Quantitative flow ratio-guided surgical intervention in symptomatic myocardial bridging

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Imaging

Background:

• Myocardial bridging (MB) poses challenges for surgical intervention, particularly with intermediate systolic stenosis.
• Fractional flow reserve (FFR) assessment is complicated by the dynamic nature of MB stenosis.
• Quantitative flow ratio (QFR) offers a rapid FFR alternative from coronary angiography.

Purpose of the Study:

• To evaluate the relationship between QFR and MB.
• To develop a prediction model for QFR-guided surgical intervention in MB patients.
• To compare the efficacy of different QFR calculations for guiding intervention.

Main Methods:

• Retrospective analysis of 45 symptomatic MB patients with intermediate left anterior descending artery stenosis.
• Calculation of systolic geometry-based QFR (SG-QFR) and diastolic geometry-based QFR (DG-QFR).
• Definition and calculation of time-averaged QFR (TA-QFR) as the average of SG-QFR and DG-QFR.

Main Results:

• TA-QFR showed the highest predictive accuracy (AUC = 0.91) for surgical intervention.
• TA-QFR outperformed DG-QFR (AUC = 0.69) and SG-QFR (AUC = 0.87) in predicting surgical need.
• The differences in AUC between TA-QFR and the other methods were statistically significant (p < 0.05).

Conclusions:

• TA-QFR enhances functional evaluation in MB patients with systolic intermediate stenosis.
• TA-QFR serves as a valuable tool for guiding surgical decisions in myocardial bridging.
• The study supports the use of TA-QFR for improved clinical management of MB.