scholarly journals TCT-620 Influence of diabetes mellitus and chronic kidney disease on diagnostic accuracy of Quantitative Flow Ratio (QFR).

2018 ◽  
Vol 72 (13) ◽  
pp. B248
Author(s):  
Martyna Zaleska ◽  
Lukasz Koltowski ◽  
Jakub Maksym ◽  
Mariusz Tomaniak ◽  
Aleksandra Chabior ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Diagnostic Accuracy ◽  
Flow Ratio ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

scholarly journals Feasibility and diagnostic reliability of quantitative flow ratio in the assessment of non-culprit lesions in acute coronary syndrome

2021 ◽  
Author(s):  
Aslihan Erbay ◽  
Lisa Penzel ◽  
Youssef S. Abdelwahed ◽  
Jens Klotsche ◽  
Anne-Sophie Schatz ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Performance ◽  
Primary Pci ◽  
Flow Ratio ◽  
Diagnostic Reliability ◽  
Index Procedure ◽  
Coronary Syndromes ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow ◽  
Good Agreement

AbstractSeveral studies have demonstrated the feasibility and safety of hemodynamic assessment of non-culprit coronary arteries in setting of acute coronary syndromes (ACS) using fractional flow reserve (FFR) measurements. Quantitative flow ratio (QFR), recently introduced as angiography-based fast FFR computation, has been validated with good agreement and diagnostic performance with FFR in chronic coronary syndromes. The aim of this study was to assess the feasibility and diagnostic reliability of QFR assessment during primary PCI. A total of 321 patients with ACS and multivessel disease, who underwent primary PCI and were planned for staged PCI of at least one non-culprit lesion were enrolled in the analysis. Within this patient cohort, serial post-hoc QFR analyses of 513 non-culprit vessels were performed. The median time interval between primary and staged PCI was 49 [42–58] days. QFR in non-culprit coronary arteries did not change between acute and staged measurements (0.86 vs 0.87, p = 0.114), with strong correlation (r = 0.94, p ≤ 0.001) and good agreement (mean difference -0.008, 95%CI -0.013–0.003) between measurements. Importantly, QFR as assessed at index procedure had sensitivity of 95.02%, specificity of 93.59% and diagnostic accuracy of 94.15% in prediction of QFR ≤ 0.80 at the time of staged PCI. The present study for the first time confirmed the feasibility and diagnostic accuracy of non-culprit coronary artery QFR during index procedure for ACS. These results support QFR as valuable tool in patients with ACS to detect further hemodynamic relevant lesions with excellent diagnostic performance and therefore to guide further revascularisation therapy.

scholarly journals Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001179 ◽  
Author(s):  
Yoshinori Kanno ◽  
Masahiro Hoshino ◽  
Rikuta Hamaya ◽  
Tomoyo Sugiyama ◽  
Yoshihisa Kanaji ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Fractional Flow Reserve ◽  
Coronary Flow ◽  
Microvascular Function ◽  
Grey Zone ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

BackgroundMeasurement of the contrast-flow quantitative flow ratio (cQFR) is a novel method for rapid computational estimation of fractional flow reserve (FFR). Discordance between FFR and cQFR has not been completely characterised.MethodsWe performed a post-hoc analysis of 504 vessels with angiographically intermediate stenosis in 504 patients who underwent measurement of FFR, coronary flow reserve (CFR), the index of microcirculatory resistance (IMR) and Duke jeopardy score.ResultsIn total, 396 (78.6%) and 108 (21.4%) lesions showed concordant and discordant FFR and cQFR functional classifications, respectively. Among lesions with a reduced FFR (FFR+), those with a preserved cQFR (cQFR−) showed significantly lower IMR, shorter mean transit time (Tmn), shorter lesion length (all, p<0.01) and similar CFR and Duke jeopardy scores compared with lesions showing a reduced cQFR (cQFR+). Furthermore, lesions with FFR+ and cQFR− had significantly lower IMR and shorter Tmn compared with lesions showing a preserved FFR (FFR−) and cQFR+. Of note, in cQFR+ lesions, higher IMR lesions were associated with decreased diagnostic accuracy (high-IMR; 63.0% and low-IMR; 75.8%, p<0.01). In contrast, in cQFR− lesions, lower IMR lesions was associated with decreased diagnostic accuracy (high-IMR group; 96.8% and low-IMR group; 80.0%, p<0.01). Notably, in total, 31 territories (6.2%; ‘jump out’ group) had an FFR above the upper limit of the grey zone (>0.80) and a cQFR below the lower limit (≤0.75). In contrast, five territories (1.0%; ‘jump in’ group) exhibited opposite results (FFR of ≤0.75 and cQFR of >0.80). The ‘jump out’ territories showed significantly higher IMR values than ‘jump in’ territories (p<0.01).ConclusionsFFR− with cQFR+ is associated with increased microvascular resistance, and FFR+ with cQFR− showed preservation of microvascular function with high coronary flow. Microvascular function affected diagnostic performance of cQFR in relation to functional stenosis significance.

