Cor Vasa 2022, 64(3):300-304 | DOI: 10.33678/cor.2022.032
Functional Evaluation of Coronary Stenosis: is Quantitative Flow Ratio a Step Forward?
- a Department of Cardiology, Adiyaman Education and Research Hospital, Adiyaman, Turkey
- b Department of Civil Engineering, Inonu University, Malatya, Turkey
The severity of coronary lesions (CL) has always been an important aspect of patient care during coronary angiography. Fractional flow reserve (FFR)-guided coronary treatments have been shown to have a positive influence on clinical outcomes. However, significant technical flaws in clinical practice have slowed global adoption of FFR. Other indices, such as the quantitative flow ratio (QFR), have recently been created and tested in clinical research. According to a computational fluid dynamics study, QFR has a good correlation with FFR values and saves time and money compared to other methods. QFR is a new angiographic technique that uses modern software to reconstruct three-dimensional vessels and calculate flow models. Modern, effective and usable tool for CL due to significant technical benefits. We aimed to analyze the application areas of the QFR and its potential clinical application in this review.
Keywords: Coronary lesions, Fractional flow reserve, Quantitative flow ratio
Received: November 17, 2021; Revised: March 25, 2022; Accepted: March 28, 2022; Published: June 22, 2022 Show citation
References
- Askin L, Uzel KE, Tanriverdi O, et al. The relationship between coronary artery disease and depression and anxiety scores. North Clin Istanb 2020;7:523-526.
Go to original source...
Go to PubMed...
- Askin L, Tibilli H, Tanriverdi O, Turkmen S. The relationship between coronary artery disease and SIRT1 protein. North Clin Istanb 2020;7:631-635.
Go to original source...
Go to PubMed...
- Aktürk E, Aşkin L, Taşolar H, et al. Evaluation of contrast nephropathy in percutaneous treatment of chronic total occlusions. Interv Med Appl Sci 2019;11:95-100.
Go to original source...
Go to PubMed...
- Al-Lamee R, Thompson D, Dehbi HM, et al. Percutaneous coronary intervention in stable angina (ORBITA): a double- -blind, randomised controlled trial. Lancet 2018;391:31-40.
Go to original source...
Go to PubMed...
- Hsia RY, Shen YC. Percutaneous coronary intervention in the United States: risk factors for untimely access. Health Serv Res 2016;51:592-609.
Go to original source...
Go to PubMed...
- Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms: results from the prospective multicenter DISCOVER-FLOW (diagnosis of ischemia-causing stenoses obtained via noni. J Am Coll Cardiol 2011;58:1989-1997.
Go to original source...
Go to PubMed...
- Papafaklis MI, Muramatsu T, Ishibashi Y, et al. Fast virtual functional assessment of intermediate coronary lesions using routine angiographic data and blood flow simulation in humans: comparison with pressure wire - fractional flow reserve. EuroIntervention 2014;10:574-583.
Go to original source...
Go to PubMed...
- Tu S, Barbato E, Köszegi Z, et al. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: a fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv 2014;7:768-777.
Go to original source...
Go to PubMed...
- Cesaro A, Gragnano F, Di Girolamo D, et al. Functional assessment of coronary stenosis: an overview of available techniques. Is quantitative flow ratio a step to the future? Expert Rev Cardiovasc Ther 2018;16:951-962.
Go to original source...
Go to PubMed...
- Van De Hoef TP, Siebes M, Spaan JAE, Piek JJ. Fundamentals in clinical coronary physiology: why coronary flow is more important than coronary pressure. Eur Heart J 2015;36:3312-3319.
Go to original source...
Go to PubMed...
- Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/ SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease. J Am Coll Cardiol 2017;69:2212-2241.
Go to original source...
Go to PubMed...
- Chu M, Dai N, Yang J, et al. A systematic review of imaging anatomy in predicting functional significance of coronarystenoses determined by fractional flow reserve. Int J Cardiovasc Imaging 2017;33:975-990.
Go to original source...
Go to PubMed...
- de Waard GA, Cook CM, van Royen N, Davies JE. Coronary autoregulation and assessment of stenosis severity without pharmacological vasodilation. Eur Heart J 2017;1-12.
Go to original source...
Go to PubMed...
- Morris PD, Ryan D, Morton AC, et al. Virtual fractional flow reserve from coronary angiography: modeling the significance of coronary lesions. Results from the VIRTU-1 (VIRTUal fractional flow reserve from coronary angiography) study. JACC Cardiovasc Interv 2013;6:149-157.
Go to original source...
Go to PubMed...
- Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms: results from the prospective multicenter DISCOVER-FLOW (diagnosis of ischemia-causing stenoses obtained via noni. J Am Coll Cardiol 2011;58:1989-1997.
Go to original source...
Go to PubMed...
- Tu S, Barbato E, Köszegi Z, et al. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: a fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv 2014;7:768-777.
Go to original source...
