Diagnostic performance of angiography-derived fractional flow reserve: a systematic review and Bayesian meta-analysis

Collet, Carlos; Onuma, Yoshinobu; Sonck, Jeroen; Asano, Taku; Vandeloo, Bert; Kornowski, Ran; Tu, Shengxian; Westra, Jelmer; Holm, Niels Ramsing; Xu, Bo; Winter, Robbert J. de; Tijssen, Jan G.P.; Miyazaki, Yosuke; Katagiri, Yuki; Tenekecioğlu, Erhan; Modolo, Rodrigo; Chichareon, Ply; Cosyns, Bernard; Schoors, Daniel; Roosens, Bram; Lochy, Stijn; Argacha, Jean-François; Rosendael, Alexandre van; Bax, Jeroen J.; Reiber, Johan H. C.; Escaned, Javier; Bruyne, Bernard De; Wijns, William; Serruys, Patrick W.

doi:10.1093/eurheartj/ehy445

Cited by 130 publications

(90 citation statements)

References 35 publications

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“…A recent meta‐analysis showed similar diagnostic performance of various FFR simulation approaches including QFR . However, the extraction of data from digitalized scatterplots is error prone and the lack of individual patient data did not allow for detailed analysis as presented in the current study .…”

Section: Discussionmentioning

confidence: 74%

“…The evaluation of coronary stenosis severity in patients with obstructive coronary artery disease has developed substantially from anatomic evaluation based on the invasive coronary angiogram, to functional testing using pressure wires, and more recently to the application of computational fluid dynamics to three‐dimensional reconstructions of the arterial tree based on noninvasive computed tomography or invasive 3D‐angiography . Pressure wire assessment was greatly facilitated by the incorporation of resting indices, that avoid cost effects and risk associated with adenosine administration.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Westra

Campo

et al. 2019

Cathet Cardio Intervent

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Objectives We aimed to provide robust performance estimates for quantitative flow ratio (QFR) in assessment of intermediary coronary lesions. Background Angiography‐based functional lesion assessment by QFR may appear as a cost saving and safe approach to expand the use of physiology‐guided percutaneous coronary interventions. QFR was proven feasible and showed good diagnostic performance in mid‐sized off‐line and on‐line studies with fractional flow reserve (FFR) as reference standard. Methods We performed a collaborative individual patient‐data meta‐analysis of all available prospective studies with paired assessment of QFR and FFR using the CE‐marked QFR application. The main outcome was agreement of QFR and FFR using a two‐step analysis strategy with a multilevel mixed model accounting for study and center level variation. Results Of 16 studies identified, four studies had prospective enrollment and provided patient level data reaching a total of 819 patients and 969 vessels with paired FFR and QFR: FAVOR Pilot (n = 73); WIFI II (n = 170); FAVOR II China (n = 304) and FAVOR II Europe‐Japan (n = 272). We found an overall agreement (mean difference 0.009 ± 0.068, I2 = 39.6) of QFR with FFR. The diagnostic performance was sensitivity 84% (95%CI: 77–90, I2 = 70.1), specificity 88% (95%CI: 84–91, I2 = 60.1); positive predictive value 80% (95%CI: 76–85, I2 = 33.4), and negative predictive value 95% (95%CI: 93–96, I2 = 75.9). Conclusions Diagnostic performance of QFR was good with FFR as reference in this meta‐analysis of high quality studies. QFR could provide an easy, safe, and cost‐effective solution for functional evaluation of coronary artery stenosis.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Westra

Campo

et al. 2019

Cathet Cardio Intervent

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“…ere is no difference regarding sensitivity and specificity between the two methods; however, the latter takes less time, does not require dedicated software, and is used in most studies. Finally, recent evidence shows similar diagnostic accuracy between online and offline analyses of QFR [11].…”

Section: Introductionmentioning

confidence: 65%

Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses

Zhang

Guo

2020

Journal of Interventional Cardiology

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Background. Use of the fractional flow reserve (FFR) technique is recommended to evaluate coronary stenosis severity and guide revascularization. However, its high cost, time to administer, and the side effects of adenosine reduce its clinical utility. Two novel adenosine-free indices, contrast-FFR (cFFR) and quantitative flow ratio (QFR), can simplify the functional evaluation of coronary stenosis. This study aimed to analyze the diagnostic performance of cFFR and QFR using FFR as a reference index. Methods. We conducted a systematic review and meta-analysis of observational studies in which cFFR or QFR was compared to FFR. A bivariate model was applied to pool diagnostic parameters. Cochran’s Q test and the I2 index were used to assess heterogeneity and identify the potential source of heterogeneity by metaregression and sensitivity analysis. Results. Overall, 2220 and 3000 coronary lesions from 20 studies were evaluated by cFFR and QFR, respectively. The pooled sensitivity and specificity were 0.87 (95% CI: 0.81, 0.91) and 0.92 (95% CI: 0.88, 0.94) for cFFR and 0.87 (95% CI: 0.82, 0.91) and 0.91 (95% CI: 0.87, 0.93) for QFR, respectively. No statistical significance of sensitivity and specificity for cFFR and QFR were observed in the bivariate analysis (P=0.8406 and 0.4397, resp.). The area under summary receiver-operating curve of cFFR and QFR was 0.95 (95% CI: 0.93, 0.97) for cFFR and 0.95 (95% CI: 0.93, 0.97). Conclusion. Both cFFR and QFR have good diagnostic performance in detecting functional severity of coronary arteries and showed similar diagnostic parameters.

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“…e advantages and limitations of the angiography-derived FFR software are summarised in Table 2. e angiography-derived FFR can be obtained from either blood flow simulation using CFD or by mathematical formula. A recent meta-analysis found no difference between the two approaches for the diagnostic accuracy of angiography-derived FFR [26]. e successful application of CFD to CTCA images to predict blood flow and lesionspecific FFR preceded the development of angiographyderived FFR software.…”

Section: Discussionmentioning

confidence: 99%

Computerised Methodologies for Non-Invasive Angiography-Derived Fractional Flow Reserve Assessment: A Critical Review

Ramasamy

Jin

Tufaro

et al. 2020

Journal of Interventional Cardiology

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Fractional flow reserve is the gold standard for assessing the haemodynamic significance of intermediate coronary artery stenoses. Cumulative evidence has shown that FFR-guided revascularisation reduces stent implantations and improves patient outcomes. However, despite the wealth of evidence and guideline recommendations, its use in clinical practice remains minimal. Patient and technical limitations of FFR as well as the need for intracoronary instrumentation, use of adenosine, and increased costs have limited FFR’s applicability in clinical practice. Over the last decade, several angiography-derived FFR software packages have been developed which do not require intracoronary pressure assessment with a guidewire or need for administration of hyperaemic agents. At present, there are 3 commercially available software packages and several other non-commercial technologies that have been described in the literature. These technologies have been validated against invasive FFR showing good accuracy and correlation. However, the methodology behind these solutions is different—some algorithms are based on solving the governing equations of fluid dynamics such as the Navier–Stokes equation while others have opted for a more simplified mathematical formula approach. The aim of this review is to critically appraise the methodology behind all the known angiography-derived FFR technologies highlighting the key differences and limitations.

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Diagnostic performance of angiography-derived fractional flow reserve: a systematic review and Bayesian meta-analysis

Cited by 130 publications

References 35 publications

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Meta-Analysis of Diagnostic Performance of Contrast-Fractional Flow Reserve versus Quantitative Flow Ratio for Functional Assessment of Coronary Stenoses

Computerised Methodologies for Non-Invasive Angiography-Derived Fractional Flow Reserve Assessment: A Critical Review

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