Applicability of 3-Dimensional Quantitative Coronary Angiography-Derived Computed Fractional Flow Reserve for Intermediate Coronary Stenosis

Background:Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).Methods and Results:We analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined con...

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Published inCirculation Journal Vol. 81; no. 7; pp. 988 - 992
Main Authors Enta, Kenji, Kataoka, Shohei, Kumagai, Asako, Kahata, Mitsuru, Yazaki, Kyoichiro, Inoue, Koji, Koganei, Hiroshi, Otsuka, Masato, Ishii, Yasuhiro
Format Journal Article
LanguageEnglish
Published Japan The Japanese Circulation Society 2017
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Online AccessGet full text
ISSN1346-9843
1347-4820
1347-4820
DOI10.1253/circj.CJ-16-1261

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Abstract Background:Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).Methods and Results:We analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined contrast flow QFR, which was derived from 3-dimensional quantitative coronary angiography (3-D QCA) withThrombolysis in Myocardial Infarction (TIMI) frame counts, was compared with FFR as a reference. QFR had good correlation (r=0.80, P<0.0001) and agreement (mean difference: 0.01±0.05) with FFR. After applying the FFR cut-off ≤0.8, the overall accuracy rate of QFR ≤0.8 was 88.0%. On receiver operating characteristics analysis, the area under the curve was 0.93 for QFR. In contrast, 3-D QCA-derived anatomical indices had insufficient correlation with FFR and diagnostic performance compared with QFR.Conclusions:QFR had good correlation and agreement with FFR and high diagnostic performance in the evaluation of intermediate coronary stenosis, suggesting that QFR may be an alternative tool for estimating myocardial ischemia.
AbstractList Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).Methods and Results:We analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined contrast flow QFR, which was derived from 3-dimensional quantitative coronary angiography (3-D QCA) withThrombolysis in Myocardial Infarction (TIMI) frame counts, was compared with FFR as a reference. QFR had good correlation (r=0.80, P<0.0001) and agreement (mean difference: 0.01±0.05) with FFR. After applying the FFR cut-off ≤0.8, the overall accuracy rate of QFR ≤0.8 was 88.0%. On receiver operating characteristics analysis, the area under the curve was 0.93 for QFR. In contrast, 3-D QCA-derived anatomical indices had insufficient correlation with FFR and diagnostic performance compared with QFR. QFR had good correlation and agreement with FFR and high diagnostic performance in the evaluation of intermediate coronary stenosis, suggesting that QFR may be an alternative tool for estimating myocardial ischemia.
Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).BACKGROUNDQuantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).We analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined contrast flow QFR, which was derived from 3-dimensional quantitative coronary angiography (3-D QCA) withThrombolysis in Myocardial Infarction (TIMI) frame counts, was compared with FFR as a reference. QFR had good correlation (r=0.80, P<0.0001) and agreement (mean difference: 0.01±0.05) with FFR. After applying the FFR cut-off ≤0.8, the overall accuracy rate of QFR ≤0.8 was 88.0%. On receiver operating characteristics analysis, the area under the curve was 0.93 for QFR. In contrast, 3-D QCA-derived anatomical indices had insufficient correlation with FFR and diagnostic performance compared with QFR.METHODS AND RESULTSWe analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined contrast flow QFR, which was derived from 3-dimensional quantitative coronary angiography (3-D QCA) withThrombolysis in Myocardial Infarction (TIMI) frame counts, was compared with FFR as a reference. QFR had good correlation (r=0.80, P<0.0001) and agreement (mean difference: 0.01±0.05) with FFR. After applying the FFR cut-off ≤0.8, the overall accuracy rate of QFR ≤0.8 was 88.0%. On receiver operating characteristics analysis, the area under the curve was 0.93 for QFR. In contrast, 3-D QCA-derived anatomical indices had insufficient correlation with FFR and diagnostic performance compared with QFR.QFR had good correlation and agreement with FFR and high diagnostic performance in the evaluation of intermediate coronary stenosis, suggesting that QFR may be an alternative tool for estimating myocardial ischemia.CONCLUSIONSQFR had good correlation and agreement with FFR and high diagnostic performance in the evaluation of intermediate coronary stenosis, suggesting that QFR may be an alternative tool for estimating myocardial ischemia.
