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Wu XQ, Li LB, You W, Wu ZM, Zhao L, Wang ZH, Meng PN, Liu B, Ye F. Clinical Value of the Quantitative Flow Ratio to Predict Long-term Target Vessel Failure in Patients with In-stent Restenosis after Drug-coated Balloon Angioplasty. Curr Med Sci 2024:10.1007/s11596-024-2876-0. [PMID: 38809380 DOI: 10.1007/s11596-024-2876-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/15/2023] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The study sought to investigate the clinical predictive value of quantitative flow ratio (QFR) for the long-term target vessel failure (TVF) outcome in patients with in-stent restenosis (ISR) by using drug-coated balloon (DCB) treatment after a long-term follow-up. METHODS This was a retrospective study. A total of 186 patients who underwent DCB angioplasty for ISR in two hospitals from March 2014 to September 2019 were enrolled. The QFR of the entire target vessel was measured offline. The primary endpoint was TVF, including target vessel-cardiac death (TV-CD), target vessel-myocardial infarction (TV-MI), and clinically driven-target vessel revascularization (CD-TVR). RESULTS The follow-up time was 3.09±1.53 years, and 50 patients had TVF. The QFR immediately after percutaneous coronary intervention (PCI) was significantly lower in the TVF group than in the no-TVF group. Multivariable Cox regression analysis indicated that the QFR immediately after PCI was an excellent predictor for TVF after the long-term follow-up [hazard ratio (HR): 5.15×10-5 (6.13×10-8-0.043); P<0.01]. Receiver-operating characteristic (ROC) curve analysis demonstrated that the optimal cut-off value of the QFR immediately after PCI for predicting the long-term TVF was 0.925 (area under the curve: 0.886, 95% confidence interval: 0.834-0.938; sensitivity: 83.40%, specificity: 88.00; P<0.01). In addition, QFR≤0.925 post-PCI was strongly correlated with the TVF, including TV-MI and CD-TVR (P<0.01). CONCLUSION The QFR immediately after PCI showed a high predictive value of TVF after a long-term follow-up in ISR patients who underwent DCB angioplasty. A lower QFR immediately after PCI was associated with a worse TVF outcome.
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Affiliation(s)
- Xiang-Qi Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Long-Bo Li
- Department of Cardiology, The Second Hospital of Jilin University, Jilin, 130000, China
| | - Wei You
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Zhi-Ming Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Lei Zhao
- Department of Cardiology, The Second Hospital of Jilin University, Jilin, 130000, China
| | - Zhi-Hui Wang
- Department of Cardiology, The Second Hospital of Jilin University, Jilin, 130000, China
| | - Pei-Na Meng
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Bin Liu
- Department of Cardiology, The Second Hospital of Jilin University, Jilin, 130000, China.
| | - Fei Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China.
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Santos LDM, Campos CM, Garcia-Garcia HM, Godinho RR, Lopes MAAM, Seleme VB, Côrtes RS, Mendes GDAC, Rosa VEE, Lopes NHM, de Brito Junior FS, Abizaid AAC. Concordance between vessel-specific and vascular territory coronary functional assessment: A comparison of quantitative flow ratio and myocardial perfusion scintigraphy. Catheter Cardiovasc Interv 2024. [PMID: 38558510 DOI: 10.1002/ccd.31021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/14/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Quantitative flow ratio (QFR) and myocardial perfusion scintigraphy (MPS) are utilized for assessing coronary artery disease (CAD) significance. We aimed to analyze their concordance and prognostic impact. AIMS We aimed to analyze the concordance between QFR and MPS and their risk stratification. METHODS Patients with invasive coronary angiography and MPS were categorized as concordant if QFR ≤ 0.80 and summed difference score (SDS) ≥ 4 or if QFR > 0.80 and SDS < 4; otherwise, they were discordant. Concordance was classified by coronary territory involvement: total (three territories), partial (two territories), poor (one territory), and total discordance (zero territories). Leaman score assessed coronary atherosclerotic burden. RESULTS 2010 coronary territories (670 patients) underwent joint QFR and MPS analysis. MPS area under the curve for QFR ≤ 0.80 was 0.637. Concordance rates were total (52.5%), partial (29.1%), poor (15.8%), and total discordance (2.6%). Most concordance occurred in patients without significant CAD or with single-vessel disease (89.5%), particularly without MPS perfusion defects (91.5%). Leaman score (odds ratio [OR]: 0.839, 95% confidence interval [CI]: 0.805-0.875, p < 0.001) and MPS perfusion defect (summed stress score [SSS] ≥ 4) (OR: 0.355, 95% CI: 0.211-0.596, p < 0.001) were independent predictors for discordance. After 1400 days, no significant difference in death/myocardial infarction was observed based on MPS assessment, but Leaman score, functional Leaman score, and average QFR identified higher risk patients. CONCLUSIONS MPS showed good overall accuracy in assessing QFR significance but substantial discordance existed. Predictors for discordance included higher atherosclerotic burden and MPS perfusion defects (SSS ≥ 4). Leaman score, QFR-based functional Leaman score, and average QFR provided better risk stratification for all-cause death and myocardial infarction than MPS.
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Affiliation(s)
- Luciano de Moura Santos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
- Department of Interventional Cardiology, Hospital Santa Lucia, Brasilia, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
- Instituto Prevent Senior, Sao Paulo, Brazil
| | - Hector Manuel Garcia-Garcia
- Instituto Prevent Senior, Sao Paulo, Brazil
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | | | | | - Rafael Silva Côrtes
- Department of Interventional Cardiology, Hospital Santa Lucia, Brasilia, Brazil
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Yuta F, Kawamori H, Toba T, Hiromasa T, Sasaki S, Hamana T, Fujii H, Osumi Y, Iwane S, Yamamoto T, Naniwa S, Sakamoto Y, Matsuhama K, Hirata KI, Otake H. Diagnostic accuracy of Murray law-based quantitative flow ratio in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Heart Vessels 2024:10.1007/s00380-024-02387-5. [PMID: 38526753 DOI: 10.1007/s00380-024-02387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Murray law-based quantitative flow ratio (μQFR) is a novel computational method that enables accurate estimation of fractional flow reserve (FFR) using a single angiographic projection. However, its diagnostic value in patients with severe aortic stenosis (AS) remains unclear. METHOD We included 25 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS with intermediate or greater (30-90%) coronary artery disease (CAD). Pre- and post-TAVR μQFR, QFR, instantaneous flow reserve (iFR), and post-TAVR invasive FFR values were measured. We evaluated the diagnostic performance of pre-TAVR μQFR, QFR, and iFR using post-TAVR FFR ≤ 0.80 as a reference standard of ischemia. RESULT Pre-TAVR μQFR was significantly correlated with post-TAVR FFR (r = 0.73, p < 0.0001). The area under the curve of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 was 0.91 (95% confidence interval [CI] 0.77-0.98), comparable to that of pre-TAVR iFR (0.86 [95% CI 0.71-0.98], p = 0.97). The accuracy, sensitivity, specificity, and positive and negative predictive values of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 were 84.2% (95% CI 68.7-93.4), 61.6% (95% CI 31.6-86.1), 96.0% (95% CI 79.6-99.9), 88.9% (95% CI 52.9-98.3), and 82.8% (95% CI 70.6-90.6), respectively. For pre-TAVR iFR, these values were 76.5% (95% CI 58.8-89.3), 90.9% (95% CI 58.7-99.8), 69.6% (95% CI 47.1-86.8), 58.8% (95% CI 42.8-73.1), and 94.1% (95% CI 70.8-99.1), respectively. CONCLUSION μQFR could be useful for the physiological evaluation of patients with severe AS with concomitant CAD.
