Reproducibility of Quantitative Flow Ratio: The QREP Study

Jelmer Westra; Martin Sejr-Hansen; Łukasz Kołtowski; Hernán Mejía-Rentería; Shengxian Tu; Janusz Kochman; Yimin Zhang; Tommy Liu; Gianluca Campo; Jakob Hjort; Lone Juul Hune Mogensen; Andrea Erriquez; Birgitte Krogsgaard Andersen; Ashkan Eftekhari; Javier Escaned; Evald Høj Christiansen; Niels Ramsing Holm

doi:10.4244/EIJ-D-21-00425

Reproducibility of Quantitative Flow Ratio: The QREP Study

Jelmer Westra, Martin Sejr-Hansen, Łukasz Kołtowski, Hernán Mejía-Rentería, Shengxian Tu, Janusz Kochman, Yimin Zhang, Tommy Liu, Gianluca Campo, Jakob Hjort, Lone Juul Hune Mogensen, Andrea Erriquez, Birgitte Krogsgaard Andersen, Ashkan Eftekhari, Javier Escaned, Evald Høj Christiansen, Niels Ramsing Holm

Institut for Klinisk Medicin - Hjertesygdomme

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

27 Citationer (Scopus)

Abstract

Background: Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography.

Aims: We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites.

Methods: We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of infra- and inter-observer reproducibility. Key secondary analysis was the identification of clinical and procedural characteristics predicting reproducibility.

Results: The intra-observer CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The inter-observer CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low fractional flow reserve (FFR) were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03).

Conclusions: The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01 +/--0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed by FFR.

Originalsprog	Engelsk
Tidsskrift	EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Vol/bind	17
Nummer	15
Sider (fra-til)	1252-1259
Antal sider	8
ISSN	1774-024X
DOI	https://doi.org/10.4244/EIJ-D-21-00425
Status	Udgivet - feb. 2022

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10.4244/EIJ-D-21-00425

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9724855/pdf/EIJ-D-21-00425_Westra.pdf

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Westra, J., Sejr-Hansen, M., Kołtowski, Ł., Mejía-Rentería, H., Tu, S., Kochman, J., Zhang, Y., Liu, T., Campo, G., Hjort, J., Mogensen, L. J. H., Erriquez, A., Andersen, B. K., Eftekhari, A., Escaned, J., Christiansen, E. H., & Holm, N. R. (2022). Reproducibility of Quantitative Flow Ratio: The QREP Study. EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, 17(15), 1252-1259. https://doi.org/10.4244/EIJ-D-21-00425

@article{e8396517be244aeb917b6446fff16cbf,

title = "Reproducibility of Quantitative Flow Ratio: The QREP Study",

abstract = "Background: Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography.Aims: We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites.Methods: We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of infra- and inter-observer reproducibility. Key secondary analysis was the identification of clinical and procedural characteristics predicting reproducibility.Results: The intra-observer CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The inter-observer CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low fractional flow reserve (FFR) were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03).Conclusions: The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01 +/--0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed by FFR.",

keywords = "Coronary Angiography, Coronary Stenosis/diagnostic imaging, Coronary Vessels/diagnostic imaging, Fractional Flow Reserve, Myocardial/physiology, Humans, Predictive Value of Tests, Reproducibility of Results, Severity of Illness Index, stable angina, QCA, fractional flow reserve, DIAGNOSTIC-ACCURACY, ANGIOGRAPHY, RESERVE",

author = "Jelmer Westra and Martin Sejr-Hansen and {\L}ukasz Ko{\l}towski and Hern{\'a}n Mej{\'i}a-Renter{\'i}a and Shengxian Tu and Janusz Kochman and Yimin Zhang and Tommy Liu and Gianluca Campo and Jakob Hjort and Mogensen, {Lone Juul Hune} and Andrea Erriquez and Andersen, {Birgitte Krogsgaard} and Ashkan Eftekhari and Javier Escaned and Christiansen, {Evald H{\o}j} and Holm, {Niels Ramsing}",

year = "2022",

month = feb,

doi = "10.4244/EIJ-D-21-00425",

language = "English",

volume = "17",

pages = "1252--1259",

journal = "EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology",

issn = "1774-024X",

publisher = "Europa Group",

number = "15",

}

Westra, J , Sejr-Hansen, M, Kołtowski, Ł, Mejía-Rentería, H, Tu, S, Kochman, J, Zhang, Y, Liu, T, Campo, G, Hjort, J , Mogensen, LJH, Erriquez, A, Andersen, BK, Eftekhari, A, Escaned, J, Christiansen, EH & Holm, NR 2022, 'Reproducibility of Quantitative Flow Ratio: The QREP Study', EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, bind 17, nr. 15, s. 1252-1259. https://doi.org/10.4244/EIJ-D-21-00425

Reproducibility of Quantitative Flow Ratio: The QREP Study. / Westra, Jelmer ; Sejr-Hansen, Martin; Kołtowski, Łukasz et al.
I: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology, Bind 17, Nr. 15, 02.2022, s. 1252-1259.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

TY - JOUR

T1 - Reproducibility of Quantitative Flow Ratio

T2 - The QREP Study

AU - Westra, Jelmer

AU - Sejr-Hansen, Martin

AU - Kołtowski, Łukasz

AU - Mejía-Rentería, Hernán

AU - Tu, Shengxian

AU - Kochman, Janusz

AU - Zhang, Yimin

AU - Liu, Tommy

AU - Campo, Gianluca

AU - Hjort, Jakob

AU - Mogensen, Lone Juul Hune

AU - Erriquez, Andrea

AU - Andersen, Birgitte Krogsgaard

AU - Eftekhari, Ashkan

AU - Escaned, Javier

AU - Christiansen, Evald Høj

AU - Holm, Niels Ramsing

PY - 2022/2

Y1 - 2022/2

N2 - Background: Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography.Aims: We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites.Methods: We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of infra- and inter-observer reproducibility. Key secondary analysis was the identification of clinical and procedural characteristics predicting reproducibility.Results: The intra-observer CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The inter-observer CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low fractional flow reserve (FFR) were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03).Conclusions: The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01 +/--0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed by FFR.

AB - Background: Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography.Aims: We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites.Methods: We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of infra- and inter-observer reproducibility. Key secondary analysis was the identification of clinical and procedural characteristics predicting reproducibility.Results: The intra-observer CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The inter-observer CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low fractional flow reserve (FFR) were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03).Conclusions: The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01 +/--0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed by FFR.

KW - Coronary Angiography

KW - Coronary Stenosis/diagnostic imaging

KW - Coronary Vessels/diagnostic imaging

KW - Fractional Flow Reserve, Myocardial/physiology

KW - Humans

KW - Predictive Value of Tests

KW - Reproducibility of Results

KW - Severity of Illness Index

KW - stable angina

KW - QCA

KW - fractional flow reserve

KW - DIAGNOSTIC-ACCURACY

KW - ANGIOGRAPHY

KW - RESERVE

UR - http://www.scopus.com/inward/record.url?scp=85124850807&partnerID=8YFLogxK

U2 - 10.4244/EIJ-D-21-00425

DO - 10.4244/EIJ-D-21-00425

M3 - Journal article

C2 - 34219667

SN - 1774-024X

VL - 17

SP - 1252

EP - 1259

JO - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

JF - EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology

IS - 15

ER -

Reproducibility of Quantitative Flow Ratio: The QREP Study

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