AIMS: To investigate the diagnostic performance of quantitative flow ratio (QFR) in assessing the physiological relevance of coronary lesions in the presence of severe aortic valve stenosis (SAS). METHODS AND RESULTS: 115 SAS patients (138 coronary arteries) were included. Functional assessment of coronary stenoses was performed with fractional flow reserve (FFR) before transcatheter aortic-valve implantation (TAVI). Subsequently, QFR was calculated at a central core laboratory, blinded to FFR results. The diagnostic yield of QFR was assessed using FFR as reference. Coronary stenoses were intermediate (diameter stenosis 48±10%, FFR 0.84 [0.77-0.89], QFR 0.82 [0.73-0.89]). Per-vessel sensitivity, specificity, area under the ROC curve and accuracy of QFR were 84% (95% CI 71-92%), 80% (95% CI 69-88%), 0.88 (95% CI 0.82-0.93) and 81%, respectively. Diagnostic accuracy of QFR significantly decreased in patients with aortic valve area (AVA) <0.60 cm2. Diagnostic performance of QFR was superior to angiography in assessing the FFR-based functional significance (AUC 0.88 [95% CI 0.82-0.93] vs. 0.74 [95% CI 0.66-0.81], respectively; p = 0.0002). CONCLUSIONS: Compared with FFR, QFR has a good diagnostic yield and is superior to angiography in assessing the functional relevance of coronary lesions in SAS patients awaiting TAVI, particularly when AVA is ≥0.6 cm2.
AIMS: To investigate the diagnostic performance of quantitative flow ratio (QFR) in assessing the physiological relevance of coronary lesions in the presence of severe aortic valve stenosis (SAS). METHODS AND RESULTS: 115 SAS patients (138 coronary arteries) were included. Functional assessment of coronary stenoses was performed with fractional flow reserve (FFR) before transcatheter aortic-valve implantation (TAVI). Subsequently, QFR was calculated at a central core laboratory, blinded to FFR results. The diagnostic yield of QFR was assessed using FFR as reference. Coronary stenoses were intermediate (diameter stenosis 48±10%, FFR 0.84 [0.77-0.89], QFR 0.82 [0.73-0.89]). Per-vessel sensitivity, specificity, area under the ROC curve and accuracy of QFR were 84% (95% CI 71-92%), 80% (95% CI 69-88%), 0.88 (95% CI 0.82-0.93) and 81%, respectively. Diagnostic accuracy of QFR significantly decreased in patients with aortic valve area (AVA) <0.60 cm2. Diagnostic performance of QFR was superior to angiography in assessing the FFR-based functional significance (AUC 0.88 [95% CI 0.82-0.93] vs. 0.74 [95% CI 0.66-0.81], respectively; p = 0.0002). CONCLUSIONS: Compared with FFR, QFR has a good diagnostic yield and is superior to angiography in assessing the functional relevance of coronary lesions in SAS patients awaiting TAVI, particularly when AVA is ≥0.6 cm2.
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: Hendrik Wienemann; Marcel C Langenbach; Victor Mauri; Maryam Banazadeh; Konstantin Klein; Christopher Hohmann; Samuel Lee; Isabel Breidert; Alexander Hof; Kaveh Eghbalzadeh; Elmar Kuhn; Marcel Halbach; David Maintz; Stephan Baldus; Alexander Bunck; Matti Adam Journal: J Cardiovasc Dev Dis Date: 2022-04-14