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In vitro Assessment of Aortic Regurgitation Using Four-Dimensional Flow Magnetic Resonance Imaging
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The effects of cardiac structure, valvular regurgitation, and left ventricular diastolic dysfunction on the

Junqing Yang1, Yuming Huang2, Xiaoshan Li3,4

  • 1Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.

Frontiers in Cardiovascular Medicine
|June 9, 2023
PubMed

Insights

Quantitative flow ratio (μQFR) accurately assesses coronary stenosis in patients with complex cardiac conditions. This novel method shows excellent agreement with fractional flow reserve (FFR), unaffected by structural or functional abnormalities.

Area of Science:

  • Cardiovascular medicine
  • Interventional cardiology
  • Diagnostic imaging

Background:

  • Quantitative flow ratio (μQFR) is a novel fluid dynamics method for deriving fractional flow reserve (FFR).
  • Previous studies on μQFR primarily focused on patients with normal cardiac structure and function.
  • The diagnostic accuracy of μQFR in patients with abnormal cardiac structure, diastolic dysfunction, or valvular regurgitation remains unclear.

Purpose of the Study:

  • To investigate the diagnostic accuracy of Murray law-based quantitative flow ratio (μQFR) using a single angiographic view.
  • To evaluate μQFR's performance in patients with abnormal cardiac structure, left ventricular diastolic dysfunction, and valvular regurgitation.
  • To compare μQFR with pressure wire-derived fractional flow reserve (FFR).

Main Methods:

  • Retrospective analysis of 261 patients (286 vessels) who underwent both FFR and μQFR before intervention.
  • Cardiac structure and function assessed using echocardiography.
  • Hemodynamically significant coronary stenosis defined as FFR ≤0.80.

Main Results:

  • μQFR demonstrated a moderate correlation with FFR (r=0.73, p<0.001) and no significant difference (0.006 ± 0.075, p=0.192) via Bland-Altman analysis.
  • Diagnostic accuracy of μQFR was 94.06%, with sensitivity 82.56%, specificity 99.00%, PPV 97.26%, and NPV 92.96% compared to FFR.
  • Concordance between μQFR and FFR was not associated with abnormal cardiac structure, valvular regurgitation, or left ventricular diastolic function.

Conclusions:

  • μQFR shows excellent agreement with FFR in assessing coronary stenosis.
  • Abnormal cardiac structure, valvular regurgitation, and diastolic dysfunction do not impact μQFR's diagnostic accuracy.
  • Coronary hemodynamics are not significantly different in patients with cardiac abnormalities compared to those without.
Abstract

Keywords:
coronary heart diseasecoronary hemodynamicsechocardiographyfractional flow reservequantitative flow ratio

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