van Rosendael A R, Koning G, Dimitriu-Leen A C, Smit J M, Montero-Cabezas J M, van der Kley F, Jukema J W, Reiber J H C, Bax J J, Scholte A J H A
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands.
Medis Medical Imaging Systems B.V., Leiden, The Netherlands.
Int J Cardiovasc Imaging. 2017 Sep;33(9):1305-1312. doi: 10.1007/s10554-017-1190-3. Epub 2017 Jun 22.
Fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) is associated with favourable outcome compared with revascularization based on angiographic stenosis severity alone. The feasibility of the new image-based quantitative flow ratio (QFR) assessed from 3D quantitative coronary angiography (QCA) and thrombolysis in myocardial infarction (TIMI) frame count using three different flow models has been reported recently. The aim of the current study was to assess the accuracy, and in particular, the reproducibility of these three QFR techniques when compared with invasive FFR. QFR was derived (1) from adenosine induced hyperaemic coronary angiography images (adenosine-flow QFR [aQFR]), (2) from non-hyperemic images (contrast-flow QFR [cQFR]) and (3) using a fixed empiric hyperaemic flow [fixed-flow QFR (fQFR)]. The three QFR values were calculated in 17 patients who prospectively underwent invasive FFR measurement in 20 vessels. Two independent observers performed the QFR analyses. Mean difference, standard deviation and 95% limits of agreement (LOA) between invasive FFR and aQFR, cQFR and fQFR for observer 1 were: 0.01 ± 0.04 (95% LOA: -0.07; 0.10), 0.01 ± 0.05 (95% LOA: -0.08; 0.10), 0.01 ± 0.04 (95% LOA: -0.06; 0.08) and for observer 2: 0.00 ± 0.03 (95% LOA: -0.06; 0.07), -0.01 ± 0.03 (95% LOA: -0.07; 0.05), 0.00 ± 0.03 (95% LOA: -0.06; 0.05). Values between the 2 observers were (to assess reproducibility) for aQFR: 0.01 ± 0.04 (95% LOA: -0.07; 0.09), for cQFR: 0.02 ± 0.04 (95% LOA: -0.06; 0.09) and for fQFR: 0.01 ± 0.05 (95% LOA: -0.07; 0.10). In a small number of patients we showed good accuracy of three QFR techniques (aQFR, cQFR and fQFR) to predict invasive FFR. Furthermore, good inter-observer agreement of the QFR values was observed between two independent observers.
与仅基于血管造影狭窄严重程度的血运重建相比，血流储备分数（FFR）指导的经皮冠状动脉介入治疗（PCI）具有更好的预后。最近有报道称，基于三维定量冠状动脉造影（QCA）和心肌梗死溶栓（TIMI）帧数，使用三种不同血流模型评估的新型基于图像的定量血流比（QFR）具有可行性。本研究的目的是评估这三种QFR技术与有创FFR相比的准确性，尤其是可重复性。QFR的推导方法如下：（1）来自腺苷诱发的充血性冠状动脉造影图像（腺苷血流QFR [aQFR]）；（2）来自非充血图像（对比剂血流QFR [cQFR]）；（3）使用固定的经验性充血血流[固定血流QFR（fQFR）]。对20支血管前瞻性接受有创FFR测量的17例患者计算了这三种QFR值。两名独立观察者进行了QFR分析。观察者1测得的有创FFR与aQFR、cQFR和fQFR之间的平均差值、标准差和95%一致性界限（LOA）分别为：0.01±0.04（95% LOA：-0.07；0.10）、0.01±0.05（95% LOA：-0.08；0.10）、0.01±0.04（95% LOA：-0.06；0.08）；观察者2测得的分别为：0.00±0.03（95% LOA：-0.06；0.07）、-0.01±0.03（95% LOA：-0.07；0.05）、0.00±0.03（95% LOA：-0.06；0.05）。两名观察者之间aQFR、cQFR和fQFR的值（用于评估可重复性）分别为：0.01±0.04（95% LOA：-0.07；0.09）、0.02±0.04（95% LOA：-0.06；0.09）和0.01±0.05（95% LOA：-0.07；0.10）。在少数患者中，我们发现三种QFR技术（aQFR、cQFR和fQFR）在预测有创FFR方面具有良好的准确性。此外，两名独立观察者之间观察到QFR值具有良好的观察者间一致性。
