Feasibility of coronary angiogram-derived vessel fractional flow reserve in the setting of standard of care percutaneous coronary intervention and its correlation with invasive FFR

Pizzato, Patricia; Samdani, Abdul Jawwad; Vergara-Martel, Armando; Dallan, Luís Augusto Palma; Pereira, Gabriel Tensol Rodrigues; Zago, Elder; Zimin, Vladislav N.; Bezerra, Hiram G.

doi:10.1016/j.ijcard.2019.10.054

Cited by 12 publications

(24 citation statements)

References 16 publications

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“…Interestingly, given the fact that the present population solely consisted of patients with optimal angiographic results, vFFR proved to be <0.90 in 41% of the cases. The present findings are at clear odds with recently reported data by Pizzato et al, who reported a weak correlation between vFFR and pressure wire based FFR 44 . However, several methodological and anatomic differences between both studies should be highlighted.…”

Section: Discussioncontrasting

confidence: 99%

Validation of novel 3‐dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting

Masdjedi¹,

Balbi²,

Nuis³

et al. 2020

Catheter Cardiovasc Interv

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Objectives To validate novel dedicated 3D‐QCA based on the software to calculate post PCI vessel‐FFR (vFFR) in a consecutive series of patients, to assess the diagnostic accuracy, and to assess inter‐observer variability. Background Low post percutaneous coronary intervention (PCI) fractional flow reserve (FFR) predicts future adverse cardiac events. However, FFR assessment requires the insertion of a pressure wire in combination with the use of a hyperemic agent. Methods FAST POST study is an observational, retrospective, single‐center cohort study. One hundred patients presenting with stable angina or non ST‐elevation myocardial infarction, who underwent post PCI FFR assessment using a dedicated microcatheter were included. Two orthogonal angiographic projections were acquired to create a 3D reconstruction of the coronary artery using the CAAS workstation 8.0. vFFR was subsequently calculated using the aortic root pressure. Results Mean age was 65±12 years and 70% were male. Mean microcatheter based FFR and vFFR were 0.91±0.07 and 0.91±0.06, respectively. A good linear correlation was found between FFR and vFFR (r = 0.88; p <.001). vFFR had a higher accuracy in the identification of patients with FFR values <0.90, AUC 0.98 (95% CI: 0.96‐1.00) as compared with 3D‐QCA AUC 0.62 (95% CI: 0.94‐0.74). Assessment of vFFR had a low inter‐observer variability (r = 0.95; p <.001). Conclusion 3D‐QCA derived post PCI vFFR correlates well with invasively measured microcatheter based FFR and has a high diagnostic accuracy to detect FFR <0.90 with low inter‐observer variability.

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Section: Discussioncontrasting

confidence: 99%

Validation of novel 3‐dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting

Masdjedi¹,

Balbi²,

Nuis³

et al. 2020

Catheter Cardiovasc Interv

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“…Nevertheless, in the FAST study, the correlation coefficient and AUC of vFFR vs. FFR were slightly higher than the present study which may be attributed to a more stricter image acquisition requirement. It is worth to note that Pizzato et al reported the feasibility of vFFR analysis was only 35.1% with a weak correlation with FFR by using an imaging database maintained in a core lab ( 10 ). However, in the study mentioned above, both pre- and post-PCI angiograms were analyzed and collected from multiple sites without a pre-specified image acquisition.…”

Section: Discussionmentioning

confidence: 99%

Agreement Between Invasive Wire-Based and Angiography-Based Vessel Fractional Flow Reserve Assessment on Intermediate Coronary Stenoses

Chang

Lee

Chuang

et al. 2021

Front. Cardiovasc. Med.

