Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland.
Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2(nd)Department of Cardiology, University Hospital, Krakow, Poland.
Adv Med Sci. 2021 Mar;66(1):1-5. doi: 10.1016/j.advms.2020.10.001. Epub 2020 Nov 12.
Quantitative flow ratio (QFR) is a recently developed image-based index for the assessment of borderline coronary artery disease. We sought to investigate a correlation between QFR and instantaneous wave-free ratio (iFR) for the assessment of intermediate coronary stenoses.
Patients with borderline coronary lesions (40-90% by visual assessment) undergoing iFR assessment were enrolled. QFR was derived from a modeled hyperemic flow velocity derived from angiography without adenosine-induced hyperemia. Pressure wire-derived iFR served as the reference.
Values of QFR and iFR from 110 vessels with a mean percent diameter stenosis of 44.6 ± 12.0% were compared. Mean iFR was 0.90 ± 0.07 and 38 (34.5%) had iFR ≤0.89. Mean QFR was 0.81 ± 0.10 and 44 (40%) had QFR ≤0.80. A good agreement between QFR and iFR measurements was confirmed with a mean difference of 0.09 (95%CI -0.027 to 0.207) and intraclass correlation coefficient of 0.87 (95%CI 0.81-0.91). The overall diagnostic accuracy (AUC in ROC analysis) of QFR in detecting iFR ≤0.89 was 0.87 (95%CI 0.79-0.93; p < 0.001). Regarding iFR ≤0.89, the optimal cutoff value of QFR was 0.79 with sensitivity, specificity, and accuracy of 76.3%, 83.3%, and 80.0%, respectively. A 100% sensitivity was observed for a QFR cutoff value of 0.88 and a 100% specificity for a QFR cutoff value of 0.69.
Our study confirmed good QFR diagnostic performance and correlation with iFR for detecting the functional ischemia caused by intermediate lesions in coronary arteries. However, the pressure wire assessment with iFR might be warranted in 2/3 of patients after QFR assessment.
定量血流比（QFR）是一种最近开发的用于评估临界冠状动脉疾病的基于图像的指标。我们旨在研究 QFR 与瞬时无波比（iFR）在评估中度冠状动脉狭窄中的相关性。
招募了接受 iFR 评估的临界冠状动脉病变（视觉评估 40-90%）患者。QFR 源自造影剂衍生的充血性血流速度的模型，而无需腺苷诱导充血。压力导丝衍生的 iFR 作为参考。
比较了 110 个平均直径狭窄 44.6 ± 12.0%的血管的 QFR 和 iFR 值。平均 iFR 为 0.90 ± 0.07，有 38 个（34.5%）iFR ≤0.89。平均 QFR 为 0.81 ± 0.10，有 44 个（40%）QFR ≤0.80。QFR 和 iFR 测量值之间存在良好的一致性，平均差异为 0.09（95%CI -0.027 至 0.207），组内相关系数为 0.87（95%CI 0.81-0.91）。QFR 检测 iFR ≤0.89 的总体诊断准确性（ROC 分析中的 AUC）为 0.87（95%CI 0.79-0.93；p<0.001）。对于 iFR ≤0.89，QFR 的最佳截断值为 0.79，灵敏度、特异性和准确性分别为 76.3%、83.3%和 80.0%。QFR 截断值为 0.88 时，灵敏度为 100%，QFR 截断值为 0.69 时，特异性为 100%。
本研究证实了 QFR 在检测冠状动脉中度病变引起的功能性缺血方面具有良好的诊断性能和与 iFR 的相关性。然而，在 QFR 评估后，仍需要对 2/3 的患者进行 iFR 压力导丝评估。
