Agreement between Murray law-based quantitative flow ratio (μQFR) and three-dimensional quantitative flow ratio (3D-QFR) in non-selected angiographic stenosis: A multicenter study

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Abstract

Background

The agreement between single-projection Murray-based quantitative flow ratio ( μQFR) and conventional three-dimensional quantitative flow ratio (3D-QFR) has not been reported hitherto.

Methods

Patients from a multinational database were randomly selected for the study of agreement, according to sample size calculation. Both conventional 3D-QFR and μQFR were analyzed for all available arteries at a central corelab by independent analysts, blinded to each other’s results.

Results

Ninety-eight coronary arteries from 35 patients were finally analyzed. Median 3D-QFR was 0.82 (interquartile range 0.78–0.87). The intraclass correlation coefficient for the absolute agreement between 3D-QFR and μQFR was 0.996 (95% confidence interval [CI]: 0.993–0.997); Lin’s coefficient 0.996 (95% CI: 0.993–0.997), without constant or proportional bias (intercept = 0 and slope = 1 in orthogonal regression). As dichotomous variable, there was absolute agreement between μQFR and 3D-QFR, resulting in no single false positive or negative. Kappa index was 1 and the diagnostic accuracy 100%.

Conclusions

μQFR using a single angiographic projection showed almost perfect agreement with standard 3D-QFR. These results encourage the interchangeable use of μQFR and 3D-QFR, which can be interesting to improve QFR feasibility in retrospective studies, wherein appropriate double angiographic projections might be challenging to obtain.

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Most cited references 26

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2018 ESC/EACTS Guidelines on myocardial revascularization

Terje Steigen, Sjoerd Hofma, Robert Xuereb … (2018)

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Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.

Pim A.L. Tonino, Bernard De Bruyne, Nico H.J. Pijls … (2009)

In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes. In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug-eluting stents guided by angiography alone or guided by FFR measurements in addition to angiography. Before randomization, lesions requiring PCI were identified on the basis of their angiographic appearance. Patients assigned to angiography-guided PCI underwent stenting of all indicated lesions, whereas those assigned to FFR-guided PCI underwent stenting of indicated lesions only if the FFR was 0.80 or less. The primary end point was the rate of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. The mean (+/-SD) number of indicated lesions per patient was 2.7+/-0.9 in the angiography group and 2.8+/-1.0 in the FFR group (P=0.34). The number of stents used per patient was 2.7+/-1.2 and 1.9+/-1.3, respectively (P<0.001). The 1-year event rate was 18.3% (91 patients) in the angiography group and 13.2% (67 patients) in the FFR group (P=0.02). Seventy-eight percent of the patients in the angiography group were free from angina at 1 year, as compared with 81% of patients in the FFR group (P=0.20). Routine measurement of FFR in patients with multivessel coronary artery disease who are undergoing PCI with drug-eluting stents significantly reduces the rate of the composite end point of death, nonfatal myocardial infarction, and repeat revascularization at 1 year. (ClinicalTrials.gov number, NCT00267774.) 2009 Massachusetts Medical Society

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Fractional Flow Reserve–Guided PCI versus Medical Therapy in Stable Coronary Disease

Bernard De Bruyne, Nico H.J. Pijls, Bindu Kalesan … (2012)

The preferred initial treatment for patients with stable coronary artery disease is the best available medical therapy. We hypothesized that in patients with functionally significant stenoses, as determined by measurement of fractional flow reserve (FFR), percutaneous coronary intervention (PCI) plus the best available medical therapy would be superior to the best available medical therapy alone. In patients with stable coronary artery disease for whom PCI was being considered, we assessed all stenoses by measuring FFR. Patients in whom at least one stenosis was functionally significant (FFR, ≤0.80) were randomly assigned to FFR-guided PCI plus the best available medical therapy (PCI group) or the best available medical therapy alone (medical-therapy group). Patients in whom all stenoses had an FFR of more than 0.80 were entered into a registry and received the best available medical therapy. The primary end point was a composite of death, myocardial infarction, or urgent revascularization. Recruitment was halted prematurely after enrollment of 1220 patients (888 who underwent randomization and 332 enrolled in the registry) because of a significant between-group difference in the percentage of patients who had a primary end-point event: 4.3% in the PCI group and 12.7% in the medical-therapy group (hazard ratio with PCI, 0.32; 95% confidence interval [CI], 0.19 to 0.53; P<0.001). The difference was driven by a lower rate of urgent revascularization in the PCI group than in the medical-therapy group (1.6% vs. 11.1%; hazard ratio, 0.13; 95% CI, 0.06 to 0.30; P<0.001); in particular, in the PCI group, fewer urgent revascularizations were triggered by a myocardial infarction or evidence of ischemia on electrocardiography (hazard ratio, 0.13; 95% CI, 0.04 to 0.43; P<0.001). Among patients in the registry, 3.0% had a primary end-point event. In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best available medical therapy alone, decreased the need for urgent revascularization. In patients without ischemia, the outcome appeared to be favorable with the best available medical therapy alone. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT01132495.).

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Author and article information

Journal

Journal ID (nlm-ta): Cardiol J

Journal ID (iso-abbrev): Cardiol J

Title: Cardiology Journal

Publisher: Via Medica

ISSN (Print): 1897-5593

ISSN (Electronic): 1898-018X

Publication date Collection: 2022

Publication date (Electronic): 31 May 2022

Volume: 29

Issue: 3

Pages: 388-395

Affiliations

[1 ]Miguel Servet University Hospital, Zaragoza, Spain

[2 ]Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

[3 ]Bundeswehrkrankenhaus (Federal Army Military Hospital), Hamburg, Germany

[4 ]Asklepios Klinik St. Georg (Asklepios St. Georg Clinic), Hamburg, Germany

[5 ]Bundeswehrzentralkrankenhaus (Federal Army Central Military Hospital), Koblenz, Germany

[6 ]Nursing High School, University of Valladolid, Valladolid, Spain

[7 ]Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

Author notes

Address for correspondence: OFA Prof. Juan Luis Gutiérrez-Chico, MD, PhD, FESC, FACC, Head of Interventional Cardiology, Bundeswehrzentralkrankenhaus, Rübenacherstraße 170, 56072 – Koblenz, Germany, tel: +49 26128121610, +34 615 319370, e-mail: juanluis.gutierrezchico@ 123456ictra.es

[*]

These authors have equally contributed.

Author information

Carlos Cortés https://orcid.org/0000-0002-9332-4236

Juan Luis Gutiérrez-Chico https://orcid.org/0000-0002-0812-7925

Article

Publisher ID: cardj-29-3-388

DOI: 10.5603/CJ.a2022.0030

PMC ID: 9170317

PubMed ID: 35578755

SO-VID: 8601a052-6a14-42f4-9608-0ffce4ce8082

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This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially

Agreement between Murray law-based quantitative flow ratio (μQFR) and three-dimensional quantitative flow ratio (3D-QFR) in non-selected angiographic stenosis: A multicenter study

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Most cited references 26

2018 ESC/EACTS Guidelines on myocardial revascularization

Fractional flow reserve versus angiography for guiding percutaneous coronary intervention.

Fractional Flow Reserve–Guided PCI versus Medical Therapy in Stable Coronary Disease

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