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Affiliation(s)
- Fukuishi Yuta
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takashi Hiromasa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Satoru Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyo Hamana
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroyuki Fujii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuto Osumi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Seigo Iwane
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tetsuya Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shota Naniwa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuki Sakamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Koshi Matsuhama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
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Dahl JN, Rasmussen LD, Ding D, Tu S, Westra J, Wijns W, Christiansen EH, Eftekhari A, Li G, Winther S, Bøttcher M. Optimal diagnostic approach for using CT-derived quantitative flow ratio in patients with stenosis on coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2024; 18:162-169. [PMID: 38242777 DOI: 10.1016/j.jcct.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-derived quantitative flow ratio (CT-QFR) is an on-site non-invasive technique estimating invasive fractional flow reserve (FFR). This study assesses the diagnostic performance of using most distal CT-QFR versus lesion-specific CT-QFR approach for identifying hemodynamically obstructive coronary artery disease (CAD). METHODS Prospectively enrolled de novo chest pain patients (n = 445) with ≥50 % visual diameter stenosis on CCTA were referred for invasive evaluation. On-site CT-QFR was analyzed post-hoc blinded to angiographic data and obtained as both most distal (MD-QFR) and lesion-specific CT-QFR (LS-QFR). Abnormal CT-QFR was defined as ≤0.80. Hemodynamically obstructive CAD was defined as invasive FFR ≤0.80 or ≥70 % diameter stenosis by 3D-quantitative coronary angiography. RESULTS In total 404/445 patients had paired CT-QFR and invasive analyses of whom 149/404 (37 %) had hemodynamically obstructive CAD. MD-QFR and LS-QFR classified 188 (47 %) and 165 (41 %) patients as abnormal, respectively. Areas under the receiver-operating characteristic curve for MD-QFR was 0.83 vs. 0.85 for LS-QFR, p = 0.01. Sensitivities for MD-QFR and LS-QFR were 80 % (95%CI: 73-86) vs. 77 % (95%CI: 69-83), p = 0.03, respectively, and specificities were 73 % (95%CI: 67-78) vs. 80 % (95%CI: 75-85), p < 0.01, respectively. Positive predictive values for MD-QFR and LS-QFR were 63 % vs. 69 %, p < 0.01, respectively, and negative predictive values for MD-QFR and LS-QFR were 86 % vs. 85 %, p = 0.39, respectively). CONCLUSION Using a lesion-specific CT-QFR approach has superior discrimination of hemodynamically obstructive CAD compared to a most distal CT-QFR approach. CT-QFR identified most cases of hemodynamically obstructive CAD while a normal CT-QFR excluded hemodynamically obstructive CAD in the majority of patients.
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Affiliation(s)
- Jonathan N Dahl
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Laust D Rasmussen
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Daixin Ding
- The Lambe Institute for Translational Research and Curam, University of Galway, Ireland; Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China.
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China; Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
| | - Jelmer Westra
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark.
| | - William Wijns
- The Lambe Institute for Translational Research and Curam, University of Galway, Ireland.
| | - Evald Høj Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Denmark.
| | - Ashkan Eftekhari
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
| | - Guanyu Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China.
| | - Simon Winther
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Morten Bøttcher
- Department of Cardiology, Gødstrup Hospital, Herning, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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5
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Chen Z, Zhang J, Cai Y, Zhao H, Wang D, Li C, He Y. Diagnostic performance of angiography-derived fractional flow reserve and CT-derived fractional flow reserve: A systematic review and Bayesian network meta-analysis. J Evid Based Med 2024; 17:119-133. [PMID: 38205918 DOI: 10.1111/jebm.12573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Accumulating evidence has demonstrated that fractional flow reserves (FFRs) derived from invasive coronary angiograms (CA-FFRs) and coronary computed tomography angiography-derived FFRs (CT-FFRs) are promising alternatives to wire-based FFRs. However, it remains unclear which method has better diagnostic performance. This systematic review and meta-analysis aimed to compare the diagnostic performances of the two approaches. METHODS The Cochrane Library, PubMed, Embase, Medline (Ovid), the Chinese China National Knowledge Infrastructure Database (CNKI), VIP, and WanFang Data databases were searched for relevant studies that included comparisons between CA-FFR and CT-FFR, from their respective database inceptions until January 1, 2023. Studies where both noninvasive FFR (including CA-FFR and CT-FFR) and invasive FFR (as a reference standard) were performed for the diagnosis of ischemic coronary artery disease and were designed as prospective, paired diagnostic studies, were pulled. The diagnostic test accuracy method and Bayesian hierarchical summary receiver operating characteristic (ROC) model for network meta-analysis (NMA) of diagnostic tests (HSROC-NMADT) were both used to perform a meta-analysis on the data. RESULTS Twenty-six studies were included in this NMA. The results from both the diagnostic test accuracy and HSROC-NMADT methods revealed that the diagnostic accuracy of CA-FFR was higher than that of CT-FFR, in terms of sensitivity (Se; 0.86 vs. 0.84), specificity (Sp; 0.90 vs. 0.78), positive predictive value (PPV; 0.83 vs. 0.70), and negative predictive value (NPV; 0.91 vs. 0.89) for the detection of myocardial ischemia. A cumulative ranking curve analysis indicated that CA-FFR had a higher diagnostic accuracy than CT-FFR in the context of this study, with a higher area under the ROC curve (AUC; 0.94 vs. 0.87). CONCLUSIONS Although both of these two commonly used virtual FFR methods showed high levels of diagnostic accuracy, we demonstrated that CA-FFR had a better Se, Sp, PPV, NPV, and AUC than CT-FFR. However, this study provided only indirect comparisions; therefore, larger studies are warranted to directly compare the diagnostic performances of these two approaches.
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Affiliation(s)
- Zhongxiu Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Junyan Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yujia Cai
- Chinese Evidence-based Medicine Center and MAGIC-China Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongsen Zhao
- Information Center, West China Hospital, Sichuan University, Chengdu, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
| | - Chen Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Chen Y, Gao L, Vogel B, Tian F, Jin Q, Guo J, Sun Z, Yang W, Jin Z, Yu B, Fu G, Pu J, Qu X, Zhang Q, Zhao Y, Yu L, Guan C, Tu S, Qiao S, Xu B, Mehran R, Song L. Sex Differences in Clinical Outcomes Associated With Quantitative Flow Ratio-Guided Percutaneous Coronary Intervention. JACC. ASIA 2024; 4:201-212. [PMID: 38463683 PMCID: PMC10920051 DOI: 10.1016/j.jacasi.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 03/12/2024]
Abstract
Background FAVOR III China (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) reported improved clinical outcomes in quantitative flow ratio (QFR) relative to angiography-guided percutaneous coronary intervention (PCI), but the clinical impact of QFR-guided PCI according to sex remains unknown. Objectives The authors sought to compare sex differences in the 2-year clinical benefits of a QFR-guided PCI strategy and to evaluate the differences in outcomes between men and women undergoing contemporary PCI. Methods This study involved a prespecified subgroup analysis of the FAVOR III China trial, in which women and men were randomized to a QFR-guided strategy or a standard angiography-guided strategy. Sex differences in clinical benefit of the QFR guidance were analyzed for major adverse cardiac events (MACE), a composite of all-cause death, myocardial infarction, or ischemia-driven revascularization within 2 years. Results A total of 1,126 women and 2,699 men were eligible and the occurrence of 2-year MACE was similar between women and men (10.3% vs 10.5%; P = 0.96). Compared with an angiography-guided strategy, a QFR-guided strategy resulted in a 7.9% and 9.7% reduction in PCI rates in men and women, respectively. A QFR-guided strategy resulted in similar relative risk reductions for 2-year MACE in women (8.0% vs 12.7%; HR: 0.62; 95% CI: 0.42-0.90) and men (8.7% vs 12.4%; HR: 0.69; 95% CI: 0.54-0.87) (Pinteraction = 0.61). Furthermore, QFR values were not significantly different between men and women with various angiographic stenosis categories. Conclusions A QFR-guided PCI strategy resulted in improved MACE in both men and women at 2 years compared with an angiography-guided PCI strategy. The FAVOR III China Study [FAVOR III China]; (NCT03656848).
