Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography

Introduction: It has been reported that sex has well-established relationships with the prevalence of coronary artery disease (CAD) and the major adverse cardiovascular events. Compared with men, the difference of coronary artery and myocardial characteristics in women has effects on anatomical and functional evaluations. Quantitative flow ratio (QFR) has been shown to be effective in assessing the hemodynamic relevance of lesions in stable coronary disease. However, its suitability in acute myocardial infarction patients is unknown. This study aimed to evaluate the sex differences in the non-infarct-related artery (NIRA)-based QFR in patients with ST-elevation myocardial infarction (STEMI).Methods: In this study, 353 patients with STEMI who underwent angiographic cQFR assessment and interventional therapy were included. According to contrast-flow QFR (cQFR) standard operating procedures: reliable software was used to modeling the hyperemic flow velocity derived from coronary angiography in the absence of pharmacologically induced hyperemia. 353 patients were divided into two groups according to sex. A cQFR ≤0.80 was considered hemodynamically significant, whereas invasive coronary angiography (ICA) luminal stenosis ≥50% was considered obstructive. Demographics, clinical data, NIRA-related anatomy, and functional cQFR values were recorded. Clinical outcomes included the NIRA reclassification rate between men and women, according to the ICA and cQFR assessments.Results: Women were older and had a higher body mass index (BMI) than men. The levels of diastolic blood pressure, troponin I, peak creatine kinase-MB, low-density lipoprotein cholesterol, N terminal pro B-type natriuretic peptide, stent diameter, and current smoking rate were found to be significantly lower in the female group than in the male group. Women had a lower likelihood of a positive cQFR ≤0.80 for the same degree of stenosis and a lower rate of NIRA revascularization. Independent predictors of positive cQFR included male sex and diameter stenosis (DS) >70%.Conclusions: cQFR values differ between the sexes, as women have a higher cQFR value for the same degree of stenosis. The findings suggest that QFR variations by sex require specific interpretation, as these differences may affect therapeutic decision-making and clinical outcomes.

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QUANTITATIVE FLOW RATIO ACCORDING TO THREE-DIMENSIONAL QUANTITATIVE CORONARY ANGIOGRAPHY DEFINED SEVERITY OF STENOSIS IN A COHORT OF WOMEN WITH STABLE CORONARY ARTERY DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)30804-4 ◽

2020 ◽

Vol 75 (11) ◽

pp. 177

Author(s):

Mauro Gitto ◽

Yuichi Saito ◽

Marabel Schneider ◽

Nikolaos Papoutsidakis ◽

Scott Ardito ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Stable Coronary Artery Disease ◽

Three Dimensional ◽

Quantitative Coronary Angiography ◽

Flow Ratio ◽

Artery Disease ◽

Quantitative Flow Ratio ◽

Quantitative Flow

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Referral of patients for fractional flow reserve using quantitative flow ratio

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jey187 ◽

2018 ◽

Vol 20 (11) ◽

pp. 1231-1238 ◽

Cited By ~ 5

Author(s):

Jeff M Smit ◽

Gerhard Koning ◽

Alexander R van Rosendael ◽

Mohammed El Mahdiui ◽

Bart J Mertens ◽

...

Keyword(s):

Coronary Angiography ◽

Fractional Flow Reserve ◽

Invasive Coronary Angiography ◽

Quantitative Coronary Angiography ◽

Coronary Intervention ◽

Flow Ratio ◽

Fractional Flow ◽

Flow Reserve ◽

Quantitative Flow Ratio ◽

Quantitative Flow

Abstract Aims Quantitative flow ratio (QFR) is a recently developed technique to calculate fractional flow reserve (FFR) based on 3D quantitative coronary angiography and computational fluid dynamics, obviating the need for a pressure-wire and hyperaemia induction. QFR might be used to guide patient selection for FFR and subsequent percutaneous coronary intervention (PCI) referral in hospitals not capable to perform FFR and PCI. We aimed to investigate the feasibility to use QFR to appropriately select patients for FFR referral. Methods and results Patients who underwent invasive coronary angiography in a hospital where FFR and PCI could not be performed and were referred to our hospital for invasive FFR measurement, were included. Angiogram images from the referring hospitals were retrospectively collected for QFR analysis. Based on QFR cut-off values of 0.77 and 0.86, our patient cohort was reclassified to ‘no referral’ (QFR ≥0.86), referral for ‘FFR’ (QFR 0.78–0.85), or ‘direct PCI’ (QFR ≤0.77). In total, 290 patients were included. Overall accuracy of QFR to detect an invasive FFR of ≤0.80 was 86%. Based on a QFR cut-off value of 0.86, a 50% reduction in patient referral for FFR could be obtained, while only 5% of these patients had an invasive FFR of ≤0.80 (thus, these patients were incorrectly reclassified to the ‘no referral’ group). Furthermore, 22% of the patients that still need to be referred could undergo direct PCI, based on a QFR cut-off value of 0.77. Conclusion QFR is feasible to use for the selection of patients for FFR referral.

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Quantification of coronary artery stenosis in patients before CABG surgery with 16-slice MSCT – Comparison to the standard invasive coronary angiography

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2004-816576 ◽

2004 ◽

Vol 52 (S 1) ◽

Author(s):

C Probst ◽

A Kovacs ◽

W Schiller ◽

C Schmitz ◽

H Schild ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Coronary Artery Stenosis ◽

Invasive Coronary Angiography ◽

Artery Stenosis ◽

Cabg Surgery

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Abstract 1631: Exclusion of Coronary Artery Stenosis by Non-invasive Coronary Angiography Using Multislice Computed Tomography Determines a Good Long-term Prognosis in Patients With Chest Pain - Follow-Up Study in 1017 Patients

Circulation ◽

10.1161/circ.116.suppl_16.ii_341-d ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Peter Steinbigler ◽

Eike Böhme ◽

Carla Weber ◽

Andreas Czernik ◽

Jürgen Buck ◽

...

