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Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio

BACKGROUND: Measurement of the contrast-flow quantitative flow ratio (cQFR) is a novel method for rapid computational estimation of fractional flow reserve (FFR). Discordance between FFR and cQFR has not been completely characterised. METHODS: We performed a post-hoc analysis of 504 vessels with ang...

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Autores principales: Kanno, Yoshinori, Hoshino, Masahiro, Hamaya, Rikuta, Sugiyama, Tomoyo, Kanaji, Yoshihisa, Usui, Eisuke, Yamaguchi, Masao, Hada, Masahiro, Ohya, Hiroaki, Sumino, Yohei, Hirano, Hidenori, Yuki, Haruhito, Horie, Tomoki, Murai, Tadashi, Lee, Tetsumin, Yonetsu, Taishi, Kakuta, Tsunekazu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999689/
https://www.ncbi.nlm.nih.gov/pubmed/32076563
http://dx.doi.org/10.1136/openhrt-2019-001179
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author Kanno, Yoshinori
Hoshino, Masahiro
Hamaya, Rikuta
Sugiyama, Tomoyo
Kanaji, Yoshihisa
Usui, Eisuke
Yamaguchi, Masao
Hada, Masahiro
Ohya, Hiroaki
Sumino, Yohei
Hirano, Hidenori
Yuki, Haruhito
Horie, Tomoki
Murai, Tadashi
Lee, Tetsumin
Yonetsu, Taishi
Kakuta, Tsunekazu
author_facet Kanno, Yoshinori
Hoshino, Masahiro
Hamaya, Rikuta
Sugiyama, Tomoyo
Kanaji, Yoshihisa
Usui, Eisuke
Yamaguchi, Masao
Hada, Masahiro
Ohya, Hiroaki
Sumino, Yohei
Hirano, Hidenori
Yuki, Haruhito
Horie, Tomoki
Murai, Tadashi
Lee, Tetsumin
Yonetsu, Taishi
Kakuta, Tsunekazu
author_sort Kanno, Yoshinori
collection PubMed
description BACKGROUND: Measurement of the contrast-flow quantitative flow ratio (cQFR) is a novel method for rapid computational estimation of fractional flow reserve (FFR). Discordance between FFR and cQFR has not been completely characterised. METHODS: We performed a post-hoc analysis of 504 vessels with angiographically intermediate stenosis in 504 patients who underwent measurement of FFR, coronary flow reserve (CFR), the index of microcirculatory resistance (IMR) and Duke jeopardy score. RESULTS: In total, 396 (78.6%) and 108 (21.4%) lesions showed concordant and discordant FFR and cQFR functional classifications, respectively. Among lesions with a reduced FFR (FFR+), those with a preserved cQFR (cQFR−) showed significantly lower IMR, shorter mean transit time (Tmn), shorter lesion length (all, p<0.01) and similar CFR and Duke jeopardy scores compared with lesions showing a reduced cQFR (cQFR+). Furthermore, lesions with FFR+ and cQFR− had significantly lower IMR and shorter Tmn compared with lesions showing a preserved FFR (FFR−) and cQFR+. Of note, in cQFR+ lesions, higher IMR lesions were associated with decreased diagnostic accuracy (high-IMR; 63.0% and low-IMR; 75.8%, p<0.01). In contrast, in cQFR− lesions, lower IMR lesions was associated with decreased diagnostic accuracy (high-IMR group; 96.8% and low-IMR group; 80.0%, p<0.01). Notably, in total, 31 territories (6.2%; ‘jump out’ group) had an FFR above the upper limit of the grey zone (>0.80) and a cQFR below the lower limit (≤0.75). In contrast, five territories (1.0%; ‘jump in’ group) exhibited opposite results (FFR of ≤0.75 and cQFR of >0.80). The ‘jump out’ territories showed significantly higher IMR values than ‘jump in’ territories (p<0.01). CONCLUSIONS: FFR− with cQFR+ is associated with increased microvascular resistance, and FFR+ with cQFR− showed preservation of microvascular function with high coronary flow. Microvascular function affected diagnostic performance of cQFR in relation to functional stenosis significance.
