Kirigaya Hidekuni, Okada Kozo, Hibi Kiyoshi, Maejima Nobuhiko, Iwahashi Noriaki, Matsuzawa Yasushi, Akiyama Eiichi, Minamimoto Yugo, Kosuge Masami, Ebina Toshiaki, Tamura Kouichi, Kimura Kazuo
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
J Cardiol. 2021 May;77(5):492-499. doi: 10.1016/j.jjcc.2020.11.002. Epub 2020 Nov 24.
This study aimed to simultaneously investigate diagnostic performance and limitation of quantitative flow reserve (QFR) for assessing functionally significant coronary stenosis, focusing on factors affecting diagnostic accuracy of QFR.
This study evaluated 1) QFR diagnostic accuracy compared with fractional flow reserve (FFR) in patients with stable coronary artery disease (Cohort-A, n = 95) and 2) QFR reproducibility for non-culprit lesions (NCLs) assessment between acute and staged (14±5 days later) procedures in patients with ST-segment elevation myocardial infarction (STEMI) (Cohort-B, n = 65). All coronary angiography image acquisition was performed before the introduction of QFR system into our institution.
Cohort-A showed good correlation (r = 0.80, p<0.0001) between QFR and FFR; diagnostic accuracy of QFR for FFR ≤0.80 was 85.2% (sensitivity 80.4%, specificity 91.0%, positive predictive value 91.1%, negative predictive value 80.0%). There were 14 lesions showing discordance between QFR and FFR, which was primarily attributable to inadequate lesion visualization due to vessel overlap/tortuosity and/or insufficient intra-coronary contrast-media injection. In Cohort-B, there was also excellent correlation between acute and staged QFR; classification agreement of acute and staged QFR was 92.3%. Five lesions showed discordance between acute and staged QFR, 4 were due to limited image acquisition and/or high coronary flow velocity at acute phase of STEMI and 1 was borderline ischemia.
QFR-derived physiological assessment of intermediate coronary stenosis is feasible, even in the acute setting of STEMI. Adjusting some technical factors may further improve the diagnostic performance of QFR.
本研究旨在同时调查定量血流储备（QFR）评估功能性显著冠状动脉狭窄的诊断性能和局限性，重点关注影响QFR诊断准确性的因素。
本研究评估了1）在稳定型冠状动脉疾病患者中（队列A，n = 95），QFR与血流储备分数（FFR）相比的诊断准确性，以及2）在ST段抬高型心肌梗死（STEMI）患者中（队列B，n = 65），非罪犯病变（NCL）在急性期和分期（14±5天后）手术之间的QFR可重复性。所有冠状动脉造影图像采集均在QFR系统引入本机构之前进行。
队列A显示QFR与FFR之间具有良好的相关性（r = 0.80，p<0.0001）；对于FFR≤0.80，QFR的诊断准确性为85.2%（敏感性80.4%，特异性91.0%，阳性预测值91.1%，阴性预测值80.0%）。有14个病变显示QFR与FFR不一致，这主要归因于血管重叠/迂曲导致的病变可视化不足和/或冠状动脉内造影剂注射不足。在队列B中，急性期和分期QFR之间也具有极好的相关性；急性期和分期QFR的分类一致性为92.3%。有5个病变显示急性期和分期QFR不一致，4个是由于STEMI急性期图像采集受限和/或冠状动脉血流速度过高，1个是临界缺血。
即使在STEMI急性期，基于QFR的冠状动脉中度狭窄生理评估也是可行的。调整一些技术因素可能会进一步提高QFR的诊断性能。
