Author + information
- Jelmer Westra1,
- Simon Winther2,
- Shengxian Tu3,
- Louise Nissen2,
- Lars Gormsen4,
- Steffen Petersen5,
- June Ejlersen2,
- Christin Isaksen6,
- Morten Bottcher2,
- Evald Christiansen1 and
- Niels Holm7
- 1Aarhus University Hospital, Aarhus, Denmark
- 2Hospital Unit West, Herning, Denmark
- 3Shanghai Jiao Tong University, Shanghai, Shanghai, China
- 4Aarhus University Hospital, Skejby, Aarhus, Denmark
- 5William Harvey Research Institute, London, United Kingdom
- 6Regional Hospital of Silkeborg, Silkeborg, Denmark
- 7Aarhus University Hospital, Aarhus N, Denmark
Quantitative flow ratio (QFR) is a novel method for physiological lesion assessment that has documented useful diagnostic performance with FFR as reference standard. However, the two modalities have not yet been compared head to head with a third modality for myocardial ischemia detection as reference.
This study is a post-hoc analysis of the Dan-NICAD study (NCT02264717). Patients with suspected coronary artery disease by coronary computed tomography angiography were randomized 1:1 to myocardial perfusion assessment by scintigraphy (MPS) and magnetic resonance imaging (CMR). All randomized patients were reffered to invasive coronary angiography with FFR and QFR measurement on all lesions with 30-90 % diameter stenosis. QFR and FFR ≤ 0.80 were used as diagnostic cut-off. Perfusion defect on either CMR or MPS was used as reference standard.
Invasive coronary angiography and MPS or MRI was performed in 291 patients. Paired data with FFR, QFR and MPS (n=62) or CMR (n=66) was available for 128 patients after excluding patients with no lesions visualized on invasive coronary angiography (n=72), one or more lesions with >90 % not feasible for FFR measurement (n=57), missing FFR (n=24) and missing QFR (n=12). Median FFR was 0.85 (IQR 0.77-0.89) and median QFR was 0.83 (IQR 0.76-0.89), p=0.22. Perfusion defect was detected in 16 patients (13%). FFR and QFR values were ≤ 0.80 in 46 (37%) and 51 (40%) patients, respectively. The overall diagnostic accuracy was not different with 60 % and 59% (p= 0.72) for FFR and QFR. The diagnostic performance for FFR and QFR was not different with AUC 0.57 vs. 0.56 (p=0.93), sensitivity 38 vs. 44 (p=0.20) and specificity 63 vs. 61 (p=0.36).
The diagnostic performance of QFR and FFR was similar but modest with MPS and CMR as reference. Performance levels comparable to FFR are highly encouraging for this pressure wire-free, functional lesion evaluation.
CORONARY: Angiography and QCA