Angiographic quantitative flow ratio in acute coronary syndrome: beyond a tool to define ischemia-causing stenosis—a literature review

Chu, Jiapeng; Lin, Hui; Yan, Wei; Yuan, Deqiang; Liu, Yan; Liu, Xuebo

doi:10.21037/cdt-22-334

Cited by 6 publications

(3 citation statements)

References 105 publications

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“… 16 , 17 , 18 Among patients with chronic coronary syndrome, a QFR‐based revascularization strategy using 0.80 as the cutoff for ischemia (and treatment), has shown to improve 1‐year clinical outcomes as compared with an angiography‐guided approach. 19 In ACS, good correlation with FFR, 20 predictive ability for clinical events, 20 , 21 as well as good agreement between acute QFR compared with staged QFR have been reported. 20 , 22 , 23 …”

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confidence: 86%

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Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Bär,

Kavaliauskaite,

Otsuka

et al. 2024

JAHA

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Background The optimal time point of staged percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) remains a matter of debate. Quantitative flow ratio (QFR) is a novel noninvasive method to assess the hemodynamic significance of coronary stenoses. We aimed to investigate whether QFR could refine the timing of staged PCI of non‐target vessels (non‐TVs) on top of clinical judgment for patients with ACS. Methods and Results For this cohort study, patients with ACS from Bern University Hospital, Switzerland, scheduled to undergo out‐of‐hospital non‐TV staged PCI were eligible. The primary end point was the composite of non‐TV myocardial infarction and urgent unplanned non‐TV PCI before planned staged PCI. The association between lowest QFR per patient measured in the non‐TV (from index angiogram) and the primary end point was assessed using multivariable adjusted Cox proportional hazards regressions with QFR included as linear or penalized spline (nonlinear) term. QFR was measured in 1093 of 1432 patients with ACS scheduled to undergo non‐TV staged PCI. Median time to staged PCI was 28 days. The primary end point occurred in 5% of the patients. In multivariable analysis (1018 patients), there was no independent association between non‐TV QFR and the primary end point (hazard ratio, 0.87 [95% CI, 0.69–1.05] per 0.1 increase; P =0.125; nonlinear P =0.648). Conclusions In selected patients with ACS scheduled to undergo staged PCI at a median of 4 weeks after index PCI, QFR did not emerge as an independent predictor of non‐TV events before planned staged PCI. Thus, this study does not provide conceptual evidence that QFR is helpful to refine the timing of staged PCI on top of clinical judgment. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02241291.

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confidence: 86%

“… 19 In ACS, good correlation with FFR, 20 predictive ability for clinical events, 20 , 21 as well as good agreement between acute QFR compared with staged QFR have been reported. 20 , 22 , 23 …”

mentioning

confidence: 86%

Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Bär,

Kavaliauskaite,

Otsuka

et al. 2024

JAHA

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“…In recent decades, the functional assessment of coronary stenosis by using invasive fractional flow reserve (FFR) has been widely adopted in clinical practice, with substantial evidence supporting the benefits of coronary physiology-guided revascularization in patients with ischemic heart disease ( 1 , 2 ). However, FFR has several limitations, including increased procedural time and cost, the need to rely on pressure wires, and the need to induce hyperemia with pharmacological agents ( 3 , 4 ). The quantitative flow ratio (QFR), derived from three-dimensional (3D) coronary artery reconstruction and fluid dynamics computations from the routine angiogram, has emerged as an alternative approach to evaluate the functional significance of coronary stenosis, exhibiting a comparable diagnostic performance with invasive FFR ( 5 , 6 ).…”

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confidence: 99%

The relationship between glycemic risk and longitudinal changes in total physiological atherosclerotic burden in patients with coronary artery disease

