Contrast medium Pd/Pa ratio in comparison to fractional flow reserve, quantitative flow ratio and instantaneous wave-free ratio for evaluation of intermediate coronary lesions

Kleczyński, Paweł; Dziewierz, Artur; Rzeszutko, Łukasz; Dudek, Dariusz; Legutko, Jacek

doi:10.5114/aic.2020.101762

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…Furthermore, QFR significantly correlated with FFR (r = 0.82, p < 0.001) with good agreement between QFR and FFR (mean difference 0.011, 95% confidence interval (CI) 0.008-0.015) [13]. Previous studies support the diagnostic value of QFR in assessing the functionality of borderline coronary stenoses and offer a promising alternative for FFR in coronary physiology [14,15].…”

Section: Discussionmentioning

confidence: 68%

Comparison of diagnostic accuracy of immediate angiography derived residual quantitative flow ratio after bioresorbable scaffold and drug eluting stent implantation

Zhan¹,

Jia²,

Fu³

et al. 2022

Rev. Cardiovasc. Med.

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Background: Quantitative flow ratio (QFR) is a novel angiography derived fractional flow reserve (FFR) technique. However, its diagnostic accuracy has only be validated in native coronary lesions but not in vessels after bioresorbable scaffold (BRS) implantation. This study aims to evaluate the diagnostic accuracy of residual QFR in coronary vessels immediately post-BRS implantation. Methods: This is a retrospective, two center, validation cohort study. 73 stable angina patients who received at least one de novo lesion of an everolimus eluting stent (EES)/BRS implantation with subsequent residual FFR assessment were screened. Patients with aorta-ostial stenoses, bridge vessels at the distal segment of targeted vessels, acute coronary syndrome, previous coronary artery bypass grafting, age <18 years, lack of ≥2 final angiographic projections were excluded. Contrast QFR assessment was performed blinded to FFR assessment. Results: A good correlation (r = 0.680, p < 0.001) was found between residual QFR and FFR. In the EES implantation cohort, a good correlation (r = 0.769, p < 0.001) was found between residual QFR and FFR, and a moderate correlation (r = 0.446, p = 0.038) in the BRS cohort. The area under the Receiver operator characteristic (ROC) curve for detecting FFR ≤ 0.86 was 0.883 for all patients. Conclusion: Residual QFR assessment after BRS implantation is feasible, and has a moderate correlation and agreement with residual FFR. QFR may be a promising tool similar to FFR to evaluate post-BRS effect.

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Section: Discussionmentioning

confidence: 68%

Comparison of diagnostic accuracy of immediate angiography derived residual quantitative flow ratio after bioresorbable scaffold and drug eluting stent implantation

Zhan¹,

Jia²,

Fu³

et al. 2022

Rev. Cardiovasc. Med.

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“…One of the reasons for the observed differences between the FFR/iFR and QFR assessments is that QFR analysis was performed retrospectively based on standard angiographic recordings, which were not always optimally performed for QFR assessment. Currently published studies indicate good agreement of the QFR assessment with the results of the assessment of invasive changes in the coronary vessels in a similar group of patients [7][8][9].…”

Section: Discussionmentioning

confidence: 74%

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

Zasada¹,

Mikołajczyk²,

Jędrychowska³

et al. 2022

pwki

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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.

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“…Coronary angiography was performed with the standard femoral or radial approach based on individual operator preferences. The methodology of FFR/iFR assessment was previously described [13,[15][16][17][18]. Assessment of iFR was repeated three times and the mean value was analyzed.…”

Section: Methodsmentioning

confidence: 99%

Impact of diabetes mellitus on the diagnostic performance of fractional flow reserve in patients with severe aortic stenosis

et al. 2022

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Background:The validity of functional assessment of coronary artery disease with fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR) in patients with severe aortic stenosis (AS) might be affected by AS per se and other factors, including diabetes mellitus. Aims:We aimed to evaluate the impact of diabetic status on FFR performance in severe AS. Methods:The functional significance of 416 stenoses of intermediate angiographic severity in 221 patients with severe AS was assessed with iFR and FFR. Patients treated with insulin or oral hypoglycemic agents were classified as diabetic patients.Results: Of 221 enrolled patients, 68 (32.1%) patients were diabetic. A total of 128 (30.8%) lesions in patients with and 288 in patients without diabetes mellitus were assessed. The mean (SD) FFR was 0.85 (0.07), and iFR was 0.90 (0.04) with no difference between nondiabetic and diabetic patients. Good agreement between iFR and FFR was confirmed for non-diabetic (ICC, 0.83 [95% confidence interval, CI, 0.79-0.86]) and diabetic (ICC, 0.82 [95% CI, 0.76-0.87]) patients. Among patients without diabetes mellitus, the optimal cutoff value for FFR to detect iFR ≤0.89 was 0.81 with sensitivity and specificity of 96.6% and 100.0%. The optimal cutoff value for FFR to detect iFR ≤0.89 for diabetic patients was 0.83 with sensitivity and specificity of 98.0% and 100.0%. Conclusions:In patients with severe AS, FFR correlates well with iFR. However, the optimal threshold for FFR to identify significant ischemia (iFR ≤0.89) in those patients may differ from the standard threshold of FFR ≤0.80 and might be affected by the diabetic status.

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Contrast medium Pd/Pa ratio in comparison to fractional flow reserve, quantitative flow ratio and instantaneous wave-free ratio for evaluation of intermediate coronary lesions

Cited by 4 publications

References 28 publications

Comparison of diagnostic accuracy of immediate angiography derived residual quantitative flow ratio after bioresorbable scaffold and drug eluting stent implantation

Comparison of diagnostic accuracy of immediate angiography derived residual quantitative flow ratio after bioresorbable scaffold and drug eluting stent implantation

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

Impact of diabetes mellitus on the diagnostic performance of fractional flow reserve in patients with severe aortic stenosis

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