Milzi Andrea, Dettori Rosalia, Burgmaier Kathrin, Marx Nikolaus, Reith Sebastian, Burgmaier Mathias
Department of Cardiology, University Hospital of the RWTH Aachen, D-52074 Aachen, Germany.
Department of Pediatrics, University Hospital Cologne, D-50441 Cologne, Germany.
J Clin Med. 2021 Apr 24;10(9):1856. doi: 10.3390/jcm10091856.
Quantitative flow ratio (QFR) is a novel method for assessing hemodynamic relevance of a coronary lesion based on angiographic projections without the need of a pressure wire. Various studies demonstrated that QFR consistently related to fractional flow reserve (FFR); however, it is still unclear to what extent QFR reflects intraluminal stenosis parameters. Given that optical coherence tomography (OCT) is currently the gold standard to assess intraluminal stenosis parameters, we investigated the relationship between OCT-derived lesion geometry and QFR. We determined QFR in 97 lesions from 87 patients who underwent coronary angiography and OCT due to stable angina. QFR was measured with proprietary software and compared with OCT-based assessment of intraluminal stenosis parameters as well as lesion morphology. Mean QFR was 0.79 ± 0.10. QFR demonstrated a consistent association with FFR (R = 0.834, < 0.001). Interestingly, QFR was associated with OCT-derived parameters such as minimal lumen area (MLA, R = 0.390, = 0.015), percent area stenosis (R = 0.412, < 0.001), minimal lumen diameter (MLD, R = 0.395, < 0.001), and percent diameter stenosis (R = 0.400, < 0.001). Both minimal luminal area (ROC = 0.734, optimal cut-off 1.75 mm) and minimal luminal diameter (ROC = 0.714, optimal cut-off 1.59 mm) presented a good diagnostic accuracy in diagnosing hemodynamic relevance (QFR ≤ 0.80). There was no significant association between QFR and anatomic features of plaque vulnerability. OCT-derived intraluminal stenosis parameters are related to QFR values and predict hemodynamic lesion relevance. The data supports the validity of QFR as 3D-vessel reconstruction method to assess coronary physiology without the need of a pressure wire.
定量血流比（QFR）是一种基于血管造影投影评估冠状动脉病变血流动力学相关性的新方法，无需使用压力导丝。多项研究表明，QFR与血流储备分数（FFR）始终相关；然而，QFR在多大程度上反映管腔内狭窄参数仍不清楚。鉴于光学相干断层扫描（OCT）目前是评估管腔内狭窄参数的金标准，我们研究了OCT衍生的病变几何形状与QFR之间的关系。我们对87例因稳定型心绞痛接受冠状动脉造影和OCT检查的患者的97处病变进行了QFR测定。使用专有软件测量QFR，并将其与基于OCT的管腔内狭窄参数评估以及病变形态进行比较。平均QFR为0.79±0.10。QFR与FFR表现出一致的相关性（R = 0.834，P < 0.001）。有趣的是，QFR与OCT衍生的参数相关，如最小管腔面积（MLA，R = 0.390，P = 0.015）、面积狭窄百分比（R = 0.412，P < 0.001）、最小管腔直径（MLD，R = 0.395，P < 0.001）和直径狭窄百分比（R = 0.400，P < 0.001）。最小管腔面积（ROC = 0.734，最佳截断值1.75 mm）和最小管腔直径（ROC = 0.714，最佳截断值1.59 mm）在诊断血流动力学相关性（QFR≤0.80）方面均具有良好的诊断准确性。QFR与斑块易损性的解剖特征之间无显著相关性。OCT衍生的管腔内狭窄参数与QFR值相关，并可预测血流动力学病变相关性。这些数据支持QFR作为一种无需压力导丝即可评估冠状动脉生理学的三维血管重建方法的有效性。
