Practical Application of Coronary Physiologic Assessment

Koo, Bon-Kwon; Lee, Joo Myung; Hwang, Doyeon; Park, Sungjoon; Shiono, Yasutsugu; Yonetsu, Taishi; Lee, Seung Hun; Kawase, Yoshiaki; Ahn, Jung-Min; Matsuo, Hitoshi; Shin, Eun-Seok; Hu, Xinyang; Ding, Daixin; Fezzi, Simone; Tu, Shengxian; Low, Adrian F.; Kubo, Takashi; Nam, Chang-Wook; Yong, Andy S.C.; Harding, Scott A.; Xu, Bo; Hur, Seung-Ho; Choo, Gim Hooi; Tan, Huay Cheem; Mullasari, Ajit; Hsieh, I-Chang; Kakuta, Tsunekazu; Akasaka, Takashi; Wang, Jian'an; Tahk, Seung-Jea; Fearon, William F.; Escaned, Javier; Park, Seung-Jung

doi:10.1016/j.jacasi.2023.07.003

Cited by 6 publications

(3 citation statements)

References 165 publications

(213 reference statements)

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“…The specific complexity of these lesions limits the application of the FFR in physiological evaluation. 23 In tandem stenoses, the hemodynamic crosstalk among stenoses under hyperemia has challenged the interpretation of hyperemic wire-based physiology. 24 For bifurcation lesions, it is often challenging for the pressure wire to cross complex stenoses, and computational solutions have enabled physiological evaluations without the need for intracoronary pressure wires and hyperemic agents.…”

Section: Clinical Role Of Ct-qfr and μQfr In Complex Lesionsmentioning

confidence: 99%

Diagnostic Performance of Angiography-Derived Quantitative Flow Ratio in Complex Coronary Lesions

Wu,

Wang,

et al. 2024

Circ: Cardiovascular Imaging

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BACKGROUND: Quantitative flow ratio derived from computed tomography angiography (CT-QFR) and invasive coronary angiography (Murray law–based quantitative flow ratio [μQFR]) are novel approaches enabling rapid computation of fractional flow reserve without the use of pressure guidewires and vasodilators. However, the feasibility and diagnostic performance of both CT-QFR and μQFR in evaluating complex coronary lesions remain unclear. METHODS: Between September 2014 and September 2021, 240 patients with 30% to 90% coronary diameter stenosis who underwent both coronary computed tomography angiography and invasive coronary angiography with fractional flow reserve within 60 days were retrospectively enrolled. The diagnostic performance of CT-QFR and μQFR in detecting functional ischemia among all lesions, especially complex coronary lesions, was analyzed using fractional flow reserve as the reference standard. RESULTS: CT-QFR and μQFR analyses were performed on 309 and 289 vessels, respectively. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for CT-QFR in all lesions at the per-vessel level were 91% (with a 95% CI of 84%–96%), 92% (95% CI, 88%–95%), 83% (95% CI, 75%–90%), 96% (95% CI, 93%–98%), and 92% (95% CI, 88%–95%), with values for μQFR of 90% (95% CI, 81%–95%), 97% (95% CI, 93%–99%), 92% (95% CI, 84%–97%), 96% (95% CI, 92%–98%), and 94% (95% CI, 91%–97%), respectively. Among bifurcation, tandem, and moderate-to-severe calcified lesions, the diagnostic values of CT-QFR and μQFR showed great correlation and agreement with those of invasive fractional flow reserve, achieving an area under the receiver operating characteristic curve exceeding 0.9 for each complex lesion at the vessel level. Furthermore, the accuracies of CT-QFR and μQFR in the gray zone were 85% and 84%, respectively. CONCLUSIONS: Angiography-derived quantitative flow ratio (CT-QFR and μQFR) demonstrated remarkable diagnostic performance in complex coronary lesions, indicating its pivotal role in the management of patients with coronary artery disease.

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Section: Clinical Role Of Ct-qfr and μQfr In Complex Lesionsmentioning

confidence: 99%

Diagnostic Performance of Angiography-Derived Quantitative Flow Ratio in Complex Coronary Lesions

Wu,

Wang,

et al. 2024

Circ: Cardiovascular Imaging

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“…In this issue of JACC: Asia , Koo et al 3 , 4 provide such a timely and focused comprehensive evidence-based 2-part report on the practical application of coronary physiology assessment. Consensus statements regarding coronary physiology have been published from organizations in other continents, one from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology 5 and another from the Society of Cardiac Angiography and Interventions (SCAI).…”

mentioning

confidence: 99%

“…Consensus statements regarding coronary physiology have been published from organizations in other continents, one from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the European Society of Cardiology 5 and another from the Society of Cardiac Angiography and Interventions (SCAI). 6 The Koo et al 3 , 4 report is unique with its thoroughness and particular attention to incorporating studies from the Asia-Pacific region.…”

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confidence: 99%

Coronary Physiology Assessment

Misumida,

Moliterno

2023

JACC: Asia

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Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and long-term clinical outcomes

Fezzi,

Del Sole,

Burzotta

et al. 2024

Clin Res Cardiol

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Background Physiological patterns of coronary artery disease (CAD) have emerged as potential determinants of functional results of percutaneous coronary interventions (PCI) and of vessel-oriented clinical outcomes (VOCE). Objectives In this study, we evaluated the impact of angiography-derived physiological patterns of CAD on post-PCI functional results and long-term clinical outcomes. Methods Pre-PCI angiography-derived fractional flow reserve (FFR) virtual pullbacks were quantitatively interpreted and used to determine the physiological patterns of CAD. Suboptimal post-PCI physiology was defined as an angiography-derived FFR value ≤ 0.91. The primary endpoint was the occurrence of VOCE at the longest available follow-up. Results Six hundred fifteen lesions from 516 patients were stratified into predominantly focal (n = 322, 52.3%) and predominantly diffuse (n = 293, 47.7%). Diffuse pattern of CAD was associated with lower post-PCI angiography-derived FFR values (0.91 ± 0.05 vs. 0.94 ± 0.05; p = 0.001) and larger rate of suboptimal post-PCI physiology (43.0 vs. 22.7%; p = 0.001), as compared to focal CAD. At the median follow-up time of 37 months (33–58), post-PCI suboptimal physiology was related to a higher risk of VOCE (16.2% vs. 7.6%; HR: 2.311; 95% CI 1.410–3.794; p = 0.0009), while no significant difference was noted according to baseline physiological pattern. In diffuse disease, the use of intracoronary imaging was associated with a lower incidence of long-term VOCE (5.1% vs 14.8%; HR: 0.313, 95% CI 0.167–0.614, p = 0.030). Conclusions Suboptimal post-PCI physiology is observed more often in diffusely diseased arteries and it is associated with higher risk of VOCE at follow-up. The use of intravascular imaging might improve clinical outcomes in the setting of diffuse CAD.

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Practical Application of Coronary Physiologic Assessment

Cited by 6 publications

References 165 publications

Diagnostic Performance of Angiography-Derived Quantitative Flow Ratio in Complex Coronary Lesions

Diagnostic Performance of Angiography-Derived Quantitative Flow Ratio in Complex Coronary Lesions

Coronary Physiology Assessment

Angiography-derived physiological patterns of coronary artery disease: implications with post-stenting physiology and long-term clinical outcomes

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