Resting distal to aortic pressure ratio and fractional flow reserve discordance affects the diagnostic performance of quantitative flow ratio: Results from an individual patient data meta‐analysis

2020 ◽  
Author(s):  
Jelmer Westra ◽  
Ashkan Eftekhari ◽  
Shengxian Tu ◽  
Gianluca Campo ◽  
Javier Escaned ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Pressure Ratio ◽  
Aortic Pressure ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

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

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Ruitao Zhang ◽  
Jianwei Zhang ◽  
Lijun Guo
Keyword(s):  
Sensitivity And Specificity ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

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.

Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio and fractional flow reserve revascularization decision making strategy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Peper ◽  
R.W Van Hamersvelt ◽  
B.J.M.W Rensing ◽  
J.P Van Kuijk ◽  
M Voskuil ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Hybrid Approach ◽  
High Accuracy ◽  
Intermediate Zone ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Hybrid Strategy ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Abstract Background Fractional flow reserve (FFR) adoption persists low mainly due to procedural and operator related factors as well as costs. An alternative for FFR, quantitative flow ratio (QFR) achieves a high accuracy mainly outside the intermediate zone without the need for hyperemia and wire-use. Currently, no outcome trials assess the role of QFR in the guidance of revascularization. Therefore, we evaluate a QFR-FFR hybrid strategy in which FFR is measured inside of the intermediate zone. Methods This retrospective multi-center study included consecutive patients who underwent both invasive coronary angiography and FFR in the participating centers. QFR was calculated for all vessels in which FFR was measured. Diagnostic performance of QFR was assessed using an FFR cut-off of 0.80 as reference standard. The QFR-FFR hybrid approach was modeled using the intermediate zone of 0.77 to 0.87 assuming that lesions within the intermediate zone follow the FFR binary cutoff. Results In total, 381 vessels in 289 patients were analyzed. The sensitivity, specificity and accuracy on a per vessel-based analysis were 84.6%, 86.3% and 85.6% for QFR and 91.1%, 95.3% and 93.4% for the QFR-FFR hybrid approach. The diagnostic accuracy of QFR-FFR hybrid strategy with invasive FFR measurement is 93.4% and results in a FFR reduction of 56.7%. Conclusion QFR has a good correlation and agreement with invasive FFR and a high diagnostic accuracy. A hybrid QFR-FFR approach could extend the use of QFR and reduces the proportion of invasive FFR-measurements needed while maintaining a high accuracy. Hybrid QFR-FFR strategy Funding Acknowledgement Type of funding source: None

scholarly journals Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joyce Peper ◽  
Robbert W. van Hamersvelt ◽  
Benno J. W. M. Rensing ◽  
Jan-Peter van Kuijk ◽  
Michiel Voskuil ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Invasive Coronary Angiography ◽  
Hybrid Approach ◽  
Intermediate Zone ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Hybrid Strategy ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

AbstractInvasive fractional flow reserve (FFR) adoption remains low mainly due to procedural and operator related factors as well as costs. Alternatively, quantitative flow ratio (QFR) achieves a high accuracy mainly outside the intermediate zone without the need for hyperaemia and wire-use. We aimed to determine the diagnostic performance of QFR and to evaluate a QFR–FFR hybrid strategy in which FFR is measured only in the intermediate zone. This retrospective study included 289 consecutive patients who underwent invasive coronary angiography and FFR. QFR was calculated for all vessels in which FFR was measured. The QFR–FFR hybrid approach was modelled using the intermediate zone of 0.77–0.87 in which FFR-measurements are recommended. The sensitivity, specificity, and accuracy on a per vessel-based analysis were 84.6%, 86.3% and 85.6% for QFR and 88.0%, 92.9% and 90.3% for the QFR–FFR hybrid approach. The diagnostic accuracy of QFR–FFR hybrid strategy with invasive FFR measurement was 93.4% and resulted in a 56.7% reduction in the need for FFR. QFR has a good correlation and agreement with invasive FFR. A hybrid QFR–FFR approach could extend the use of QFR and reduces the proportion of invasive FFR-measurements needed while improving accuracy.

