Accuracy and latest research progress of quantitative flow ratio evaluation based on fractional flow reserve_West China Medical Journal

Authors：

LUO Wanshuo ^1,2 ,  WANG Min ² ,  CHEN Lin ²

1. School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430000, P. R. China;
2. Department of Cardiology, Wuhan Asian Heart Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, Hubei 430000, P. R. China;

Corresponding author：

WANG Min, Email: zeta331@aliyun.com; CHEN Lin, Email: 411028111@qq.com

Keywords：

Quantitative flow ratio; fractional flow reserve; percutaneous coronary intervention; functional assessment; coronary artery

DOI：

10.7507/1002-0179.202208032

Video：

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New functional evaluation methods for coronary artery lesions have received widespread attention at home and abroad. As a new functional evaluation technique, the clinical value of quantitative flow ratio (QFR) in the accuracy and feasibility of diagnosing myocardial ischemia caused by coronary artery stenosis has been confirmed in many clinical trials. Compared with the traditional gold standard fractional flow reserve (FFR) for diagnosing coronary artery stenosis, QFR has the advantages of simple operation, time-saving and low cost. This article reviews the comparison of the diagnostic accuracy of FFR and QFR and the progress of clinical research, aiming to explore whether QFR may replace FFR as a functional evaluation method of coronary artery disease and guide clinical blood circulation reconstruction.

Citation： LUO Wanshuo, WANG Min, CHEN Lin. Accuracy and latest research progress of quantitative flow ratio evaluation based on fractional flow reserve. West China Medical Journal, 2023, 38(1): 121-125. doi: 10.7507/1002-0179.202208032 Copy