scholarly journals Impact of type 2 diabetes mellitus on coronary function evaluated by quantitative flow ratio in patients underwent percutaneous coronary intervention

2021 ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Percutaneous Coronary Intervention ◽  
Type 2 Diabetes Mellitus ◽  
Coronary Intervention ◽  
Flow Ratio ◽  
Percutaneous Coronary ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Abstract The full text of this preprint has been withdrawn by the authors due to author disagreement with the posting of the preprint. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.

scholarly journals Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

2018 ◽  
Vol 82 (3) ◽  
pp. 807-814 ◽  
Author(s):  
Hiroki Emori ◽  
Takashi Kubo ◽  
Takeyoshi Kameyama ◽  
Yasushi Ino ◽  
Yoshiki Matsuo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Ischemia ◽  
Diagnostic Accuracy ◽  
Flow Ratio ◽  
Prior Myocardial Infarction ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

scholarly journals Influence of lesion and disease subsets on the diagnostic performance of the quantitative flow ratio in real-world patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kwan Yong Lee ◽  
Byung-Hee Hwang ◽  
Moo Jun Kim ◽  
Eun-Ho Choo ◽  
Ik Jun Choi ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Real World ◽  
Multiple Testing ◽  
Diagnostic Performance ◽  
Computational Method ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Quantitative Flow Ratio ◽  
Tandem Lesions ◽  
Quantitative Flow

AbstractThe quantitative flow ratio (QFR) is a novel angiography-based computational method assessing functional ischemia caused by coronary stenosis. This study aimed to evaluate the diagnostic performance of quantitative flow ratio (QFR) in patients with angina and acute myocardial infarction (AMI) and to identify the conditions with low diagnostic performance. We assessed the QFR for 1077 vessels under fractional flow ratio (FFR) evaluation in 915 patients with angina and AMI. The diagnostic accuracies of the QFR for identifying an FFR ≤ 0.8 were 95.98% (95% confidence interval [CI] 94.52 to 97.14%) for the angina group and 92.42% (95% CI 86.51 to 96.31%) for the AMI group. The diagnostic accuracy of the QFR in the borderline FFR zones (> 0.75, ≤ 0.85) (91.23% [95% CI 88.25 to 93.66%]) was significantly lower than that in others (difference: 4.32; p = 0.001). The condition accompanying both AMI and the borderline FFR zone showed the lowest QFR diagnostic accuracy in our data (83.93% [95% CI 71.67 to 92.38]). The diagnostic accuracy was reduced for tandem lesions (p = 0.04, not correcting for multiple testing). Our study found that the QFR method yielded a high overall diagnostic performance in real-world patients. However, low diagnostic accuracy has been observed in borderline FFR zones with AMI, and the hybrid FFR approach needs to be considered.

OP608 The Diagnostic Accuracy Of Quantitative Flow Ratio In Myocardial Ischemia Of Coronary Artery Disease: A Meta-Analysis

2020 ◽  
Vol 36 (S1) ◽  
pp. 15-15
Author(s):  
Guo Huang ◽  
Di Xue
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Ischemia ◽  
Diagnostic Accuracy ◽  
Literature Search ◽  
Meta Analysis ◽  
Flow Ratio ◽  
Artery Disease ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

IntroductionQuantitative flow ratio (QFR) is a novel approach to derive fractional flow reserve (FFR) from coronary angiography. QFR based on 3-dimensional reconstruction of angiographic images assesses the significance of coronary artery disease (CAD) without using an invasive pressure wire. This study aimed to evaluate the diagnostic accuracy of quantitative flow ratio in myocardial ischemia of coronary artery disease.MethodsA meta-analysis was conducted of published research articles on diagnostic accuracy of QFR between January 2016 and September 2019 in the databases of PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform and China Bio-medicine Database. Statistical analysis was performed with software Meta-Disc 1.4 and Stata 12.0, and the summary receiver operating characteristic (SROC) curve was drawn to evaluate accuracy of the method.ResultsA total of 11 articles were retreived, including 1,782 patients and 2,054 vessels. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for quantitative flow ratio respectively, were 0.86 (95% confidence interval [CI]: 0.85-0.89), 0.89 (95%CI: 0.87–0.91), 7.51(95%CI: 6.40–8.82), 0.15 (95%CI: 0.10–0.23), 54.18 (95%CI: 34.09–86.12), and the pooled AUC was 0.9458.ConclusionsSeveral limitations should be considered when interpreting the findings of this meta-analysis. First, despite the extensive literature search, the number of included studies was small; however, the number of patients and vessels enrolled was satisfactory, thereby decreasing type II error. Furthermore, data acquisition is not comprehensive enough because the language of the literature search was limited to Chinese and English. Despite these limitations, our study suggests with a definition of ischemia as FFR ≤ 0.8, the QFR obtains high diagnostic efficacy in myocardial ischemia of CAD. It can be used as a non-invasive novel method to screen CAD patients with myocardial ischemia.

