scholarly journals TCT CONNECT-202 Diagnostic Accuracy of Novel Ultrasonic Flow Ratio in Identifying Hemodynamical Significance of Coronary Stenosis

2020 ◽  
Vol 76 (17) ◽  
pp. B86
Author(s):  
Wei Yu ◽  
Toru Tanigaki ◽  
Daixin Ding ◽  
Peng Wu ◽  
Haiyan Du ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Coronary Stenosis ◽  
Flow Ratio

P2720Diagnostic accuracy of Quantitative Flow Ratio (QFR) and Vessel Fractional Flow Reserve (vFFR) compared to Fractional Flow Reserve (FFR) based on 7.5 frames/second coronary angiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Y Jin ◽  
A Ramasamy ◽  
C V Bourantas ◽  
H Safi ◽  
Y Kilic ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
Fractional Flow Reserve ◽  
Gold Standard ◽  
Coronary Stenosis ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Significant Coronary Stenosis

Abstract Background Fractional flow reserve (FFR) is the gold standard for the physiological assessment of intermediate coronary artery lesions. Recently, several novel methods for computation of FFR based on 3-dimensional quantitative coronary angiography have been developed. These techniques allow analyses to be performed retrospectively and do not require induction of hyperaemia. The development and validation of these techniques are based on good quality coronary angiography with high frames per second (15 fps) acquisition. The diagnostic accuracy of Quantitative Flow Ratio (QFR) and Vessel Fractional Flow Reserve (vFFR) in real world “radiation-save mode” coronary angiography has not been studied. Purpose To validate the accuracy of QFR and vFFR compared to FFR based on a series of coronary angiography acquired at 7.5 fps. Methods We retrospectively analyzed 134 vessels (102 patients) with intermediate coronary artery stenosis (30–90%) in whom an FFR measurement had been performed. All the coronary angiography were acquired at 7.5 fps. 33 vessels (20 patients) were excluded from the study due to unsuitable coronary anatomy, invalid FFR measurements, poor image quality and lack of 2 projections ≥25° apart. A total of 101 vessels (82 patients) were included in the final analysis. Contrast-QFR (cQFR), fixed-QFR (fQFR) and vFFR analysis were performed in these vessels by two independent trained experts blinded to the FFR readings. FFR measurements at hyperaemic steady state was taken as the gold standard reference. Results Good intra- and inter-observer reliability was noted for fQFR, cQFR and vFFR analysis (intra-observer mean difference for fQFR: 0.016±0.060, p=0.066; cQFR: 0.009±0.053, p=0.230; vFFR: 0.008±0.040, p=0.175; inter-observer mean difference for fQFR: 0.001±0.036, p=0.847; cQFR: −0.001±0.049; p=0.910, vFFR: −0.005±0.037, p=0.393). fQFR and cQFR showed good correlation with FFR (r=0.694, p<0.001 and r=0.674, p<0.001, respectively) while vFFR showed moderate correlation with FFR (r=0.388, p<0.001). Similarly, fQFR and cQFR showed good accuracy for the detection of functionally significant coronary stenosis (fQFR AUC 0.882 (95% CI 0.803–0.938) and cQFR AUC 0.886 (95% CI 0.807–0.940)) while vFFR showed moderate accuracy with AUC 0.719 (95% CI 0.621–0.804). For identifying functionally significant stenosis (FFR ≤0.80), the overall diagnostic accuracy were 81.2%, 85.2%, 75.3% for fQFR, cQFR and vFFR, repectively. The sensitivity and specificity were 72.7%, 89.9% (fQFR); 83.5%, 31.8% (cQFR) and 68.2%, 87.3% (vFFR). Conclusion Functional assessment of intermediate coronary stenosis based on 7.5 fps angiography-derived computational modelling is feasible. Our study shows that fQFR and cQFR have a better diagnostic accuracy for detecting functionally significant coronary stenosis compared to vFFR. At the lower radiation-save mode 7.5 fps angiography, cQFR does not appear to provide additional diagnostic accuracy compared to fQFR.

scholarly journals Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series

2020 ◽  
Vol 27 (4) ◽  
pp. 350-361 ◽  
Author(s):  
Juan Luis Gutiérrez-Chico ◽  
Yundai Chen ◽  
Wei Yu ◽  
Daixin Ding ◽  
Jiayue Huang ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Optical Flow ◽  
Coronary Stenosis ◽  
Functional Evaluation ◽  
Flow Ratio

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.

