Diagnostic performance and limitation of quantitative flow ratio for functional assessment of intermediate coronary stenosis. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Kirigaya, Hidekuni; Okada, Kozo; Hibi, Kiyoshi; Maejima, Nobuhiko; Iwahashi, Noriaki; Matsuzawa, Yasushi; Akiyama, Eiichi; Minamimoto, Yugo; Kosuge, Masami; Ebina, Toshiaki; Tamura, Kouichi; Kimura, Kazuo
• Is Part Of: Journal of cardiology. Volume 77:Issue 5(2021)
• Page Start: 492
• Page End: 499
• Publication Date: 2021-05
• Subjects: Fractional flow reserve -- Quantitative flow reserve -- ST-segment elevation myocardial infarction -- Discordance; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2020.11.002
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: l Quantitative flow ratio (QFR) had good correlation and agreement with fractional flow reserve (FFR) in patients with stable coronary artery disease. l QFR had good diagnostic accuracy in non-culprit lesions (NCLs) at the acute setting of ST-segment elevation myocardial infarction (STEMI). l 15% of the lesions had discordant results between QFR and FFR. l 5 lesions showed discordant values between acute and staged QFR in NCLs of STEMI. l Technical factors such as inadequate lesion visualization affect QFR assessment. Abstract: Background: This study aimed to simultaneously investigate diagnostic performance and limitation of quantitative flow reserve (QFR) for assessing functionally significant coronary stenosis, focusing on factors affecting diagnostic accuracy of QFR. Methods: This study evaluated 1) QFR diagnostic accuracy compared with fractional flow reserve (FFR) in patients with stable coronary artery disease (Cohort-A, n = 95) and 2) QFR reproducibility for non-culprit lesions (NCLs) assessment between acute and staged (14±5 days later) procedures in patients with ST-segment elevation myocardial infarction (STEMI) (Cohort-B, n = 65). All coronary angiography image acquisition was performed before the introduction of QFR system into our institution. Results: Cohort-A showed good correlation ( r = 0.80, p <0.0001) between QFR and FFR; diagnostic accuracy of QFR for FFR ≤0.80 was 85.2% (sensitivity 80.4%, specificity 91.0%, positive predictive value 91.1%, negative predictive value 80.0%). There were 14 lesions showing discordance between QFR and FFR, which was primarily attributable to inadequate lesion visualization due to vessel overlap/tortuosity and/or insufficient intra-coronary contrast-media injection. In Cohort-B, there was also excellent correlation between acute and staged QFR; classification agreement of acute and staged QFR was 92.3%. Five lesions showed discordance between acute and staged QFR, 4 were due to limited image acquisition and/or high coronary flow velocity at acute phase of STEMI and 1 was borderline ischemia. Conclusions: QFR-derived physiological assessment of intermediate coronary stenosis is feasible, even in the acute setting of STEMI. Adjusting some technical factors may further improve the diagnostic performance of QFR.