Novel Indices of Coronary Physiology

Maria, Giovanni Luigi De; García‐García, Héctor M.; Scarsini, Roberto; Lopez, Nieves Gonzalo; Leone, Antonio Maria; Sarno, Giovanna; Daemen, Joost; Shlofmitz, Evan; Jeremias, Allen; Tebaldi, Matteo; Bezerra, Hiram G.; Tu, Shengxian; Lemos, Pedro A.; Ozaki, Yuichi; Dan, Kazuhiro; Collet, Carlos; Barbato, Emanuele; Johnson, Nils P.; Waksman, Ron

doi:10.1161/circinterventions.119.008487

Cited by 52 publications

(18 citation statements)

References 35 publications

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“…Invasive fractional flow reserve (FFR) is currently considered the gold standard for evaluating the ischemic potential of CAD (8). However, due to the additional pressure guidewire requirements, invasive nature of the operation, and side effects of adenosine, the use of FFR in daily clinical practice is limited (9). QFR is a non-invasive angiographically derived FFR measurement.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Immunoinflammation and Coronary Physiology Evaluated by Quantitative Flow Ratio in Patients With Coronary Artery Disease

Liu

Chen

et al. 2021

Front. Cardiovasc. Med.

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Background: The association between coronary physiology and immunoinflammation has not been investigated. We performed a retrospective study using quantitative flow ratio (QFR) to evaluate the interaction between immunoinflammatory biomarkers and coronary physiology.Methods: A total of 172 patients with CAD who underwent coronary arteriography (CAG) and QFR were continuously enrolled from May 2020 to February 2021. As a quantitative indicator of coronary physiology, QFR can reflect the functional severity of coronary artery stenosis. The target vessel measured by QFR was defined as that with the most severe lesions. Significant coronary anatomical stenosis was defined as 70% stenosis in the target vessel.Results: Compared with the QFR > 0.8 group, interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ were increased and CD3+ and CD4+ T lymphocyte counts were decreased in the QFR ≤ 0.8 group. In addition, patients with DS ≤ 70% had higher IL-6, IL-10, and TNF-α levels and decreased CD3+ and CD4+ T lymphocyte counts than those with DS > 70%. Logistic regression analysis indicated IL-6 to be an independent predictor of significant coronary functional and anatomic stenosis (odds ratio, 1.125; 95% CI, 1.059–1.196; P < 0.001). Receiver operating characteristic (ROC) analyses showed that IL-6 > 6.36 was predictive of QFR ≤ 0.8 of the target vessel. The combination of IL-6, IL-10 and CD4 improved the value for predicting QFR ≤ 0.8 of the target vessel (AUC, 0.737; 95% CI, 0.661–0.810).Conclusion: Among immunoinflammatory biomarkers, IL-6 was independently associated with a higher risk of QFR ≤ 0.8 of the target vessel. The combination of immunoinflammatory biomarkers was highly predictive of significant coronary functional and anatomic stenosis.

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Section: Introductionmentioning

confidence: 99%

Relationship Between Immunoinflammation and Coronary Physiology Evaluated by Quantitative Flow Ratio in Patients With Coronary Artery Disease

Liu

Chen

et al. 2021

Front. Cardiovasc. Med.

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“…FFR CT is based on the application of computational fluid dynamic analysis to a CCTA dataset under maximum computationally simulated hyperemia. FFR CT is cost-effective and has lesser complication rates, thus decreasing the need for invasive coronary angiography ( Table 1 ) ( 13 , 14 ). FFR CT has been noted to correlate very well with the reference standard invasive indices (i.e.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Invasive and Non-invasive Hemodynamic Assessment of Coronary Artery Disease: Strengths and Weaknesses

Gajanan

Samant

Hovseth

et al. 2022

Front. Cardiovasc. Med.

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Coronary angiography has been the gold standard for assessment of coronary artery disease (CAD) and guidance for percutaneous coronary interventions (PCI). Physiology–guided PCI has shown increased safety and efficacy, improved resource utilization, and better clinical outcomes in patients with stable angina and acute coronary syndromes. The three cases presented and discussed in this report illustrate the strengths and weaknesses of the available invasive and non-invasive methods for the physiological assessment of CAD. As technology evolves, invasive non-wire-based (angiography-derived FFR) and non-invasive (FFRCT) modalities for the hemodynamic assessment of CAD appear to provide reliable and user-friendly alternatives to the gold standard invasive wire-based techniques. Interventional cardiologists and cardiovascular healthcare providers should be familiar with the strengths and weaknesses of the available hemodynamic assessment modalities.

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“…Additional costs, prolonged procedural time, invasive instrumentation of the culprit artery, and, for hyperemic indices, use of vasodilator agents, which can cause uncomfortable side effects are among the factors that may explain the low penetration of coronary physiology into the standard clinical practice. In order to address these limitations, pressure‐wire‐free and adenosine‐free alternatives to invasive‐FFR have been developed and validated 8,15 …”

Section: Discussionmentioning

confidence: 99%

Impact of physiologically diffuse versus focal pattern of coronary disease on quantitative flow reserve diagnostic accuracy

Scarsini

Fezzi

Pesarini

et al. 2021

Cathet Cardio Intervent

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Background: Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) disagree in about 20% of intermediate coronary lesions. As the physiological pattern of coronary artery disease has a significant influence on FFR-iFR discordance, we sought to assess it may impact on the diagnostic accuracy of quantitative flow reserve (QFR).Methods: One hundred and ninety-four patients with 224 intermediate coronary lesions were investigated with iFR, FFR, and QFR. The physiological pattern of disease was assessed with iFR Scout pullback and QFR virtual pullback in all the cases.Results: A predominantly physiologically focal pattern was observed in 81 (36.2%) lesions, whereas a predominantly physiologically diffuse was observed in 143 (63.8%) cases. QFR demonstrated a significant correlation (r = 0.581, p < 0.001) and a substantial agreement with iFR, both in diffuse (AUC = 0.798) and in focal (AUC = 0.812) pattern of disease. Discordance between QFR and iFR was observed in 51 (22.8%) lesions, consisting of iFR+/QFRÀ (64.7%) and iFRÀ/QFR+ (35.3%).Notably, the physiological pattern of disease was the only variable significantly associated with iFR/QFR discordance. QFR virtual pullback demonstrated an excellent agreement (83.9%) with iFR Scout pullback in classifying the physiological pattern of disease.Conclusions: QFR has a good diagnostic accuracy in assessing myocardial ischemia independently of the pattern of coronary disease. However, the physiological pattern of disease has an influence on the QFR/iFR discordance, which occurs in $20% of the cases. The QFR virtual pullback correctly defined the physiological pattern of disease in the majority of the cases using the iFR pullback as reference.

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Novel Indices of Coronary Physiology

Cited by 52 publications

References 35 publications

Relationship Between Immunoinflammation and Coronary Physiology Evaluated by Quantitative Flow Ratio in Patients With Coronary Artery Disease

Relationship Between Immunoinflammation and Coronary Physiology Evaluated by Quantitative Flow Ratio in Patients With Coronary Artery Disease

Case Report: Invasive and Non-invasive Hemodynamic Assessment of Coronary Artery Disease: Strengths and Weaknesses

Impact of physiologically diffuse versus focal pattern of coronary disease on quantitative flow reserve diagnostic accuracy

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