Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography

Tu, Shengxian; Westra, Jelmer; Yang, Jian; Birgelen, Clemens von; Ferrara, Angela; Pellicano, Mariano; Nef, Holger; Tebaldi, Matteo; Murasato, Yoshinobu; Lansky, Alexandra J.; Barbato, Emanuele; Heijden, Liefke C. van der; Reiber, Johan H. C.; Holm, Niels Ramsing; Wijns, William

doi:10.1016/j.jcin.2016.07.013

Cited by 456 publications

(567 citation statements)

References 29 publications

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“…The higher accuracy (92.7%) in FAVOR II China may be explained by the smaller number of lesions with FFR values close to the FFR 0.80 cutpoint. Results in both studies showed improved performance of QFR compared with early validation studies on offline computation of QFR 11, 15. The improved precision may be facilitated by the online analysis setup with instant feedback between operator and analyst.…”

Section: Discussionmentioning

confidence: 86%

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Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Westra

Andersen

Campo

et al. 2018

JAHA

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288

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BackgroundQuantitative flow ratio (QFR) is a novel modality for physiological lesion assessment based on 3‐dimensional vessel reconstructions and contrast flow velocity estimates. We evaluated the value of online QFR during routine invasive coronary angiography for procedural feasibility, diagnostic performance, and agreement with pressure‐wire–derived fractional flow reserve (FFR) as a gold standard in an international multicenter study.Methods and Results FAVOR II E‐J (Functional Assessment by Various Flow Reconstructions II Europe‐Japan) was a prospective, observational, investigator‐initiated study. Patients with stable angina pectoris were enrolled in 11 international centers. FFR and online QFR computation were performed in all eligible lesions. An independent core lab performed 2‐dimensional quantitative coronary angiography (2D‐QCA) analysis of all lesions assessed with QFR and FFR. The primary comparison was sensitivity and specificity of QFR compared with 2D‐QCA using FFR as a reference standard. A total of 329 patients were enrolled. Paired assessment of FFR, QFR, and 2D‐QCA was available for 317 lesions. Mean FFR, QFR, and percent diameter stenosis were 0.83±0.09, 0.82±10, and 45±10%, respectively. FFR was ≤0.80 in 104 (33%) lesions. Sensitivity and specificity by QFR was significantly higher than by 2D‐QCA (sensitivity, 86.5% (78.4–92.4) versus 44.2% (34.5–54.3); P<0.001; specificity, 86.9% (81.6–91.1) versus 76.5% (70.3–82.0); P=0.002). Area under the receiver curve was significantly higher for QFR compared with 2D‐QCA (area under the receiver curve, 0.92 [0.89–0.96] versus 0.64 [0.57–0.70]; P<0.001). Median time to QFR was significantly lower than median time to FFR (time to QFR, 5.0 minutes [interquartile range, –6.1] versus time to FFR, 7.0 minutes [interquartile range, 5.0–10.0]; P<0.001).ConclusionsOnline computation of QFR in the catheterization laboratory is clinically feasible and is superior to angiographic assessment for evaluation of intermediary coronary artery stenosis using FFR as a reference standard.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02959814.

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Section: Discussionmentioning

confidence: 86%

“…The optimal approach was validated in the FAVOR (Functional Assessment by Various Flow Reconstructions) multicenter study, proving that QFR can be computed without pharmacology‐induced hyperemia 11. In FAVOR, QFR was computed post hoc in a core‐lab setting.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Westra

Andersen

Campo

et al. 2018

JAHA

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288

305

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“…The international, multicenter FAVOR pilot study confirmed the good diagnostic performance of QFR and its designated software. 15 Contrast-flow QFR, which is based on the computational hyperemic state and TIMI frame count, had good correlation and agreement with FFR and similar diagnostic accuracy to that achieved using the pharmacologic hyperemic state.…”

mentioning

confidence: 68%

“…The detailed algorithm and theory of QFR computation have been described in a previous report. 15 Examples of reconstructed 3-D QCA and measured QFR are shown in Figure 1D. Lumen diameter pullback and QFR are shown in Figure 1E.…”