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Background: Angiography-based functional assessment of coronary stenoses emerges as a novel approach to assess coronary physiology. We sought to investigate the agreement between invasive coronary wire-based fractional flow reserve (FFR), resting full-cycle ratio (RFR), and angiography-based vessel FFR (vFFR) for the functional assessment of coronary stenoses in patients with coronary artery disease.Materials and Methods: Between Jan 01, 2018, and Dec 31, 2020, 298 patients with 385 intermediate lesions received invasive coronary wire-based functional assessment (FFR, RFR or both) at a single tertiary medical center. Coronary lesions involving ostium or left main artery were excluded. vFFR analysis was performed retrospectively based on aortic root pressure and two angiographic projections.Results: In total, 236 patients with 291 lesions were eligible for vFFR analysis. FFR and RFR were performed in 258 and 162 lesions, respectively. The mean FFR, RFR and vFFR value were 0.84 ± 0.08, 0.90 ± 0.09, and 0.83 ± 0.10. vFFR was significantly correlated with FFR (r = 0.708, P < 0.001) and RFR (r = 0.673, P < 0.001). The diagnostic performance of vFFR vs. FFR was accuracy 81.8%, sensitivity 77.4%, specificity 83.9%, positive predictive value 69.9%, and negative predictive value 88.5%. The discriminative power of vFFR for FFR ≤ 0.80 or RFR ≤ 0.89 was excellent. Area under the receiver operating characteristic curve (AUC) was 0.87 (95% CI:0.83–0.92) for FFR and 0.80 (95% CI:0.73–0.88) for RFR.Conclusion: Angiography-based vFFR has a substantial agreement with invasive wire-based FFR and RFR in patients with intermediate coronary stenoses. vFFR can be utilized to assess coronary physiology without a pressure wire in a post hoc manner.

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“…Similarly, post-PCI QFR and vFFR measurements correlated reasonably well-with post-PCI wire-based FFR measurements (28,29). However, in a retrospective study of data collected by more than 50 centers, a weak correlation was reported between vFFR measurement and wire-based FFR measurement because of poor image quality and the difficulty tracking aortic pressure (30). The prognostic value of QFR measurements has been confirmed under various conditions (8,9,31), although the optimal cutoff values for post-PCI QFR measurements have been reported as 0.89, 0.91, and 0.80 in different studies.…”

Section: Discussionmentioning

confidence: 65%

Agreement of Angiography-Derived and Wire-Based Fractional Flow Reserves in Percutaneous Coronary Intervention

Zheng

et al. 2021

Front. Cardiovasc. Med.

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Background: Coronary angiography-derived fractional flow reserve (caFFR) measurements have shown good correlations and agreement with invasive wire-based fractional flow reserve (FFR) measurements. However, few studies have examined the diagnostic performance of caFFR measurements before and after percutaneous coronary intervention (PCI). This study sought to compare the diagnostic performance of caFFR measurements against wire-based FFR measurements in patients before and after PCI.Methods: Patients who underwent FFR-guided PCI were eligible for the acquisition of caFFR measurements. Offline caFFR measurements were performed by blinded hospital operators in a core laboratory. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as a composite of vessel-related cardiovascular death, vessel-related myocardial infarction, and target vessel revascularization.Results: A total of 105 pre-PCI caFFR measurements and 65 post-PCI caFFR measurements were compared against available wire-based FFR measurements. A strong linear correlation was found between wire-based FFR and caFFR measurements (r = 0.77; p < 0.001) before PCI, and caFFR measurements also showed a high correlation (r = 0.82; p < 0.001) with wire-based FFR measurements after PCI. A total of 6 VOCEs were observed in 61 patients during follow-up. Post-PCI FFR values (≤0.82) in the target vessel was the strongest predictor of VOCE [hazard ratio (HR): 5.59; 95% confidence interval (CI): 1.12–27.96; p = 0.036). Similarly, patients with low post-PCI caFFR values (≤0.83) showed an 8-fold higher risk of VOCE than those with high post-PCI caFFR values (>0.83; HR: 8.83; 95% CI: 1.46–53.44; p = 0.017).Conclusion: The study showed that the caFFR measurements were well-correlated and in agreement with invasive wire-based FFR measurements before and after PCI. Similar to wire-based FFR measurements, post-PCI caFFR measurements can be used to identify patients with a higher risk for adverse events associated with PCI.

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Feasibility of coronary angiogram-derived vessel fractional flow reserve in the setting of standard of care percutaneous coronary intervention and its correlation with invasive FFR

Cited by 12 publications

References 16 publications

Validation of novel 3‐dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting

Validation of novel 3‐dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting

Agreement Between Invasive Wire-Based and Angiography-Based Vessel Fractional Flow Reserve Assessment on Intermediate Coronary Stenoses

Agreement of Angiography-Derived and Wire-Based Fractional Flow Reserves in Percutaneous Coronary Intervention

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