Background:Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).Methods and Results:We analyzed 151 coronary arteries with intermediate stenosis in 142 patients undergoing wire-based FFR measurement using dedicated software. Predefined contrast flow QFR, which was derived from 3-dimensional quantitative coronary angiography (3-D QCA) withThrombolysis in Myocardial Infarction (TIMI) frame counts, was compared with FFR as a reference. QFR had good correlation (r=0.80, P<0.0001) and agreement (mean difference: 0.01±0.05) with FFR. After applying the FFR cut-off ≤0.8, the overall accuracy rate of QFR ≤0.8 was 88.0%. On receiver operating characteristics analysis, the area under the curve was 0.93 for QFR. In contrast, 3-D QCA-derived anatomical indices had insufficient correlation with FFR and diagnostic performance compared with QFR.Conclusions:QFR had good correlation and agreement with FFR and high diagnostic performance in the evaluation of intermediate coronary stenosis, suggesting that QFR may be an alternative tool for estimating myocardial ischemia.
Author Yazaki, Kyoichiro
Ishii, Yasuhiro
Kahata, Mitsuru
Kumagai, Asako
Kataoka, Shohei
Inoue, Koji
Enta, Kenji
Otsuka, Masato
Koganei, Hiroshi
Author_xml – sequence: 1
  fullname: Enta, Kenji
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
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  fullname: Kataoka, Shohei
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
– sequence: 1
  fullname: Kumagai, Asako
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
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  fullname: Kahata, Mitsuru
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
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  fullname: Yazaki, Kyoichiro
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
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  fullname: Inoue, Koji
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
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  fullname: Koganei, Hiroshi
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
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  fullname: Otsuka, Masato
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
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  fullname: Ishii, Yasuhiro
  organization: Department of Cardiology, Cardiovascular Center, Ogikubo Hospital
BackLink https://www.ncbi.nlm.nih.gov/pubmed/28331135$$D View this record in MEDLINE/PubMed
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References 8. Morris PD, van de Vosse FN, Lawford PV, Hose DR, Gunn JP. “Virtual” (computed) fractional flow reserve: Current challenges and limitations. JACC Cardiovasc Interv 2015; 8: 1009–1017.
9. Norgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: The NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol 2014; 63: 1145–1155.
15. Tu S, Westra J, Yang J, von Birgelen C, Ferrara A, Pellicano M, et al. Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography: The International Multicenter FAVOR Pilot Study. JACC Cardiovasc Interv 2016; 9: 2024–2035.
3. van Nunen LX, Zimmermann FM, Tonino PAL, Barbato E, Baumbach A, Engstrøm T, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 2015; 386: 1853–1860.
12. Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 2011; 58: 1989–1997.
17. Kirkeeide RL. Coronary obstructions, morphology and physiologic significance. In: Reiber JHC, Serruys PW, editors. Quantitative coronary arteriography. Dordrecht: Springer Netherlands, 1991; 229 – 244.
5. Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van’t Veer M, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol 2007; 49: 2105–2111.
11. Tu S, Barbato E, Koszegi Z, Yang J, Sun Z, Holm NR, et al. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: A fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv 2014; 7: 768–777.
6. Pijls NHJ. Fractional flow reserve to guide coronary revascularization. Circ J 2013; 77: 561–569.
16. De Bruyne B, Paulus WJ, Pijls NHJ. Rationale and application of coronary transstenotic pressure gradient measurements. Cathet Cardiovasc Diagn 1994; 33: 250–261.
13. Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 2012; 308: 1237–1245.
4. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64: 1929–1949.
2. Tonino PAL, De Bruyne B, Pijls NHJ, Siebert U, Ikeno F, van’t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009; 360: 213–224.
14. Nakazato R, Park HB, Berman DS, Gransar H, Koo BK, Erglis A, et al. Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: Results from the DeFACTO study. Circ Cardiovasc Imaging 2013; 6: 881–889.
1. Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol 2010; 55: 173–185.
7. Morris PD, Ryan D, Morton AC, Lycett R, Lawford PV, Hose DR, et al. Virtual fractional flow reserve from coronary angiography: Modeling the significance of coronary lesions: Results from the VIRTU-1 (VIRTUal Fractional Flow Reserve From Coronary Angiography) study. JACC Cardiovasc Interv 2013; 6: 149–157.
10. Papafaklis MI, Muramatsu T, Ishibashi Y, Lakkas LS, Nakatani S, Bourantas CV, et al. Fast virtual functional assessment of intermediate coronary lesions using routine angiographic data and blood flow simulation in humans: Comparison with pressure wire: Fractional flow reserve. EuroIntervention 2014; 10: 574–583.
