Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient-data meta-analysis

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

DOI

  • Jelmer Westra
  • Shengxian Tu, Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
  • ,
  • Gianluca Campo, Maria Cecilia Hospital, GVM Care and Research, Cotignola (RA), Italy.
  • ,
  • Shubin Qiao, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
  • ,
  • Hitoshi Matsuo, Department of Cardiovascular Medicine, Gifu Heart Center, Gifu City, Japan.
  • ,
  • Xinkai Qu, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
  • ,
  • Lukasz Koltowski, 1st Chair and Department of Cardiology, Warsaw Medical University, Warsaw, Poland.
  • ,
  • Yunxiao Chang, Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
  • ,
  • Tommy Liu, Department of Cardiology, Hagaziekenhuis, The Hague, The Netherlands.
  • ,
  • Junqing Yang, Department of Cardiology, Guangdong General Hospital, Guangzhou, China.
  • ,
  • Birgitte Krogsgaard Andersen
  • ,
  • Ashkan Eftekhari
  • Evald Høj Christiansen
  • ,
  • Javier Escaned, Interventional Cardiology Department, Hospital Clinico San Carlos, Madrid, Spain (J.E.).
  • ,
  • William Wijns, Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland.
  • ,
  • Bo Xu, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
  • ,
  • Niels Ramsing Holm

OBJECTIVES: We aimed to provide robust performance estimates for quantitative flow ratio (QFR) in assessment of intermediary coronary lesions.

BACKGROUND: Angiography-based functional lesion assessment by QFR may appear as a cost saving and safe approach to expand the use of physiology-guided percutaneous coronary interventions. QFR was proven feasible and showed good diagnostic performance in mid-sized off-line and on-line studies with fractional flow reserve (FFR) as reference standard.

METHODS: We performed a collaborative individual patient-data meta-analysis of all available prospective studies with paired assessment of QFR and FFR using the CE-marked QFR application. The main outcome was agreement of QFR and FFR using a two-step analysis strategy with a multilevel mixed model accounting for study and center level variation.

RESULTS: Of 16 studies identified, four studies had prospective enrollment and provided patient level data reaching a total of 819 patients and 969 vessels with paired FFR and QFR: FAVOR Pilot (n = 73); WIFI II (n = 170); FAVOR II China (n = 304) and FAVOR II Europe-Japan (n = 272). We found an overall agreement (mean difference 0.009 ± 0.068, I2 = 39.6) of QFR with FFR. The diagnostic performance was sensitivity 84% (95%CI: 77-90, I2 = 70.1), specificity 88% (95%CI: 84-91, I2 = 60.1); positive predictive value 80% (95%CI: 76-85, I2 = 33.4), and negative predictive value 95% (95%CI: 93-96, I2 = 75.9).

CONCLUSIONS: Diagnostic performance of QFR was good with FFR as reference in this meta-analysis of high quality studies. QFR could provide an easy, safe, and cost-effective solution for functional evaluation of coronary artery stenosis.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
ISSN1522-1946
DOIs
Publication statusE-pub ahead of print - 9 Apr 2019

See relations at Aarhus University Citationformats

ID: 150094271