Angio-Based Fractional Flow Reserve, Functional Pattern of Coronary Artery Disease, and Prediction of Percutaneous Coronary Intervention Result: a Proof-of-Concept Study

Biscaglia, Simone; Uretsky, Barry F.; Tebaldi, Matteo; Erriquez, Andrea; Brugaletta, Salvatore; Cerrato, Enrico; Quadri, Giorgio; Spitaleri, Giosafat; Colaiori, Iginio; Girolamo, Domenico Di; Scoccia, Alessandra; Zucchetti, Ottavio; D’Aniello, Emanuele; Manfrini, Marco; Pavasini, Rita; Barbato, Emanuele; Campo, Gianluca

doi:10.1007/s10557-021-07162-6

Cited by 21 publications

(18 citation statements)

References 10 publications

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“…In principle, assessment of non-focal (serial, diffuse) stenoses was performed using a dedicated software for calculation of quantitative flow ratio (QFR) based on coronary angiography (QAngio XA 3D version 2.0, Medis Medical Imaging Systems) (24).…”

Section: Pressure Wire Assessmentmentioning

confidence: 99%

Comparison of Resting Full-Cycle Ratio and Fractional Flow Reserve in a German Real-World Cohort

Wienemann

Meyer

Mauri

et al. 2021

Front. Cardiovasc. Med.

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Objective: The aim of this study was to evaluate non-hyperemic resting pressure ratios (NHPRs), especially the novel “resting full-cycle ratio” (RFR; lowest pressure distal to the stenosis/aortic pressure during the entire cardiac cycle), compared to the gold standard fractional flow reserve (FFR) in a “real-world” setting.Methods: The study included patients undergoing coronary pressure wire studies at one German University Hospital. No patients were excluded based on any baseline or procedural characteristics, except for insufficient quality of traces. The diagnostic performance of four NHPRs vs. FFR ≤ 0.80 was tested. Morphological characteristics of stenoses were analyzed by quantitative coronary angiography.Results: 617 patients with 712 coronary lesions were included. RFR showed a significant correlation with FFR (r = 0.766, p < 0.01). Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of RFR were 78% (95% confidence interval = 75; 81), 72% (65; 78), 81% (77; 84), 63% (57; 69), and 86% (83; 89). Relevant predictors for discordance of RFR ≤ 0.89/FFR > 0.8 were LAD lesions, peripheral artery disease, age, female sex and non-focal stenoses. Predictors for discordance of RFR > 0.89/FFR ≤ 0.8 included non-LCX lesions, percent diameter stenosis and previous percutaneous coronary intervention in the target vessel. RFR and all other NHPRs were highly correlated with each other.Conclusion: All NHPRs have a similar correlation with the gold standard FFR and may facilitate the acceptance and implementation of physiological assessments of lesion severity. However, we found ~20% discordant results between NHPRs and FFR in our “all-comers” German cohort.

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Section: Pressure Wire Assessmentmentioning

confidence: 99%

Comparison of Resting Full-Cycle Ratio and Fractional Flow Reserve in a German Real-World Cohort

Wienemann

Meyer

Mauri

et al. 2021

Front. Cardiovasc. Med.

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“…Several studies proposed focal (abrupt pressure drop) pattern and diffuse (gradual pressure drop) pattern on pressure-wire pullback. 12,13,20 However, definitions are heterogeneous and, ultimately, depend on the operator. In this study, all the pressure-wire traces, iFR pullback, and QFR virtual pullback were reviewed independently by two different expert operators blinded of the clinical and procedural data.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there are no established validated criteria to define the physiological pattern of disease as focal or diffuse using coronary pressure‐wire pullback. Several studies proposed focal (abrupt pressure drop) pattern and diffuse (gradual pressure drop) pattern on pressure‐wire pullback 12,13,20 . However, definitions are heterogeneous and, ultimately, depend on the operator.…”

Section: Limitationsmentioning

confidence: 99%

Impact of physiologically diffuse versus focal pattern of coronary disease on quantitative flow reserve diagnostic accuracy