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References_xml – reference: 3. van Nunen LX, Zimmermann FM, Tonino PAL, Barbato E, Baumbach A, Engstrøm T, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet 2015; 386: 1853–1860.
– reference: 8. Morris PD, van de Vosse FN, Lawford PV, Hose DR, Gunn JP. “Virtual” (computed) fractional flow reserve: Current challenges and limitations. JACC Cardiovasc Interv 2015; 8: 1009–1017.
– reference: 12. Koo BK, Erglis A, Doh JH, Daniels DV, Jegere S, Kim HS, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol 2011; 58: 1989–1997.
– reference: 6. Pijls NHJ. Fractional flow reserve to guide coronary revascularization. Circ J 2013; 77: 561–569.
– reference: 2. Tonino PAL, De Bruyne B, Pijls NHJ, Siebert U, Ikeno F, van’t Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009; 360: 213–224.
– reference: 14. Nakazato R, Park HB, Berman DS, Gransar H, Koo BK, Erglis A, et al. Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: Results from the DeFACTO study. Circ Cardiovasc Imaging 2013; 6: 881–889.
– reference: 16. De Bruyne B, Paulus WJ, Pijls NHJ. Rationale and application of coronary transstenotic pressure gradient measurements. Cathet Cardiovasc Diagn 1994; 33: 250–261.
– reference: 9. Norgaard BL, Leipsic J, Gaur S, Seneviratne S, Ko BS, Ito H, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: The NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol 2014; 63: 1145–1155.
– reference: 5. Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van’t Veer M, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol 2007; 49: 2105–2111.
– reference: 10. Papafaklis MI, Muramatsu T, Ishibashi Y, Lakkas LS, Nakatani S, Bourantas CV, et al. Fast virtual functional assessment of intermediate coronary lesions using routine angiographic data and blood flow simulation in humans: Comparison with pressure wire: Fractional flow reserve. EuroIntervention 2014; 10: 574–583.
– reference: 7. Morris PD, Ryan D, Morton AC, Lycett R, Lawford PV, Hose DR, et al. Virtual fractional flow reserve from coronary angiography: Modeling the significance of coronary lesions: Results from the VIRTU-1 (VIRTUal Fractional Flow Reserve From Coronary Angiography) study. JACC Cardiovasc Interv 2013; 6: 149–157.
– reference: 13. Min JK, Leipsic J, Pencina MJ, Berman DS, Koo BK, van Mieghem C, et al. Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 2012; 308: 1237–1245.
– reference: 15. Tu S, Westra J, Yang J, von Birgelen C, Ferrara A, Pellicano M, et al. Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography: The International Multicenter FAVOR Pilot Study. JACC Cardiovasc Interv 2016; 9: 2024–2035.
– reference: 11. Tu S, Barbato E, Koszegi Z, Yang J, Sun Z, Holm NR, et al. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: A fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv 2014; 7: 768–777.
– reference: 17. Kirkeeide RL. Coronary obstructions, morphology and physiologic significance. In: Reiber JHC, Serruys PW, editors. Quantitative coronary arteriography. Dordrecht: Springer Netherlands, 1991; 229 – 244.
– reference: 1. Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol 2010; 55: 173–185.
– reference: 4. Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64: 1929–1949.
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Snippet Background:Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).Methods and Results:We analyzed...
Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).Methods and Results:We analyzed 151 coronary...
Quantitative flow ratio (QFR) is a newly developed image-based index for estimating fractional flow reserve (FFR).BACKGROUNDQuantitative flow ratio (QFR) is a...
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SubjectTerms 3-dimensional quantitative coronary angiography
Aged
Aged, 80 and over
Blood Flow Velocity
Computed Tomography Angiography - methods
Coronary Angiography - methods
Coronary Stenosis - diagnostic imaging
Coronary Stenosis - physiopathology
Female
Fractional flow reserve
Humans
Imaging, Three-Dimensional - methods
Male
Middle Aged
Myocardial ischemia
Quantitative flow ratio
Retrospective Studies
Software
Title Applicability of 3-Dimensional Quantitative Coronary Angiography-Derived Computed Fractional Flow Reserve for Intermediate Coronary Stenosis
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https://www.ncbi.nlm.nih.gov/pubmed/28331135
https://www.proquest.com/docview/1880466725
https://www.jstage.jst.go.jp/article/circj/81/7/81_CJ-16-1261/_pdf
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