TY - JOUR
T1 - Comparison of diagnostic performance between quantitative flow ratio, non-hyperemic pressure indices and fractional flow reserve
AU - Mehta, Ojas Hrakesh
AU - Hay, Michael
AU - Lim, Ren Yik
AU - Ihdayhid, Abdul Rahman
AU - Michail, Michael
AU - Zhang, Jun Michael
AU - Cameron, James D.
AU - Wong, Dennis T.L.
PY - 2020/6
Y1 - 2020/6
N2 - Background: Quantitative flow ratio (QFR) is an estimate of fractional flow reserve (FFR) and is derived from 3-dimensional quantitative coronary angiography. The DILEMMA score is an angiographic technique developed to predict FFR. Unlike other diastolic indices such as instantaneous wave-free ratio (iFR), diastolic pressure ratio (dPR) and dPR25–75, neither QFR nor DILEMMA score require pressure wires. This study sought to compare the diagnostic performance of QFR, diastolic indices and DILEMMA score to predict FFR. Methods: Between January 2010 and December 2013, patients who underwent invasive coronary angiography and FFR assessments were retrospectively studied. iFR and dPR were derived from FFR pressure tracings. QFR was computed using commercial software. Results: Eighty-five lesions (25% FFR significant) were included in this study. Median FFR was 0.88 (0.81–0.92). QFR (rs=0.801), iFR (rs=0.710), dPR (rs=0.716), dPR25–75 (rs=0.715) and DILEMMA score (rs=-0.623) significantly correlated with FFR (P<0.001). QFR ≤0.8 had a specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of 95%, 86%, 86% and 95% respectively of predicting significant FFR (P<0.001). Receiver-operating characteristic (ROC) analysis revealed the AUC to predict significant FFR for QFR (0.947), iFR (0.880), dPR (0.883), dPR25–75 (0.880) and DILEMMA score (0.916) were not significantly different. However, QFR was a better predictor of FFR than iFR (0.947 vs. 0.770, P<0.01). Conclusions: QFR had excellent correlation and accuracy as measured against FFR. When compared to other diastolic indices and DILEMMA score, QFR performed at least as well as the other indices. QFR predicts FFR better than it predicts iFR. QFR is a convenient tool to assess significance of coronary stenosis and a reliable alternative to pressure-wire based indices. Prospective studies are required to investigate the performance and cost-effectiveness of QFR when independently used to guide clinical decision making.
AB - Background: Quantitative flow ratio (QFR) is an estimate of fractional flow reserve (FFR) and is derived from 3-dimensional quantitative coronary angiography. The DILEMMA score is an angiographic technique developed to predict FFR. Unlike other diastolic indices such as instantaneous wave-free ratio (iFR), diastolic pressure ratio (dPR) and dPR25–75, neither QFR nor DILEMMA score require pressure wires. This study sought to compare the diagnostic performance of QFR, diastolic indices and DILEMMA score to predict FFR. Methods: Between January 2010 and December 2013, patients who underwent invasive coronary angiography and FFR assessments were retrospectively studied. iFR and dPR were derived from FFR pressure tracings. QFR was computed using commercial software. Results: Eighty-five lesions (25% FFR significant) were included in this study. Median FFR was 0.88 (0.81–0.92). QFR (rs=0.801), iFR (rs=0.710), dPR (rs=0.716), dPR25–75 (rs=0.715) and DILEMMA score (rs=-0.623) significantly correlated with FFR (P<0.001). QFR ≤0.8 had a specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of 95%, 86%, 86% and 95% respectively of predicting significant FFR (P<0.001). Receiver-operating characteristic (ROC) analysis revealed the AUC to predict significant FFR for QFR (0.947), iFR (0.880), dPR (0.883), dPR25–75 (0.880) and DILEMMA score (0.916) were not significantly different. However, QFR was a better predictor of FFR than iFR (0.947 vs. 0.770, P<0.01). Conclusions: QFR had excellent correlation and accuracy as measured against FFR. When compared to other diastolic indices and DILEMMA score, QFR performed at least as well as the other indices. QFR predicts FFR better than it predicts iFR. QFR is a convenient tool to assess significance of coronary stenosis and a reliable alternative to pressure-wire based indices. Prospective studies are required to investigate the performance and cost-effectiveness of QFR when independently used to guide clinical decision making.
KW - Adenosine
KW - Coronary artery disease
KW - Fractional flow reserve (FFR)
KW - Instantaneous wave-free ratio (iFR)
KW - Physiology
KW - Pressure ratio
KW - Quantitative flow ratio (QFR)
UR - http://www.scopus.com/inward/record.url?scp=85088486370&partnerID=8YFLogxK
U2 - 10.21037/cdt-20-179
DO - 10.21037/cdt-20-179
M3 - Article
C2 - 32695624
AN - SCOPUS:85088486370
SN - 2223-3652
VL - 10
SP - 442
EP - 452
JO - Cardiovascular Diagnosis and Therapy
JF - Cardiovascular Diagnosis and Therapy
IS - 3
ER -