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Yuasa S, Lauri FM, Mejia-Renteria H, Liontou C, Lee HJ, Tanigaki T, Nakayama M, Warisawa T, Uchiyama T, Matsuo H, Davies JE, Sato T, Escaned J. Angiography-derived functional assessment of left main coronary stenoses. Catheter Cardiovasc Interv 2023; 101:1045-1052. [PMID: 36934387 DOI: 10.1002/ccd.30633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 01/22/2023] [Accepted: 02/20/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVES We aimed to evaluate the diagnostic accuracy of quantitative flow ratio (QFR) in left main (LM) coronary stenoses, using Fractional Flow Reserve (FFR) as reference. BACKGROUND QFR has demonstrated a high accuracy in determining the functional relevance of coronary stenoses in non-LM. However, there is an important paucity of data regarding its diagnostic value in the specific anatomical subset of LM disease. METHODS This is a retrospective, observational, multicenter, international, and blinded study including patients with LM stenoses. Cases with significant ostial LM disease were excluded. QFR was calculated from conventional angiograms at blinded fashion with respect to FFR. RESULTS Sixty-seven patients with LM stenoses were analyzed. Overall, LM had intermediate severity, both from angiographic (diameter stenosis [%DS] 43.8 ± 11.1%) and functional perspective (FFR 0.756 ± 0.105). Mean QFR was 0.733 ± 0.159. Correlation between QFR and FFR was moderate (r = 0.590). Positive and negative predictive value, sensitivity and specificity were 85.4%, 64%, 85.4%, and 69.6% respectively. Classification agreement of QFR and FFR in terms of functional stenosis severity was 78.1%. Area under the receiver operating characteristics of QFR using FFR as reference was 0.82 [95% confidence interval [CI], 0.71-0.93], and significantly better than angiographic evaluation including %DS (area under the receiver-operating characteristic curve [AUC] 0.45 [95% CI, 0.32-0.58], p < 0.001) and minimum lumen diameter (AUC 0.60 [95% CI, 0.47-0.74], p < 0.001). CONCLUSIONS Compared with FFR, QFR has acceptable diagnostic performance in determining the functional relevance of LM stenosis, being better than conventional angiographic assessment. Nonetheless, caution should be taken when applying functional angiography techniques for the assessment of LM stenosis given its particular anatomical characteristics.
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Affiliation(s)
- Sonoka Yuasa
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Francesco Maria Lauri
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain.,Servicio de Cardiología de Adultos, Hospital Ramon y Cajal, Madrid, Spain
| | - Hernan Mejia-Renteria
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | - Catherine Liontou
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain.,Department of Cardiology, Evangelismos General Hospital, Athens, Greece
| | - Hyun-Jong Lee
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain.,Department of Internal Medicine, Division of Cardiology, Sejong General Hospital, Republic of Korea
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Masafumi Nakayama
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.,Cardiovascular Center, Todachuo General Hospital, Toda, Japan
| | - Takayuki Warisawa
- Department of Internal Medicine, Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan.,Cardiovascular Science, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Justin E Davies
- Cardiovascular Science, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Takao Sato
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA.,Department of Cardiovascular Medicine, Tachikawa General Hospital, Niigata, Japan
| | - Javier Escaned
- Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
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