Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Catheterization Laboratories, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Int J Cardiol. 2024 Apr 1;400:131765. doi: 10.1016/j.ijcard.2024.131765. Epub 2024 Jan 9.
Ultrasonic flow ratio (UFR) is a novel intravascular ultrasound (IVUS)-derived modality for fast computation of fractional flow reserve (FFR) without pressure wires and adenosine.
This study was sought to compare the diagnostic performance of UFR and quantitative flow ratio (QFR), using FFR as the reference standard.
This is a retrospective study enrolling consecutive patients with intermediate coronary artery lesions (diameter stenosis of 30%-90% by visual estimation) for IVUS and FFR measurement. UFR and QFR were performed offline in a core-lab by independent analysts blinded to FFR.
From December 2022 to May 2023, a total of 78 eligible patients were enrolled. IVUS and FFR measurements were successfully conducted in 104 vessels, finally 98 vessels with both FFR, UFR and QFR evaluation were analyzed. Mean FFR was 0.79 ± 0.12. UFR showed a strong correlation with FFR similar to QFR (r = 0.83 vs. 0.82, p = 0.795). Diagnostic accuracy of UFR was non-inferior to QFR (94% [89%-97%] versus 90% [84%-94%], p = 0.113). Sensitivity and specificity in identifying hemodynamically significant stenosis were comparable between UFR and QFR (sensitivity: 89% [79%-96%] versus 85% [74%-92%], p = 0.453; specificity: 97% [91%-99%] versus 95% [88%-99%], p = 0.625). The area under curve for UFR was 0.95 [0.90-0.98], non-inferior to QFR (difference = 0.021, p = 0.293), and significantly higher than minimum lumen area (MLA; difference = 0.13, p < 0.001). Diagnostic accuracy of UFR and QFR was not statically different in bifurcation nor non-bifurcation lesions.
UFR showed excellent concordance with FFR, non-inferior to QFR, superior to MLA. UFR provides a potentiality for the integration of physiological assessment and intravascular imaging in clinical practice.
超声血流比值（UFR）是一种新的血管内超声（IVUS）衍生模式，可在无需压力导丝和腺苷的情况下快速计算血流储备分数（FFR）。
本研究旨在比较 UFR 和定量血流比值（QFR）的诊断性能，以 FFR 为参考标准。
这是一项回顾性研究，纳入了 78 名接受 IVUS 和 FFR 测量的中间冠状动脉病变患者（通过目测估计直径狭窄 30%-90%）。UFR 和 QFR 由独立的分析人员在核心实验室进行离线分析，分析人员对 FFR 不知情。
从 2022 年 12 月至 2023 年 5 月，共纳入 78 名符合条件的患者。104 个血管成功进行了 IVUS 和 FFR 测量，最终分析了 98 个有 FFR、UFR 和 QFR 评估的血管。平均 FFR 为 0.79±0.12。UFR 与 FFR 的相关性与 QFR 相似（r=0.83 与 0.82，p=0.795）。UFR 的诊断准确性不劣于 QFR（94%[89%-97%]与 90%[84%-94%]，p=0.113）。UFR 和 QFR 识别血流动力学显著狭窄的敏感性和特异性相当（敏感性：89%[79%-96%]与 85%[74%-92%]，p=0.453；特异性：97%[91%-99%]与 95%[88%-99%]，p=0.625）。UFR 的曲线下面积为 0.95[0.90-0.98]，不劣于 QFR（差值=0.021，p=0.293），明显高于最小管腔面积（MLA；差值=0.13，p<0.001）。UFR 和 QFR 在分叉病变和非分叉病变中的诊断准确性无统计学差异。
UFR 与 FFR 具有极好的一致性，不劣于 QFR，优于 MLA。UFR 为将生理评估与血管内成像整合到临床实践中提供了潜力。
