Angiography-based quantitative coronary contrast-flow ratio measurements correlate with myocardial ischemia assessed by stress MRI

Abstract

Contrast-flow quantitative flow ratio (cQFR) is a new technology for quantitative evaluation of coronary stenosis using computational fluid dynamics based on angiograms. The aim of this study was to assess the sensitivity and specificity of cQFR to detect myocardial ischemia using stress magnetic resonance imaging (MRI) as a reference standard. Patients who received stress MRI and coronary angiography were selected from the hospital database. Relevant ischemia on stress MRI was defined as a perfusion deficit in ≥ 2 of 16 segments. cQFR was quantitated based on 3-dimensional quantitative coronary angiography using QAngio XA3D1.1 software by two blinded and independent investigators. A cQFR of ≤ 0.80 was considered abnormal. Among 87 patients 230 vessels met the criteria for full analysis by cQFR (88%). In vascular territories with a significant perfusion deficit, cQFR was significantly lower compared to areas with normal perfusion (0.72 (0.62–0.78) vs. 0.96 (0.89–0.99); p < 0.001). The sensitivity of cQFR in detecting significant epicardial stenoses of coronary vessels with documented ischemia in stress MRI was 81% (68–90%), the specificity was 88% (82–92%). Diameter stenoses (DS) and area stenoses (AS) in vessels with positive stress MRI were significantly higher than in vessels without ischemia (DS 59.1% (49.4–68.4%) vs. 34.8% (27.1–46.1%) p < 0.001; AS 75.6% (63.0–85.2%) vs. 45.0% (30.8–63.6%), p < 0.001). The analysis reveals a high correlation between coronary stenosis measured by cQFR and ischemic areas detected by stress MRI. The data set the stage to plan randomized studies assessing cQFR measurements with regard to clinical outcomes.

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“…A comprehensive cardiac magnetic resonance imaging (CMR) examination was performed, including steady-state free precession cine sequences, T1 and T2 mapping, T2STIR (T2 weighted imaging with short tau inversion recovery), early and late gadolinium enhancement (LGE) using a T1 weighted fast gradient-echo sequence with adjusted inversion recovery pre-pulse as well as phase-sensitive inversion recovery sequence, on a 3.0-T scanner (Achieva, Philips Medical System, Best, The Netherlands) with a 32-channel phased-array surface coil with dS anterior and posterior coil. A standardized protocol was used as described earlier 12 . Cine images were acquired covering the entire left ventricle in contiguous short axis and long axis using a steady-state free precession sequence (slice thickness 8 mm, no interslice gap).…”

Quantitative Flow Ratio Is Associated with Extent and Severity of Ischemia in Non-Culprit Lesions of Patients with Myocardial Infarction

“…So far, only a limited number of studies compared the diagnostic accuracy of QFR with non-invasive myocardial perfusion imaging modalities, achieving in part discordant results. Lenk et al recently revealed a high association between QFR and myocardial ischemia assessed by stress CMR with a diagnostic accuracy of 86% [ 14 ]. In line with these observations, Smit et al showed an overall accuracy of 90% of QFR in the detection of myocardial ischemia on single-photon emission computed tomography myocardial perfusion imaging (SPECT) [ 15 ].…”

“…Furthermore, we and others could demonstrate in large retrospective studies that QFR may be effectively used to evaluate the presence of ischemia in non-culprit lesions in the context of acute coronary syndromes [ 9 , 10 , 11 , 12 ]. QFR also shows a good concordance with stenosis geometry [ 13 ] and with non-invasive detection of ischemia, although the latter is less extensively explored [ 1 , 14 , 15 ].…”

Quantitative Flow Ratio

“…In their study, QFR demonstrated a higher diagnostic value for determining FFR-defined, lesion-specific ischemia compared to SPECT and PET. Lenk et al 33) revealed that coronary stenosis calculated by QFR is highly correlated with ischemic areas detected by stress magnetic resonance imaging (MRI).…”