1.	中华医学会心血管病学分会介入心脏病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会, 中华心血管病杂志编辑委员会. 中国经皮冠状动脉介入治疗指南(2016). 中华心血管病杂志, 2016, 44(5): 382-400.
2.	《中国冠状动脉血流储备分数测定技术临床路径专家共识》专家组. 中国冠状动脉血流储备分数测定技术临床路径专家共识. 中国介入心脏病学杂志, 2019, 27(3): 121-133.
3.	Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis:15-year follow-up of the DEFER trial. Eur Heart J, 2015, 36(45): 3182-3188.
4.	Muller O, Mangiacapra F, Ntalianis A, et al. Long-term follow-up after fractional flow reserve-guided treatment strategy in patients with an isolated proximal left anterior descending coronary artery stenosis. JACC Cardiovasc Interv, 2011, 4(11): 1175-1182.
5.	Pijls NH, Fearon WF, Tonino PA, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol, 2010, 56(3): 177-184.
6.	van Nunen LX, Zimmermann FM, Tonino PA, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet, 2015, 386(10006): 1853-1860.
7.	De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med, 2012, 367(11): 991-1001.
8.	涂圣贤. 定量血流分数的原理与应用//第十二届东方心脏病学术会议论文集, 2018: 128-132.
9.	Song L, Tu S, Sun Z, et al. Quantitative flow ratio-guided strategy versus angiography-guided strategy for percutaneous coronary intervention: rationale and design of the FAVOR III China trial. Am Heart J, 2020, 223: 72-80.
10.	Tang J, Chu J, Hou H, et al. Clinical implication of QFR in patients with ST-segment elevation myocardial infarction after drug-eluting stent implantation. Int J Cardiovasc Imaging, 2021, 37(3): 755-766.
11.	Biscaglia S, Tebaldi M, Brugaletta S, et al. Prognostic value of QFR measured immediately after successful stent implantation: the international multicenter prospective HAWKEYE study. JACC Cardiovasc Interv, 2019, 12(20): 2079-2088.
12.	Bär S, Kavaliauskaite R, Ueki Y, et al. Quantitative flow ratio to predict nontarget vessel-related events at 5 years in patients with ST-segment-elevation myocardial infarction undergoing angiography-guided revascularization. J Am Heart Assoc, 2021, 10(9): e019052.
13.	Milzi A, Dettori R, Marx N, et al. Quantitative flow ratio (QFR) identifies functional relevance of non-culprit lesions in coronary angiographies of patients with acute myocardial infarction. Clin Res Cardiol, 2021, 110(10): 1659-1667.
14.	Tu S, Westra J, Yang J, et al. Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography: the international multicenter FAVOR pilot study. JACC Cardiovasc Interv, 2016, 9(19): 2024-2035.
15.	Westra J, Tu S, Winther S, et al. Evaluation of coronary artery stenosis by quantitative flow ratio during invasive coronary angiography: the WIFI II study (Wire-Free Functional Imaging II). Circ Cardiovasc Imaging, 2018, 11(3): e007107.
16.	Westra J, Andersen BK, Campo G, et al. Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve: the FAVOR II Europe-Japan study. J Am Heart Assoc, 2018, 7(14): e009603.
17.	van Diemen PA, Driessen RS, Kooistra RA, et al. Comparison between the performance of quantitative flow ratio and perfusion imaging for diagnosing myocardial ischemia. JACC Cardiovasc Imaging, 2020, 13(9): 1976-1985.
18.	Peper J, van Hamersvelt RW, Rensing BJWM, et al. Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio-FFR revascularization decision-making strategy. Sci Rep, 2021, 11(1): 6425.
19.	Tu S, Ding D, Chang Y, et al. Diagnostic accuracy of quantitative flow ratio for assessment of coronary stenosis significance from a single angiographic view: a novel method based on bifurcation fractal law. Catheter Cardiovasc Interv, 2021, 97(Suppl 2): 1040-1047.
20.	Mejía-Rentería H, Lee JM, Lauri F, et al. Influence of microcirculatory dysfunction on angiography-based functional assessment of coronary stenoses. JACC Cardiovasc Interv, 2018, 11(8): 741-753.
21.	Chen L, Chen Q, Zhong J, et al. Effect of low-density lipoprotein cholesterol goal achievement on vascular physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention. Front Cardiovasc Med, 2021, 8: 679599.
22.	Emori H, Kubo T, Kameyama T, et al. Diagnostic accuracy of quantitative flow ratio for assessing myocardial ischemia in prior myocardial infarction. Circ J, 2018, 82(3): 807-814.
23.	Mejía-Rentería H, Lauri FM, Lee JM, et al. Interindividual variations in the adenosine-induced hemodynamics during fractional flow reserve evaluation: implications for the use of quantitative flow ratio in assessing intermediate coronary stenoses. J Am Heart Assoc, 2019, 8(16): e012906.
24.	Westra J, Eftekhari A, Tu S, et al. 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. Catheter Cardiovasc Interv, 2021, 97(5): 825-832.
25.	Westra J, Sejr-Hansen M, Koltowski L, et al. Reproducibility of quantitative flow ratio: the QREP study. EuroIntervention, 2022, 17(15): 1252-1259.

