Comparison of FFR, iFR, and QFR assessment in patients with severe aortic stenosis and coronary heart disease

Abstract

Introduction: Some patients with coronary heart disease are diagnosed with severe aortic stenosis. For further treatment, coronary angiography is performed in these patients. For intermediate lesions, obtaining coronary artery physiological data can facilitate clinical decision-making regarding revascularization.Aim: The study compared the physiological significance of coronary artery stenosis using the fractional flow reserve (FFR) method with instantaneous wave-free pressure ratio (iFR) and quantitative flow ratio (QFR) in patients qualified for aortic valve replacement.Material and methods: Data were collected on patients hospitalized in the years 2019-2020 at the 2 nd Department of Cardiology, University Hospital in Krakow.Results: Twelve patients with severe aortic stenosis and borderline lesions in the coronary artery were qualified for physiological assessment. There were 6 women, whose mean age was 73.8 ±7.5 years. The mean left ventricular ejection fraction was 52 ±15%. The mean aortic valve area was 0.80 ±0.16 cm 2 . The left anterior descending artery was assessed in 12 from 13 cases (92%). In comparison to FFR, all iFR measurements were concordant with FFR. The total agreement between QFR and FFR/iFR assessment was 69%.Conclusions: Despite the controversy and uncertainty of some operators regarding the interpretation of the FFR test in patients with severe aortic stenosis, we obtained complete agreement of FFR with iFR assessment. This fact suggests that in patients with severe aortic stenosis the choice of an invasive method to assess the physiological significance of the stenosis in the coronary artery is not crucial -both iFR and FFR allow comparable results.

Prognostic value of quantitative flow ratio in patients with coronary heart disease after percutaneous coronary intervention therapy: a meta-analysis

“…As a new non-invasive physiological evaluation index, QFR has many advantages such as fast calculation time and no use of drugs (adenosine). In addition to this, recent studies have reported that QFR also has good diagnostic efficacy in patients with coronary artery disease combined with severe aortic stenosis (AS), superior to the resting distal to aortic coronary pressure (Pd/Pa) ratio and instantaneous wave-free pressure ratio (iFR), when using FFR as a reference ( 37 , 38 ). This technology has been continuously upgraded and improved, with AI techniques being added to the latest QFR ( 39 ).…”

Comparison of outcomes in patients with severe aortic stenosis treated with small and large Medtronic Evolut R and Evolut PRO self-expandable prosthetic valves

“…Very often, bicuspid valves have more oval orifices, and the self-expandable valve assumes a more oval shape after implantation. This, in turn, may result in PVL and/or make the retrieval of the delivery system difficult after implantation [26][27][28].…”

The Impact of Age on the Physiological Assessment of Borderline Coronary Stenoses

“…Clinical characteristics and risk factors of patients undergoing physiological assessment of borderline coronary stenosis varied significantly by age. Refining the definition of borderline lesions to include not only angiographic findings but also age, gender, and other clinical factors [25] may improve the ability to identify patients who would benefit from physiological assessment and coronary revascularization. However, this promising approach, supported by the existing literature [26,27], warrants further investigation.…”