Quantitative Flow Ratio As a New Tool for angiography-based Physiological Evaluation of Coronary Artery Disease: A Review

Cerrato, Enrico; Mejía‐Rentería, Hernán; Franzé, Alfonso; Quadri, Giorgio; Belliggiano, Davide; Biscaglia, Simone; Savio, Luca Lo; Spataro, F.; Erriquez, Andrea; Giacobbe, Federico; Vergara-Uzcategui, Carlos; Girolamo, Domenico Di; Tebaldi, Matteo; Varbella, Ferdinando; Campo, Gianluca; Escaned, Javier

doi:10.2217/fca-2020-0199

Cited by 5 publications

(5 citation statements)

References 83 publications

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“…Angiographic projections were at least 25° apart and aimed to provide minimal vessel foreshortening and vessel overlap. In agreement with previous studies [7,26,27], operators followed a table of recommended projection angles.…”

Section: Study Proceduressupporting

confidence: 82%

“…Third, in the HAWKEYE study [ 7 ], post-PCI FFR was not invasively measured. Thus, we cannot provide any direct comparison between TSG FFR and QFR, although previous studies have demonstrated an excellent correlation between FFR and QFR [ 26 , 27 ]. In addition, when present, TSG was numerically very low.…”

Section: Discussionmentioning

confidence: 99%

“…QFR computation was performed offline, using the software package QAngio XA 3D (Medis Medical Imaging System, Leiden, the Netherlands) in agreement with the step-by-step procedure validated in previous studies [ 7 , 26 , 27 ]. In the present analysis, we considered the contrast QFR value that was calculated in the entire vessel, starting from the most proximal available segment until its diameter became less than 1.5 mm.…”

Section: Methodsmentioning

confidence: 99%

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Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy

Erriquez

Uretsky

Brugaletta

et al. 2022

Int J Cardiovasc Imaging

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To test whether quantitative flow ratio (QFR)-based trans-stent gradient (TSG) is associated with adverse clinical events at follow-up. A post-hoc analysis of the multi-center HAWKEYE study was performed. Vessels post-PCI were divided into four groups (G) as follows: G1: QFR ≥ 0.90 TSG = 0 (n = 412, 54.8%); G2: QFR ≥ 0.90, TSG > 0 (n = 216, 28.7%); G3: QFR < 0.90, TSG = 0 (n = 37, 4.9%); G4: QFR < 0.90, TSG > 0 (n = 86, 11.4%). Cox proportional hazards regression model was used to analyze the effect of baseline and prognostic variables. The final reduced model was obtained by backward stepwise variable selection. Receiver operating characteristic (ROC) was plotted and area under the curve (AUC) was calculated and reported. Overall, 449 (59.8%) vessels had a TSG = 0 whereas (40.2%) had TSG > 0. Ten (2.2%) vessel-oriented composite endpoint (VOCE) occurred in vessels with TSG = 0, compared with 43 (14%) in vessels with TSG > 0 (p < 0.01). ROC analysis showed an AUC of 0.74 (95% CI: 0.67 to 0.80; p < 0.001). TSG > 0 was an independent predictor of the VOCE (HR 2.95 [95% CI 1.77–4.91]). The combination of higher TSG and lower final QFR (G4) showed the worst long-term outcome while low TSG and high QFR showed the best outcome (G1) while either high TSG or low QFR (G2, G3) showed intermediate and comparable outcomes. Higher trans-stent gradient was an independent predictor of adverse events and identified a subgroup of patients at higher risk for poor outcomes even when vessel QFR was optimal (> 0.90).

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Section: Study Proceduressupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy

Erriquez

Uretsky

Brugaletta

et al. 2022

Int J Cardiovasc Imaging

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“…The Q-rFSS model is superior at predicting the risk of MACE. 28 As a consequence of these fi ndings, Cerrato et al 29 issued strong guidelines for functional assessment of CS. However, advancing a wire into the CA to interrogate the CS has prevented the adoption of coronary wire-based functional assessment in catheterization labs.…”

Section: Recent Studiesmentioning

confidence: 99%

Functional Evaluation of Coronary Stenosis: is Quantitative Flow Ratio a Step Forward?

