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Physiological benefits evaluated by quantitative flow ratio in patients with reduced left ventricular ejection
Jiaxin Zhong1,2,3, Qin Chen1,2,3, Long Chen1,2,3
1Department of Cardiology, Fujian Medical University Union Hospital, No. 29 Xin Quan Road, Fuzhou, 350001, Fujian, People's Republic of China.
Insights
Patients with reduced left ventricular ejection fraction (LVEF) experience greater physiological benefits from revascularization, showing improved flow reserve and heart function. Despite similar restenosis rates, they face higher risks of major adverse cardiovascular events, primarily heart failure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Quantitative Flow Analysis
Background:
- Left ventricular ejection fraction (LVEF) is a key indicator of cardiac function.
- Revascularization aims to improve blood flow in coronary arteries.
- Quantitative Flow Ratio (QFR) provides a physiological assessment of stenosis severity.
Purpose of the Study:
- To evaluate the clinical benefits of revascularization in patients with reduced versus normal LVEF.
- To assess the role of Quantitative Flow Ratio (QFR) in understanding these benefits.
- To compare outcomes including major adverse cardiovascular and cerebrovascular events (MACCEs).
Main Methods:
- Retrospective analysis of 301 patients undergoing successful percutaneous coronary intervention (PCI).
- Patients categorized into reduced LVEF (≤50%) and normal LVEF (>50%) groups.
- Comparison of pre-PCI, post-PCI, and follow-up QFR, late lumen loss (LLL), LVEF, and MACCEs.
Main Results:
- Reduced LVEF group showed greater improvements in QFR and LVEF post-PCI.
- No significant difference in restenosis (LLL) between groups.
- Reduced LVEF group experienced higher MACCEs, mainly driven by heart failure.
Conclusions:
- Successful revascularization yields greater physiological benefits in patients with reduced LVEF.
- Reduced LVEF patients gain more from improved coronary flow, despite similar restenosis.
- Increased heart failure risk in reduced LVEF patients post-PCI warrants further investigation.
Background:
To explore the clinical benefits of revascularization in patients with different levels of left ventricular ejection fraction (LVEF) from the perspective of quantitative flow ratio (QFR).
Methods:
Patients who underwent successful percutaneous coronary intervention (PCI) and one-year angiographic follow-up were retrospectively screened and computed by QFR analysis. Based on their LVEF, 301 eligible patients were classified into reduced LVEF (≤ 50%, n = 48) and normal LVEF (> 50%, n = 253) groups. Pre-PCI QFR, post-PCI QFR, follow-up QFR, late lumen loss (LLL), LVEF and major adverse cardiovascular and cerebrovascular events (MACCEs) at one year were compared between groups.
Results:
The reduced LVEF group had a lower mean pre-PCI QFR than the normal LVEF group (0.67 ± 0.16 vs. 0.73 ± 0.15, p = 0.004), but no significant difference was found in the post-PCI or one-year follow-up QFR. No association was found between LVEF and QFR at pre-PCI or follow-up. The reduced LVEF group had greater increases in QFR (0.27 ± 0.18 vs. 0.22 ± 0.15, p = 0.043) and LVEF (6.05 ± 9.45% vs. - 0.37 ± 8.11%, p < 0.001) than the normal LVEF group. The LLL results showed no difference between the two groups, indicating a similar degree of restenosis. The reduced LVEF group had a higher incidence of MACCEs (14.6% vs. 4.3%, p = 0.016), which was mainly due to the higher risk of heart failure (6.3% vs. 0%, p = 0.004).
Conclusion:
Compared to the corresponding normal LVEF patients, patients with reduced LVEF who underwent successful PCI were reported to have greater increases in QFR and LVEF, a similar degree of restenosis, and a higher incidence of MACCEs due to a higher risk of heart failure. It seems that patients with reduced LVEF gain more coronary benefits from successful revascularization from the perspective of flow physiology evaluations.
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