The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Interventions for valvular disease and heart failure

Angiography-based quantitative flow ratio versus fractional flow reserve in patients with coronary artery disease and severe aortic stenosis

EuroIntervention 2020;16:e285-e292. DOI: 10.4244/EIJ-D-19-01001

1. Hospital Clínico San Carlos, IDISSC and Universidad Complutense de Madrid, Madrid, Spain; 2. Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; 3. Cardiovascular Division, Department of Medicine, University of Verona, Verona, Italy; 4. Department of Internal Medicine and Cardiovascular Centre, Heart Vascular Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 5. CIBERCV, Cardiology Department, ICICORELAB, Hospital Clínico Universitario, Valladolid, Spain; 6. Department of Cardiology, Hospital Universitario Marques de Valdecilla, Santander, Spain; 7. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA; 8. Division of Cardiovascular Medicine, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Centre, Cleveland, OH, USA

Aims: The aim of this study was to investigate the diagnostic performance of quantitative flow ratio (QFR) in assessing the physiological relevance of coronary lesions in the presence of severe aortic valve stenosis (SAS).

Methods and results: A total of 115 SAS patients (138 coronary arteries) were included. Functional assessment of coronary stenoses was performed with fractional flow reserve (FFR) before transcatheter aortic valve implantation (TAVI). Subsequently, QFR was calculated at a central core laboratory, blinded to FFR results. The diagnostic yield of QFR was assessed using FFR as reference. Coronary stenoses were intermediate (diameter stenosis 48±10%, FFR 0.84 [0.77-0.89], QFR 0.82 [0.73-0.89]). Per-vessel sensitivity, specificity, area under the ROC curve and accuracy of QFR were 84% (95% CI: 71-92%), 80% (95% CI: 69-88%), 0.88 (95% CI: 0.82-0.93) and 81%, respectively. Diagnostic accuracy of QFR decreased significantly in patients with aortic valve area (AVA) <0.60 cm2. Diagnostic performance of QFR was superior to angiography in assessing the FFR-based functional significance (AUC 0.88 [95% CI: 0.82-0.93] vs 0.74 [95% CI: 0.66-0.81], respectively; p=0.0002).

Conclusions: Compared with FFR, QFR has a good diagnostic yield and is superior to angiography in assessing the functional relevance of coronary lesions in SAS patients awaiting TAVI, particularly when AVA is ≥0.6 cm2.

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