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Affiliation(s)
- Yundai Chen
- Department of Cardiology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lei Gao
- Senior Department of Cardiology, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Birgit Vogel
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Feng Tian
- Senior Department of Cardiology, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qinhua Jin
- Senior Department of Cardiology, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jun Guo
- Senior Department of Cardiology, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhijun Sun
- Senior Department of Cardiology, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Weixian Yang
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zening Jin
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing China
| | - Bo Yu
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinkai Qu
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Changdong Guan
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shubin Qiao
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
| | - Roxana Mehran
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lei Song
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - FAVOR III China Study Group
- Department of Cardiology, the First Medical Center of Chinese PLA General Hospital, Beijing, China
- Senior Department of Cardiology, the Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing China
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
- Department of Cardiology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Cardiovascular Research Institute, Wuhan University; Hubei Key Laboratory of Cardiology, Wuhan, China
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, China
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Wu X, Wang K, Li G, Wu J, Jiang J, Gao F, Zhu L, Xu Q, Wang X, Xu M, Chen H, Ma L, Han X, Luo N, Tu S, Wang J, Hu X. Diagnostic Performance of Angiography-Derived Quantitative Flow Ratio in Complex Coronary Lesions. Circ Cardiovasc Imaging 2024; 17:e016046. [PMID: 38502735 DOI: 10.1161/circimaging.123.016046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/23/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Quantitative flow ratio derived from computed tomography angiography (CT-QFR) and invasive coronary angiography (Murray law-based quantitative flow ratio [μQFR]) are novel approaches enabling rapid computation of fractional flow reserve without the use of pressure guidewires and vasodilators. However, the feasibility and diagnostic performance of both CT-QFR and μQFR in evaluating complex coronary lesions remain unclear. METHODS Between September 2014 and September 2021, 240 patients with 30% to 90% coronary diameter stenosis who underwent both coronary computed tomography angiography and invasive coronary angiography with fractional flow reserve within 60 days were retrospectively enrolled. The diagnostic performance of CT-QFR and μQFR in detecting functional ischemia among all lesions, especially complex coronary lesions, was analyzed using fractional flow reserve as the reference standard. RESULTS CT-QFR and μQFR analyses were performed on 309 and 289 vessels, respectively. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for CT-QFR in all lesions at the per-vessel level were 91% (with a 95% CI of 84%-96%), 92% (95% CI, 88%-95%), 83% (95% CI, 75%-90%), 96% (95% CI, 93%-98%), and 92% (95% CI, 88%-95%), with values for μQFR of 90% (95% CI, 81%-95%), 97% (95% CI, 93%-99%), 92% (95% CI, 84%-97%), 96% (95% CI, 92%-98%), and 94% (95% CI, 91%-97%), respectively. Among bifurcation, tandem, and moderate-to-severe calcified lesions, the diagnostic values of CT-QFR and μQFR showed great correlation and agreement with those of invasive fractional flow reserve, achieving an area under the receiver operating characteristic curve exceeding 0.9 for each complex lesion at the vessel level. Furthermore, the accuracies of CT-QFR and μQFR in the gray zone were 85% and 84%, respectively. CONCLUSIONS Angiography-derived quantitative flow ratio (CT-QFR and μQFR) demonstrated remarkable diagnostic performance in complex coronary lesions, indicating its pivotal role in the management of patients with coronary artery disease.
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Affiliation(s)
- Xianpeng Wu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Kan Wang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Guohua Li
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Jie Wu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, Jinhua People's Hospital, Jinhua, China (J. Wu)
| | - Jun Jiang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Feng Gao
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Lingjun Zhu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Qiyuan Xu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Xinhong Wang
- Department of Radiology (X. Wang, M.X.), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengxi Xu
- Department of Radiology (X. Wang, M.X.), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Chen
- Department of Cardiology (H.C., L.M.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Longhui Ma
- Department of Cardiology (H.C., L.M.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xianjun Han
- Department of Radiology (X. Han, N.L.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Nan Luo
- Department of Radiology (X. Han, N.L.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (S.T.)
| | - Jian'an Wang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Xinyang Hu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
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8
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Terentes-Printzios D, Oikonomou D, Gkini KP, Gardikioti V, Aznaouridis K, Dima I, Tsioufis K, Vlachopoulos C. Prognostic role of discordance between quantitative flow ratio and visual estimation in revascularization guidance. EUROPEAN HEART JOURNAL OPEN 2024; 4:oead125. [PMID: 38174345 PMCID: PMC10763540 DOI: 10.1093/ehjopen/oead125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 01/05/2024]
Abstract
Aims Revascularization guided by functional severity has presented improved outcomes compared with visual angiographic guidance. Quantitative flow ratio (QFR) is a reliable angiography-based method for functional assessment. We sought to investigate the prognostic value of discordance between QFR and visual estimation in coronary revascularization guidance. Methods and results We performed offline QFR analysis on all-comers undergoing coronary angiography. Vessels with calculated QFR were divided into four groups based on the decision to perform or defer percutaneous coronary intervention (PCI) and on the QFR result, i.e.: Group A (PCI-, QFR > 0.8); Group B (PCI+, QFR ≤ 0.8); Group C (PCI+, QFR > 0.8); Group D (PCI-, QFR ≤ 0.8). Patients with at least one vessel falling within the disagreement groups formed the discordance group, whereas the remaining patients formed the concordance group. The primary endpoint was the composite endpoint of cardiovascular death, myocardial infarction, and ischaemia-driven revascularization. Overall, 546 patients were included in the study. Discordance between QFR and visual estimation was found in 26.2% of patients. After a median follow-up period of 2.5 years, the discordance group had a significantly higher rate of the composite outcome (hazard ratio: 3.34, 95% confidence interval 1.99-5.60, P < 0.001). Both disagreement vessel Groups C and D were associated with increased cardiovascular risk compared with agreement Groups A and B. Conclusion Discordance between QFR and visual estimation in revascularization guidance was associated with a worse long-term prognosis. Our results highlight the importance of proper patient selection for intervention and the need to avoid improper stent implantations when not dictated by a comprehensive functional assessment.
