Journal
CARDIOVASCULAR DIAGNOSIS AND THERAPY
Volume -, Issue -, Pages -Publisher
AME PUBLISHING COMPANY
DOI: 10.21037/cdt-21-574
Keywords
Quantitative flow ratio (QFR); fractional flow reserve (FFR); instantaneous wave-free ratio (iFR); aortic stenosis; computed tomography (CT)
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Funding
- National Health and Medical Research Early Career Fellowship
- National Heart Foundation Post-Doctoral Scholarship
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QFR demonstrates acceptable diagnostic performance in patients with severe aortic stenosis, predicting functionally significant hemodynamic indices and showing discrimination power for both FFR and non-hyperaemic pressure indices.
Background: Quantitative flow ratio (QFR) may be used to assess the functional significance of coronary lesions. Only limited validation exists for this technology in the setting of severe aortic stenosis. Methods: A prospective study was performed on patients who were being considered for transcatheter aortic valve implantation. QFR analysis was performed (Medis Medical Imaging System, Leiden, The Netherlands) and compared to invasive measurements of haemodynamic assessment [fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), diastolic pressure ratio during the wave-free period (dPR) and distal arterial pressure/arterial pressure (Pd/Pa)]. Results: A total of 35 patients were included in the study. Mean age was 75.5 +/- 6.5 and mean aortic valve gradient was 44.3 +/- 11.8 mmHg. There were 57 vessels analysed. The mean FFR was 0.83 +/- 0.10 and 22 vessels (39%) had a functionally significant FFR 50.80. QFR demonstrated a discriminatory power to predict functionally significant FFR [area under the receiver operating characteristic curve (AUC), 0.92; 95% confidence interval (CI): 0.84 to 1.00], representing a sensitivity of 73%, specificity of 91%, positive predictive value of 84%, negative predictive value of 84% and an accuracy of 84%. QFR also demonstrated a discriminatory power to predict functionally significant iFR 50.89 (AUC =0.92; 95% CI: 0.85 to 0.99), dPR 50.89 (AUC =0.90; 95% CI: 0.83 to 0.98) and Pd/Pa 50.92 (AUC =0.89; 95% CI: 0.80 to 0.97). Conclusions: QFR demonstrates acceptable diagnostic performance in patients with severe aortic stenosis when both FFR and non-hyperaemic pressure indices are used as reference standards.
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