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Diagnostic Performance of Quantitative Flow Ratio for the Assessment of Non-Culprit Lesions in Myocardial Infarction
José Alfredo Salinas-Casanova1,2, Vicente Alonso Jiménez-Franco1,2, Carlos Jerjes-Sanchez1,2
1Tecnologico de Monterrey. Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México.
Insights
Quantitative flow ratio (QFR) effectively assesses non-culprit lesions (NCLs) in myocardial infarction (MI) patients. This non-invasive method shows high diagnostic accuracy comparable to invasive fractional flow reserve (FFR).
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Diagnostic imaging
Background:
- Quantitative flow ratio (QFR) is a non-invasive method for coronary artery disease assessment, correlating with fractional flow reserve (FFR).
- Evidence for QFR use in non-culprit lesions (NCLs) within myocardial infarction (MI) contexts is lacking.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic accuracy of QFR for functionally significant NCLs post-MI.
- To compare QFR's performance against invasive FFR and non-hyperemic pressure ratios.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA and PROSPERO guidelines.
- Inclusion of eight studies involving 713 patients and 920 vessels assessed by QFR.
- Calculation of diagnostic accuracy metrics: AUC, sensitivity, specificity, PPV, NPV, with sensitivity analysis.
Main Results:
- Overall QFR analysis yielded an AUC of 0.941 (sensitivity 87.3%, specificity 89.4%).
- Comparison with FFR showed an AUC of 0.957 (sensitivity 89.6%, specificity 89.8%).
- Sensitivity analysis confirmed consistent diagnostic performance across studies.
Conclusions:
- QFR demonstrates effectiveness and significant diagnostic yield in evaluating NCLs in MI patients, with excellent accuracy compared to FFR.
- Prospective multicenter studies are recommended to further validate these findings in this specific population.
Background:
Quantitative flow ratio (QFR) analysis is a simple and non-invasive coronary physiological assessment method with evidence for evaluating stable coronary artery disease with correlation to fractional flow reserve (FFR). However, there is no evidence to recommend its use in non-culprit lesions (NCLs) in myocardial infarction (MI).
Methods:
We performed a systematic review and meta-analysis using the PRISMA and PROSPERO statements. The study's primary objective was to assess the diagnostic accuracy of QFR in identifying functionally significant NCLs after MI based on invasive FFR and non-hyperemic pressure ratios as references. We obtained values of the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We performed a leave-one-out sensitivity analysis for each study's impact on the overall effect.
Results:
We included eight studies, with 713 patients and 920 vessels evaluated with QFR. The overall AUC was 0.941 (I2 = 0.559, p < 0.002), with a sensitivity of 87.3%, a specificity of 89.4%, a PPV of 86.6%, and an NPV of 90.1%. Compared to FFR, we found an AUC of 0.957 (I2 = 0.331, p < 0.194), a sensitivity of 89.6%, a specificity of 89.8%, a PPV of 88.3%, and an NPV of 91%. The sensitivity analysis showed a similar diagnostic performance in both studies.
Conclusions:
QFR is effective in analyzing NCLs with a significant diagnostic yield compared to FFR, with an excellent AUC in MI patients. Performing prospective multicenter studies to characterize this population and reproduce our results is essential.
