Quantitative Flow Ratio Identifies Nonculprit Coronary Lesions Requiring Revascularization in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel Disease

Spitaleri, Giosafat; Tebaldi, Matteo; Biscaglia, Simone; Westra, Jelmer; Brugaletta, Salvatore; Erriquez, Andrea; Passarini, Giulia; Brieda, Alessandro; Leone, Antonio Maria; Picchi, Andrea; Ielasi, Alfonso; Girolamo, Domenico Di; Trani, Carlo; Ferrari, Roberto; Reiber, Johan H. C.; Valgimigli, Marco; Sabaté, Manel; Campo, Gianluca

doi:10.1161/circinterventions.117.006023

Cited by 90 publications

(117 citation statements)

References 19 publications

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“…We found a high classification agreement between acute QFR and staged QFR with no relation to follow‐up time. These results are in line with a proof of concept study that indicated that QFR assessment of NCLs was not notably affected by nonculprit physiological alterations induced by STEMI . In contrast, the main iSTEMI study showed that the agreement of acute iFR with staged iFR was lower and with increasing difference with increasing time interval between acute and staged iFR assessment .…”

Section: Discussionsupporting

confidence: 87%

“…These results are in line with a proof of concept study that indicated that QFR assessment of NCLs was not notably affected by nonculprit physiological alterations induced by STEMI. 11 In contrast, the main iSTEMI study showed that the agreement of acute iFR with staged iFR was lower and with increasing difference with increasing time interval between acute and staged iFR assessment. 4 While QFR was slightly higher in the acute setting, iFR was significantly lower.…”

Section: Discussionmentioning

confidence: 87%

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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: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 87%

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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“…The diagnostic precision of QFR in nonculprit lesions, as recently assessed in a proof concept study by Spitaleri et al, could thus not be confirmed 26. We excluded lesions with Medina type 1.1.1 and 1.0.1 bifurcations attributed to specific limitations of the present QFR application; hence, the diagnostic precision of QFR in bifurcation needs further developments and investigation.…”

Section: Study Limitationsmentioning

confidence: 77%

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Westra

Andersen

Campo

et al. 2018

JAHA

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BackgroundQuantitative flow ratio (QFR) is a novel modality for physiological lesion assessment based on 3‐dimensional vessel reconstructions and contrast flow velocity estimates. We evaluated the value of online QFR during routine invasive coronary angiography for procedural feasibility, diagnostic performance, and agreement with pressure‐wire–derived fractional flow reserve (FFR) as a gold standard in an international multicenter study.Methods and Results FAVOR II E‐J (Functional Assessment by Various Flow Reconstructions II Europe‐Japan) was a prospective, observational, investigator‐initiated study. Patients with stable angina pectoris were enrolled in 11 international centers. FFR and online QFR computation were performed in all eligible lesions. An independent core lab performed 2‐dimensional quantitative coronary angiography (2D‐QCA) analysis of all lesions assessed with QFR and FFR. The primary comparison was sensitivity and specificity of QFR compared with 2D‐QCA using FFR as a reference standard. A total of 329 patients were enrolled. Paired assessment of FFR, QFR, and 2D‐QCA was available for 317 lesions. Mean FFR, QFR, and percent diameter stenosis were 0.83±0.09, 0.82±10, and 45±10%, respectively. FFR was ≤0.80 in 104 (33%) lesions. Sensitivity and specificity by QFR was significantly higher than by 2D‐QCA (sensitivity, 86.5% (78.4–92.4) versus 44.2% (34.5–54.3); P<0.001; specificity, 86.9% (81.6–91.1) versus 76.5% (70.3–82.0); P=0.002). Area under the receiver curve was significantly higher for QFR compared with 2D‐QCA (area under the receiver curve, 0.92 [0.89–0.96] versus 0.64 [0.57–0.70]; P<0.001). Median time to QFR was significantly lower than median time to FFR (time to QFR, 5.0 minutes [interquartile range, –6.1] versus time to FFR, 7.0 minutes [interquartile range, 5.0–10.0]; P<0.001).ConclusionsOnline computation of QFR in the catheterization laboratory is clinically feasible and is superior to angiographic assessment for evaluation of intermediary coronary artery stenosis using FFR as a reference standard.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02959814.

