Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
The Lambe Institute for Translational Research, Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland.
EuroIntervention. 2023 Jun 5;19(2):e145-e154. doi: 10.4244/EIJ-D-22-01098.
Optical flow ratio (OFR) is a novel method for the fast computation of fractional flow reserve (FFR) from optical coherence tomography.
We aimed to evaluate the diagnostic accuracy of OFR in assessing intermediate coronary stenosis using wire-based FFR as the reference.
We performed an individual patient-level meta-analysis of all available studies with paired OFR and FFR assessments. The primary outcome was vessel-level diagnostic concordance of the OFR and FFR, using a cut-off of ≤0.80 to define ischaemia and ≤0.90 to define suboptimal post-percutaneous coronary intervention (PCI) physiology. This meta-analysis was registered in PROSPERO (CRD42021287726).
Five studies were finally included, providing 574 patients and 626 vessels (404 pre-PCI and 222 post-PCI) with paired OFR and FFR from 9 international centres. Vessel-level diagnostic concordance of the OFR and FFR was 91% (95% confidence interval [CI]: 88%-94%), 87% (95% CI: 82%-91%), and 90% (95% CI: 87%-92%) in pre-PCI, post-PCI, and overall, respectively. The overall sensitivity, specificity, and positive and negative predictive values were 84% (95% CI: 79%-88%), 94% (95% CI: 92%-96%), 90% (95% CI: 86%-93%), and 89% (95% CI: 86%-92%), respectively. Multivariate logistic regression indicated that a low pullback speed (odds ratio [OR] 7.02, 95% CI: 1.68-29.43; p=0.008) was associated with a higher risk of obtaining OFR values at least 0.10 higher than FFR. Increasing the minimal lumen area was associated with a lower risk of obtaining an OFR at least 0.10 lower than FFR (OR 0.39, 95% CI: 0.18-0.82; p=0.013).
This individual patient data meta-analysis demonstrated a high diagnostic accuracy of OFR. OFR has the potential to provide an improved integration of intracoronary imaging and physiological assessment for the accurate evaluation of coronary artery disease.
光流比（OFR）是一种从光学相干断层扫描中快速计算分流量储备（FFR）的新方法。
我们旨在评估 OFR 在评估中间冠状动脉狭窄时的诊断准确性，以基于导丝的 FFR 作为参考。
我们对所有具有配对 OFR 和 FFR 评估的可用研究进行了个体患者水平的荟萃分析。主要结果是使用 ≤0.80 定义缺血和 ≤0.90 定义经皮冠状动脉介入治疗（PCI）后不理想的生理学的血管水平诊断一致性。这项荟萃分析在 PROSPERO（CRD42021287726）中进行了注册。
最终纳入了五项研究，来自 9 个国际中心的 574 名患者和 626 支血管（404 支 PCI 前和 222 支 PCI 后），具有配对的 OFR 和 FFR。OFR 和 FFR 的血管水平诊断一致性分别为 PCI 前 91%（95%置信区间[CI]：88%-94%）、PCI 后 87%（95% CI：82%-91%）和整体 90%（95% CI：87%-92%）。整体敏感性、特异性、阳性和阴性预测值分别为 84%（95% CI：79%-88%）、94%（95% CI：92%-96%）、90%（95% CI：86%-93%）和 89%（95% CI：86%-92%）。多变量逻辑回归表明，较低的回撤速度（比值比[OR] 7.02，95% CI：1.68-29.43；p=0.008）与获得至少比 FFR 高 0.10 的 OFR 值的风险增加相关。最小管腔面积的增加与获得至少比 FFR 低 0.10 的 OFR 值的风险降低相关（OR 0.39，95% CI：0.18-0.82；p=0.013）。
这项个体患者数据荟萃分析显示 OFR 的诊断准确性很高。OFR 有可能为准确评估冠状动脉疾病提供更好的腔内成像和生理学评估的整合。