Keyword(s):

Computed Tomography ◽

Chest Pain ◽

Coronary Artery ◽

Coronary Angiography ◽

Multislice Computed Tomography ◽

Coronary Artery Stenosis ◽

Invasive Coronary Angiography ◽

Artery Stenosis ◽

Noninvasive Coronary Angiography

Long-term prognosis following exclusion of coronary artery stenosis by noninvasive coronary angiography using multislice computed tomography (MSCT) up to now has not been determined. We therefore performed noninvasive coronary angiography using MSCT (Philips Brilliance, 4 – 64 slices, retrospective ECG gating, 0.625mm collimation, 0.4sec gantry rotation time) in 1017 consecutive patients (657 male, 360 female, age 64±11years, 240 patients with known coronary artery disease (CAD)) referred to MSCT-study with chest pain. Patients with acute coronary syndromes, stents, atrial fibrillation and calcium scores > 1500 were not included. Based on MSCT results invasive study was recommended or not. All patients or the referring clinician were contacted by telephone or mail at least 6 months after their scan. Diagnostic image quality could be obtained in 992/1017 (98%) patients. In 620 of 992 patients (=63%) coronary artery stenosis could be excluded and invasive study was not recommended. Despite these recommendations invasive study was performed due to other clinical indications in 83/620 patients within < 30 days and in 43/537 patients within > 30days after the scan. Only in 13/126 patients stenoses >50% were found but no treatment was necessary. During the mean follow-up period of 612±192days 7/620 patients died but no patient suffered from cardiac death or acute myocardial infarction. In 372 of 992 patients invasive coronary angiography was recommended and performed in 230 patients (n=167 within < 30days, n=63 within >30days). In 165/230 patients stenoses >50% were found, treated by angioplasty or stents in 139/165 patients. During the mean follow-up period of 602±161days 11/372 patients died, two patients suffered from sudden, two patients from non-sudden cardiac death and one patient survived acute myocardial infarction. Thus, exclusion of coronary artery stenoses by noninvasive coronary angiography using multislice computed tomography determines a good lomg-term prognosis in patients with chest pain.

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TCT-10 Physiological testing of coronary artery stenosis by computation of invasive coronary angiography. The wire-free functional imaging (WIFI-II) study

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.09.887 ◽

2016 ◽

Vol 68 (18) ◽

pp. B4-B5 ◽

Cited By ~ 1

Author(s):

Jelmer Westra ◽

Shengxian Tu ◽

Louise Nissen ◽

Mai-Britt Vestergaard ◽

Birgitte Krogsgaard Andersen ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Angiography ◽

Functional Imaging ◽

Coronary Artery Stenosis ◽

Invasive Coronary Angiography ◽

Artery Stenosis ◽

The Wire

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P1252Diagnostic performance of quantitative flow ratio from coronary angiography versus fractional flow reserve from computed tomography

European Heart Journal ◽

10.1093/eurheartj/ehz748.0210 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Emori ◽

T Kubo ◽

T Tanigaki ◽

Y Kawase ◽

Y Shiono ◽

...

Keyword(s):

Computed Tomography ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Flow Ratio ◽

Fractional Flow ◽

Flow Reserve ◽

Artery Disease ◽

Quantitative Flow Ratio ◽

Quantitative Flow

Abstract Background QFR and FFRCT are recently developed, less-invasive techniques for functional assessment of coronary artery disease. Objectives We compared the diagnostic performance between fractional flow reserve derived from computed tomography (FFRCT) and quantitative flow ratio (QFR) derived from coronary angiography, using FFR as the standard reference. Methods We measured FFRCT, QFR and FFR in 152 patients (233 vessels) with stable coronary artery disease. Results QFR was highly correlated with FFR (r=0.78, p<0.001), while FFRCT was moderately correlated with FFR (r=0.63, p<0.001). Both QFR and FFRCT showed good agreements with FFR, presenting small values of mean difference and root-mean-squared deviation (FFR -QFR: 0.02±0.09 and FFR -FFRCT: 0.03±0.11). The AUC of QFR was significantly greater than that of 3D-QCA-derived %DS (0.93 vs. 0.78; difference: 0.15; 95% CI: 0.09 to 0.20; p<0.001). The AUC of FFRCTwas significantly greater than that of CCTA-derived %DS (0.82 vs. 0.70; difference: 0.12; 95% CI: 0.05 to 0.19; p<0.001). The AUC of QFR was significantly greater than that of FFRCT (0.93 vs. 0.82; difference: 0.11; 95% CI: 0.05 to 0.16; p<0.001). The sensitivity, specificity, positive predictive value, and negative predictive valueof QFR ≤0.80 for predicting FFR ≤0.80 were 90%, 82%, 81%, and 90%, respectively. Those of FFRCT ≤0.80 for predicting FFR ≤0.80 were 82%, 70%, 70%, and 82%, respectively. The diagnostic accuracy of QFR ≤0.80 for predicting FFR ≤0.80 was 85% [95% confidence interval: 81% to 89%], while that of FFRCT≤0.80 for predicting FFR ≤0.80was 76% [95% confidence interval: 70% to 80%]. Figure 1. Comparison of FFR ≤0.80 predictors Conclusions Both QFR and FFRCTpossessed the ability to accurately evaluate the functional severity of coronary stenosis.

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