Giosafat Spitaleri1, Matteo Tebaldi1, Simone Biscaglia1, Jelmer Westra1, Salvatore Brugaletta1, Andrea Erriquez1, Giulia Passarini1, Alessandro Brieda1, Antonio Maria Leone1, Andrea Picchi1, Alfonso Ielasi1, Domenico Di Girolamo1, Carlo Trani1, Roberto Ferrari1, Johan H C Reiber1, Marco Valgimigli1, Manel Sabatè1, Gianluca Campo2. 1. From the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy (G.S., M.T., S.B., A.E., G.P., A.B., R.F., G.C.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W.); University Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., M.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (A.M.L., C.T.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (A.P.); Bolognini Hospital, Seriate (BG), Italy (A.I.); Cardiologia Interventistica, A.O. Sant'Anna e San Sebastiano, Caserta, Italy (D.D.G.); Maria Cecilia Hospital, GVM Care and Research, E.S: Health Science Foundation, Cotignola, Italy (R.F., G.C.); Department of Radiology, Leiden University Medical Center, the Netherlands (J.H.C.R.); and University Hospital of Bern, Inselspital, Switzerland (M.V.). 2. From the Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy (G.S., M.T., S.B., A.E., G.P., A.B., R.F., G.C.); Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W.); University Hospital Clínic, Cardiovascular Clinic Institute, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., M.S.); Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy (A.M.L., C.T.); Division of Cardiology, Misericordia Hospital, Grosseto, Italy (A.P.); Bolognini Hospital, Seriate (BG), Italy (A.I.); Cardiologia Interventistica, A.O. Sant'Anna e San Sebastiano, Caserta, Italy (D.D.G.); Maria Cecilia Hospital, GVM Care and Research, E.S: Health Science Foundation, Cotignola, Italy (R.F., G.C.); Department of Radiology, Leiden University Medical Center, the Netherlands (J.H.C.R.); and University Hospital of Bern, Inselspital, Switzerland (M.V.). cmpglc@unife.it.
Abstract
BACKGROUND: The nonculprit lesion (NCL) management in ST-segment-elevation myocardial infarction patients with multivessel disease is debated. We sought to assess whether quantitative flow ratio (QFR), a noninvasive tool to identify potentially flow-limiting lesions, may be reliable in this scenario. METHODS AND RESULTS: The present proof-of-concept study is based on a 3-step process: (1) identification of the QFR reproducibility in NCLs assessment (cohort A, n=31); (2) prospective validation of QFR diagnostic accuracy in respect to fractional flow reserve (cohort B, n=45); and (3) investigation of long-term clinical outcomes of NCLs stratified according to QFR (cohort C, n=110). A blinded core laboratory computed QFR values for all NCLs. Cohort A showed a good correlation and agreement between QFR values at index (acute) and at staged (subacute, 3-4 days later) procedures (r=0.98; 95% confidence interval, 0.96-0.99; mean difference, 0.004 [-0.027 to 0.34]). The inter-rater agreement was κ=0.9. In cohort B, fractional flow reserve and QFR identified 16 (33%) and 17 (35%) NCLs potentially flow limiting. Sensitivity, specificity, negative, and positive predictive values were 88%, 97%, 94%, and 94%. The area under the receiver operating characteristics curve was 0.96 (95% confidence interval, 0.89-0.99). Finally, in cohort C, we identified 110 ST-segment-elevation myocardial infarction patients where at least 1 NCL was left untreated. Patients with NCLs showing a QFR value ≤0.80 were at higher risk of adverse events (hazard ratio, 2.3; 95% confidence interval, 1.2-4.5; P=0.01). CONCLUSIONS: In a limited and selected study population, our study showed that QFR computation may be a safe and reliable tool to guide coronary revascularization of NCLs in ST-segment-elevation myocardial infarction patients.
BACKGROUND: The nonculprit lesion (NCL) management in ST-segment-elevation myocardial infarctionpatients with multivessel disease is debated. We sought to assess whether quantitative flow ratio (QFR), a noninvasive tool to identify potentially flow-limiting lesions, may be reliable in this scenario. METHODS AND RESULTS: The present proof-of-concept study is based on a 3-step process: (1) identification of the QFR reproducibility in NCLs assessment (cohort A, n=31); (2) prospective validation of QFR diagnostic accuracy in respect to fractional flow reserve (cohort B, n=45); and (3) investigation of long-term clinical outcomes of NCLs stratified according to QFR (cohort C, n=110). A blinded core laboratory computed QFR values for all NCLs. Cohort A showed a good correlation and agreement between QFR values at index (acute) and at staged (subacute, 3-4 days later) procedures (r=0.98; 95% confidence interval, 0.96-0.99; mean difference, 0.004 [-0.027 to 0.34]). The inter-rater agreement was κ=0.9. In cohort B, fractional flow reserve and QFR identified 16 (33%) and 17 (35%) NCLs potentially flow limiting. Sensitivity, specificity, negative, and positive predictive values were 88%, 97%, 94%, and 94%. The area under the receiver operating characteristics curve was 0.96 (95% confidence interval, 0.89-0.99). Finally, in cohort C, we identified 110 ST-segment-elevation myocardial infarctionpatients where at least 1 NCL was left untreated. Patients with NCLs showing a QFR value ≤0.80 were at higher risk of adverse events (hazard ratio, 2.3; 95% confidence interval, 1.2-4.5; P=0.01). CONCLUSIONS: In a limited and selected study population, our study showed that QFR computation may be a safe and reliable tool to guide coronary revascularization of NCLs in ST-segment-elevation myocardial infarctionpatients.
Authors: Cameron Dowling; Michael Michail; Jun Michael Zhang; Andrea Comella; Udit Thakur; Robert Gooley; Liam McCormick; Adam J Brown; Dennis T L Wong Journal: Cardiovasc Diagn Ther Date: 2022-06
Authors: Aslihan Erbay; Lisa Penzel; Youssef S Abdelwahed; Jens Klotsche; Anne-Sophie Schatz; Julia Steiner; Arash Haghikia; Ulf Landmesser; Barbara E Stähli; David M Leistner Journal: Int J Cardiovasc Imaging Date: 2021-03-02 Impact factor: 2.357