Diagnostic Concordance and Clinical Outcomes in Patients Undergoing Fractional Flow Reserve and Stress Echocardiography for the Assessment of Coronary Stenosis of Intermediate Severity

Gurunathan, Sothinathan; Ahmed, Asrar; Vamvakidou, Anastasia; Ramzy, Ihab S.; Akhtar, Mohammed; Ali, Aamir; Karogiannis, Nikos; Zidros, Spyridon; Balaji, G.; Young, Grace; Elghamaz, Ahmed; Senior, Roxy

doi:10.1016/j.echo.2017.10.012

Cited by 9 publications

(9 citation statements)

References 20 publications

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“…As it is a simpler method that does not require the use of radiation, which has been shown to induce cell damage, this study has focused on SE, which was necessary to diagnose CAD with sensitivities ranging from 44 to 100%. [12][13][14][15][16][17][18][19][20][21][22][23][24][25] These data are extremely valid for actions to be taken in order to spread the method to the population, so that the diagnosis of CAD is made as early as possible and the appropriate treatment, so that we reduce the high incidence of deaths from cardiovascular causes in the country.…”

Section: Discussionmentioning

confidence: 92%

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Stress echocardiography in the diagnosis of coronary artery disease: A systematic review

Filho¹,

Neufeld

2021

BJHBS

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Introduction: Coronary Artery Disease (CAD) contributes to the increase in the prevalence of cardiovascular disease, being the main cause of death worldwide. Objectives: This study compares the sensitivity of different methods of execution of Stress Echocardiography (SE) as to the accuracy in determining the presence of CAD, through a Systematic Literature Review (RSL). Methods: The databases of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (Lilacs) and the Spanish Bibliographic Index of Health Sciences (IBECS) were searched through the Virtual Health Library (VHL) for articles published until December 2018 and including scientific articles published in journals, in any language, which met the following criteria: (A) Descriptive or analytical studies of primary or secondary basis and (B) Studies whose theme was the SE in adult coronary heart disease. Studies related to: (a) Elderly; (b) Animals; (c) Children and Adolescents; (d) Pregnant women; (e) Articles that alluded to left ventricular function, valvulopathies, aneurysms, endocarditis, arrhythmias, implanted electronic devices and other titles that were outside the scope of this work and (f) Articles published in languages other than English or Neolatin languages. Results: The study has selected 14 articles, which demonstrated that SE was accurate to diagnose CAD with sensitivities ranging from 41 to 100% with studies included within the normality curve, demonstrating that it is an excellent tool for the diagnosis of CAD compared to other methods.

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Section: Discussionmentioning

confidence: 92%

“…Čelutkienė et al, 22 Kataoka et al, 23 and Gurunathan et al 25 concluded that the myocardial deformation assessed by SE is an important ischemia marker that in the case of Čelutkienė et al 22 could not be replaced by an automated model.…”

mentioning

confidence: 99%

Stress echocardiography in the diagnosis of coronary artery disease: A systematic review

Filho¹,

Neufeld

2021

BJHBS

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“…In the SA cohort, the diagnostic accuracy of FFR was similar to the results of previously published studies with smaller sample sizes. 13,22,28) Decreasing the FFR cutoff value from < 0.80 to < 0.75 improved the concordance of FFR with DSE in the SA group without significant changes in its discriminatory power (according to AUC values). In the ACS group, the lower cutoff value further deteriorated the diagnostic performance of FFR.…”

Section: Discussionmentioning

confidence: 96%

“…20) In patients with insufficient image quality for native wall motion evaluation, an intravenous ultrasound contrast agent (Sonovue, Bracco, Italy) was administered. 22) Endpoints were determined as the maximum dose of pharmacological agents, achievement of at least age-predicted submaximal (85%) target heart rate, echocardiographic positivity for ischemia [new or worsening wall motion abnormality (WMA) or biphasic response in !2 contiguous myocardium segments], or severe chest pain or as per the patient's request. 20) In regional distribution, coronary supplying areas were determined as following: left anterior descending (LAD) artery with nine segments (apical septal, mid.…”

Section: Methodsmentioning

confidence: 99%

“…[12][13][14]28) Although the inclusion criteria (e.g., lesion severity), the DSE method (e.g., in our study contrast agent was used only in selected patients with a poor acoustic window), and the FFR cutoff values (< 0.80 versus < 0.75) were slightly different, our results are in line with the prospective trials that we have cited above and other previously published retrospective studies. 22) In most of these previous studies, the AUC value was not calculated, and the diagnostic accuracy was not assessed using two different cutoff values. The ratios of discordant DSE-FFR results in our SA group are 29.4% and 18.3% depending on the FFR cutoff value (< 0.80 versus < 0.75, respectively).…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

