Sex Differences in Murray Law‐Based Quantitative Flow Ratio Among Patients With Intermediate Coronary Lesions

Zuo, Wenjie; Sun, Renhua; Ji, Zhenjun; Zuo, Pengfei; Zhang, Xiaoguo; Huang, Rong; Tao, Zaixiao; Tu, Shengxian; Li, Yongjun; Ma, Genshan

doi:10.1161/jaha.123.029330

Cited by 3 publications

(1 citation statement)

References 45 publications

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“…The patient population was predominantly male (88.9%) in this study. Recently, it was reported that µQFR had comparable diagnostic performance between the sexes and significantly improved the detection of physiological significance, as defined by FFR, over angiography alone [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

Kotoku,

Ninomiya,

Ding

et al. 2023

Int J Cardiovasc Imaging

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Murray law-based quantitative flow ratio (µQFR) assesses fractional flow reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised in suboptimal angiographic projections. FFRCT is a well-validated non-invasive method measuring FFR from coronary computed tomographic angiography (CCTA). We evaluated the feasibility of µQFR in left main (LM) bifurcations, the impact of the optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance with FFRCT. In 300 patients with three-vessel disease, the values of FFRCT and µQFR were compared at distal LM, proximal left anterior descending artery (pLAD) and circumflex artery (pLCX). The optimal viewing angle of LM bifurcation was defined on CCTA by 3-dimensional coordinates and converted into a 2-dimensional fluoroscopic view. The best fluoroscopic projection was considered the closest angulation to the optimal viewing angle on CCTA. µQFR was successfully computed in 805 projections. In the best projections, µQFR sensitivity was 88.2% (95% CI 76.1–95.6) and 84.8% (71.1–93.7), and specificity was 96.8% (93.8–98.6) and 97.2% (94.4–98.9), in pLAD and pLCX, respectively, with regard to FFRCT. The AUC of µQFR for predicting FFRCT ≤ 0.80 tended to be improved using the best versus suboptimal projections (0.94 vs. 0.89 [p = 0.048] in pLAD; 0.94 vs. 0.88 [p = 0.075] in pLCX). Computation of µQFR in LM bifurcations using a single angiographic view showed high feasibility from post-hoc analysis of coronary angiograms obtained for clinical purposes. The fluoroscopic viewing angle influences the diagnostic performance of physiological assessment using a single angiographic view.

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Section: Discussionmentioning

confidence: 99%

Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

Kotoku,

Ninomiya,

Ding

et al. 2023

Int J Cardiovasc Imaging

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Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics

Asano,

Tanigaki,

Ikeda

et al. 2024

Cardiovasc Interv and Ther

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Invasive functional coronary angiography (FCA), an angiography-derived physiological index of the functional significance of coronary obstruction, is a novel physiological assessment tool for coronary obstruction that does not require the utilization of a pressure wire. This technology enables operators to rapidly evaluate the functional relevance of coronary stenoses during and even after angiography while reducing the burden of cost and complication risks related to the pressure wire. FCA can be used for treatment decision-making for revascularization, strategy planning for percutaneous coronary intervention, and procedure optimization. Currently, various software-computing FCAs are available worldwide, with unique features in their computation algorithms and functions. With the emerging application of this novel technology in various clinical scenarios, the Japanese Association of Cardiovascular Intervention and Therapeutics task force was created to outline expert consensus on the clinical use of FCA. This consensus document advocates optimal clinical applications of FCA according to currently available evidence while summarizing the concept, history, limitations, and future perspectives of FCA along with globally available software. Graphical abstract Overview and proposed clinical applications of functional coronary angiography (FCA). The FCA was developed according to computed fluid dynamics (CFD), considering the pressure drop across the coronary stenosis. CFD analysis was performed with a three-dimensional coronary model derived from angiography, allowing the calculation of the physiological index without the use of a pressure wire. Another direction of development in FCA is using artificial intelligence throughout the entire process, enabling “hands-free” FFR simulation. The advantage of the FCA is that it eliminates the use of a pressure wire, resulting in reduced invasiveness, shorter procedure times, and reduced medical costs. However, FCA requires high-quality angiography for a clear visualization of the lesion. In addition, the current version of FCA requires several manual corrections; thus, its reproducibility is limited. Further data on clinical outcomes after the use of FCA, such as percutaneous coronary intervention (PCI) with FCA guidance, are warranted. The consensus group of the Japanese Association of Cardiovascular Intervention and Therapeutics proposed the application of FCA in various clinical scenarios considering the advantages of this technology. QFR, quantitative flow ratio; iFR, instantaneous wave-free ratio; CCS, chronic coronary syndrome; ACS, acute coronary syndrome; MVD, multivessel disease; AMI, acute myocardial infarction.

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Cardiovascular Imaging in Women

Massalha,

Kennedy,

Hussein

et al. 2024

Seminars in Nuclear Medicine

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Sex Differences in Murray Law‐Based Quantitative Flow Ratio Among Patients With Intermediate Coronary Lesions

Cited by 3 publications

References 45 publications

Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics

Cardiovascular Imaging in Women

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