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Concordance between vessel-specific and vascular territory coronary functional assessment: A comparison of
Luciano de Moura Santos1,2, Carlos M Campos1,3, Hector Manuel Garcia-Garcia3,4
1Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
Insights
Quantitative flow ratio (QFR) and myocardial perfusion scintigraphy (MPS) show significant discordance in assessing coronary artery disease (CAD). Leaman score and QFR offer superior risk stratification for death and myocardial infarction compared to MPS.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Accuracy
Background:
- Coronary artery disease (CAD) assessment relies on Quantitative flow ratio (QFR) and myocardial perfusion scintigraphy (MPS).
- Understanding the concordance and prognostic value of these methods is crucial for clinical decision-making.
Purpose of the Study:
- To analyze the concordance between QFR and MPS in evaluating CAD significance.
- To compare the prognostic impact of QFR and MPS on major adverse cardiovascular events.
Main Methods:
- Patients with invasive coronary angiography, QFR, and MPS were categorized based on concordance criteria.
- Concordance was assessed by coronary territory involvement.
- Leaman score was used to evaluate coronary atherosclerotic burden.
Main Results:
- A total of 2010 coronary territories from 670 patients were analyzed.
- Concordance rates included total (52.5%), partial (29.1%), poor (15.8%), and total discordance (2.6%).
- Higher atherosclerotic burden (Leaman score) and MPS perfusion defects were independent predictors of discordance.
- Leaman score, functional Leaman score, and average QFR better stratified risk for death/myocardial infarction than MPS after 1400 days.
Conclusions:
- While MPS shows overall accuracy, substantial discordance with QFR exists in CAD assessment.
- Predictors for discordance include atherosclerotic burden and perfusion defects.
- QFR-derived metrics provide superior risk stratification for adverse cardiovascular outcomes compared to MPS.
Background:
Quantitative flow ratio (QFR) and myocardial perfusion scintigraphy (MPS) are utilized for assessing coronary artery disease (CAD) significance. We aimed to analyze their concordance and prognostic impact.
Aims:
We aimed to analyze the concordance between QFR and MPS and their risk stratification.
Methods:
Patients with invasive coronary angiography and MPS were categorized as concordant if QFR ≤ 0.80 and summed difference score (SDS) ≥ 4 or if QFR > 0.80 and SDS < 4; otherwise, they were discordant. Concordance was classified by coronary territory involvement: total (three territories), partial (two territories), poor (one territory), and total discordance (zero territories). Leaman score assessed coronary atherosclerotic burden.
Results:
2010 coronary territories (670 patients) underwent joint QFR and MPS analysis. MPS area under the curve for QFR ≤ 0.80 was 0.637. Concordance rates were total (52.5%), partial (29.1%), poor (15.8%), and total discordance (2.6%). Most concordance occurred in patients without significant CAD or with single-vessel disease (89.5%), particularly without MPS perfusion defects (91.5%). Leaman score (odds ratio [OR]: 0.839, 95% confidence interval [CI]: 0.805-0.875, p < 0.001) and MPS perfusion defect (summed stress score [SSS] ≥ 4) (OR: 0.355, 95% CI: 0.211-0.596, p < 0.001) were independent predictors for discordance. After 1400 days, no significant difference in death/myocardial infarction was observed based on MPS assessment, but Leaman score, functional Leaman score, and average QFR identified higher risk patients.
Conclusions:
MPS showed good overall accuracy in assessing QFR significance but substantial discordance existed. Predictors for discordance included higher atherosclerotic burden and MPS perfusion defects (SSS ≥ 4). Leaman score, QFR-based functional Leaman score, and average QFR provided better risk stratification for all-cause death and myocardial infarction than MPS.
