Resting distal to aortic pressure ratio and fractional flow reserve discordance affects the diagnostic performance of quantitative flow ratio: Results from an individual patient data meta-analysis

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DOI

  • Jelmer Westra
  • Ashkan Eftekhari
  • Shengxian Tu, Shanghai Jiao Tong Univ, Shanghai Jiao Tong University, Shanghai Peoples Hosp 1, Dept Lab Med
  • ,
  • Gianluca Campo, Dedinje Cardiovascular Institute
  • ,
  • Javier Escaned, Liver Unit, Hospital Clínic de Barcelona, University de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain; Centro d'Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBEReHD), Barcelona, Spain.
  • ,
  • Simon Winther
  • Hitoshi Matsuo, Gifu Heart Center, Gifu, Japan.
  • ,
  • Xinkai Qu, Shanghai Fudan Univ, Fudan University
  • ,
  • Lukasz Koltowski, Medical University of Warsaw
  • ,
  • Yunxiao Chang, Shanghai Jiao Tong Univ, Shanghai Jiao Tong University, Shanghai Peoples Hosp 1, Dept Lab Med
  • ,
  • Tommy Liu, The Netherlands Cancer Institute, Amsterdam, The Netherlands
  • ,
  • Junqing Yang, China Medical University, Department of Histology and Embryology, China Medical University, Shenyang, China
  • ,
  • Birgitte Krogsgaard Andersen, The Headache Clinic, Aarhus University Hospital, Aarhus, Denmark Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
  • ,
  • William Wijns, National University of Ireland, Galway
  • ,
  • Morten Böttcher
  • Evald Høj Christiansen
  • Bo Xu, Chinese Academy of Medical Sciences
  • ,
  • Niels Ramsing Holm

OBJECTIVE: To evaluate the diagnostic performance of quantitative flow ratio (QFR) related to fractional flow reserve (FFR) and resting distal-to-aortic pressure ratio (resting Pd/Pa) concordance.

BACKGROUND: QFR is a method for computation of FFR based on standard coronary angiography. It is unclear how QFR is performed in patients with discordance between FFR and resting pressure ratios (distal-to-aortic pressure ratio [Pd/Pa]).

MATERIALS AND METHODS: The main comparison was the diagnostic performance of QFR with FFR as reference stratified by correspondence between FFR and resting Pd/Pa. Secondary outcome measures included distribution of clinical or procedural characteristics stratified by FFR and resting Pd/Pa correspondence.

RESULTS: Four prospective studies matched the inclusion criteria. Analysis was performed on patient level data reaching a total of 759 patients and 887 vessels with paired FFR, QFR, and resting Pd/Pa. Median FFR was 0.85 (IQR: 0.77-0.90). Diagnostic accuracy of QFR with FFR as reference was higher if FFR corresponded to resting Pd/Pa: accuracy 90% (95% CI: 88-92) versus 72% (95% CI: 64-80), p < .001, and sAUC 0.95 (95% CI: 0.92-0.96) versus 0.73 (95% CI: 0.69-0.77), p < .001. Resting Pd/Pa and FFR discordance were related to age, sex, hypertension, and lesion severity.

CONCLUSION: Diagnostic performance of QFR with FFR as reference is reduced for lesions with discordant FFR (≤0.80) and resting Pd/Pa (≤0.92) measurements.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
ISSN1522-1946
DOIs
Publication statusE-pub ahead of print - 1 Jun 2020

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