreement were analyzed, and diagnostic performance of UFR in LMCA stenosis was evaluated. Results Eighty‐three paired comparisons between UFR and QFR were obtained. UFR excellently correlated with QFR (r = 0.74, p < 0.01). The Bland‒Altman plot showed good agreement between UFR and QFR (mean differences: 0.01 ± 0.05, p = 0.34). The area under the curve of UFR for identifying physiological LMCA stenosis was 0.97 (95% confidence interval [CI]: 0.93–1.00, p < 0.01). The overall UFR diagnostic accuracy was 0.95 (95% CI: 0.88–0.99). Conclusions UFR showed excellent correlation and good agreement with QFR in LMCA stenosis assessment, indicating that it is highly feasible to use UFR for functional evaluation of LMCA stenosis.

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Diagnostic accuracy of angiography-based quantitative flow ratio in patients with left main disease

Cited by 2 publications

References 5 publications

Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

Diagnostic performance of intravascular ultrasound‐based fractional flow reserve versus angiography‐based quantitative flow ratio measurements for evaluating left main coronary artery stenosis

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