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spelling pubmed-69996892020-02-19 Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio Kanno, Yoshinori Hoshino, Masahiro Hamaya, Rikuta Sugiyama, Tomoyo Kanaji, Yoshihisa Usui, Eisuke Yamaguchi, Masao Hada, Masahiro Ohya, Hiroaki Sumino, Yohei Hirano, Hidenori Yuki, Haruhito Horie, Tomoki Murai, Tadashi Lee, Tetsumin Yonetsu, Taishi Kakuta, Tsunekazu Open Heart Coronary Artery Disease BACKGROUND: Measurement of the contrast-flow quantitative flow ratio (cQFR) is a novel method for rapid computational estimation of fractional flow reserve (FFR). Discordance between FFR and cQFR has not been completely characterised. METHODS: We performed a post-hoc analysis of 504 vessels with angiographically intermediate stenosis in 504 patients who underwent measurement of FFR, coronary flow reserve (CFR), the index of microcirculatory resistance (IMR) and Duke jeopardy score. RESULTS: In total, 396 (78.6%) and 108 (21.4%) lesions showed concordant and discordant FFR and cQFR functional classifications, respectively. Among lesions with a reduced FFR (FFR+), those with a preserved cQFR (cQFR−) showed significantly lower IMR, shorter mean transit time (Tmn), shorter lesion length (all, p<0.01) and similar CFR and Duke jeopardy scores compared with lesions showing a reduced cQFR (cQFR+). Furthermore, lesions with FFR+ and cQFR− had significantly lower IMR and shorter Tmn compared with lesions showing a preserved FFR (FFR−) and cQFR+. Of note, in cQFR+ lesions, higher IMR lesions were associated with decreased diagnostic accuracy (high-IMR; 63.0% and low-IMR; 75.8%, p<0.01). In contrast, in cQFR− lesions, lower IMR lesions was associated with decreased diagnostic accuracy (high-IMR group; 96.8% and low-IMR group; 80.0%, p<0.01). Notably, in total, 31 territories (6.2%; ‘jump out’ group) had an FFR above the upper limit of the grey zone (>0.80) and a cQFR below the lower limit (≤0.75). In contrast, five territories (1.0%; ‘jump in’ group) exhibited opposite results (FFR of ≤0.75 and cQFR of >0.80). The ‘jump out’ territories showed significantly higher IMR values than ‘jump in’ territories (p<0.01). CONCLUSIONS: FFR− with cQFR+ is associated with increased microvascular resistance, and FFR+ with cQFR− showed preservation of microvascular function with high coronary flow. Microvascular function affected diagnostic performance of cQFR in relation to functional stenosis significance. BMJ Publishing Group 2020-01-23 /pmc/articles/PMC6999689/ /pubmed/32076563 http://dx.doi.org/10.1136/openhrt-2019-001179 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Coronary Artery Disease
Kanno, Yoshinori
Hoshino, Masahiro
Hamaya, Rikuta
Sugiyama, Tomoyo
Kanaji, Yoshihisa
Usui, Eisuke
Yamaguchi, Masao
Hada, Masahiro
Ohya, Hiroaki
Sumino, Yohei
Hirano, Hidenori
Yuki, Haruhito
Horie, Tomoki
Murai, Tadashi
Lee, Tetsumin
Yonetsu, Taishi
Kakuta, Tsunekazu
Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio
title Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio
title_full Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio
title_fullStr Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio
title_full_unstemmed Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio
title_short Functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio
title_sort functional classification discordance in intermediate coronary stenoses between fractional flow reserve and angiography-based quantitative flow ratio
topic Coronary Artery Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6999689/
https://www.ncbi.nlm.nih.gov/pubmed/32076563
http://dx.doi.org/10.1136/openhrt-2019-001179
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