Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve

Adjedj, Julien; Xaplanteris, Panagiotis; Tóth, Gábor G.; Ferrara, Angela; Pellicano, Mariano; Ciccarelli, Giovanni; Floré, Vincent; Barbato, Emanuele; Bruyne, Bernard De

doi:10.1161/circimaging.117.006243

Cited by 44 publications

(49 citation statements)

References 40 publications

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“…Invasive methods to assess the hemodynamic significance of coronary artery stenoses are associated with improved short-and long-term outcomes, principally driven by a reduced incidence of revascularization and target vessel myocardial infarction [1][2][3]. Despite their advantages, the penetration of these invasive techniques remains low due to cost or logistic considerations, limited access, and a perceived increased risk associated with intracoronary procedures and the administration of vasodilators.…”

Section: Discussionmentioning

confidence: 99%

“…Several tools have been developed to overcome this limitation, among which fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) represent the most frequently adopted. Given their reliability in the prediction of cardiovascular events and consequently in guiding the decision whether to perform percutaneous coronary intervention (PCI) [1][2][3][4][5][6][7][8], the use of these methods is recommended as Class IA in the current guidelines on myocardial revascularization [9]. Despite the indisputable benefit of these functional indexes, their use increases the invasiveness and the cost of procedure, and their penetration remains unfortunately low.…”

Section: Introductionmentioning

confidence: 99%

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QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

Buono¹,

Mühlenhaus²,

Schäfer³

et al. 2020

JCM

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AIMS: We evaluate feasibility and reproducibility of post hoc quantitative flow ratio (QFR) measurements and their prognostic predictive power during long-term follow-up. METHODS AND RESULTS: Between 2010 and 2012, 167 patients without angiographic evidence of significant stenoses were enrolled in a prospective registry. Of these patients, 96% presented 7 years follow-up data. QFR was measured post hoc by three certified investigators. QFR analysis was feasible in 71% of left anterior descending (LAD), 72% of left circumflex (LCX), and 61% of right (RCA) coronaries for a total of 350 measurements repeated in triplicate. Coefficients of variation were 2.1% for RCA and LCX, and 2.8% for the LAD (quartile coefficients of dispersion respectively 1.5, 1.4, and 1.3). QFR ≤0.80 was recorded in 25 patients (27 vessels, in 74% of the cases LAD). A total of 86 major adverse cardiovascular and cerebrovascular events were observed in 76 patients. QFR ≤0.80 in at least one of the three vessels was the strongest predictor of events (HR 3.14, 95%CI 1.78–5.54, p = 0.0001). This association was maintained in several sensitivity analyses. CONCLUSIONS: QFR reproducibility is acceptable, even when analysis is performed post hoc. A pathological QFR is not rare in patients without angiographic evidence of significant stenosis and is a predictor of incident events during long-term follow-up. Condensed Abstract: In a post hoc analysis of 167 patients without evidence of angiographic significant stenosis, the presence of QFR value ≤0.80 in at least one of the three coronary vessels showed to be the strongest predictor of major adverse cardiovascular and cerebrovascular events during long-term follow-up. QFR reproducibility have been shown to be acceptable among experienced operators.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

Buono¹,

Mühlenhaus²,

Schäfer³

et al. 2020

JCM

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“…In this issue of Circulation: Cardiovascular Imaging, Adjedj et al 4 examined the diagnostic accuracy of coronary angiography by visual estimate and quantitative measurement with invasive FFR. This report includes a robust patient sample with over 1000 patients undergoing invasive coronary angiography with FFR measurements.…”

Section: See Article By Adjedj Et Almentioning

confidence: 99%

“…These and other answers to questions remain ill-defined but prove to be fruitful areas of ongoing research exploration. It is clear that more data, such as the report by Adjedj et al, 4 are needed and provide important clues to the anatomy-physiology disconnect. Moreover, these data remain fundamental to patient care and impact a large proportion of patients and, thus, are informative.…”

Section: See Article By Adjedj Et Almentioning

confidence: 99%

Clues to Discordance and Dissimilarity Between Coronary Stenosis and Lesion-Specific Ischemia

Shaw

Min

2017

Circ: Cardiovascular Imaging

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“…1 ) ( 11 ). In this general paradox, the percentage of diameter stenosis (DS) does not reliably relate to FFR ( 12 , 13 ); therefore, revascularization procedures to improve coronary blood flow based on coronary angiogram do not reduce coronary events compared with optimal medical therapy in randomized trials ( 14 ). In contrast to these trials, revascularization guided by FFR had significantly fewer follow-up coronary events than percutaneous coronary intervention (PCI) based on angiographic DS ( 15 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

Coronary artery disease evaluation by coronary angiography and intracoronary imaging compared to Fractional Flow Reserve: anatomical-functional mismatch.

Adjedj¹

2018

Anatol J Cardiol

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Myocardial ischemia is a leading cause of death worldwide, and it corresponds to the imbalance between blood supply and myocardial demand. Epicardial coronary artery disease (CAD) is detected on the basis of coronary angiogram, whereas invasive detection of myocardial ischemia induced by coronary stenosis is commonly based on fractional flow reserve (FFR). The use of FFR for revascularization decision-making demonstrated clinical benefit and cost-effectiveness compared with that of angiographic indices. Discrepancies between anatomical metrics and physiological assessment of CAD are frequent, which lead to change in revascularization decision from angiography compared to functional evaluation of CAD. Despite several clinical studies and guidelines recommending with high level of evidence demonstrating that FFR should be adopted in stable CAD, revascularization decision-making is still based on coronary angiogram in current practice. Because of the unique coronary anatomy, coronary stenosis characteristics, risk factors profile, and microcirculation quality, the unique evaluation based on epicardial coronary stenosis threshold failed to be a landmark of ischemia compared with FFR. Furthermore, coronary angiogram can detect only epicardial vessels, which represent only 10% of the entire coronary vasculature; therefore, microcirculation is not seen and is poorly assessed in clinical practice. Thus, the role of microcirculation is of importance in myocardial ischemia and might impact these discrepancies between angiography and FFR evaluation of CAD. In this review, we aimed to describe the poor correlation between anatomical evaluation compared with physiological evaluation to detect myocardial ischemia induced by coronary stenosis as well as the clinical implications of this visual–functional mismatch.

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Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve

Abstract: Background-The

Cited by 44 publications

References 40 publications

QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

QFR Predicts the Incidence of Long-Term Adverse Events in Patients with Suspected CAD: Feasibility and Reproducibility of the Method

Clues to Discordance and Dissimilarity Between Coronary Stenosis and Lesion-Specific Ischemia

Coronary artery disease evaluation by coronary angiography and intracoronary imaging compared to Fractional Flow Reserve: anatomical-functional mismatch.

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