scholarly journals Non-invasive imaging software to assess the functional significance of coronary stenoses: a systematic review and economic evaluation

2021 ◽  
Vol 25 (56) ◽  
pp. 1-230
Author(s):  
Ana Duarte ◽  
Alexis Llewellyn ◽  
Ruth Walker ◽  
Laetitia Schmitt ◽  
Kath Wright ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Accuracy ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
Clinical Effectiveness ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Background QAngio® XA 3D/QFR® (three-dimensional/quantitative flow ratio) imaging software (Medis Medical Imaging Systems BV, Leiden, the Netherlands) and CAAS® vFFR® (vessel fractional flow reserve) imaging software (Pie Medical Imaging BV, Maastricht, the Netherlands) are non-invasive technologies to assess the functional significance of coronary stenoses, which can be alternatives to invasive fractional flow reserve assessment. Objectives The objectives were to determine the clinical effectiveness and cost-effectiveness of QAngio XA 3D/QFR and CAAS vFFR. Methods We performed a systematic review of all evidence on QAngio XA 3D/QFR and CAAS vFFR, including diagnostic accuracy, clinical effectiveness, implementation and economic analyses. We searched MEDLINE and other databases to January 2020 for studies where either technology was used and compared with fractional flow reserve in patients with intermediate stenosis. The risk of bias was assessed with quality assessment of diagnostic accuracy studies. Meta-analyses of diagnostic accuracy were performed. Clinical and implementation outcomes were synthesised narratively. A simulation study investigated the clinical impact of using QAngio XA 3D/QFR. We developed a de novo decision-analytic model to estimate the cost-effectiveness of QAngio XA 3D/QFR and CAAS vFFR relative to invasive fractional flow reserve or invasive coronary angiography alone. Scenario analyses were undertaken to explore the robustness of the results to variation in the sources of data used to populate the model and alternative assumptions. Results Thirty-nine studies (5440 patients) of QAngio XA 3D/QFR and three studies (500 patients) of CAAS vFFR were included. QAngio XA 3D/QFR had good diagnostic accuracy to predict functionally significant fractional flow reserve (≤ 0.80 cut-off point); contrast-flow quantitative flow ratio had a sensitivity of 85% (95% confidence interval 78% to 90%) and a specificity of 91% (95% confidence interval 85% to 95%). A total of 95% of quantitative flow ratio measurements were within 0.14 of the fractional flow reserve. Data on the diagnostic accuracy of CAAS vFFR were limited and a full meta-analysis was not feasible. There were very few data on clinical and implementation outcomes. The simulation found that quantitative flow ratio slightly increased the revascularisation rate when compared with fractional flow reserve, from 40.2% to 42.0%. Quantitative flow ratio and fractional flow reserve resulted in similar numbers of subsequent coronary events. The base-case cost-effectiveness results showed that the test strategy with the highest net benefit was invasive coronary angiography with confirmatory fractional flow reserve. The next best strategies were QAngio XA 3D/QFR and CAAS vFFR (without fractional flow reserve). However, the difference in net benefit between this best strategy and the next best was small, ranging from 0.007 to 0.012 quality-adjusted life-years (or equivalently £140–240) per patient diagnosed at a cost-effectiveness threshold of £20,000 per quality-adjusted life-year. Limitations Diagnostic accuracy evidence on CAAS vFFR, and evidence on the clinical impact of QAngio XA 3D/QFR, were limited. Conclusions Quantitative flow ratio as measured by QAngio XA 3D/QFR has good agreement and diagnostic accuracy compared with fractional flow reserve and is preferable to standard invasive coronary angiography alone. It appears to have very similar cost-effectiveness to fractional flow reserve and, therefore, pending further evidence on general clinical benefits and specific subgroups, could be a reasonable alternative. The clinical effectiveness and cost-effectiveness of CAAS vFFR are uncertain. Randomised controlled trial evidence evaluating the effect of quantitative flow ratio on clinical and patient-centred outcomes is needed. Future work Studies are required to assess the diagnostic accuracy and clinical feasibility of CAAS vFFR. Large ongoing randomised trials will hopefully inform the clinical value of QAngio XA 3D/QFR. Study registration This study is registered as PROSPERO CRD42019154575. Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 56. See the NIHR Journals Library website for further project information.

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