Aşkın¹,

Tanrıverdi²,

Gül³

2022

Cor Vasa

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Závažnost koronárních lézí vždy představovala významný aspekt péče o pacienty během koronarografi ckého vyšetření. Je prokázáno, že léčba vedená na základě hodnot frakční průtokové rezervy (fractional fl ow reserve, FFR) má pozitivní vliv na klinický výsledný stav pacienta. Zavádění FFR do klinické praxe v celosvětovém měřítku nicméně zpomalily závažné technické nedostatky. V poslední době byla představena a v klinickém výzkumu ověřována jiná kritéria, jako například kvantitativní poměr průtoků (quantitative fl ow ratio, QFR). Podle jedné studie používající výpočetní mechaniku tekutin a plynů koreluje QFR s hodnotami FFR a ve srovnání s jinými metodami šetří čas i peníze. QFR představuje novou angiografi ckou metodu, která pomocí moderního softwaru provádí trojrozměrnou rekonstrukci cév a vytváří modely průtoku. Jedná se tedy o technicky vyspělou metodu a o moderní, účinný a praktický nástroj pro hodnocení koronárních lézí. Cílem tohoto přehledu bylo prozkoumat oblasti případného využití QFR v klinické praxi.

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“…Studies have shown that FFR is not only related to the degree of coronary stenosis but also to the blood supply territory of the affected coronary artery: the larger the supply territory is, the lower the FFR value measured from the diseased coronary artery ( 9 , 10 ). The limitations of using these methods, however, include the side effects of hyperemia-induced agents, additional costs, and vulnerability to microvascular resistance ( 11 ). The Coronary Artery Tree Description and Lesion Evaluation System (CatLet) angiographic scoring system (also known as Hexu ) was independently developed by our research team based on the 17-segment myocardial model, the rule of competitive blood supply, and the law of flow conservation ( 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

Coronary Artery Tree Description and Lesion Evaluation (CatLet) score for functional evaluation of coronary stenosis: a comparison study with pressure wire fractional flow reserve

Wang,

Xu,

et al. 2024

Quant Imaging Med Surg

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Background Pressure wire fractional flow reserve (FFR) and its derivatives, such as quantitative flow ratio (QFR), computational pressure flow-derived FFR (caFFR), coronary angiography-derived FFR (FFR angio ), and computed tomography-derived FFR (FFR CT ), have been validated for identifying functionally significant stenosis and guiding revascularization strategy. The limitations of using these methods include the side effects of hyperemia-induced agents, additional costs, and vulnerability to microvascular resistance. FFR is related both to the degree of a stenotic coronary artery and to its subtended myocardial territory. Coronary Artery Tree Description and Lesion Evaluation (CatLet) score (also known as Hexu ) is a product of the degree of a stenosis and the weighting of the affected coronary artery (myocardial territory). Hence, we hypothesized that the CatLet score could predict hemodynamically significant coronary stenosis. Methods We retrospectively enrolled consecutive patients with stable coronary artery disease. They attended Sichuan Science City Hospital with at least one lesion of 50-90% diameter stenosis in a coronary artery of 2 mm or larger. FFR measurement was obtained during invasive coronary angiography. The CatLet score was obtained by multiplying a fixed value of 2.0 (for non-occlusive lesions) and the weight of the affected coronary artery. The primary endpoint was the CatLet score’s diagnostic accuracy in identifying hemodynamically significant coronary stenosis, with a pressure wire FFR of ≤0.80 being used as reference. Results We analyzed the FFR and CatLet scores from 206 vessels in 175 patients with stable coronary disease and intermediate coronary lesions. The per-vessel analysis revealed an overall good correlation between the CatLet score and the FFR [r=–0.61; 95% confidence interval (95% CI): –0.69 to –0.52; P<0.01]. We also noted a significant CatLet score-FFR correlation for each of the left anterior descending artery (LAD), left circumflex (LCX), and right coronary artery (RCA). With a CatLet score ≥10 as a predictor of FFR ≤0.80, the overall diagnostic accuracy included a sensitivity of 78.80% (95% CI: 67.00–87.90%), a specificity of 85.00% (95% CI: 78.00–90.50%), a positive likelihood ratio of 5.25, a negative likelihood ratio of 0.25, and an area under the curve of 0.90 (95% CI: 0.85–0.94). Equivalent vessel-specific results were also achieved for each of the LAD, LCX, and RCA. Conclusions The CatLet score, solely based on visual estimation of the results of coronary angiography, demonstrated good diagnostic performance with respect to myocardial ischemia. Its clinical values in guiding revascularization warrant further investigation.

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Quantitative Flow Ratio As a New Tool for angiography-based Physiological Evaluation of Coronary Artery Disease: A Review

Cited by 5 publications

References 83 publications

Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy

Impact of trans-stent gradient on outcome after PCI: results from a HAWKEYE substudy

Functional Evaluation of Coronary Stenosis: is Quantitative Flow Ratio a Step Forward?

Coronary Artery Tree Description and Lesion Evaluation (CatLet) score for functional evaluation of coronary stenosis: a comparison study with pressure wire fractional flow reserve

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