Abstract 18795: Resting Patient- and Vessel-Specific Myocardial Perfusion Attenuation Patterns Improves Diagnostic Performance of Coronary Computed Tomographic Angiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Guanglei Xiong ◽  
Iksung Cho ◽  
Heidi Gransar ◽  
Deeksha Kola ◽  
Kimberly Elmore ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Diagnostic Accuracy ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Ct Perfusion ◽  
Quantitative Coronary Angiography ◽  
High Grade ◽  
Operating Characteristics ◽  
Luminal Diameter ◽  
Coronary Stenoses

Introduction: Coronary CT angiography (CCTA) demonstrates improved performance for diagnosis of high-grade coronary stenoses, but may be affected by artifacts and overestimation of stenosis severity. Whether the addition of resting myocardial perfusion attenuation patterns subtended by stenosis seen on CCTA improves diagnostic performance has not been examined to date. Methods: We evaluated 127 patients (mean age 53.0, 54.3% male) who underwent CCTA and ICA. Percentage of coronary stenosis was assessed by quantitative coronary angiography (QCA), which served as the reference comparator to CCTA. CCTA stenosis was categorized as 0%, 1-24%, 25-49%, 50-69%, 70-99%, and 100% luminal diameter reduction. Automated software (SmartHeart, Redwood City, CA) was used to measure resting CT perfusion attenuation patterns in myocardial segments by AHA 17-segment model. Segmental CT attenuation values were assigned to territories subtended by left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA). Per-patient and per-vessel analyses were based on highest severity (maximal stenosis, minimal attenuation). On both per-patient and per-vessel basis, logistic regression was devised for CCTA stenosis alone and for CCTA plus resting myocardial attenuation. Diagnostic accuracy and area under the receiver operating characteristics curve (AUC) were determined. Results: Diagnostic accuracy of CCTA alone was 84.0%, 85.5%, 90.4%, and 88.6%, at per-patient, per-LAD, per-LCX and per-RCA level, respectively. In comparison, the accuracy of CCTA plus myocardial attenuation were 89.6%, 91.9%, 95.2%, and 92.7%. The AUCs using CCTA alone to discriminate QCA-confirmed coronary stenoses >70% were 0.823 (95% CI: 0.737-0.909), 0.782 (95% CI: 0.667-0.898), 0.690 (95% CI: 0.503-0.878), and 0.793 (95% CI: 0.640-0.945) for per-patient, per-LAD, per-LCX, and per-RCA analysis, respectively. The AUCs using CCTA plus myocardial attenuation improved to 0.864 (95% CI: 0.765-0.962), 0.881 (95% CI: 0.793-0.968), 0.772 (95% CI: 0.535-1.000), and 0.820 (95% CI: 0.685-0.954). Conclusions: The addition of resting CT myocardial perfusion attenuation patterns improves identification and discrimination of high-grade coronary stenosis by CCTA.

Abstract 14743: Usefulness of Estimated Coronary Flow Velocity Using Quantitative Flow Ratio for Intermediate Coronary Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eiji Ichimoto ◽  
Nao Konagai ◽  
Sawako Horie ◽  
Atsushi Hasegawa ◽  
Hirofumi Miyahara ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Stenosis ◽  
Coronary Flow ◽  
Flow Ratio ◽  
Operating Characteristics ◽  
Fractional Flow ◽  
Coronary Flow Velocity ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Introduction: Quantitative flow ratio (QFR) is a diagnostic modality for functional assessment for intermediate coronary stenosis without the use of pressure wire. QFR is calculated from 3-dimensional quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis. Hypothesis: We assessed the usefulness of QFR and the association with an estimated coronary flow velocity (eCFV) for intermediate coronary stenosis. Methods: A total of 100 lesions in 80 consecutive patients were assessed Fractional Flow Reserve (FFR) for intermediate coronary stenosis between January 2011 and April 2019. Of these, 97 lesions in 77 patients who underwent QFR were included in this study. Patients were classified into two groups (FFR ≤ 0.80 or FFR > 0.80). QFR and eCFV using contrast were measured by Thrombolysis in Myocardial Infarction (TIMI) frame counts. Results: There was no significant differences in target vessels (p = 0.90) and diffuse lesions (p = 0.06) between the two groups (FFR ≤ 0.80 or FFR > 0.80). Mean FFR and QFR values were 0.78 ± 0.12 and 0.77 ± 0.11, respectively. QFR had a good correlation with FFR values (r = 0.86, p < 0.0001). The diagnostic accuracy, sensitivity, and specificity on QFR ≤ 0.80 were 91.8%, 92.7% and 90.5%, respectively. The eCFV of FFR ≤ 0.80 was greater than that of FFR > 0.80 (0.19 ± 0.08 m/s vs. 0.14 ± 0.06 m/s, p<0.001). Figure showed that the eCFV correlated with FFR values (r = -0.29, p < 0.01). Moreover, the eCFV had a high area under the curve (AUC = 0.71, p < 0.01) on Receiver operating characteristics curve (ROC) analysis with FFR ≤ 0.80. Conclusions: QFR was useful for the assessment of functional stenosis severity. As eCFV was faster, FFR was lower for intermediate coronary stenosis. The eCFV had a good correlation with FFR and may become one of the evaluations for ischemia.

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