Quantitative flow ratio and fractional flow reserve mismatch – clinical and biochemical predictors of measurement discrepancy

Abstract

A b s t r a c t Introduction: Fractional flow reserve (FFR) is the gold standard for functional assessment of intermediate lesions. However, assessing a stenosis with pressure wire prolongs the procedure, increases costs and carries a risk of procedure-related adverse events. Quantitative flow ratio (QFR) is a wire-free method for detection of significant ischemia based on 3D reconstruction of angiographic images and TIMI frame count.Aim: To evaluate the influence of laboratory and clinical variables on QFR-FFR mismatch. Material and methods: We retrospectively computed QFR (Medis Suite XA/QAngio XA 3D/QFR, Medis/Netherlands) in suitable cases with corresponding FFR (PressureWire, Abbott, US). Uni-/multivariate analysis was performed to identify clinical and biochemical predictors of QFR-FFR mismatch.Results: Two hundred six lesions (196 patients, 76% male, mean age: 66.4 ±10.1 years) were included. Chronic kidney disease (CKD) and insulin-treated diabetes mellitus (ITDM) were associated with significantly larger differences between QFR and FFR values (-0.062 ±0.031 vs. -0.025 ±0.068; p = 0.027 and -0.059 ±0.07 vs. -0.027 ±0.074; p = 0.039; respectively). CKD was associated with a decrease of diagnostic efficiency (AUC = 0.67, 95% CI: 0.46-0.88 vs. AUC = 0.89, 95% CI: 0.84-0.94, p = 0.05). For biochemical variables only weak Spearman correlations were identified for hemoglobin concentration (r = -0.18) and hematocrit levels (r = -0.18).Conclusions: CKD may impair the QFR diagnostic accuracy. Larger, prospective studies are needed to further explore this potential relationship.

Fractional flow reserve, quantitative flow ratio, and instantaneous wave-free ratio: a comparison of the procedure-related dose of ionising radiation

“…Also, the necessity of a stiff wire insertion through a tight lesion might be complicated by a failure to pass through the lesion or in forceful manoeuvres by a plaque rupture, a CA dissection or perforation [ 9 ]. Moreover, an FFR measurement requires intravenous or intracoronary adenosine injection which occasionally may cause drug-related adverse reactions including dyspnoea, chest discomfort, bradycardia, atrioventricular blocks, ventricular arrhythmias, cardiac arrest, asystole and even death [ 10 ]. An iFR is advantageous due to redundancy of adenosine due to exploitation of the natural heart cycle hyperaemic phase [ 11 ].…”

Quantitative Flow Ratio for Assessment of Non-Culprit Coronary Artery Lesions During Percutaneous Coronary Intervention (PCI) in 79 Patients Diagnosed with ST-Elevation Myocardial Infarction (STEMI): A Study from a Single Center in Lithuania

“…Musto et al found lower rates of adverse events in iFR-guided PCIs, but since it was a quite small population study, further randomized clinical trials are necessary to confirm the findings [24]. QFR reliability in stable patients are non-negotiable and has been previously repeatedly proved in various studies in APPROVED GALLEY PROOF comparison to both hyperemic and resting indices [25][26][27][28][29]. Sejr-Hansen et al demonstrated that acute QFR compared with staged QFR has higher diagnostic performance than acute FFR and staged FFR or acute iFR and staged iFR [18], which is why we did not double the QFR analyses with hyperemic or resting indices methods.…”

“…QFR reliability in stable patients are non-negotiable and has been previously repeatedly proved in various studies in comparison to both hyperemic and resting indices [ 25 – 29 ]. Sejr-Hansen et al demonstrated that acute QFR compared with staged QFR has higher diagnostic performance than acute FFR and staged FFR or acute iFR and staged iFR [ 18 ], which is why we did not double the QFR analyses with hyperemic or resting indices methods.…”