TCT-70 Influence of microcirculatory resistance on the assessment of coronary stenosis severity with Quantitative Flow Ratio (QFR): Results of an international multicentre study

Mejía‐Rentería, Hernán; Lauri, Francesco; Lee, Joo Myung; Hoeven, Nina van der; Waard, Guus de; Hoyos, Alfonso de; Macaya, Fernando; Ryan, Nicola; Gonzalo, Nieves; Jiménez‐Quevedo, Pilar; Franco, Luis Nombela; Nuñez-Gil, Ivan; Salinas, Pablo; Trigo, María Del; Pérez-Vizcayno, Marı́a José; Fernández‐Ortíz, Antonio; Macaya, Carlos; Koo, Bon‐Kwon; Royen, Niels van; Escaned, Javier

doi:10.1016/j.jacc.2017.09.121

Cited by 2 publications

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“…Nine studies were retrieved for a more detailed evaluation. Finally, 9 studies consisting of 1175 vessels in 1047 patients met our inclusion criteria [4-6 ), ( 9-15] . Characteristics of included studies were shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Clinical heterogeneity was mostly due to different inclusion criteria. Mejia-Renteria [9] and Emori [13] included patients with myocardial infarction. Emori [13] included two different populations: patients with previous myocardial infarction (MI) and patients without previous MI.…”

Section: Resultsmentioning

confidence: 99%

“…Emori, et al [13] and Mejia-Renteria, et al [9] included patients with previous MI that might affect the diagnostic accuracy. Exclusion of these two trials slightly improved the specificity (0.90, 0.87-0.92), but did not affect sensitivity.…”

Section: Resultsmentioning

confidence: 99%

“…However, the simple size was too small. Our meta-analysis included [9] studies of which the majority were performed in China and Japan from 2016 to 2018, with a total of 1175 vessels in 1047patients, and demonstrated that the diagnostic accuracy of QFR for functionally significant stenosis confirmed by FFR was high, with a summary sensitivity and specificity of 0.89 (95% CI: 0.86-0.92) and 0.88 (95% CI: 0.86-0.91), respectively.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Performance of QFR for the Evaluation of Intermediate Coronary Artery Stenosis Confirmed by Fractional Flow Reserve

Xing¹,

Pei²,

Huang³

et al. 2019

Braz J Cardiovasc Surg

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Introduction Quantitative flow ratio (QFR) is a novel method enabling efficient computation of FFR from three-dimensional quantitative coronary angiography (3D QCA) and thrombolysis in myocardial infarction (TIMI) frame counting. We decided to perform a systematic review and quantitative meta-analysis of the literature to determine the correlation between the diagnosis of functionally significant stenosis obtained by QFR versus FFR and to determine the diagnostic accuracy of QFR for intermediate coronary artery stenosis. Methods We searched PubMed, Embase, and Web of Science for studies concerning the diagnostic performance of QFR. Our meta-analysis was performed using the DerSimonian and Laird random effects model to determine sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). The sROC was used to determine diagnostic test accuracy. Results Nine studies consisting of 1175 vessels in 1047 patients were included in our study. The pooled sensitivity, specificity, LR+, LR-, and DOR for QFR were 0.89 (95% CI: 0.86-0.92), 0.88 (95% CI: 0.86-0.91), 6.86 (95% CI,: 5.22-9.02), 0.14 (95% CI: 0.10-0.21), and 53.05 (95% CI: 29.75-94.58), respectively. The area under the summary receiver operating characteristic (sROC) curve for QFR was 0.94. Conclusion QFR is a simple, useful, and noninvasive modality for diagnosis of functional significance of intermediate coronary artery stenosis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Diagnostic Performance of QFR for the Evaluation of Intermediate Coronary Artery Stenosis Confirmed by Fractional Flow Reserve

Xing¹,

Pei²,

Huang³

et al. 2019

Braz J Cardiovasc Surg

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Non-invasive imaging software to assess the functional significance of coronary stenoses: a systematic review and economic evaluation