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Affiliation(s)
- Dimitrios Terentes-Printzios
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vassilisis Sofias St, 11527 Athens, Greece
| | - Dimitrios Oikonomou
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vassilisis Sofias St, 11527 Athens, Greece
| | - Konstantia-Paraskevi Gkini
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vassilisis Sofias St, 11527 Athens, Greece
| | - Vasiliki Gardikioti
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vassilisis Sofias St, 11527 Athens, Greece
| | - Konstantinos Aznaouridis
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vassilisis Sofias St, 11527 Athens, Greece
| | - Ioanna Dima
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vassilisis Sofias St, 11527 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vassilisis Sofias St, 11527 Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Hippokration Hospital, 114 Vassilisis Sofias St, 11527 Athens, Greece
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9
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Amat-Santos IJ, Marengo G, Sánchez-Luna JP, Cortés Villar C, Rivero Crespo F, Jiménez Díaz VA, de la Torre Hernández JM, Pérez de Prado A, Sabaté M, López-Palop R, Vegas Valle JM, Suárez de Lezo J, Fernandez Cordon C, Gonzalez JC, García-Gómez M, Redondo A, Carrasco Moraleja M, San Román JA. Validation of Quantitative Flow Ratio-Derived Virtual Angioplasty with Post-Angioplasty Fractional Flow Reserve-The QIMERA-I Study. J Cardiovasc Dev Dis 2023; 11:14. [PMID: 38248884 PMCID: PMC10816683 DOI: 10.3390/jcdd11010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
Background: Quantitative flow ratio (QFR) virtual angioplasty with pre-PCI residual QFR showed better results compared with an angiographic approach to assess post-PCI functional results. However, correlation with pre-PCI residual QFR and post-PCI fractional flow reserve (FFR) is lacking. Methods: A multicenter prospective study including consecutive patients with angiographically 50-90% coronary lesions and positive QFR results. All patients were evaluated with QFR, hyperemic and non-hyperemic pressure ratios (NHPR) before and after the index PCI. Pre-PCI residual QFR (virtual angioplasty) was calculated and compared with post-PCI fractional flow reserve (FFR), QFR and NHPR. Results: A total of 84 patients with 92 treated coronary lesions were included, with a mean age of 65.5 ± 10.9 years and 59% of single vessel lesions being the left anterior descending artery in 69%. The mean vessel diameter was 2.82 ± 0.41 mm. Procedural success was achieved in all cases, with a mean number of implanted stents of 1.17 ± 0.46. The baseline QFR value was 0.69 ± 0.12 and baseline FFR and NHPR were 0.73 ± 0.08 and 0.82 ± 0.11, respectively. Mean post-PCI FFR increased to 0.87 ± 0.05 whereas residual QFR had been estimated as 0.95 ± 0.05, showing poor correlation with post-PCI FFR (0.163; 95% CI:0.078-0.386) and low diagnostic accuracy (30.9%, 95% CI:20-43%). Conclusions: In this analysis, the results of QFR-based virtual angioplasty did not seem to accurately correlate with post-PCI FFR.
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Affiliation(s)
- Ignacio J. Amat-Santos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Giorgio Marengo
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Juan Pablo Sánchez-Luna
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Carlos Cortés Villar
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Cardiology Department, Hospital Miguel Servet, 50009 Zaragoza, Spain
| | | | | | | | | | - Manel Sabaté
- Cardiology Department, Hospital Clinic Universitari, 08001 Barcelona, Spain
| | - Ramón López-Palop
- Cardiology Department, Hospital Virgen de la Arrixaca, 30120 Murcia, Spain
| | | | | | - Clara Fernandez Cordon
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Jose Carlos Gonzalez
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Mario García-Gómez
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Alfredo Redondo
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Cardiology Department, Hospital Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | | | - J. Alberto San Román
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
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10
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Milzi A, Dettori R, Lubberich RK, Reith S, Burgmaier K, Marx N, Burgmaier M. Quantitative Flow Ratio Is Feasible and Accurate Even at Lower Frame Acquisition Rate. Circ Cardiovasc Interv 2023; 16:e013266. [PMID: 37846560 DOI: 10.1161/circinterventions.123.013266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Andrea Milzi
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), Università Della Svizzera Italiana, Lugano, Switzerland (A.M.)
| | - Rosalia Dettori
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Richard Karl Lubberich
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Sebastian Reith
- Department of Cardiology, Angiology and Electrophysiology, St. Franziskus Hospital, Münster, Germany (S.R.)
| | - Kathrin Burgmaier
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Germany (K.B., M.B.)
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
| | - Mathias Burgmaier
- Department of Internal Medicine I, University Hospital of the RWTH Aachen, Germany (A.M., R.D., R.K.L., N.M., M.B.)
- Faculty of Applied Healthcare Science, Deggendorf Institute of Technology, Germany (K.B., M.B.)
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11
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Cortés C, Fernández-Corredoira PM, Liu L, López-Palop R, Rivero F, Jiménez O, Freites A, Goncalves-Ramirez LR, Minguito C, Concepción R, Pérez A, Del Val D, Leithod G, Oberhuber-Kurth J, Amat-Santos IJ, Diarte JA, San Román JA, Ortas Nadal MR, Gutiérrez-Chico JL. Long-term prognostic value of quantitative-flow-ratio-concordant revascularization in stable coronary artery disease. Int J Cardiol 2023; 389:131176. [PMID: 37442350 DOI: 10.1016/j.ijcard.2023.131176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Confirming the prognostic value of global QFR and evaluating the long-term prognosis of QFR-concordant therapy in stable coronary artery disease. BACKGROUND Wire-based functional evaluation of coronary disease is linked to patient's prognosis. Quantitative Flow Ratio (QFR) is a newer index of computational physiology, linked to clinical outcomes and prognosis at 1 year follow-up. Long-term prognosis of QFR-concordant revascularization in stable coronary artery disease is however unknown hitherto. METHODS Consecutive patients with stable coronary disease undergoing coronary angiography were included. Centralized and blinded QFR analysis of three coronary territories was performed. Three vessel QFR (3vQFR) was defined as the sum of the basal QFR of each coronary territory. QFR-concordant revascularization was met if all significant lesions (QFR ≤ 0.80) were revascularized and all non-significant lesions (QFR > 0.80) were not; otherwise, the case was defined as QFR-discordant revascularization. Patient-oriented composite end-point (POCE) of cardiac death, myocardial infarction and unscheduled revascularization was the primary endpoint. RESULTS A total of 803 patients from six high-volume centers were included. Canadian Cardiovascular Society (CCS) class II angina was the most frequent (48.9%) clinical presentation. Median of follow-up was 68.8 months. 3vQFR was an independent predictor of POCE (HR 1.79 CI95% 1.01-3.18), with 2.75 as optimal cut-off value, irrespective of the therapy received. QFR-discordant revascularization (QFR+/Revascularization- or QFR-/Revascularization+) was an independent predictor of POCE in multivariate analysis (HR 1.65, CI 95% 1.03-2.64). CONCLUSION Global burden of epicardial coronary atherosclerosis, as evaluated by 3vQFR, as well as QFR-discordant therapy are independent predictors of adverse clinical outcome at long-term follow-up in stable coronary artery disease.
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Affiliation(s)
- Carlos Cortés
- Hospital Clínico Universitario de Valladolid, Valladolid, CIBERCV, Spain; Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | | | - Lili Liu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Fernando Rivero
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP. Madrid, Spain
| | | | - Alfonso Freites
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | | | | | - Ainhoa Pérez
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - David Del Val
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP. Madrid, Spain
| | - Gunnar Leithod
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | | | - José A Diarte
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Juan Luis Gutiérrez-Chico
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Bundeswehrzentralkrankenhaus, Koblenz, Germany
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12
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Koo BK, Lee JM, Hwang D, Park S, Shiono Y, Yonetsu T, Lee SH, Kawase Y, Ahn JM, Matsuo H, Shin ES, Hu X, Ding D, Fezzi S, Tu S, Low AF, Kubo T, Nam CW, Yong AS, Harding SA, Xu B, Hur SH, Choo GH, Tan HC, Mullasari A, Hsieh IC, Kakuta T, Akasaka T, Wang J, Tahk SJ, Fearon WF, Escaned J, Park SJ. Practical Application of Coronary Physiologic Assessment: Asia-Pacific Expert Consensus Document: Part 1. JACC. ASIA 2023; 3:689-706. [PMID: 38095005 PMCID: PMC10715899 DOI: 10.1016/j.jacasi.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 12/30/2023]
Abstract
Coronary physiologic assessment is performed to measure coronary pressure, flow, and resistance or their surrogates to enable the selection of appropriate management strategy and its optimization for patients with coronary artery disease. The value of physiologic assessment is supported by a large body of evidence that has led to major recommendations in clinical practice guidelines. This expert consensus document aims to convey practical and balanced recommendations and future perspectives for coronary physiologic assessment for physicians and patients in the Asia-Pacific region based on updated information in the field that including both wire- and image-based physiologic assessment. This is Part 1 of the whole consensus document, which describes the general concept of coronary physiology, as well as practical information on the clinical application of physiologic indices and novel image-based physiologic assessment.
