Focus on Coronary Artery Assessment
QFR Versus FFR Derived From Computed Tomography for Functional Assessment of Coronary Artery Stenosis

https://doi.org/10.1016/j.jcin.2019.06.043Get rights and content
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Abstract

Objectives

The aim of this study was to compare diagnostic performance between quantitative flow ratio (QFR) derived from coronary angiography and fractional flow reserve derived from computed tomography (FFRCT) using fractional flow reserve (FFR) as the reference standard.

Background

QFR and FFRCT are recently developed, less invasive techniques for functional assessment of coronary artery disease.

Methods

QFR, FFRCT, and FFR were measured in 152 patients (233 vessels) with stable coronary artery disease.

Results

QFR was highly correlated with FFR (r = 0.78; p < 0.001), whereas FFRCT was moderately correlated with FFR (r = 0.63; p < 0.001). Both QFR and FFRCT showed moderately good agreement with FFR, presenting small values of mean difference but large values of root mean squared deviation (FFR-QFR, 0.02 ± 0.09; FFR-FFRCT, 0.03 ± 0.11). The sensitivity, specificity, positive predictive value, and negative predictive value of QFR ≤0.80 for predicting FFR ≤0.80 were 90%, 82%, 81%, and 90%, respectively. Those of FFRCT ≤0.80 for predicting FFR ≤0.80 were 82%, 70%, 70%, and 82%, respectively. The diagnostic accuracy of QFR ≤0.80 for predicting FFR ≤0.80 was 85% (95% confidence interval [CI]: 81% to 89%), whereas that of FFRCT ≤0.80 for predicting FFR ≤0.80 was 76% (95% CI: 70% to 80%).

Conclusions

QFR and FFRCT showed significant correlation with FFR. Mismatches between QFR and FFR and between FFRCT and FFR were frequent.

Key Words

computed tomography angiography
fractional flow reserve
quantitative coronary angiography
quantitative flow ratio

Abbreviations and Acronyms

3D
3-dimensional
AUC
area under the curve
CTA
computed tomographic angiography
CI
confidence interval
FFR
fractional flow reserve
FFRCT
fractional flow reserve derived from computed tomography
%DS
percentage diameter stenosis
QCA
quantitative coronary angiography
QFR
quantitative flow ratio
ROC
receiver-operating characteristic

Cited by (0)

The international FFRCT registry (ADVANCE [Assessing Diagnostic Value of Non-Invasive FFRCT in Coronary Care]) was supported by HeartFlow. Dr. Akasaka has served on the advisory boards of Abbott Vascular and HeartFlow; and has received lecture fees and research grants from Abbott Vascular and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Drs. Tanigaki and Emori contributed equally to this work.

Drs. H. Matsuo and Akasaka contributed equally to this work.