Scarsini

Fezzi

Pesarini

et al. 2021

Cathet Cardio Intervent

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Background: Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) disagree in about 20% of intermediate coronary lesions. As the physiological pattern of coronary artery disease has a significant influence on FFR-iFR discordance, we sought to assess it may impact on the diagnostic accuracy of quantitative flow reserve (QFR).Methods: One hundred and ninety-four patients with 224 intermediate coronary lesions were investigated with iFR, FFR, and QFR. The physiological pattern of disease was assessed with iFR Scout pullback and QFR virtual pullback in all the cases.Results: A predominantly physiologically focal pattern was observed in 81 (36.2%) lesions, whereas a predominantly physiologically diffuse was observed in 143 (63.8%) cases. QFR demonstrated a significant correlation (r = 0.581, p < 0.001) and a substantial agreement with iFR, both in diffuse (AUC = 0.798) and in focal (AUC = 0.812) pattern of disease. Discordance between QFR and iFR was observed in 51 (22.8%) lesions, consisting of iFR+/QFRÀ (64.7%) and iFRÀ/QFR+ (35.3%).Notably, the physiological pattern of disease was the only variable significantly associated with iFR/QFR discordance. QFR virtual pullback demonstrated an excellent agreement (83.9%) with iFR Scout pullback in classifying the physiological pattern of disease.Conclusions: QFR has a good diagnostic accuracy in assessing myocardial ischemia independently of the pattern of coronary disease. However, the physiological pattern of disease has an influence on the QFR/iFR discordance, which occurs in $20% of the cases. The QFR virtual pullback correctly defined the physiological pattern of disease in the majority of the cases using the iFR pullback as reference.

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“…The higher the PPGindex, the more focal the physiological pattern; the lower the PPGindex, the more diffuse the pattern 91 . A similar index, with analogous computation and values is the QFR virtual pullback index derived from ICAbased computational QFR 94 . Another approach, dFFR(t)/dt, provides an instantaneous FFR gradient per unit of time.…”

Section: Patterns Of Epicardial Atherosclerosismentioning

confidence: 99%

Coronary physiology in the catheterisation laboratory: an A to Z practical guide

Fezzi¹,

Huang²,

Lunardi³

et al. 2022

AsiaIntervention

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Coronary revascularisation, either percutaneous or surgical, aims to improve coronary flow and relieve myocardial ischaemia. The decision-making process in patients with coronary artery disease (CAD) remains largely based on invasive coronary angiography (ICA), even though until recently ICA could not assess the functional significance of coronary artery stenoses. Invasive wire-based approaches for physiological evaluations were developed to properly assess the ischaemic relevance of epicardial CAD. Fractional flow reserve (FFR) and later, instantaneous wave-free ratio (iFR), were shown to improve clinical outcomes in several patient subsets when used for coronary revascularisation guidance or deferral and for procedural optimisation of percutaneous coronary intervention (PCI) results. Despite accumulating evidence and positive guideline recommendations, the adoption of invasive physiology has remained quite low, mainly due to technical and economic issues as well as to operator-resistance to change. Coronary image-based computational physiology has been recently developed, with promising results in terms of accuracy and a reduction in computational time, costs, radiation exposure and risks for the patient. Lastly, the integration of intracoronary imaging and physiology allows for individualised PCI treatment, aiming at complete relief of ischaemia through optimised morpho-functional immediate procedural results. Instead of a conventional state-of-the-art review, this A to Z dictionary attempts to provide a practical guide for the application of coronary physiology in the catheterisation laboratory, exploring several methods, their pitfalls, and useful tips and tricks.

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Angio-Based Fractional Flow Reserve, Functional Pattern of Coronary Artery Disease, and Prediction of Percutaneous Coronary Intervention Result: a Proof-of-Concept Study

Cited by 21 publications

References 10 publications

Comparison of Resting Full-Cycle Ratio and Fractional Flow Reserve in a German Real-World Cohort

Comparison of Resting Full-Cycle Ratio and Fractional Flow Reserve in a German Real-World Cohort

Impact of physiologically diffuse versus focal pattern of coronary disease on quantitative flow reserve diagnostic accuracy

Coronary physiology in the catheterisation laboratory: an A to Z practical guide

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