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Affiliation(s)
- Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sungjoon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taishi Yonetsu
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seung Hun Lee
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yoshiaki Kawase
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Xinyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
| | - Simone Fezzi
- The Lambe Institute for Translational Medicine, The Smart Sensors Lab and Curam, National University of Ireland, University Road, Galway, Ireland
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Adrian F. Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Takashi Kubo
- Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan
| | - Chang-Wook Nam
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Andy S.C. Yong
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Scott A. Harding
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
| | - Bo Xu
- Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Seung-Ho Hur
- Department of Internal Medicine and Cardiovascular Research Institute, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Gim Hooi Choo
- Department of Cardiology, Cardiac Vascular Sentral KL (CVSKL), Kuala Lumpur, Malaysia
| | - Huay Cheem Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Heart Centre, National University Health System, Singapore
| | - Ajit Mullasari
- Department of Cardiology, Madras Medical Mission, Chennai, India
| | - I-Chang Hsieh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Seung-Jea Tahk
- Department of Cardiology, Ajou University Medical Center, Suwon, Korea
| | - William F. Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC, Complutense University of Madrid, Madrid, Spain
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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13
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Kan J, Ge Z, Nie S, Gao X, Li X, Sheiban I, Zhang JJ, Chen SL. Clinical prognostic value of a novel quantitative flow ratio from a single projection in patients with coronary bifurcation lesions treated with the provisional approach. ASIAINTERVENTION 2023; 9:114-123. [PMID: 37736199 PMCID: PMC10507452 DOI: 10.4244/aij-d-22-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/11/2023] [Indexed: 09/23/2023]
Abstract
Background A novel quantitative flow ratio (μQFR) for bifurcated coronary vessels, derived from a single projection, has been recently reported. Provisional stenting is effective for most bifurcation lesions. However, the clinical value of the side branch (SB) μQFR in patients with coronary bifurcation lesions undergoing provisional stenting remains unclear. Aims This study aims to determine the clinical predictive value of the SB μQFR after provisional stenting in patients with coronary bifurcation lesions. Methods Between June 2015 and May 2018, 288 patients with true coronary bifurcation lesions who underwent a provisional approach without SB treatment (including predilation, kissing balloon inflation or stenting) were classified by an SB μQFR <0.8 (n=65) and ≥0.8 (n=223) groups. The primary endpoint was the three-year composite of target vessel failure (TVF), including cardiac death, target vessel myocardial infarction (TVMI), and revascularisation (TVR). Results Three years after the procedures, there were 43 (14.9%) TVFs, with 19 (29.2%) in the SB μQFR <0.8 and 24 (10.8%) in the SB μQFR ≥0.8 groups (adjusted hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.39-5.54; p=0.003), mainly driven by increased TVMI (16.9% vs 5.4%, adjusted HR 3.29, 95% CI: 1.15-6.09; p=0.030) and TVR (15.4% vs 2.2%, adjusted HR 6.39, 95% CI: 2.04-13.48; p=0.007). Baseline diameter stenosis at the ostial SB and SB lesion length were the two predictors of an SB μQFR <0.8 immediately after stenting the main vessel, whereas previous percutaneous coronary intervention and an SB μQFR <0.8 were the two independent factors of 3-year TVF. Conclusions An SB μQFR <0.8 immediately after the provisional approach is strongly associated with clinical events. Further randomised studies with large patient populations are warranted.
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Affiliation(s)
- Jing Kan
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Shaoping Nie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | | | - Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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Boutaleb AM, Ghafari C, Ungureanu C, Carlier S. Fractional flow reserve and non-hyperemic indices: Essential tools for percutaneous coronary interventions. World J Clin Cases 2023; 11:2123-2139. [PMID: 37122527 PMCID: PMC10131021 DOI: 10.12998/wjcc.v11.i10.2123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/22/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Hemodynamical evaluation of a coronary artery lesion is an important diagnostic step to assess its functional impact. Fractional flow reserve (FFR) received a class IA recommendation from the European Society of Cardiology for the assessment of angiographically moderate stenosis. FFR evaluation of coronary artery disease offers improvement of the therapeutic strategy, deferring unnecessary procedures for lesions with a FFR > 0.8, improving patients' management and clinical outcome. Post intervention, an optimal FFR > 0.9 post stenting should be reached and > 0.8 post drug eluting balloons. Non-hyperemic pressure ratio measurements have been validated in previous studies with a common threshold of 0.89. They might overestimate the hemodynamic significance of some lesions but remain useful whenever hyperemic agents are contraindicated. FFR remains the gold standard reference for invasive assessment of ischemia. We illustrate this review with two cases introducing the possibility to estimate also non-invasively FFR from reconstructed 3-D angiograms by quantitative flow ratio. We conclude introducing a hybrid approach to intermediate lesions (DFR 0.85-0.95) potentially maximizing clinical decision from all measurements.
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Affiliation(s)
- Amine Mamoun Boutaleb
- Department of Cardiology, Ibn Rochd University Hospital, Casablanca 20230, Casablanca, Morocco
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, Mons 7000, Belgium
| | - Chadi Ghafari
- Department of Cardiology, University of Mons, Mons 7000, Belgium
| | - Claudiu Ungureanu
- Department of Cardiology, University of Mons, Mons 7000, Belgium
- Catheterization Unit, Jolimont Hospital, La Louvière 7100, Belgium, Belgium
| | - Stéphane Carlier
- Department of Cardiology, Centre Hospitalier Universitaire Ambroise Paré, Mons 7000, Belgium
- Department of Cardiology, University of Mons, Mons 7000, Belgium
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15
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In Vivo Validation of a Novel Computational Approach to Assess Microcirculatory Resistance Based on a Single Angiographic View. J Pers Med 2022; 12:jpm12111798. [PMID: 36573725 PMCID: PMC9692562 DOI: 10.3390/jpm12111798] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
(1) Background: In spite of the undeniable clinical value of the index of microvascular resistance (IMR) in assessing the status of coronary microcirculation, its use globally remains very low. The aim of this study was to validate the novel single-view, pressure-wire- and adenosine-free angiographic microvascular resistance (AMR) index, having the invasive wire-based IMR as a reference standard. (2) Methods: one hundred and sixty-three patients (257 vessels) were investigated with pressure wire-based IMR. Microvascular dysfunction (CMD) was defined by IMR ≥ 25. AMR was independently computed from the diagnostic coronary angiography in a blinded fashion. (3) Results: AMR demonstrated a good correlation (r = 0.83, p < 0.001) and diagnostic performance (AUC 0.94; 95% CI: 0.91 to 0.97) compared with wire-based IMR. The best cutoff value for AMR in determining IMR ≥ 25 was 2.5 mmHg*s/cm. The overall diagnostic accuracy of AMR was 87.2% (95% CI: 83.0% to 91.3%), with a sensitivity of 93.5% (95% CI: 87.0% to 97.3%), a specificity of 82.7% (95% CI: 75.6% to 88.4%), a positive predictive value of 79.4% (95% CI: 71.2% to 86.1%) and a negative predictive value of 94.7% (95% CI: 89.3% to 97.8%). No difference in terms of CMD rate was described among different clinical presentations. (4) Conclusions: AMR derived solely from a single angiographic view is a feasible computational alternative to pressure wire-based IMR, with good diagnostic accuracy in assessing CMD.