Go to PubMed...
- 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;9:2024-2035.
Go to original source...
Go to PubMed...
- Tu S, Xu L, Ligthart J, et al. In vivo comparison of arterial lümen dimensions assessed by co-registered three-dimensional (3D) quantitative coronary angiography, intravascular ultrasound and optical coherence tomography. Int J Cardiovasc Imaging 2012;28:1315-1327.
Go to original source...
Go to PubMed...
- Xu B, Tu S, Qiao S, et al. Diagnostic accuracy of angiographybased quantitative flow ratio measurements for online assessment of coronary stenosis. J Am Coll Cardiol 2017;70:3077-3087.
Go to original source...
Go to PubMed...
- 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:e009603.
Go to original source...
Go to PubMed...
- 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:e007107.
Go to original source...
Go to PubMed...
- Yazaki K, Otsuka M, Kataoka S, et al. Applicability of 3-dimensional quantitative coronary angiography-derived computed fractional flow reserve for intermediate coronary stenosis. Circ J 2017;81:988-992.
Go to original source...
Go to PubMed...
- 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;82:807-814.
Go to original source...
Go to PubMed...
- Götberg M, Cook CM, Sen S, et al. The evolving future of instantaneous wave-free ratio and fractional flow reserve. J Am Coll Cardiol 2017;70:1379-1402.
Go to original source...
Go to PubMed...
- Desai NR, Bradley SM, Parzynski CS, et al. Appropriate use criteria for coronary revascularization and trends in utilization patient selection, and appropriateness ofpercutaneous coronary intervention. JAMA 2015;314:2045-2053.
Go to original source...
Go to PubMed...
- Tebaldi M, Biscaglia S, Fineschi M, et al. Evolving routine standards in invasive hemodynamic assessment of coronary stenosis: the nationwide italian SICI-GISE cross-sectional ERIS study. JACC Cardiovasc Interv 2018;11:1482-1491.
Go to original source...
Go to PubMed...
- Cortés C, Carrasco-Moraleja M, Aparisi A, et al. Quantitative flow ratio - Meta-analysis and systematic review. Catheter Cardiovasc Interv 2021;97:807-814.
Go to original source...
Go to PubMed...
- Tang J, Lai Y, Tu S, et al. Quantitative flow ratio-guided residual functional SYNTAX score for risk assessment in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. EuroIntervention 2021;17:e287-e293.
Go to original source...
Go to PubMed...
- Cerrato E, Mejía-Rentería H, Franzè A, et al. Quantitative flow ratio as a new tool for angiography-based physiological evaluation of coronary artery disease: a review. Future Cardiol 2021;doi: 10.2217/fca-2020-0199. Epub ahead of print.
Go to original source...
Go to PubMed...
- Jin C, Ramasamy A, Safi H, et al. Diagnostic accuracy of quantitative flow ratio (QFR) and vessel fractional flow reserve (vFFR) estimated retrospectively by conventional radiation saving X-ray angiography. Int J Cardiovasc Imaging 2021;37:1491-1501.
Go to original source...
Go to PubMed...
- Dai N, Hwang D, Lee JM, et al. Association of Quantitative Flow Ratio with Lesion Severity and Its Ability to Discriminate Myocardial Ischemia. Korean Circ J 2021;51:126-139.
Go to original source...
Go to PubMed...
- Kleczyński P, Dziewierz A, Rzeszutko Ł, et al. Borderline coronary lesion assessment with quantitative flow ratio and its relation to the instantaneous wave-free ratio. Adv Med Sci 2021;66:1-5.
Go to original source...
Go to PubMed...
- Kleczynski P, Dziewierz A, Rzeszutko L, et al. Quantitative flow ratio for evaluation of borderline coronary lesions in patients with severe aortic stenosis. Rev Esp Cardiol (Engl Ed) 2021:S1885-5857(21)00137-7.
- Choi KH, Lee SH, Lee JM, et al. Clinical relevance and prognostic implications of contrast quantitative flow ratio in patients with coronary artery disease. Int J Cardiol 2021;325:23-29.
Go to original source...
Go to PubMed...
- Milzi A, Dettori R, Burgmaier K, et al. Quantitative Flow Ratio Is Related to Intraluminal Coronary Stenosis Parameters as Assessed with Optical Coherence Tomography. J Clin Med 2021;10:1856.
Go to original source...
Go to PubMed...
- Ziubryte G, Jarusevicius G. Fractional flow reserve, quantitative flow ratio, and instantaneous wave-free ratio: a comparison of the procedure-related dose of ionising radiation. Postepy Kardiol Interwencyjnej 2021;17:33-38.
Go to original source...
Go to PubMed...
- Westra J, Sejr-Hansen M, Kołtowski Ł, et al. Reproducibility of Quantitative Flow Ratio: The QREP Study. EuroIntervention 2022;17:1252-1259.
Go to original source...
Go to PubMed...
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