Chu,

Lai,

Yao

et al. 2024

Quant Imaging Med Surg

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Background The effects of glycemic status on coronary physiology have not been well evaluated. This study aimed to investigate changes in coronary physiology by using angiographic quantitative flow ratio (QFR), and their relationships with diabetes mellitus (DM) and glycemic control status. Methods This retrospective cohort study included 530 patients who underwent serial coronary angiography (CAG) measurements between January 2016 and December 2021 at Tongji Hospital of Tongji University. Based on baseline and follow-up angiograms, 3-vessel QFR (3V-QFR) measurements were performed. Functional progression of coronary artery disease (CAD) was defined as a change in 3V-QFR (Δ3V-QFR = 3V-QFR follow-up − 3V-QFR baseline ) ≤−0.05. Univariable and multivariable logistic regression analyses were applied to identify the independent predictors of coronary functional progression. Subgroup analysis according to diabetic status was performed. Results During a median interval of 12.1 (10.6, 14.3) months between the two QFR measurements, functional progression was observed in 169 (31.9%) patients. Follow-up glycosylated hemoglobin (HbA1c) was predictive of coronary functional progression with an area under the curve (AUC) of 0.599 [95% confidence interval (CI): 0.546–0.651; P<0.001] in the entire population. Additionally, the Δ3V-QFR values were significantly lower in diabetic patients with HbA1c ≥7.0% compared to those with well-controlled HbA1c or non-diabetic patients [−0.03 (−0.09, 0) vs. −0.02 (−0.05, 0.01) vs. −0.02 (−0.05, 0.02); P=0.002]. In a fully adjusted multivariable logistics analysis, higher follow-up HbA1c levels were independently associated with progression in 3V-QFR [odds ratio (OR), 1.263; 95% CI: 1.078–1.479; P=0.004]. Furthermore, this association was particularly strong in diabetic patients (OR, 1.353; 95% CI: 1.082–1.693; P=0.008) compared to patients without DM. Conclusions Among patients with established CAD, on-treatment HbA1c levels were independently associated with progression in physiological atherosclerotic burden, especially in patients with DM.

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Diagnostic Performance of Quantitative Flow Ratio for the Assessment of Non‐Culprit Lesions in Myocardial Infarction (QFR‐OUTSMART): Systematic Review and Meta‐Analysis

Salinas‐Casanova,

Jiménez‐Franco,

Jerjes‐Sanchez

et al. 2024

Cathet Cardio Intervent

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BackgroundQuantitative flow ratio (QFR) analysis is a simple and non‐invasive coronary physiological assessment method with evidence for evaluating stable coronary artery disease with correlation to fractional flow reserve (FFR). However, there is no evidence to recommend its use in non‐culprit lesions (NCLs) in myocardial infarction (MI).MethodsWe performed a systematic review and meta‐analysis using the PRISMA and PROSPERO statements. The study's primary objective was to assess the diagnostic accuracy of QFR in identifying functionally significant NCLs after MI based on invasive FFR and non‐hyperemic pressure ratios as references. We obtained values of the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We performed a leave‐one‐out sensitivity analysis for each study's impact on the overall effect.ResultsWe included eight studies, with 713 patients and 920 vessels evaluated with QFR. The overall AUC was 0.941 (I2 = 0.559, p < 0.002), with a sensitivity of 87.3%, a specificity of 89.4%, a PPV of 86.6%, and an NPV of 90.1%. Compared to FFR, we found an AUC of 0.957 (I2 = 0.331, p < 0.194), a sensitivity of 89.6%, a specificity of 89.8%, a PPV of 88.3%, and an NPV of 91%. The sensitivity analysis showed a similar diagnostic performance in both studies.ConclusionsQFR is effective in analyzing NCLs with a significant diagnostic yield compared to FFR, with an excellent AUC in MI patients. Performing prospective multicenter studies to characterize this population and reproduce our results is essential.

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Angiographic quantitative flow ratio in acute coronary syndrome: beyond a tool to define ischemia-causing stenosis—a literature review

Cited by 6 publications

References 105 publications

Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

Quantitative Flow Ratio to Predict Non–Target‐Vessel Events Before Planned Staged Percutaneous Coronary Intervention in Patients With Acute Coronary Syndrome

The relationship between glycemic risk and longitudinal changes in total physiological atherosclerotic burden in patients with coronary artery disease

Diagnostic Performance of Quantitative Flow Ratio for the Assessment of Non‐Culprit Lesions in Myocardial Infarction (QFR‐OUTSMART): Systematic Review and Meta‐Analysis

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