TY - JOUR
T1 - Diagnostic concordance and discordance between angiography-based quantitative flow ratio and fractional flow reserve derived from computed tomography in complex coronary artery disease
AU - Kawashima, Hideyuki
AU - Kogame, Norihiro
AU - Ono, Masafumi
AU - Hara, Hironori
AU - Takahashi, Kuniaki
AU - Reiber, Johan H. C.
AU - Thomsen, Brian
AU - de Winter, Robbert J.
AU - Tanaka, Kaoru
AU - la Meir, Mark
AU - de Mey, Johan
AU - Schneider, Ulrich
AU - Doenst, Torsten
AU - Teichgräber, Ulf
AU - Wijns, William
AU - Mushtaq, Saima
AU - Pompilio, Giulio
AU - Bartorelli, Antonio L.
AU - Andreini, Daniele
AU - Serruys, Patrick W.
AU - Onuma, Yoshinobu
N1 - Funding Information: Dr. Hara reports a grant for studying overseas from Japanese Circulation Society and a grant from Fukuda Foundation for Medical Technology, outside the submitted work. Publisher Copyright: © 2022 The Authors
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Background: Both quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFRCT) have shown significant correlations with invasive wire-based fractional flow reserve. However, the correlation between QFR and FFRCT is not fully investigated in patients with complex coronary artery disease (CAD). The aim of this study is to investigate the correlation and agreement between QFR and FFRCT in patients with de novo three-vessel disease and/or left main CAD. Methods: This is a post-hoc sub-analysis of the international, multicenter, and randomized SYNTAX III REVOLUTION trial, in which both invasive coronary angiography and coronary computed tomography angiography were prospectively obtained prior to the heart team discussion. QFR was performed in an independent core laboratory and compared with FFRCT analyzed by HeartFlow™. The correlation and agreement between QFR and FFRCT were assessed per vessel. Furthermore, independent factors of diagnostic discordance between QFR and FFRCT were evaluated. Results: Out of 223 patients, 40 patients were excluded from this analysis due to the unavailability of FFRCT and/or QFR, and a total of 469 vessels (183 patients) were analyzed. There was a strong correlation between QFR and FFRCT (R = 0.759; p < 0.001), and the Bland-Altman analysis demonstrated a mean difference of −0.005 and a standard deviation of 0.116. An independent predictor of diagnostic concordance between QFR and FFRCT was the lesion location in right coronary artery (RCA) (odds ratio 0.395; 95% confidence interval 0.174–0.894; P = 0.026). Conclusion: In patients with complex CAD, QFR and FFRCT were strongly correlated. The location of the lesion in RCA was associated with the highest diagnostic concordance between QFR and FFRCT.
AB - Background: Both quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFRCT) have shown significant correlations with invasive wire-based fractional flow reserve. However, the correlation between QFR and FFRCT is not fully investigated in patients with complex coronary artery disease (CAD). The aim of this study is to investigate the correlation and agreement between QFR and FFRCT in patients with de novo three-vessel disease and/or left main CAD. Methods: This is a post-hoc sub-analysis of the international, multicenter, and randomized SYNTAX III REVOLUTION trial, in which both invasive coronary angiography and coronary computed tomography angiography were prospectively obtained prior to the heart team discussion. QFR was performed in an independent core laboratory and compared with FFRCT analyzed by HeartFlow™. The correlation and agreement between QFR and FFRCT were assessed per vessel. Furthermore, independent factors of diagnostic discordance between QFR and FFRCT were evaluated. Results: Out of 223 patients, 40 patients were excluded from this analysis due to the unavailability of FFRCT and/or QFR, and a total of 469 vessels (183 patients) were analyzed. There was a strong correlation between QFR and FFRCT (R = 0.759; p < 0.001), and the Bland-Altman analysis demonstrated a mean difference of −0.005 and a standard deviation of 0.116. An independent predictor of diagnostic concordance between QFR and FFRCT was the lesion location in right coronary artery (RCA) (odds ratio 0.395; 95% confidence interval 0.174–0.894; P = 0.026). Conclusion: In patients with complex CAD, QFR and FFRCT were strongly correlated. The location of the lesion in RCA was associated with the highest diagnostic concordance between QFR and FFRCT.
KW - Coronary artery disease
KW - Fractional flow reserve derived from computed tomography angiography
KW - Multivessel disease
KW - Quantitative flow ratio
KW - SYNTAX score
UR - http://www.scopus.com/inward/record.url?scp=85125525549&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jcct.2022.02.004
DO - https://doi.org/10.1016/j.jcct.2022.02.004
M3 - Article
C2 - 35246403
SN - 1934-5925
VL - 16
SP - 336
EP - 342
JO - Journal of cardiovascular computed tomography
JF - Journal of cardiovascular computed tomography
IS - 4
ER -