Duarte

Llewellyn

Walker

et al. 2021

Health Technol Assess

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Background QAngio® XA 3D/QFR® (three-dimensional/quantitative flow ratio) imaging software (Medis Medical Imaging Systems BV, Leiden, the Netherlands) and CAAS® vFFR® (vessel fractional flow reserve) imaging software (Pie Medical Imaging BV, Maastricht, the Netherlands) are non-invasive technologies to assess the functional significance of coronary stenoses, which can be alternatives to invasive fractional flow reserve assessment. Objectives The objectives were to determine the clinical effectiveness and cost-effectiveness of QAngio XA 3D/QFR and CAAS vFFR. Methods We performed a systematic review of all evidence on QAngio XA 3D/QFR and CAAS vFFR, including diagnostic accuracy, clinical effectiveness, implementation and economic analyses. We searched MEDLINE and other databases to January 2020 for studies where either technology was used and compared with fractional flow reserve in patients with intermediate stenosis. The risk of bias was assessed with quality assessment of diagnostic accuracy studies. Meta-analyses of diagnostic accuracy were performed. Clinical and implementation outcomes were synthesised narratively. A simulation study investigated the clinical impact of using QAngio XA 3D/QFR. We developed a de novo decision-analytic model to estimate the cost-effectiveness of QAngio XA 3D/QFR and CAAS vFFR relative to invasive fractional flow reserve or invasive coronary angiography alone. Scenario analyses were undertaken to explore the robustness of the results to variation in the sources of data used to populate the model and alternative assumptions. Results Thirty-nine studies (5440 patients) of QAngio XA 3D/QFR and three studies (500 patients) of CAAS vFFR were included. QAngio XA 3D/QFR had good diagnostic accuracy to predict functionally significant fractional flow reserve (≤ 0.80 cut-off point); contrast-flow quantitative flow ratio had a sensitivity of 85% (95% confidence interval 78% to 90%) and a specificity of 91% (95% confidence interval 85% to 95%). A total of 95% of quantitative flow ratio measurements were within 0.14 of the fractional flow reserve. Data on the diagnostic accuracy of CAAS vFFR were limited and a full meta-analysis was not feasible. There were very few data on clinical and implementation outcomes. The simulation found that quantitative flow ratio slightly increased the revascularisation rate when compared with fractional flow reserve, from 40.2% to 42.0%. Quantitative flow ratio and fractional flow reserve resulted in similar numbers of subsequent coronary events. The base-case cost-effectiveness results showed that the test strategy with the highest net benefit was invasive coronary angiography with confirmatory fractional flow reserve. The next best strategies were QAngio XA 3D/QFR and CAAS vFFR (without fractional flow reserve). However, the difference in net benefit between this best strategy and the next best was small, ranging from 0.007 to 0.012 quality-adjusted life-years (or equivalently £140–240) per patient diagnosed at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year. Limitations Diagnostic accuracy evidence on CAAS vFFR, and evidence on the clinical impact of QAngio XA 3D/QFR, were limited. Conclusions Quantitative flow ratio as measured by QAngio XA 3D/QFR has good agreement and diagnostic accuracy compared with fractional flow reserve and is preferable to standard invasive coronary angiography alone. It appears to have very similar cost-effectiveness to fractional flow reserve and, therefore, pending further evidence on general clinical benefits and specific subgroups, could be a reasonable alternative. The clinical effectiveness and cost-effectiveness of CAAS vFFR are uncertain. Randomised controlled trial evidence evaluating the effect of quantitative flow ratio on clinical and patient-centred outcomes is needed. Future work Studies are required to assess the diagnostic accuracy and clinical feasibility of CAAS vFFR. Large ongoing randomised trials will hopefully inform the clinical value of QAngio XA 3D/QFR. Study registration This study is registered as PROSPERO CRD42019154575. Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 56. See the NIHR Journals Library website for further project information.

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TCT-70 Influence of microcirculatory resistance on the assessment of coronary stenosis severity with Quantitative Flow Ratio (QFR): Results of an international multicentre study

Cited by 2 publications

References 0 publications

Diagnostic Performance of QFR for the Evaluation of Intermediate Coronary Artery Stenosis Confirmed by Fractional Flow Reserve

Diagnostic Performance of QFR for the Evaluation of Intermediate Coronary Artery Stenosis Confirmed by Fractional Flow Reserve

Non-invasive imaging software to assess the functional significance of coronary stenoses: a systematic review and economic evaluation

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