Association of quantitative flow ratio-derived microcirculatory indices with anatomical-functional discordance in intermediate coronary lesions

Geng, Liang; Yuan, Yuan; Du, Peizhao; Gao, Liming; Wang, Yunkai; Li, Jiming; Guo, Wei; Huang, Ying; Zhang, Qi

doi:10.1007/s10554-021-02292-2

Cited by 10 publications

(11 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When underexpansion occurs, luminal dimension losses in the traditional ways result in insufficient distal blood flow and impaired blood flow reserve. A recent study showed stenosis and plaque > 70% predicts QFR </= 80% ( 27 ). However, when the vessels or stents undergo overexpansion, emboli, such as lipid pool and necrotic material, are squeezed out and may embolize the distal vessels, resulting in increased microcirculation resistance and a slow blood velocity.…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, this study reflected the experience with a limited number of patients. Since IVUS is not routinely used in pPCI of STEMI in clinical work, the sample sizes of previous studies that focused on IVUS, vascular physiology, and STEMI are generally small ( n = 117, Geng; n = 51, Luo, D) ( 27 , 29 ). To increase the sample size, minimize the bias, and improve reliability, this study was designed as a multicenter clinical trial.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound

Sun

Luo

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundWhile coronary stent implantation in ST-elevation myocardial infarction (STEMI) can mechanically revascularize culprit epicardial vessels, it might also cause distal embolization. The relationship between geometrical and functional results of stent expansion during the primary percutaneous coronary intervention (pPCI) is unclear.ObjectiveWe sought to determine the optimal stent expansion strategy in pPCI using novel angiography-based approaches including angiography-derived quantitative flow ratio (QFR)/microcirculatory resistance (MR) and intravascular ultrasound (IVUS).MethodsPost-hoc analysis was performed in patients with acute STEMI and high thrombus burden from our prior multicenter, prospective cohort study (ChiCTR1800019923). Patients aged 18 years or older with STEMI were eligible. IVUS imaging, QFR, and MR were performed during pPCI, while stent expansion was quantified on IVUS images. The patients were divided into three subgroups depending on the degree of stent expansion as follows: overexpansion (>100%), optimal expansion (80%−100%), and underexpansion (<80%). The patients were followed up for 12 months after PCI. The primary endpoint included sudden cardiac death, myocardial infarction, stroke, unexpected hospitalization or unplanned revascularization, and all-cause death.ResultsA total of 87 patients were enrolled. The average stent expansion degree was 82% (in all patients), 117% (in overexpansion group), 88% (in optimal expansion), and 75% (in under-expansion). QFR, MR, and flow speed increased in all groups after stenting. The overall stent expansion did not affect the final QFR (p = 0.08) or MR (p = 0.09), but it reduced the final flow speed (−0.14 cm/s per 1%, p = 0.02). Under- and overexpansion did not affect final QFR (p = 0.17), MR (p = 0.16), and flow speed (p = 0.10). Multivariable Cox analysis showed that stent expansion was not the risk factor for MACE (hazard ratio, HR = 0.97, p = 0.13); however, stent expansion reduced the risk of MACE (HR = 0.95, p = 0.03) after excluding overexpansion patients. Overexpansion was an independent risk factor for no-reflow (HR = 1.27, p = 0.02) and MACE (HR = 1.45, p = 0.007). Subgroup analysis shows that mild underexpansion of 70%−80% was not a risk factor for MACE (HR = 1.11, p = 0.08) and no-reflow (HR = 1.4, p = 0.08); however, stent expansion <70% increased the risk of MACE (HR = 1.36, p = 0.04).ConclusionsStent expansion does not affect final QFR and MR, but it reduces flow speed in STEMI. Appropriate stent underexpansion of 70–80% does not seem to be associated with short-term prognosis, so it may be tolerable as noninferior compared with optimal expansion. Meanwhile, overexpansion and underexpansion of <70% should be avoided due to the independent risk of MACEs and no-reflow events.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound

Sun

Luo

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…22 Angiography-derived index of microvascular resistance (IMRangio) was calculated according to the method described previously and used to assess coronary microvascular status. 15,23 Nframes fps IMRangio = Pa × QFR × , and PB ≥70. Other IVUS-derived anatomical parameters including area stenosis (AS, %), remodeling index (RI) and plaque eccentricity were calculated according to the published standards.…”

Section: Maxppg20mmmentioning

confidence: 99%

“…28,29 The mechanism of anatomical and functional discrepancy of intermediate coronary lesions in diabetic patients is multifactorial, but may be likely related to microvascular disease and diffuse coronary lesions. 15,30,31 It has been shown that microcirculatory dysfunction interferes with the measurement of hyperemic indices, including FFR or virtual FFR, such as QFR. [32][33][34] In contrast, iFR, as a resting physiological index, is less affected by microvascular dysfunction, and there was a disagreement between iFR and FFR value in 15-20% of diabetic patients, and diabetes was an independent predictor of discordance between (high)FFR and (low)iFR.…”

