Quantitative flow ratio and instantaneous wave-free ratio for the assessment of the functional severity of intermediate coronary artery stenosis

Emori, Hiroki; Kubo, Takashi; Kameyama, Takeyoshi; Ino, Yasushi; Matsuo, Yoshiki; Kitabata, Hironori; Terada, Kosei; Katayama, Yosuke; Taruya, Akira; Shimamura, Kazuo; Shiono, Yasutsugu; Tanaka, Atsushi; Hozumi, Takeshi; Akasaka, Takashi

doi:10.1097/mca.0000000000000650

Cited by 39 publications

(37 citation statements)

References 9 publications

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“…Recently, a good correlation between QFR and iFR has been reported in stable patients. 16 However, the optimal strategy for assessment of NCL significance (whether based on QFR, FFR, or iFR) and the timing (acute vs. staged) of this evaluation has not been clarified and will be the subject of future studies.…”

Section: Discussionmentioning

confidence: 99%

Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST‐segment elevation myocardial infarction—An iSTEMI substudy

Sejr-Hansen

Thim

Christiansen

et al. 2019

Cathet Cardio Intervent

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Objectives We evaluated the diagnostic performance of quantitative flow ratio (QFR) assessment of nonculprit lesions (NCLs) based on acute setting angiograms obtained in patients with ST‐segment elevation myocardial infarction (STEMI) with QFR, fractional flow reserve (FFR), and instantaneous wave‐free ratio (iFR) in the staged setting as reference. Background QFR is an angiography‐based approach for the functional evaluation of coronary artery lesions. Methods This was a post‐hoc analysis of the iSTEMI study. NCLs were assessed with iFR in the acute setting and with iFR and FFR at staged (median 13 days) follow‐up. Acute and staged QFR values were computed in a core laboratory based on the coronary angiography recordings. Diagnostic cut‐off values were ≤0.80 for QFR and FFR, and ≤0.89 for iFR. Results Staged iFR and FFR data were available for 146 NCLs in 112 patients in the iSTEMI study. Among these, QFR analysis was feasible in 103 (71%) lesions assessed in the acute setting with a mean QFR value of 0.82 (IQR: 0.73–0.91). Staged QFR, FFR, and iFR were 0.80 (IQR: 0.70–0.90), 0.81 (IQR: 0.71–0.88), and 0.91 (IQR: 0.87–0.96), respectively. Classification agreement of acute and staged QFR was 93% (95%Cl: 87–99). The classification agreement of acute QFR was 84% (95%CI: 76–90) using staged FFR as reference and 74% (95%CI: 65–83) using staged iFR as reference. Conclusions Acute QFR showed a very good diagnostic performance with staged QFR as reference, a good diagnostic performance with staged FFR as reference, and a moderate diagnostic performance with staged iFR as reference.

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Section: Discussionmentioning

confidence: 99%

Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST‐segment elevation myocardial infarction—An iSTEMI substudy

Sejr-Hansen

Thim

Christiansen

et al. 2019

Cathet Cardio Intervent

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“…QFR does not require induction of hyperemia or the use of pressure wires and can be computed within the time of conventional FFR measurement [5][6][7]. QFR approaches FFR with an overall good diagnostic accuracy (ranging from 80 to 95%) [5,6,[8][9][10][11] and recent studies reported a good agreement between QFR and myocardial perfusion scintigraphy, MPS [1,5,12].…”

Section: Introductionmentioning

confidence: 96%

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

Sejr-Hansen

Winther

et al. 2019

Int J Cardiovasc Imaging

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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.

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“…Overall, our meta-analysis consists of 19 studies (6492 lesions) and 9 studies (1721 lesions) for iFR and QFR, respectively. It was noted that a retrospective, single-center trial [15] involving 100 patients is the only study comparing iFR and QFR directly, which was included in both the iFR group and the QFR group. The details of 28 studies are described in Table 1 including the first author, published year, the number of lesions, research type, FFR cutoff, and iFR/QFR cutoff.…”

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of Diagnostic Performance of Instantaneous Wave-Free Ratio versus Quantitative Flow Ratio for Detecting the Functional Significance of Coronary Stenosis

Zuo

Yang

Chen

et al. 2019

BioMed Research International

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Background. Fractional flow reserve (FFR), as a functional measurement of coronary stenosis, is recommended for guiding revascularization in intermediate coronary lesions. However, it still remains underutilized for potential reasons including time consumption, costs, or contraindications associated with adenosine administration. Here we performed this meta-analysis to assess the diagnostic performance of two adenosine-free indices, instantaneous wave free-ratio (iFR), and quantitative flow ratio (QFR) in evaluating coronary stenosis severity with FFR as the reference standard. Methods. PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to include relevant studies with the diagnostic accuracy of iFR or QFR referenced to FFR. A bivariate model was applied to pool diagnostic parameters. We used Cochran’s Q test and I2 index to assess heterogeneity and identify the potential source of heterogeneity by meta-regression. Results. A total of 8213 lesions from 28 studies (19 for iFR and 9 for QFR) were included in this meta-analysis. The pooled sensitivity and specificity were 0.79 (95% CI, 0.75 to 0.83) and 0.85 (95% CI, 0.82 to 0.87) for iFR and 0.90 (95% CI, 0.84 to 0.93) and 0.88 (95% CI, 0.86 to 0.90) for QFR, respectively. Significantly higher sensitivity and specificity were observed in the bivariate analysis for QFR than for iFR (P < 0.001 for both). The area under summary receiver-operating curve of iFR and QFR was 0.89 (95% CI, 0.86 to 0.92) and 0.92 (95% CI, 0.89 to 0.94). Conclusion. Evidence suggests that both of the two indices have good performance in detecting functional ischemia of coronary arteries and QFR might be a promising method without requiring the pressure wire. Further application of QFR may potentially provide important information to clinicians in the assessment of coronary lesions.

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Quantitative flow ratio and instantaneous wave-free ratio for the assessment of the functional severity of intermediate coronary artery stenosis

Abstract: QFR was correlated highly with iFR as well as FFR. Like FFR and iFR, QFR might be reliable for assessing the physiological severity of coronary stenosis in the angiographic intermediate lesions.

Cited by 39 publications

References 9 publications

Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST‐segment elevation myocardial infarction—An iSTEMI substudy

Quantitative flow ratio for immediate assessment of nonculprit lesions in patients with ST‐segment elevation myocardial infarction—An iSTEMI substudy

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

Meta-Analysis of Diagnostic Performance of Instantaneous Wave-Free Ratio versus Quantitative Flow Ratio for Detecting the Functional Significance of Coronary Stenosis

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