Diagnostic concordance and discordance between angiography-based quantitative flow ratio and fractional flow reserve derived from computed tomography in complex coronary artery disease
Journal of cardiovascular computed tomography, vol. 16, pp. 336–342
Abstract
Background Both quantitative flow ratio (QFR) and fractional flow reserve derived from computed tomography (FFR CT ) have shown significant correlations with invasive wire-based fractional flow reserve. However, the correlation between QFR and FFR CT is not fully investigated in patients with complex coronary artery disease (CAD). The aim of this study is to investigate the correlation and agreement between QFR and FFR CT in patients with de novo three-vessel disease and/or left main CAD. Methods This is a post-hoc sub-analysis of the international, multicenter, and randomized SYNTAX III REVOLUTION trial, in which both invasive coronary angiography and coronary computed tomography angiography were prospectively obtained prior to the heart team discussion. QFR was performed in an independent core laboratory and compared with FFR CT analyzed by HeartFlow™. The correlation and agreement between QFR and FFR CT were assessed per vessel. Furthermore, independent factors of diagnostic discordance between QFR and FFR CT were evaluated. Results Out of 223 patients, 40 patients were excluded from this analysis due to the unavailability of FFR CT and/or QFR, and a total of 469 vessels (183 patients) were analyzed. There was a strong correlation between QFR and FFR CT (R = 0.759; p < 0.001), and the Bland-Altman analysis demonstrated a mean difference of −0.005 and a standard deviation of 0.116. An independent predictor of diagnostic concordance between QFR and FFR CT was the lesion location in right coronary artery (RCA) (odds ratio 0.395; 95% confidence interval 0.174–0.894; P = 0.026). Conclusion In patients with complex CAD, QFR and FFR CT were strongly correlated. The location of the lesion in RCA was associated with the highest diagnostic concordance between QFR and FFR CT .
Authors 21
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Ollscoil na Gaillimhe – University of Galway · University Hospital Galway · Amsterdam UMC Location University of Amsterdam · Health Service Executive · Teikyo University Hospital · Saolta University Health Care Group · Teikyo University · University of Amsterdam
Affiliation as printed
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland; Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland
Division of Cardiology, Department of Internal Medicine, Teikyo University Hospital, Tokyo, Japan
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Amsterdam UMC Location University of Amsterdam · University of Amsterdam
Affiliation as printed
Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Ollscoil na Gaillimhe – University of Galway · University Hospital Galway · Amsterdam UMC Location University of Amsterdam · Health Service Executive · Saolta University Health Care Group · University of Amsterdam
Affiliation as printed
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland; Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland
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Ollscoil na Gaillimhe – University of Galway · University Hospital Galway · Amsterdam UMC Location University of Amsterdam · Health Service Executive · Saolta University Health Care Group · University of Amsterdam
Affiliation as printed
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland; Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland
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Amsterdam UMC Location University of Amsterdam · University of Amsterdam
Affiliation as printed
Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation as printed
GE Healthcare, Milwaukee, WI, USA
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Amsterdam UMC Location University of Amsterdam · University of Amsterdam
Affiliation as printed
Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
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Universitair Ziekenhuis Brussel
Affiliation as printed
Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
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Universitair Ziekenhuis Brussel
Affiliation as printed
Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
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Universitair Ziekenhuis Brussel
Affiliation as printed
Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
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Jena University Hospital · Friedrich Schiller University Jena
Affiliation as printed
Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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Jena University Hospital · Friedrich Schiller University Jena
Affiliation as printed
Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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Jena University Hospital · Friedrich Schiller University Jena
Affiliation as printed
Jena University Hospital, Friedrich-Schiller-University of Jena, Jena, Germany
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Ollscoil na Gaillimhe – University of Galway · University Hospital Galway · Health Service Executive · Saolta University Health Care Group
Affiliation as printed
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland; CÚRAM, The SFI Research Centre for Medical Devices, Galway, Ireland
CÚRAM, The SFI Research Centre for Medical Devices, Galway, Ireland
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland
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Affiliation as printed
Centro Cardiologico Monzino, IRCCS, Milan, Italy
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University of Milan · Centro Cardiologico Monzino
Affiliation as printed
Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
Centro Cardiologico Monzino, IRCCS, Milan, Italy
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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University of Milan · Centro Cardiologico Monzino
Affiliation as printed
Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
Centro Cardiologico Monzino, IRCCS, Milan, Italy
Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
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University of Milan · Centro Cardiologico Monzino
Affiliation as printed
Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
Centro Cardiologico Monzino, IRCCS, Milan, Italy
Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy
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Patrick W.J.C. Serruys corresponding
Ollscoil na Gaillimhe – University of Galway · University Hospital Galway · Health Service Executive · Saolta University Health Care Group · Imperial College London
Affiliation as printed
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland; CÚRAM, The SFI Research Centre for Medical Devices, Galway, Ireland; NHLI, Imperial College London, London, United Kingdom. Electronic address: patrick.w.j.c.serruys@gmail.com
CÚRAM, The SFI Research Centre for Medical Devices, Galway, Ireland
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland
NHLI, Imperial College London, London, United Kingdom
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Ollscoil na Gaillimhe – University of Galway · University Hospital Galway · Health Service Executive · Saolta University Health Care Group
Affiliation as printed
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland; CÚRAM, The SFI Research Centre for Medical Devices, Galway, Ireland
CÚRAM, The SFI Research Centre for Medical Devices, Galway, Ireland
Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, National University of Ireland Galway (NUIG), Galway, Ireland
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