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Devineni A, Levine MB, Melaku GD, Kahsay Y, Finizio M, Waksman R, Garcia-Garcia HM. Diagnostic comparison of automatic and manual TIMI frame-counting-generated quantitative flow ratio (QFR) values. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1663-1670. [PMID: 37726521 DOI: 10.1007/s10554-022-02666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/28/2022] [Indexed: 11/24/2022]
Abstract
Quantitative flow ratio (QFR) is a computational measurement of FFR (fractional flow reserve), calculated from coronary angiography. Latest QFR software automates TIMI frame counting (TFC), which occurs during the flow step of QFR analyses, making the analysis faster and more reproducible. The objective is to determine the diagnostic performance of QFR values obtained from analyses using automatic TFC compared to those obtained from analyses using manual TFC. This was a single-arm clinical trial that used the prospective analysis of the coronary angiographic image series of 97 patients who underwent evaluation of stable coronary artery disease with FFR/iFR at MedStar Washington Hospital Center in Washington, DC, USA. Automatic and manual TFC QFR values were obtained from the analyses of each of the 97 patients' image series, with manual TFC QFR values as the current gold standard for comparison. The diagnostic performance of automatic TFC QFR values was measured as follows: sensitivity was 0.87 (95% CI 0.66-0.97) and specificity was 1.00 (95% CI 0.9514-1.00), positive predictive value (PPV) was 1.00 (95%CI 1.00-1.00), while the NPV was 0.96 (95% CI 0.96-0.99). Overall accuracy was 96.91% (95% CI 91.23%-99.36%). The agreement as illustrated by the Bland-Altman plot shows a bias of 0.0023 (SD 0.0208) and narrow limits of agreement (LOA): Upper LOA 0.0573 and Lower LOA - 0.0528. The area under curve (AUC) was 0.996. QFR values generated from automatic TFC are comparable to those generated from manual TFC in diagnostic capability. The most recent software update produces values equivalent to those of the previous manual option, and can therefore be used interchangeably.
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Affiliation(s)
- Aditya Devineni
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Molly B Levine
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Gebremedhin D Melaku
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Yirga Kahsay
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Michael Finizio
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
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17
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Functional Evaluation of Coronary Stenosis: is Quantitative Flow Ratio a Step Forward? COR ET VASA 2022. [DOI: 10.33678/cor.2022.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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18
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Wang J, Li C, Ding D, Zhang M, Wu Y, Xu R, Lu H, Chen Z, Chang S, Dai Y, Qian J, Zhang F, Tu S, Ge J. Functional comparison of different jailed balloon techniques in treating non-left main coronary bifurcation lesions. Int J Cardiol 2022; 364:20-26. [PMID: 35597490 DOI: 10.1016/j.ijcard.2022.05.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a paucity of data comparing functional difference between active jailed balloon technique (A-JBT) and conventional jailed balloon technique (C-JBT) in treating non-left main coronary bifurcation lesions (CBLs). METHODS In this retrospective cohort study, we consecutively enrolled 232 patients with non-left main CBLs who underwent percutaneous coronary intervention (PCI) using JBTs between January 2018 and March 2019. Among them, 191 patients entered the final analysis with 12-months angiographic follow-up. We stratified patients into A-JBT group (130 patients) and C-JBT group (61 patients). The functional analysis by Murray law-based quantitative flow ratio (μQFR) and Seattleanginaquestionnaire (SAQ) were performed to compare the two techniques. RESULTS Compared with C-JBT group, A-JBT group observed a lower abrupt (0.8% vs. 11.1%, p = 0.002) and final SB occlusion (0 vs. 7.9%, p = 0.005). Meanwhile, A-JBT group had a significantly higher μQFR of side branch (SB) both post-PCI and 12-months follow-up (median [interquartile range (IQR)]: 0.91 (0.86-0.96) vs. 0.82 (0.69-0.92), p < 0.001; median [IQR]: 0.95 (0.89-0.98) vs. 0.85 (0.74-0.93), p < 0.001) than C-JBT group. Besides, A-JBT group gained a μQFR improvement at follow-up period compared with post-PCI data (median [IQR]: 0.95 [0.89-0.98] vs. 0.91[0.86-0.96] of SB, p < 0.001) and a higher SAQ scores at 12-months follow-up compared with C-JBT group (p < 0.001). CONCLUSIONS Compared with C-JBT, A-JBT provided excellent SB protection during MV stenting and improved the SB functional blood flow as well as the angina relief even after 12 months.
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Affiliation(s)
- Jingpu Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Chenguang Li
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daixin Ding
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
| | - Mingyou Zhang
- Department of Cardiology, The first hospital of Jilin university, Changchun, China
| | - Yizhe Wu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Rende Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Hao Lu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Zhangwei Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shufu Chang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuxiang Dai
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Feng Zhang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China..
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
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19
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Chen Z, Shou X, Wang M, Zhang X, He Y, Zhao Q, Tang Y, Li C. Diagnostic accuracy of CT-derived and angiogram-derived fractional flow reserve. Int J Cardiol 2022:S0167-5273(22)00395-3. [PMID: 35306031 DOI: 10.1016/j.ijcard.2022.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
Abstract
AIMS Although accumulating evidence demonstrated that virtual fractional flow reserve (FFR) based on coronary computed tomography angiography (CCTA) (CT-FFR) or invasive coronary angiogram (ICA) (CA-FFR) are promising alternatives to wire based FFR, which method has better diagnostic accuracy was still unclear. In our study, we aim to directly compare the diagnostic performance of CT-FFR and CA-FFR. METHODS During the period of September 2019 to December 2020, patients with at least one 30%-90% coronary artery stenosis were enrolled and received invasive FFR. Then, virtual FFR values were calculated based on both CCTA and ICA, and then compared with the invasive FFR value. RESULTS Invasive FFR measurements were successfully performed in 114 vessels of 96 patients. Both CT-FFR and CA-FFR showed good correlation with wire-based FFR, with r values of 0.84 and 0.71 respectively. In paired t-test, the deviation of CT-FFR and CA-FFR was not significantly different (t = -1.9083, p = 0.05889). In Bland-Altman analysis, the coefficients of variation were 8.4% and 13.2% for CT-FFR and CA-FFR respectively. In ROC curve analysis, the per-vessel diagnostic accuracy of CT-FFR and CA-FFR was 94.7% and 92.1% respectively. The area under the curve of CT-FFR was slightly higher than that of CA-FFR (0.986 and 0.916 respectively, the difference between areas = 0.070, 95% CI 0.003-0.137, p = 0.0227). CONCLUSION Both CT-FFR and CA-FFR had good diagnostic concordance with wire-based FFR. In ROC Curve analysis, CT-FFR demonstrated slightly higher diagnostic accuracy than CA-FFR. CLINICAL TRIAL REGISTRATION URL: https://www.chictr.org.cn/showproj.aspx?proj=44719. Unique Identifier: ChiCTR1900026971.
