Cardiovascular revascularization medicine : including molecular interventions · 2025
Quantitative flow ratio and non-hyperemic pressure ratio in patients with intermediate coronary lesions.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Finocchiaro Simone, Mauro Maria Sara, Sclofani Davide, Spagnolo Marco, Greco Antonio, Capodanno Davide
Аннотация
BACKGROUND: Quantitative flow ratio (QFR) is a recent, non-invasive method for functional coronary assessment, providing estimates of lesion-specific ischemia without the need for pressure wires or hyperemic agents. While its diagnostic concordance with fractional flow reserve (FFR) has been previously explored, data comparing QFR to non-hyperemic pressure ratios (NHPRs), such as instantaneous wave-free ratio (iwFR) and resting full-cycle ratio (RFR), remain limited.
OBJECTIVES: This study aimed to evaluate the diagnostic agreement between QFR and NHPRs in real-world patients undergoing physiological assessment for intermediate coronary stenoses.
METHODS: Lesions from the CAST registry with available iwFR or RFR and analyzable angiograms for QFR computation were included. Ischemia was defined as NHPRs ≤0.89 or QFR ≤0.80. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and ROC analysis (AUC via DeLong's method). Agreement was evaluated with Cohen's kappa and Bland-Altman analysis. McNemar's test assessed asymmetry in discordant pairs. Spearman's correlation and logistic univariate and multivariable regressions identified predictors of QFR-NHPRs discordance.
RESULTS: A total of 174 lesions from 142 patients were included in the final analysis. QFR demonstrated a diagnostic accuracy of 79 %, with a sensitivity of 90 % and a negative predictive value of 82 %, in respect of NHPRs. Specificity and positive predictive value were 63 % and 78 %, respectively. The area under the ROC curve was 0.80 (95 % CI, 0.733-0.867). QFR underestimated ischemia in 14.9 % of lesions (false negatives), and overall diagnostic discordance with NHPRs occurred in 20.7 % of cases. Longer lesion length was independently associated with higher concordance (OR 0.95, 95 % CI 0.91-0.99, p = 0.012), while bifurcation lesions were predictors of discordance (OR 4.81, 95 % CI 1.30-21.12, p = 0.024).
CONCLUSIONS: QFR shows moderate concordance with NHPRs and may serve as a useful, wire-free alternative for excluding functionally significant stenoses. While it demonstrated high sensitivity, the risk of false negatives in certain anatomical subsets highlights the value of a cautious, individualized approach, possibly integrating QFR with invasive indices or imaging modalities in selected cases.
OBJECTIVES: This study aimed to evaluate the diagnostic agreement between QFR and NHPRs in real-world patients undergoing physiological assessment for intermediate coronary stenoses.
METHODS: Lesions from the CAST registry with available iwFR or RFR and analyzable angiograms for QFR computation were included. Ischemia was defined as NHPRs ≤0.89 or QFR ≤0.80. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and ROC analysis (AUC via DeLong's method). Agreement was evaluated with Cohen's kappa and Bland-Altman analysis. McNemar's test assessed asymmetry in discordant pairs. Spearman's correlation and logistic univariate and multivariable regressions identified predictors of QFR-NHPRs discordance.
RESULTS: A total of 174 lesions from 142 patients were included in the final analysis. QFR demonstrated a diagnostic accuracy of 79 %, with a sensitivity of 90 % and a negative predictive value of 82 %, in respect of NHPRs. Specificity and positive predictive value were 63 % and 78 %, respectively. The area under the ROC curve was 0.80 (95 % CI, 0.733-0.867). QFR underestimated ischemia in 14.9 % of lesions (false negatives), and overall diagnostic discordance with NHPRs occurred in 20.7 % of cases. Longer lesion length was independently associated with higher concordance (OR 0.95, 95 % CI 0.91-0.99, p = 0.012), while bifurcation lesions were predictors of discordance (OR 4.81, 95 % CI 1.30-21.12, p = 0.024).
CONCLUSIONS: QFR shows moderate concordance with NHPRs and may serve as a useful, wire-free alternative for excluding functionally significant stenoses. While it demonstrated high sensitivity, the risk of false negatives in certain anatomical subsets highlights the value of a cautious, individualized approach, possibly integrating QFR with invasive indices or imaging modalities in selected cases.