1. 中华医学会心血管病学分会介入心脏病学组, 中国医师协会心血管内科医师分会血栓防治专业委员会, 中华心血管病杂志编辑委员会. 中国经皮冠状动脉介入治疗指南(2016). 中华心血管病杂志, 2016, 44(5): 382-400.
2. 《中国冠状动脉血流储备分数测定技术临床路径专家共识》专家组. 中国冠状动脉血流储备分数测定技术临床路径专家共识. 中国介入心脏病学杂志, 2019, 27(3): 121-133.
3. Zimmermann FM, Ferrara A, Johnson NP, et al. Deferral vs. performance of percutaneous coronary intervention of functionally non-significant coronary stenosis:15-year follow-up of the DEFER trial. Eur Heart J, 2015, 36(45): 3182-3188.
4. Muller O, Mangiacapra F, Ntalianis A, et al. Long-term follow-up after fractional flow reserve-guided treatment strategy in patients with an isolated proximal left anterior descending coronary artery stenosis. JACC Cardiovasc Interv, 2011, 4(11): 1175-1182.
5. Pijls NH, Fearon WF, Tonino PA, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol, 2010, 56(3): 177-184.
6. van Nunen LX, Zimmermann FM, Tonino PA, et al. Fractional flow reserve versus angiography for guidance of PCI in patients with multivessel coronary artery disease (FAME): 5-year follow-up of a randomised controlled trial. Lancet, 2015, 386(10006): 1853-1860.
7. De Bruyne B, Pijls NH, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med, 2012, 367(11): 991-1001.
8. 涂圣贤. 定量血流分数的原理与应用//第十二届东方心脏病学术会议论文集, 2018: 128-132.
9. Song L, Tu S, Sun Z, et al. Quantitative flow ratio-guided strategy versus angiography-guided strategy for percutaneous coronary intervention: rationale and design of the FAVOR III China trial. Am Heart J, 2020, 223: 72-80.
10. Tang J, Chu J, Hou H, et al. Clinical implication of QFR in patients with ST-segment elevation myocardial infarction after drug-eluting stent implantation. Int J Cardiovasc Imaging, 2021, 37(3): 755-766.
11. Biscaglia S, Tebaldi M, Brugaletta S, et al. Prognostic value of QFR measured immediately after successful stent implantation: the international multicenter prospective HAWKEYE study. JACC Cardiovasc Interv, 2019, 12(20): 2079-2088.
12. Bär S, Kavaliauskaite R, Ueki Y, et al. Quantitative flow ratio to predict nontarget vessel-related events at 5 years in patients with ST-segment-elevation myocardial infarction undergoing angiography-guided revascularization. J Am Heart Assoc, 2021, 10(9): e019052.
13. Milzi A, Dettori R, Marx N, et al. Quantitative flow ratio (QFR) identifies functional relevance of non-culprit lesions in coronary angiographies of patients with acute myocardial infarction. Clin Res Cardiol, 2021, 110(10): 1659-1667.
14. Tu S, Westra J, Yang J, et al. Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography: the international multicenter FAVOR pilot study. JACC Cardiovasc Interv, 2016, 9(19): 2024-2035.
15. Westra J, Tu S, Winther S, et al. Evaluation of coronary artery stenosis by quantitative flow ratio during invasive coronary angiography: the WIFI II study (Wire-Free Functional Imaging II). Circ Cardiovasc Imaging, 2018, 11(3): e007107.
16. Westra J, Andersen BK, Campo G, et al. Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve: the FAVOR II Europe-Japan study. J Am Heart Assoc, 2018, 7(14): e009603.
17. van Diemen PA, Driessen RS, Kooistra RA, et al. Comparison between the performance of quantitative flow ratio and perfusion imaging for diagnosing myocardial ischemia. JACC Cardiovasc Imaging, 2020, 13(9): 1976-1985.
18. Peper J, van Hamersvelt RW, Rensing BJWM, et al. Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio-FFR revascularization decision-making strategy. Sci Rep, 2021, 11(1): 6425.
19. Tu S, Ding D, Chang Y, et al. Diagnostic accuracy of quantitative flow ratio for assessment of coronary stenosis significance from a single angiographic view: a novel method based on bifurcation fractal law. Catheter Cardiovasc Interv, 2021, 97(Suppl 2): 1040-1047.
20. Mejía-Rentería H, Lee JM, Lauri F, et al. Influence of microcirculatory dysfunction on angiography-based functional assessment of coronary stenoses. JACC Cardiovasc Interv, 2018, 11(8): 741-753.
21. Chen L, Chen Q, Zhong J, et al. Effect of low-density lipoprotein cholesterol goal achievement on vascular physiology evaluated by quantitative flow ratio in patients who underwent percutaneous coronary intervention. Front Cardiovasc Med, 2021, 8: 679599.
22. Emori H, Kubo T, Kameyama T, et al. Diagnostic accuracy of quantitative flow ratio for assessing myocardial ischemia in prior myocardial infarction. Circ J, 2018, 82(3): 807-814.
23. Mejía-Rentería H, Lauri FM, Lee JM, et al. Interindividual variations in the adenosine-induced hemodynamics during fractional flow reserve evaluation: implications for the use of quantitative flow ratio in assessing intermediate coronary stenoses. J Am Heart Assoc, 2019, 8(16): e012906.
24. Westra J, Eftekhari A, Tu S, et al. 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. Catheter Cardiovasc Interv, 2021, 97(5): 825-832.
25. Westra J, Sejr-Hansen M, Koltowski L, et al. Reproducibility of quantitative flow ratio: the QREP study. EuroIntervention, 2022, 17(15): 1252-1259.

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