TY - JOUR
T1 - Characterization of quantitative flow ratio and fractional flow reserve discordance using doppler flow and clinical follow-up
AU - Westra, Jelmer
AU - Eftekhari, Ashkan
AU - Renkens, Mick P. L.
AU - Mejía-Rentería, Hernán
AU - Sejr-Hansen, Martin
AU - Stegehuis, Valérie
AU - Holm, Niels Ramsing
AU - de Winter, Robbert J.
AU - Piek, Jan J.
AU - Escaned, Javier
AU - Wykrzykowska, J. J.
AU - Christiansen, Evald H. j
N1 - Funding Information: Dr. Mejia-Renteria has received consultancy fees from Medis Medical Imaging and speaker fees from Philips and Abbott out of the submitted work. Dr. Evald Christiansen received research grants from Medis and Philips/Volcano to his institution outside of the submitted work. The remaining authors have no disclosures to report. Publisher Copyright: © 2022, The Author(s), under exclusive licence to Springer Nature B.V.
PY - 2022/6
Y1 - 2022/6
N2 - Abstract: The physiological mechanisms of quantitative flow ratio and fractional flow reserve disagreement are not fully understood. We aimed to characterize the coronary flow and resistance profile of intermediate stenosed epicardial coronary arteries with concordant and discordant FFR and QFR. Post-hoc analysis of the DEFINE-FLOW study. Anatomical and Doppler-derived physiological parameters were compared for lesions with FFR+QFR− (n = 18) vs. FFR+QFR+ (n = 43) and for FFR−QFR+ (n = 34) vs. FFR−QFR− (n = 139). The association of QFR results with the two-year rate of target vessel failure was assessed in the proportion of vessels (n = 195) that did not undergo revascularization. Coronary flow reserve was higher [2.3 (IQR: 2.1–2.7) vs. 1.9 (IQR: 1.5–2.4)], hyperemic microvascular resistance lower [1.72 (IQR: 1.48–2.31) vs. 2.26 (IQR: 1.79–2.87)] and anatomical lesion severity less severe [% diameter stenosis 45.5 (IQR: 41.5–52.5) vs. 58.5 (IQR: 53.1–64.0)] for FFR+QFR− lesions compared with FFR+QFR+ lesions. In comparison of FFR−QFR+ vs. FFR-QFR- lesions, lesion severity was more severe [% diameter stenosis 55.2 (IQR: 51.7–61.3) vs. 43.4 (IQR: 35.0–50.6)] while coronary flow reserve [2.2 (IQR: 1.9–2.9) vs. 2.2 (IQR: 1.9–2.6)] and hyperemic microvascular resistance [2.34 (IQR: 1.85–2.81) vs. 2.57 (IQR: 2.01–3.22)] did not differ. The agreement and diagnostic performance of FFR using hyperemic stenosis resistance (> 0.80) as reference standard was higher compared with QFR and coronary flow reserve. Disagreement between FFR and QFR is partly explained by physiological and anatomical factors. Clinical Trials Registrationhttps://www.clinicaltrials.gov; Unique identifier: NCT01813435. Graphical abstract: Changes in central physiological and anatomical parameters according to FFR and QFR match/mismatch quadrants.[Figure not available: see fulltext.]
AB - Abstract: The physiological mechanisms of quantitative flow ratio and fractional flow reserve disagreement are not fully understood. We aimed to characterize the coronary flow and resistance profile of intermediate stenosed epicardial coronary arteries with concordant and discordant FFR and QFR. Post-hoc analysis of the DEFINE-FLOW study. Anatomical and Doppler-derived physiological parameters were compared for lesions with FFR+QFR− (n = 18) vs. FFR+QFR+ (n = 43) and for FFR−QFR+ (n = 34) vs. FFR−QFR− (n = 139). The association of QFR results with the two-year rate of target vessel failure was assessed in the proportion of vessels (n = 195) that did not undergo revascularization. Coronary flow reserve was higher [2.3 (IQR: 2.1–2.7) vs. 1.9 (IQR: 1.5–2.4)], hyperemic microvascular resistance lower [1.72 (IQR: 1.48–2.31) vs. 2.26 (IQR: 1.79–2.87)] and anatomical lesion severity less severe [% diameter stenosis 45.5 (IQR: 41.5–52.5) vs. 58.5 (IQR: 53.1–64.0)] for FFR+QFR− lesions compared with FFR+QFR+ lesions. In comparison of FFR−QFR+ vs. FFR-QFR- lesions, lesion severity was more severe [% diameter stenosis 55.2 (IQR: 51.7–61.3) vs. 43.4 (IQR: 35.0–50.6)] while coronary flow reserve [2.2 (IQR: 1.9–2.9) vs. 2.2 (IQR: 1.9–2.6)] and hyperemic microvascular resistance [2.34 (IQR: 1.85–2.81) vs. 2.57 (IQR: 2.01–3.22)] did not differ. The agreement and diagnostic performance of FFR using hyperemic stenosis resistance (> 0.80) as reference standard was higher compared with QFR and coronary flow reserve. Disagreement between FFR and QFR is partly explained by physiological and anatomical factors. Clinical Trials Registrationhttps://www.clinicaltrials.gov; Unique identifier: NCT01813435. Graphical abstract: Changes in central physiological and anatomical parameters according to FFR and QFR match/mismatch quadrants.[Figure not available: see fulltext.]
KW - Coronary flow reserve
KW - Coronary physiology
KW - Fractional flow reserve
KW - Quantitative coronary angiography
UR - http://www.scopus.com/inward/record.url?scp=85123115682&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s10554-022-02522-1
DO - https://doi.org/10.1007/s10554-022-02522-1
M3 - Article
C2 - 35041147
SN - 1569-5794
VL - 38
SP - 1181
EP - 1190
JO - international journal of cardiovascular imaging
JF - international journal of cardiovascular imaging
IS - 6
ER -