scholarly journals Diagnostic Performance of Immediate Angiography Derived Quantitative Flow Ratio In Patients After Second Generation Drug Eluting Stent And Bioresorable Scaffold Implantation

2021 ◽  
Author(s):  
Zhengwei Li ◽  
Jiachen Zhan ◽  
Jia Han ◽  
Guosheng Fu ◽  
Chongying Jin
Keyword(s):  
Stent Implantation ◽  
Diagnostic Performance ◽  
Artery Bypass ◽  
Drug Eluting Stent ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Abstract Quantitative flow ratio (QFR) is a novel angiography derived fractional flow reserve (FFR). However, its diagnostic performance has only be validated in native coronary lesion but not yet in vessels after stent implantation. This study aims to evaluate the diagnostic performance of QFR in coronary vessels immediately after everolimus eluting stent (EES) and bioresorbable scaffold (BRS) implantation. This is a retrospective, two centers, validation cohort study. 73 stable angina patients who received at least one native vessel EES/BRS implantation with immediate FFR assessment were screened. Cases with aorta-ostial stenoses, bridge vessel at the distal of targated vessel, acute coronary syndrome, previous coronary artery bypass grafting, age < 18 years, lack of ≥ 2 final angiographic projections were excluded. Contrast QFR assessment was performed blinded to FFR assessment. A good correlation (r = 0.680, p < 0.001) was found between QFR and FFR. In the EES implantation cohort, a good correlation (r = 0.769, p < 0.001) was found between QFR and FFR, while moderate correlation (r = 0.446, p = 0.038) was found in the BRS cohort. The area under the ROC curve for detecting FFR ≤ 0.86 was 0.883 for the total subjects. QFR assessment after immediate EES/BRS implantation is feasible, and remains good correlation and agreement with FFR. QFR might be a promising tool for guiding stent implantation optimizing to improve clinical outcomes.

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

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Wenjie Zuo ◽  
Mingming Yang ◽  
Yifan Chen ◽  
Aiming Xie ◽  
Lijuan Chen ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Receiver Operating Curve ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Coronary Lesions ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

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.

Diagnostic Agreement of Quantitative Flow Ratio with Fractional Flow Reserve in a Latin-American Population

2021 ◽  
Author(s):  
Mauro Echavarria Pinto ◽  
Tim P. Van de Hoef ◽  
Nancy Pacheco-Beltran ◽  
Jesus Eduardo Reyes-Carrera ◽  
Eduardo Rangel-Alvarado ◽  
...  
Keyword(s):  
Latin American ◽  
Fractional Flow Reserve ◽  
Diagnostic Performance ◽  
American Population ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow ◽  
Latin American Population

Abstract Purpose: Quantitative flow ratio (QFR) is a recently proposed angiographic index that allows to assess the pressure loss in coronary arteries in a similar fashion as the accepted standard fractional flow reserve (FFR). The purpose of this study was to evaluate the diagnostic performance of QFR as compared to FFR, in a Latin-American population of patients with suspected ischaemic heart disease.Methods: QFR was retrospectively derived from coronary angiograms. The association, diagnostic performance, and continuous agreement of fixed-flow QFR (fQFR) and contrast-flow QFR (cQFR) with FFR was assessed by continuous and dichotomous methods.Results: 90 vessels form 63 patients were finally included. The study comprised coronary stenoses of intermediate severity, both angiographically (diameter stenosis: 46.6 ± 12.8%) and physiologically [median FFR=0.86 (quartile 1-3, 0.76-0.89)]. The correlation of FFR with both fQFR [ρ=0.841, (95% CI: 0.767 to 0.893), p<0.001] and cQFR [ρ=0.833, (95% CI: 0.755 to 0.887), p<0.001] was strong. The diagnostic performance of cQFR was numerically better [area under the ROC curve of 0.92 (95% CI: 0.86 to 0.97, p<0.001)], with 0.80 as the optimal cQFR cut-off against FFR≤0.80. This 0.80 cQFR cut-off classified correctly 83.3% of total stenoses, with a sensitivity of 85.2% and specificity of 80.6%.Conclusions: QFR was strongly associated with FFR and exhibited a high diagnostic performance in this Latin-American population.

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