Samaan Amir Anwar, Mostafa Amir, Wahba Sherif Lotfy, Kerlos Matteo, Elamragy Ahmed Adel, Shelbaya Khaled, Elsobky Yasmin, Hassan Mohamed
Cardiology Department, Cairo University, Giza, Egypt.
Cardiology Department, AlNas Hospital, Qalyubia, Egypt.
Egypt Heart J. 2024 Aug 26;76(1):113. doi: 10.1186/s43044-024-00541-y.
Instantaneous wave-free ratio (iwFR) is a well-validated method for functional evaluation of intermediate coronary lesions. A recently developed Murray law-based QFR (µQFR) allows wire-free FFR estimation using a high-quality single angiographic projection. We aim to determine the diagnostic accuracy of µQFR as compared to wire-based iwFR for physiological assessment of coronary lesions in a sample of Egyptian patients.
Over a one-year period, patients who previously underwent iwFR assessment of an intermediate coronary stenosis (40-90%) were retrospectively included. μQFR analysis was then performed offline using a dedicated artificial intelligence (AI)-aided computation software. All the measurements were performed blinded to iwFR results, and the agreement between iwFR and μQFR values was tested. Forty-nine patients (mean age 57.9 ± 9 years, 72.9% males) were included. Mean value of iwFR and μQFR was 0.90 ± 0.075 and 0.79 ± 0.129, respectively. There was a significant moderate positive linear correlation between μQFR and iwFR (r = 0.47, p = 0.001; 95% CI 0.22-0.68) with moderate-to-substantial agreement between the two methods (Kappa 0.6). In assessing the diagnostic accuracy of μQFR, the receiver operating characteristic (ROC) curve yielded an area under the curve (AUC) of 0.84 (95% CI 0.717-0.962) for predicting functionally significant lesions defined as iwFR < 0.89. The sensitivity and specificity of μQFR < 0.8 for detecting physiological significance of coronary lesions were 89% and 74% with positive and negative predictive values of 70 and 91%, respectively.
µQFR has good diagnostic accuracy for predicting functionally significant coronary lesions with moderate correlation and agreement with the gold standard iwFR. Angiography-derived µQFR could be a promising tool for improving the utilization of physiology-guided revascularization.
瞬时无波比值（iwFR）是一种经过充分验证的评估冠状动脉中度病变功能的方法。最近开发的基于莫雷定律的定量血流分数（µQFR）可通过高质量的单幅血管造影投影进行无导丝的血流储备分数（FFR）估算。我们旨在确定在一组埃及患者样本中，与基于导丝的iwFR相比，µQFR对冠状动脉病变进行生理评估的诊断准确性。
在一年的时间里，回顾性纳入了之前接受过冠状动脉中度狭窄（40 - 90%）iwFR评估的患者。然后使用专用的人工智能（AI）辅助计算软件进行离线µQFR分析。所有测量均在对iwFR结果不知情的情况下进行，并测试了iwFR与µQFR值之间的一致性。纳入了49例患者（平均年龄57.9 ± 9岁，72.9%为男性）。iwFR和µQFR的平均值分别为0.90 ± 0.075和0.79 ± 0.129。µQFR与iwFR之间存在显著的中度正线性相关性（r = 0.47，p = 0.001；95%可信区间0.22 - 0.68），两种方法之间存在中度至高度一致性（卡帕值0.6）。在评估µQFR的诊断准确性时，对于预测定义为iwFR < 0.89的功能上有意义的病变，受试者操作特征（ROC）曲线的曲线下面积（AUC）为0.84（95%可信区间0.717 - 0.962）。µQFR < 0.8用于检测冠状动脉病变生理意义的敏感性和特异性分别为89%和74%，阳性预测值和阴性预测值分别为70%和91%。
µQFR在预测功能上有意义的冠状动脉病变方面具有良好的诊断准确性，与金标准iwFR具有中度相关性和一致性。血管造影衍生的µQFR可能是改善生理引导下血管重建术应用的一种有前景的工具。