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Affiliation(s)
- Zhongxiu Chen
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiling Shou
- Department of Cardiology, Shaanxi Provincial People's Hospital, 256# youyi west road, Xian, Shaanxi, China
| | - Mian Wang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaoling Zhang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yong He
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | | - Yida Tang
- Department of Cardiovascular Medicine, Peking University Third Hospital, Beijing, China
| | - Chen Li
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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20
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Li X, Sun S, Luo D, Yang X, Ye J, Guo X, Xu S, Sun B, Zhang Y, Luo J, Zhou Y, Tu S, Dong H. Microvascular and Prognostic Effect in Lesions With Different Stent Expansion During Primary PCI for STEMI: Insights From Coronary Physiology and Intravascular Ultrasound. Front Cardiovasc Med 2022; 9:816387. [PMID: 35355977 PMCID: PMC8959302 DOI: 10.3389/fcvm.2022.816387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background While coronary stent implantation in ST-elevation myocardial infarction (STEMI) can mechanically revascularize culprit epicardial vessels, it might also cause distal embolization. The relationship between geometrical and functional results of stent expansion during the primary percutaneous coronary intervention (pPCI) is unclear. Objective We sought to determine the optimal stent expansion strategy in pPCI using novel angiography-based approaches including angiography-derived quantitative flow ratio (QFR)/microcirculatory resistance (MR) and intravascular ultrasound (IVUS). Methods Post-hoc analysis was performed in patients with acute STEMI and high thrombus burden from our prior multicenter, prospective cohort study (ChiCTR1800019923). Patients aged 18 years or older with STEMI were eligible. IVUS imaging, QFR, and MR were performed during pPCI, while stent expansion was quantified on IVUS images. The patients were divided into three subgroups depending on the degree of stent expansion as follows: overexpansion (>100%), optimal expansion (80%−100%), and underexpansion (<80%). The patients were followed up for 12 months after PCI. The primary endpoint included sudden cardiac death, myocardial infarction, stroke, unexpected hospitalization or unplanned revascularization, and all-cause death. Results A total of 87 patients were enrolled. The average stent expansion degree was 82% (in all patients), 117% (in overexpansion group), 88% (in optimal expansion), and 75% (in under-expansion). QFR, MR, and flow speed increased in all groups after stenting. The overall stent expansion did not affect the final QFR (p = 0.08) or MR (p = 0.09), but it reduced the final flow speed (−0.14 cm/s per 1%, p = 0.02). Under- and overexpansion did not affect final QFR (p = 0.17), MR (p = 0.16), and flow speed (p = 0.10). Multivariable Cox analysis showed that stent expansion was not the risk factor for MACE (hazard ratio, HR = 0.97, p = 0.13); however, stent expansion reduced the risk of MACE (HR = 0.95, p = 0.03) after excluding overexpansion patients. Overexpansion was an independent risk factor for no-reflow (HR = 1.27, p = 0.02) and MACE (HR = 1.45, p = 0.007). Subgroup analysis shows that mild underexpansion of 70%−80% was not a risk factor for MACE (HR = 1.11, p = 0.08) and no-reflow (HR = 1.4, p = 0.08); however, stent expansion <70% increased the risk of MACE (HR = 1.36, p = 0.04). Conclusions Stent expansion does not affect final QFR and MR, but it reduces flow speed in STEMI. Appropriate stent underexpansion of 70–80% does not seem to be associated with short-term prognosis, so it may be tolerable as noninferior compared with optimal expansion. Meanwhile, overexpansion and underexpansion of <70% should be avoided due to the independent risk of MACEs and no-reflow events.
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Affiliation(s)
- Xida Li
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
- Department of Cardiology, Southern Medical University, Guangzhou, China
| | - Shuo Sun
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Demou Luo
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xing Yang
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Jingguang Ye
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Xiaosheng Guo
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Shenghui Xu
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Boyu Sun
- Guangdong Provincial People's Hospital Zhuhai Hospital (Zhuhai Golden Bay Hospital), Zhuhai, China
| | - Youti Zhang
- Department of Cardiology, Guangdong Provincial Jiexi People's Hospital, Jiexi, China
| | - Jianfang Luo
- Department of Cardiology, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingling Zhou
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shengxian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Shengxian Tu
| | - Haojian Dong
- Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Haojian Dong
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21
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Takahashi T, Shin D, Kuno T, Lee JM, Latib A, Fearon WF, Maehara A, Kobayashi Y. Diagnostic performance of fractional flow reserve derived from coronary angiography, intravascular ultrasound, and optical coherence tomography; a meta-analysis. J Cardiol 2022; 80:1-8. [DOI: 10.1016/j.jjcc.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/06/2022] [Accepted: 02/17/2022] [Indexed: 10/18/2022]
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22
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Westra J, Sejr-Hansen M, Koltowski L, Mejía-Rentería H, Tu S, Kochman J, Zhang Y, Liu T, Campo G, Hjort J, Mogensen LJH, Erriquez A, Andersen BK, Eftekhari A, Escaned J, Christiansen EH, Holm NR. Reproducibility of quantitative flow ratio: the QREP study. EUROINTERVENTION 2022; 17:1252-1259. [PMID: 34219667 PMCID: PMC9724855 DOI: 10.4244/eij-d-21-00425] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography. AIMS We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites. METHODS We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of intra- and inter-observer reproducibility. Key secondary analysis was the identification of clinical and procedural characteristics predicting reproducibility. RESULTS The intra-observer CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The inter-observer CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low fractional flow reserve (FFR) were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03). CONCLUSIONS The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01±0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed by FFR.
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Affiliation(s)
- Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | | | - Lukasz Koltowski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Janusz Kochman
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Yimin Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tommy Liu
- Department of Cardiology, Hagaziekenhuis, The Hague, the Netherlands
| | - Gianluca Campo
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy and Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Jakob Hjort
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Andrea Erriquez
- Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Ferrara, Italy and Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | | | - Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Madrid, Spain
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Performance of Integrated Near-Infrared Spectroscopy and Intravascular Ultrasound (NIRS-IVUS) System against Quantitative Flow Ratio (QFR). Diagnostics (Basel) 2021; 11:diagnostics11071148. [PMID: 34201889 PMCID: PMC8305529 DOI: 10.3390/diagnostics11071148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Quantitative flow ratio (QFR) is a new opportunity to analyze functional stenosis during invasive coronary angiography. Together with a well-known intravascular ultrasound (IVUS) and a new player in the field, near-infrared spectroscopy (NIRS), it is gaining a lot of interest. The aim of the study was to compare QFR results with integrated IVUS-NIRS results acquired simultaneously in the same coronary lesion. We retrospectively enrolled 66 patients in whom 66 coronary lesions were assessed by NIRS-IVUS and QFR. Lesions were divided into two groups based on QFR results as QFR-positive group (QFR ≤ 0.8) or QFR-negative group (QFR > 0.8). Based on ROC curve analysis, the best cut-off values of minimal lumen area (MLA), minimal lumen diameter (MLD) and percent diameter stenosis for predicting QFR ≤ 80 were 2.4 (AUC 0.733, 95%CI 0.61, 0.834), 1.6 (AUC 0.768, 95%CI 0.634, 0.872) and 59.5 (AUC 0.918, 95%CI 0.824, 0.971), respectively. In QFR-positive lesions, the maxLCBI4mm was significantly higher than in QFR-negative lesions (450.12 ± 251.0 vs. 329.47 ± 191.14, p = 0.046). The major finding of the present study is that values of IVUS-MLA, IVUS-MLD and percent diameter stenosis show a good efficiency in predicting QFR ≤ 0.80. Moreover, QFR-positive lesions are characterized by higher maxLCBI4mm as compared to the QFR-negative group.