Section: Study Limitationsmentioning

confidence: 99%

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

Geng

Shi

Yuan

et al. 2023

Circ J

Self Cite

View full text Add to dashboard Cite

Background: Data regarding the performance of computational fractional flow reserve in patients with diabetes mellitus (DM) remain scarce. This study sought to explore the impact of DM on quantitative flow ratio (QFR) and its association with intravascular ultrasound (IVUS)-derived anatomical references.Methods and Results: IVUS and QFR were retrospectively analyzed in 237 non-diabetic and 93 diabetic patients with 250 and 102 intermediate lesions, respectively. Diabetics were further categorized based on adequate (HbA1c <7.0%: 47 patients with 53 lesions) or poor (HbA1c ≥7.0%: 46 patients with 49 lesions) glycemic control. Lesions with QFR ≤0.8 or minimum lumen area (MLA) ≤4.0 mm 2 and plaque burden (PB, %) ≥70 were considered functionally or anatomically significant, respectively. PB increased, and MLA decreased stepwise across non-diabetics, diabetics with adequate glycemic control and those with poor glycemic control. In contrast, QFR was similar among the 3 groups. PB correlated significantly with the QFR for lesions in non-diabetics, but not for lesions in diabetics. DM was independently correlated with the functionally non-significant lesions (QFR >0.8) with high-risk IVUS features (MLA ≤4.0 mm 2 and PB ≥70; OR 2.053, 95% CI: 1.137-3.707, P=0.017). When considering the effect of glycemic control, HbA1c was an independent predictor of anatomical-functional discordance (OR 1.347, 95% CI: 1.089-1.667, P=0.006).Conclusions: Anatomical-functional discordance of intermediate coronary lesions assessed by IVUS and QFR is exacerbated in patients with diabetes, especially when glycemia is poorly controlled.

show abstract

“…The angiography-derived FFR was invasive detection for patients and inconveniently derived for cardiologists (Tu et al, 2016;Westra et al, 2018). Geng et al (2021) presented that angiography-derived FFR ignored the influence of individual risk factors of patients [such as gender, age, heart rate (HR), and so on] on predicting FFR. Based on the available literature, and the limitedly used DS of coronary angiography to predict FFR, there is a clear urgency to develop a new method to calculate FFR.…”

Section: Introductionmentioning

confidence: 99%

Research on the Method of Predicting Fractional Flow Reserve Based on Multiple Independent Risk Factors

Zhang

Hou

et al. 2021

Front. Physiol.

View full text Add to dashboard Cite

The use of diameter stenosis (DS), as revealed by coronary angiography, for predicting fractional flow reserve (FFR) usually results in a high error rate of detection. In this study, we investigated a method for predicting FFR in patients with coronary stenosis based on multiple independent risk factors. The aim of the study was to improve the accuracy of detection. First, we searched the existing literature to identify multiple independent risk factors and then calculated the corresponding odds ratios. The improved analytic hierarchy process (IAHP) was then used to determine the weighted value of each independent risk factor, based on the corresponding odds ratio. Next, we developed a novel method, based on the top seven independent risk factors with the highest weighted values, to predict FFR. This model was then used to predict the FFR of 253 patients with coronary stenosis, and the results were then compared with previous methods (DS alone and a simplified scoring system). In addition to DS, we identified a range of other independent risk factors, with the highest weighted values, for predicting FFR, including gender, body mass index, location of stenosis, type of coronary artery distribution, left ventricular ejection fraction, and left myocardial mass. The area under the receiver-operating characteristic curve (AUC) for the newly developed method was 84.3% (95% CI: 79.2–89.4%), which was larger than 65.3% (95% CI: 61.5–69.1%) of DS alone and 74.8% (95% CI: 68.4–81.2%) of the existing simplified scoring system. The newly developed method, based on multiple independent risk factors, effectively improves the prediction accuracy for FFR.

show abstract

Association of quantitative flow ratio-derived microcirculatory indices with anatomical-functional discordance in intermediate coronary lesions

Cited by 10 publications

References 32 publications

Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound

Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

Research on the Method of Predicting Fractional Flow Reserve Based on Multiple Independent Risk Factors

Contact Info

Product

Resources

About

Association of quantitative flow ratio-derived microcirculatory indices with anatomical-functional discordance in intermediate coronary lesions

Cited by 10 publications

References 32 publications

Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound

Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions ― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―

Research on the Method of Predicting Fractional Flow Reserve Based on Multiple Independent Risk Factors

Contact Info

Product

Resources

About

Anatomical and Functional Discrepancy in Diabetic Patients With Intermediate Coronary Lesions　― An Intravascular Ultrasound and Quantitative Flow Ratio Study ―