Cor Vasa 2021, 63(6):683-687 | DOI: 10.33678/cor.2021.060

Systemic analysis of diagnostic performance and agreement between fractional flow reserve and quantitative flow ratio

Mindaugas Barauskas

^a Department of Cardiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas, Lithuania

^b Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania

Introduction: Physiology guided percutaneous coronary interventions (PCIs) are supported by experts worldwide. Despite its reliability, fractional flow reserve (FFR) method remains rarely used in clinical practice due to its cost and time-duration. The demand of physiology guided PCIs encouraged the search of faster, cheaper and not less reliable alternative coronary flow evalua- tion method. Since a novel minimally invasive FFR computation method has been presented interventional the of method FFR - and a novel alternative - quantitative flow ratio (QFR) - method has become a subject for numerous studies.

Methods: In total, 23 publication representing results of more than 4000 patients comparing QFR and FFR reproducibility and agreement were studied.

Results: Agreement between QFR and FFR performed in non-culprit arteries in patients with and without previous myocardial infarction was 0.88 and 0.94, respectively. Less reliable QFR seemed in diabetic patients, as agreement between QFR and FFR was 0.74 and 0.83 in diabetic and non-diabetic respectively. it suggested all with between 0.75 and 0.85 should be covered by FFR. Detailed analyses of cut-off value showed only a mild mismatch between FFR and QFR when the lower cut-off is 0.77 and the upper 0.86. Comparison of FFR and three types of QFR (fixed - fQFR, contrast - cQFR, and adenosine - aQFR) showed any adenosine based QFR measurement superiority over contrast flow QFR measurements, accordingly 0.83, 0.87, and 0.87.

Conclusions: QFR is a straightforward and quick method for an experienced specialist. QFR is an accurate, specific and reliable method for physiological evaluation which could become the first-line choice in the near future.

Keywords: Fractional flow reserve (FFR), Instantaneous wave-free ratio (iFR), Quantitative flow ratio (QFR)

Received: April 10, 2021; Revised: April 10, 2021; Accepted: May 11, 2021; Published: December 13, 2021  Show citation