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Association Between Pathophysiological Disease Pattern and an Increase in Absolute Coronary Flow Velocity After

Hikaru Shimosato1, Eisuke Usui1, Yoshihisa Kanaji1

  • 1Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|August 28, 2025
PubMed

Insights

The quantitative flow ratio-derived pullback pressure gradient (QFR-PPG) index, alongside fractional flow reserve (FFR) and stress-transthoracic Doppler echocardiography (S-TDE), predicts coronary flow improvement after percutaneous coronary intervention (PCI). This noninvasive method aids in optimizing PCI decisions.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Percutaneous coronary intervention (PCI) aims to restore blood flow but predicting absolute flow improvement post-PCI remains challenging.
  • Fractional flow reserve (FFR) guides PCI, yet lesion patterns (focal vs. diffuse) influence outcomes.
  • Quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) offers a wire-free method to characterize coronary lesions.

Purpose of the Study:

  • To determine if the pre-PCI QFR-PPG index predicts absolute coronary flow velocity improvement after elective PCI.
  • To assess the utility of S-TDE in measuring flow velocity changes post-PCI.

Main Methods:

  • A retrospective analysis of 118 patients undergoing elective FFR-guided PCI with pre- and post-PCI LAD flow assessment via S-TDE.
  • Calculation of pre-PCI QFR-PPG index to evaluate its association with post-PCI coronary flow velocity changes.
  • Utilized institutional QFR-PPG database registered in UMIN000056097.

Main Results:

  • Post-PCI hyperemic diastolic peak velocity (hDPV) improved in 81.3% of patients; 18.6% showed decreased values despite FFR improvement.
  • Greater hDPV improvement (>30%) was associated with lower pre-PCI FFR, lower pre-PCI hDPV, and higher QFR-PPG index.
  • QFR-PPG index, FFR, and hDPV were identified as independent predictors of flow improvement, with QFR-PPG showing incremental value.

Conclusions:

  • The pre-PCI QFR-PPG index, combined with FFR and S-TDE-derived hDPV, effectively predicts absolute flow improvement post-PCI.
  • This noninvasive, wire-free QFR-PPG approach may enhance revascularization decision-making in interventional cardiology.
  • Further validation of QFR-PPG in predicting PCI outcomes is warranted.
Abstract

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