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Diagnostic Agreement of Quantitative Flow Ratio With Fractional Flow Reserve and Instantaneous Wave-Free Ratio

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Affiliated Author(s)
남창욱
Alternative Author(s)
Nam, Chang Wook
Journal Title
Journal of the American Heart Association
ISSN
2047-9980
Issued Date
2019
Keyword
computational fluid dynamicsdiagnostic agreementfractional flow reserveinstantaneous wave-free ratioquantitative flow ratio
Abstract
Background-
—Quantitative flow ratio (QFR) has a high diagnostic accuracy in assessing functional stenoses relevance, as judged by fractional flow reserve (FFR). However, its diagnostic performance has not been thoroughly evaluated using instantaneous wavefree ratio (iFR) or coronary flow reserve as the reference standard. This study sought to evaluate the diagnostic performance of QFR using other reference standards beyond FFR.

Methods and Results-
—We analyzed 182 patients (253 vessels) with stable ischemic heart disease and 82 patients (105 nonculprit vessels) with acute myocardial infarction in whom coronary stenoses were assessed with FFR, iFR, and coronary flow reserve. Contrast QFR analysis of interrogated vessels was performed in blinded fashion by a core laboratory, and its diagnostic performance was evaluated with respect to the other invasive physiological indices. Mean percentage diameter stenosis, FFR, iFR, coronary flow reserve, and QFRwere 53.1 19.0%, 0.80 0.13, 0.88 0.12, 3.14 1.30, and 0.81 0.14, respectively. QFRshowed higher correlation (r=0.863 with FFR versus 0.740 with iFR, P<0.001), diagnostic accuracy (90.8% versus 81.3%, P<0.001), and discriminant function (area under the curve=0.953 versus 0.880, P<0.001) when FFR was used as a reference standard than when iFR was used as the reference standard. However, when coronary flow reserve was used as an independent reference standard, FFR, iFR, and QFR showed modest discriminant function (area under the curve=0.682, 0.765, and 0.677, respectively) and there were no significant differences in diagnostic accuracy among FFR, iFR, and QFR (65.4%, 70.6%, and 64.9%; all P values in pairwise comparisons >0.05, overall comparison P=0.061).

Conclusions-
—QFR has a high correlation and agreement with respect to both FFR and iFR, although it is better when FFR is used as the comparator. As a pressure-derived index not depending on wire or adenosine, QFR might be a promising tool for improving the adoption rate of physiology-based revascularization in clinical practice.
Department
Dept. of Internal Medicine (내과학)
Publisher
School of Medicine (의과대학)
Citation
Doyeon Hwang et al. (2019). Diagnostic Agreement of Quantitative Flow Ratio With Fractional Flow Reserve and Instantaneous Wave-Free Ratio. Journal of the American Heart Association, 8(8), e011605–e011605. doi: 10.1161/JAHA.118.011605
Type
Article
ISSN
2047-9980
DOI
10.1161/JAHA.118.011605
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/41984
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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