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Patients with Moderate Non-Culprit Coronary Lesions of Recent Acute Coronary Syndrome

et al. 2021

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Fractional flow reserve (FFR) measurement was compared to dobutamine stress echocardiography (DSE) instable angina (SA) with stable coronary lesion(s) (SCL(s)) in a few trials; however, similar comparisons in patients with acute coronary syndrome (ACS) with non-culprit lesion(s) (NCL(s)) are lacking. Our objectives were to prospectively evaluate the diagnostic performance of FFR with two different cutoff values (< 0.80 and < 0.75) relative to DSE in moderate (30%-70% diameter stenosis) NCLs (ACS group) and to compare these observations with those measured in SCLs (SA group). One hundred seventy-five consecutive patients with SA (n = 86) and ACS (n = 89) with 225 coronary lesions (109 SCLs and 116 NCLs) were enrolled. In contrast to the ACS cohort in SA patients, normal DSE was associated with higher FFR values compared to those with abnormal DSE (P = 0.051 versus P = 0.006). In addition, in the SA group, a significant correlation was observed between DSE (regional wall motion score index at peak stress) and FFR (r = −0.290; P = 0.002), whereas a similar association was absent (r = −0.029; P = 0.760) among ACS patients. In the SA group, decreasing the FFR cutoff value (< 0.80 versus < 0.75) improved the concordance of FFR with DSE (70.6% versus 81.7%) without altering its discriminatory power (area under the curve; 0.68 versus 0.63; P = 0.369), whereas in the ACS group, concordance remained similar (69.0% versus 71.6%) and discriminatory power decreased (0.62 versus 0.51; P = 0.049), respectively. In conclusion, lesion-specific FFR assessment may have different relevance in patients with moderate NCLs than in patients with SCLs.

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Heart Team risk assessment with angiography‐derived fractional flow reserve determining the optimal revascularization strategy in patients with multivessel disease: Trial design and rationale for the DECISION QFR randomized trial

Miyata

Asano

Saito

et al. 2022

Clinical Cardiology

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In patients with multivessel disease (MVD), functional information on lesions improves the prognostic capability of the SYNTAX score. Quantitative flow ratio (QFR®) is an angiography‐derived fractional flow reserve (FFR) that does not require a pressure wire or pharmacological hyperemia. We aimed to investigate the feasibility of QFR‐based patient information in Heart Teams' discussions to determine the optimal revascularization strategy for patients with MVD. We hypothesized that there is an acceptable agreement between treatment recommendations based on the QFR approach and recommendation based on the FFR approach. The DECISION QFR study is a prospective, multicenter, randomized controlled trial that will include patients with MVD who require revascularization. Two Heart Teams comprising cardiologists and cardiac surgeons will be randomized to select a revascularization strategy (percutaneous coronary intervention or coronary artery bypass graft) according to patient information either based on QFR or on FFR. All 260 patients will be assessed by both teams with reference to the anatomical and functional SYNTAX score/SYNTAX score II 2020 derived from the allocated physiological index (QFR or FFR). The primary endpoint of the trial is the level of agreement between the treatment recommendations of both teams, assessed using Cohen's κ. As of March 2022, the patient enrollment has been completed and 230 patients have been discussed in both Heart Teams. The current trial will indicate the usefulness of QFR, which enables a wireless multivessel physiological interrogation, in the discussions of Heart Teams to determine the optimal revascularization strategy for MVD.

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Diagnostic Concordance and Clinical Outcomes in Patients Undergoing Fractional Flow Reserve and Stress Echocardiography for the Assessment of Coronary Stenosis of Intermediate Severity

Cited by 9 publications

References 20 publications

Stress echocardiography in the diagnosis of coronary artery disease: A systematic review

Stress echocardiography in the diagnosis of coronary artery disease: A systematic review

Patients with Moderate Non-Culprit Coronary Lesions of Recent Acute Coronary Syndrome

Heart Team risk assessment with angiography‐derived fractional flow reserve determining the optimal revascularization strategy in patients with multivessel disease: Trial design and rationale for the DECISION QFR randomized trial

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