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“…The calculation of the cQFR incorporates the frame counting at rest to compute mean HFV as a boundary condition . A recent study indicated that both fQFR and cQFR directly correlated with FFR, and that cQFR was relatively higher than fQFR in the myocardial infarction‐related coronary arteries, while no such difference was found in noninfarction cases . These interesting results suggested that cQFR which incorporates HFV might be strongly influenced by MVD.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] Recently, a novel approach has been developed, enabling rapid computation of FFR pullbacks from three-dimensional (3D) quantitative coronary angiography. [17][18][19][20] The computational FFR, also termed quantitative flow ratio (QFR), can be obtained using two different flow models: fixed-flow QFR (fQFR) using empiric hyperemic flow velocity (HFV) and contrast-flow QFR (cQFR) using HFV derived from coronary angiography. 21,22 Because fQFR is based only on anatomic information obtained from 3D-QCA, it does not reflect the influence of microcirculation function.…”

mentioning

confidence: 99%

Novel application of quantitative flow ratio for predicting microvascular dysfunction after ST‐segment‐elevation myocardial infarction

Sheng

Qiao

et al. 2020

Cathet Cardio Intervent

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Objectives This study evaluated quantitative flow ratio (QFR) to predict microvascular dysfunction (MVD) in patients with ST‐segment elevation myocardial infarction (STEMI). Background QFR is a novel approach for the rapid computation of fractional flow reserve based on three‐dimensional quantitative coronary angiography. We hypothesized that QFR computation could be used to predict MVD after STEMI. Methods Indexes such as contrast‐flow QFR (cQFR), fixed‐flow QFR (fQFR), and hyperemic flow velocity (HFV) were calculated in 130 STEMI patients with culprit lesion with ≥50% diameter stenosis and TIMI flow grade 2/3 in the spontaneously recanalized culprit artery on initial angiography. MVD was defined as microvascular obstruction determined by contrast‐enhanced cardiac magnetic resonance at a median of 5 days after percutaneous coronary intervention. Results Patients were divided into the MVD group (76/130, 58.5%) and non‐MVD group (54/130, 41.5%). Patients with MVD had higher cQFR‐fQFR value (0.080 ± 0.058 vs. 0.038 ± 0.039, p < .001) and lower modeled HFV (0.096 ± 0.044 vs. 0.144 ± 0.041 m/s, p < .001). Receiver operator characteristic curve analysis revealed that both the cQFR‐fQFR value (area under the curve, AUC = 0.716, p < .001) and modeled HFV (AUC = 0.805, p < .001) had high specificity and positive predictive value to predict MVD. In multivariable logistic analysis, cQFR‐fQFR was identified as an independent predictor of MVD (odds ratio = 9.800, p < .001). Conclusions This proof‐of‐concept study suggested that QFR computation may be a useful tool to predict MVD after STEMI (Trial Registration:NCT03780335).

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Quantitative Flow Ratio Identifies Nonculprit Coronary Lesions Requiring Revascularization in Patients With ST-Segment–Elevation Myocardial Infarction and Multivessel Disease

Abstract: In a limited and selected study population, our study showed that QFR computation may be a safe and reliable tool to guide coronary revascularization of NCLs in ST-segment-elevation myocardial infarction patients.

Cited by 90 publications

References 19 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

Diagnostic Performance of In‐Procedure Angiography‐Derived Quantitative Flow Reserve Compared to Pressure‐Derived Fractional Flow Reserve: The FAVOR II Europe‐Japan Study

Novel application of quantitative flow ratio for predicting microvascular dysfunction after ST‐segment‐elevation myocardial infarction

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