Comparison of quantitative flow ratio and fractional flow reserve with myocardial perfusion scintigraphy and cardiovascular magnetic resonance as reference standard. A Dan-NICAD substudy

Abstract

Quantitative flow ratio (QFR) and fractional flow reserve (FFR) have not yet been compared head to head with perfusion imaging as reference for myocardial ischemia. We aimed to compare the diagnostic accuracy of QFR and FFR with myocardial perfusion scintigraphy (MPS) or cardiovascular magnetic resonance (CMR) as reference. This study is a predefined post hoc analysis of the Dan-NICAD study (NCT02264717). Patients with suspected coronary artery disease by coronary computed tomography angiography (CCTA) were randomized 1:1 to MPS or CMR and were referred to invasive coronary angiography with FFR and predefined QFR assessment. Paired data with FFR, QFR and MPS or CMR were available for 232 vessels with stenosis in 176 patients. Perfusion defects were detected in 57 vessel territories (25%). For QFR and FFR the diagnostic accuracy was 61% and 57% (p = 0.18) and area under the receiver operating curve was 0.64 vs. 0.58 (p = 0.22). Stenoses with absolute indication for stenting due to diameter stenosis > 90% by visual estimate were not classified as significant by either QFR or MPS/CMR in 21% (7 of 34) of cases. The diagnostic performance of QFR and FFR was similar but modest with MPS or CMR as reference. Comparable performance levels for QFR and FFR are encouraging for this pressure wire-free diagnostic method. Keywords Quantitative flow ratio • Fractional flow reserve • Myocardial perfusion scintigraphy • Cardiovascular magnetic resonance • Stable angina • Myocardial ischemia Martin Sejr-Hansen and Jelmer Westra equally contributed.

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

“…One of the main reasons is the burden of disease which is reflected by the different QFR-values. Our study had a mean QFR of 0.94, which is in contrast to the study of Sejr-Hansen and colleagues with a mean QFR of 0.84 [ 9 ]. Another reason might be the selection process of patients for the study.…”

“…The recently published MR-INFORM trial demonstrated the use of myocardial- perfusion cardiovascular MRI in guiding initial management of patient care was noninferior to the use of invasive coronary angiography combined with FFR with respect to the primary outcome of major adverse cardiac events at 1 year [ 22 ]. Until now only one study has investigated the association between stress MRI and cQFR [ 9 ]. Interestingly, there is an obvious difference between the two studies regarding sensitivity and specificity.…”

“…Given this, all three major vessels can be analysed one after another. Although this new technique has shown a high accuracy in determining the functional significance of coronary stenosis, using FFR as reference [ 7 , 8 ], studies investigating its reliability in detecting relevant epicardial stenosis leading to ischemia in non-invasive stress testing are scarce [ 9 , 10 ]. None-invasive stress tests have long been a gold standard for identifying relevant ischemia in patients with chronic coronary syndrome.…”

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

“…Quantitative flow ratio (QFR) is a novel method to assess hemodynamic relevance of coronary lesions based on a three-dimensional vessel reconstruction and estimation of its contrast media flow velocity [ 1 , 2 , 3 , 4 ]. In contrast to wire based methods such as fractional flow reserve (FFR) or instantaneous wave-free ratio (iFR), QFR does not require pressure wires or drug-induced hyperemia [ 1 , 2 ].…”

Cardiovascular imaging 2020 in the international journal of cardiovascular imaging: the 10 most downloaded papers in the year 2020

“…“Comparison of quantitative flow ratio and fractional flow reserve with myocardial perfusion scintigraphy and cardiovascular magnetic resonance as reference standard. A Dan-NICAD substudy” by Sejr-Hansen et al [ 5 ] was downloaded 1087 times. These workers compared FFR CT and CT perfusion (CTP) to FFR.…”