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Kim YK, Jang CW, Kwon SH, Kim JH, Lerman A, Bae JH. Ten-year clinical outcomes in patients with intermediate coronary stenosis according to the combined culprit lesion. Clin Cardiol 2021; 44:1161-1168. [PMID: 34133033 PMCID: PMC8364722 DOI: 10.1002/clc.23668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/22/2021] [Accepted: 06/03/2021] [Indexed: 11/20/2022] Open
Abstract
Background We assessed the long‐term clinical outcomes of an intermediate lesion (IL) according to the presence of a combined culprit lesion (CCL). Hypothesis Long‐term clinical outcomes of IL may be affected by the presence of a CCL. Methods Angiographic findings (n = 1096) and medical chart were reviewed. Patients with IL were divided into two groups: IL without CCL group (n = 383, 64.5%) and IL with CCL group (n = 211, 35.5%). Results The major adverse cardiovascular events (MACE) in the IL with CCL group were significantly higher than those in the IL without CCL group (death: 12.3% vs. 7.0%, myocardial infarction: 3.3%vs. 0.5%, stroke: 6.6% vs. 2.6%, and revascularization [RVSC]: 25.1% vs. 7.6%) during a mean follow up period of 118.4 ± 5.5 months. IL related RVSC rate in the IL with CCL group was higher than that in the IL without CCL group (5.7% vs. 2.1%, p = 0.020). RVSC rate related to IL in total subjects was lower than that related to stented lesion (3.4% vs. 6.4%). The important predictors of total MACE in total subjects were the presence of CCL, IL percent diameter stenosis, hypertension, history of percutaneous coronary intervention, blood glucose and ejection fraction. The predictors of IL related RVSC were IL percent diameter stenosis and IL located in the right coronary artery. Conclusion 10‐year clinical outcomes of an IL (especially IL without CCL) were better than those of stented lesions. This study suggests that the IL can be safely followed up in sites that do not have ability to assess functional study.
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Affiliation(s)
- Yong Kyun Kim
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea
| | - Chae Won Jang
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea
| | - Soon Ho Kwon
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea
| | - Jae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea
| | - Amir Lerman
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Jang-Ho Bae
- Division of Cardiology, Department of Internal Medicine, Konyang University Hospital, Daejeon, South Korea
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Abstract
PURPOSE OF REVIEW Percutaneous coronary intervention (PCI) is a commonly used treatment option in coronary artery disease (CAD). Reduced major adverse cardiovascular events (MACE) in those randomized to PCI compared to optimal medical therapy have been demonstrated only if it is performed for physiologically significant coronary lesions. Despite data demonstrating improved outcomes primarily in stable CAD and then acute settings, physiology-guided PCI remains underutilized. This review summarizes the evidence and commonly used methods for physiologic assessment of coronary stenosis. RECENT FINDINGS Fractional flow reserve (FFR) is the gold standard for the analysis of lesion severity. Its use is limited by the need for adenosine, which adds time, complexity, and potential adverse effects. Non-hyperemic instantaneous wave-free ratio-guided revascularization and quantitative flow reserve ratio assessment both have shown safety and effectiveness with improved patient outcomes. Coronary physiological assessment solves the ambiguity of coronary angiography. Detecting physiologically significant stenoses is crucial to decide which lesion needs to be treated. Technological advances have led to the development of new assessment indices in addition to FFR.
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Cerrato E, Mejía-Rentería H, Franzè A, Quadri G, Belliggiano D, Biscaglia S, Lo Savio L, Spataro F, Erriquez A, Giacobbe F, Vergara-Uzcategui C, di Girolamo D, Tebaldi M, Varbella F, Campo G, Escaned J. Quantitative flow ratio as a new tool for angiography-based physiological evaluation of coronary artery disease: a review. Future Cardiol 2021; 17:1435-1452. [PMID: 33739146 DOI: 10.2217/fca-2020-0199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The functional evaluation of coronary stenoses has obtained important clinical results in recent years, resulting in strong guideline recommendations. Nonetheless, the use of coronary wire-based functional evaluation has not yet become part of the routine in catheterization laboratories for several reasons, including the need to advance a wire into the coronary vessel to interrogate the stenosis. Angiography-derived indexes have been introduced to expand the current use of physiology to estimate the functional meaning of a stenosis on the basis of angiographic data only. The most studied and validated angiography-derived index is certainly the quantitative flow ratio. This article will summarize the basics of the quantitative flow ratio, the related validation studies and its current and future applications.
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Affiliation(s)
- Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Hernan Mejía-Rentería
- Department of Cardiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos & Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Franzè
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Giorgio Quadri
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Davide Belliggiano
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Simone Biscaglia
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Luca Lo Savio
- Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Fabio Spataro
- Interventional Cardiology Unit, Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Andrea Erriquez
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Federico Giacobbe
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Carlos Vergara-Uzcategui
- Department of Cardiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos & Universidad Complutense de Madrid, Madrid, Spain
| | | | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Ferdinando Varbella
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano & Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy.,Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Javier Escaned
- Department of Cardiology, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria San Carlos & Universidad Complutense de Madrid, Madrid, Spain
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Big data and new information technology: what cardiologists need to know. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:81-89. [PMID: 33008773 DOI: 10.1016/j.rec.2020.06.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022]
Abstract
Technological progress in medicine is constantly garnering pace, requiring that physicians constantly update their knowledge. The new wave of technologies breaking through into clinical practice includes the following: a) mHealth, which allows constant monitoring of biological parameters, anytime, anyplace, of hundreds of patients at the same time; b) artificial intelligence, which, powered by new deep learning techniques, are starting to beat human experts at their own game: diagnosis by imaging or electrocardiography; c) 3-dimensional printing, which may lead to patient-specific prostheses; d) systems medicine, which has arisen from big data, and which will open the way to personalized medicine by bringing together genetic, epigenetic, environmental, clinical and social data into complex integral mathematical models to design highly personalized therapies. This state-of-the-art review aims to summarize in a single document the most recent and most important technological trends that are being applied to cardiology, and to provide an overall view that will allow readers to discern at a glance the direction of cardiology in the next few years.
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Cortés C, Rivero F, Gutiérrez-Ibañes E, Aparisi Á, San Román JA, Amat-Santos IJ. Validación prospectiva y comparación de los nuevos índices de evaluación de las estenosis coronarias: resting full-cycle y quantitative flow ratio. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Baladrón C, Gómez de Diego JJ, Amat-Santos IJ. Big data y nuevas tecnologías de la información: qué necesita saber el cardiólogo. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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30
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Cortés C, Rivero F, Gutiérrez-Ibañes E, Aparisi Á, San Román JA, Amat-Santos IJ. Prospective validation and comparison of new indexes for the assessment of coronary stenosis: resting full-cycle and quantitative flow ratio. ACTA ACUST UNITED AC 2020; 74:94-97. [PMID: 32792309 DOI: 10.1016/j.rec.2020.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Carlos Cortés
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain; Servicio de Cardiología, Hospital de San Pedro, Logroño, Spain.
| | - Fernando Rivero
- Servicio de Cardiología, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Enrique Gutiérrez-Ibañes
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital General Universitario Gregorio Marañón; Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III, Madrid, Spain
| | - Álvaro Aparisi
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain
| | - José A San Román
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ignacio J Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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