Section: Calculation Of Qfrmentioning

confidence: 99%

Applicability of 3-Dimensional Quantitative Coronary Angiography-Derived Computed Fractional Flow Reserve for Intermediate Coronary Stenosis

Yazaki

Otsuka

Kataoka

et al. 2017

Circ J

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Background: Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR). Methods and Results:We analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined contrast flow QFR, which was derived from 3-dimensional quantitative coronary angiography (3-D QCA) withThrombolysis in Myocardial Infarction (TIMI) frame counts, was compared with FFR as a reference. QFR had good correlation (r=0.80, P<0.0001) and agreement (mean difference: 0.01±0.05) with FFR. After applying the FFR cut-off ≤0.8, the overall accuracy rate of QFR ≤0.8 was 88.0%. On receiver operating characteristics analysis, the area under the curve was 0.93 for QFR. In contrast, 3-D QCA-derived anatomical indices had insufficient correlation with FFR and diagnostic performance compared with QFR.Conclusions: QFR had good correlation and agreement with FFR and high diagnostic performance in the evaluation of intermediate coronary stenosis, suggesting that QFR may be an alternative tool for estimating myocardial ischemia.

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“…This aim can also be achieved using technology that does not require the use of sensor-equipped guide wires, and even non-invasively. In this context, various efforts have been directed towards the further development of technology that allows calculation of FFR using high fidelity imaging data without the use of a pressure sensor-equipped guide wire in the catheterization laboratory [8][9][10]. For the setting of non-invasive physiological assessment, Yang and Kim [11] summarize current status and future perspectives of computed tomography myocardial perfusion (CTP), focusing on technical considerations, clinical applications, and future research topics.…”

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confidence: 99%

Whence we came, whither we go?

Hoef

Kim

et al. 2017

Int J Cardiovasc Imaging

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both invasive and non-invasive coronary physiology aim to simplify and improve diagnosis of ischemic heart disease.The strong fundament of FFR is discussed in this issue by Corcoran and colleagues [4], who provide a state-ofart review summarizing the theoretical, experimental and clinical basis for FFR measurement. Over the years, it has become clear that conventional coronary anatomy parameters revealed by coronary angiography or intracoronary imaging cannot represent the complex nature of coronary physiology, and thereby do not allow appropriate characterization of the hemodynamic significance of coronary artery disease. Chu and colleagues [5] performed a systematic review of studies reporting accuracy of anatomical parameters in predicting significant FFR and highlighted the importance of study population composition in the diagnostic performance of anatomical parameters. Large scatters, and hence poor diagnostic value of anatomical parameters, were observed in patients with intermediate coronary stenosis where FFR is regarded most useful in determining the need for revascularization in daily practice.Considering the benefit of FFR-guided intervention and the relative complexity of the technology, various efforts have been directed towards simplification of assessment and interpretation of FFR, as well as the development of novel concepts to simplify the assessment of physiological coronary disease severity. Corcoran and colleagues [6] present the validation results of a "smart minimum" FFR algorithm in an unselected all-comer population of patients with intermediate coronary stenoses, aiming to simplify interpretation of FFR in the catheterization laboratory. Meimoun and colleagues [7] report on a comparison of the instantaneous wave-free ratio (iFR) and non-invasive coronary flow reserve for the identification of hemodynamically relevant coronary disease in the left anterior descending coronary artery, using FFR as the reference standard. iFR Over the past years, clinical evidence has pointed to the value of routine integration of coronary physiology in the cardiac catheterization laboratory to optimize

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Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography

Cited by 456 publications

References 29 publications

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Applicability of 3-Dimensional Quantitative Coronary Angiography-Derived Computed Fractional Flow Reserve for Intermediate Coronary Stenosis

Whence we came, whither we go?

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