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Association of Quantitative Flow Ratio with Lesion Severity and Its Ability to Discriminate Myocardial Ischemia

Korean Circulation Journal 2021년 51권 2호 p.126 ~ 139
Dai Neng, 황도연, 이주명, Zhang Jinlong, Tong Yaliang, 전기현, 팽진철, 천기정, 구본권, Ge Junbo,
소속 상세정보
 ( Dai Neng ) - Fudan University Zhongshan Hospital Department of Cardiology
황도연 ( Hwang Do-Yeon ) - Seoul National University Hospital Department of Internal Medicine
이주명 ( Lee Joo-Myung ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Internal Medicine
 ( Zhang Jinlong ) - Seoul National University Hospital Department of Internal Medicine
 ( Tong Yaliang ) - Jilin University China-Japan Union Hospital Department of Cardiology
전기현 ( Jeon Ki-Hyun ) - Sejong General Hospital Department of Internal Medicine
팽진철 ( Paeng Jin-Chul ) - Seoul National University Hospital Department of Nuclear Medicine
천기정 ( Cheon Gi-Jeong ) - Seoul National University Hospital Department of Nuclear Medicine
구본권 ( Koo Bon-Kwon ) - Seoul National University Hospital Department of Internal Medicine
 ( Ge Junbo ) - Fudan University Zhongshan Hospital Department of Cardiology

Abstract


Background and Objectives: Quantitative flow ratio (QFR) is an angiography-based technique for functional assessment of coronary artery stenosis. This study investigated the response of QFR to different degree of stenosis severity and its ability to predict the positron emission tomography (PET)-defined myocardial ischemia.

Methods: From 109 patients with 185 vessels who underwent both 13N-ammonia PET and invasive physiological measurement, we compared QFR, fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) for the responses to the different degree of anatomical (percent diameter stenosis [%DS]) and hemodynamic (relative flow reserve [RFR], coronary flow reserve, hyperemic stenosis resistance, and stress myocardial flow) stenosis severity and diagnostic performance against PET-derived parameters.

Results: QFR, FFR, and iFR showed similar responses to both anatomic and hemodynamic stenosis severity. Regarding RFR, the diagnostic accuracy of QFR was lower than FFR (76.2% vs. 83.2%, p=0.021) and iFR (76.2% vs. 84.3%, p=0.031). For coronary flow capacity (CFC), QFR showed a lower accuracy than iFR (74.1% vs. 82%, p=0.031) and lower discriminant function than FFR (area under curve: 0.74 vs. 0.79, p=0.044). Discordance between QFR and FFR or iFR was shown in 14.6% of cases and was driven by the difference in %DS and heterogeneous distribution of PET-derived RFR and stress myocardial blood flow.

Conclusions: QFR demonstrated a similar response to different anatomic and hemodynamic stenosis severity as FFR or iFR. However, its diagnostic performance was inferior to FFR and iFR when PET-derived RFR and CFC were used as a reference.

키워드

Coronary artery disease; Myocardial ischemia; Positron emission tomography

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