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Diagnostic Performance of Angiography-Derived Quantitative Flow Ratio: A Systematic Review and Meta-Analysis.
Guo Huang1,2, Pu Ge3, He Zhu1,2
1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
Medical Sciences (Basel, Switzerland)
|February 20, 2026
Summary
Quantitative flow ratio (QFR) accurately assesses coronary stenosis significance, offering an alternative to invasive fractional flow reserve (FFR). Murray law-based QFR (μQFR) shows the highest diagnostic performance in this meta-analysis.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Performance
Background:
- Quantitative flow ratio (QFR) is a novel angiography-based technology for assessing coronary stenosis functional significance.
- QFR aims to serve as a non-invasive alternative to invasive fractional flow reserve (FFR) assessment.
- Existing evidence for QFR is limited, necessitating a comprehensive evaluation of its diagnostic capabilities.
Purpose of the Study:
- To systematically determine the diagnostic performance of QFR in identifying functionally significant coronary stenoses.
- To compare QFR's accuracy against invasive FFR, the established reference standard.
- To evaluate different QFR methodologies and identify the most effective approach.
Main Methods:
- A systematic review and meta-analysis of studies evaluating angiography-derived QFR systems.
- Inclusion of 57 studies with 13,215 patients and 16,125 vessels from six literature databases.
- Calculation of pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) using DerSimonian-Laird methodology.
Main Results:
- QFR demonstrated strong diagnostic performance with pooled sensitivity of 0.826 and specificity of 0.919.
- The overall area under the summary receiver operating characteristic curve (AUC) was 0.94, indicating high accuracy.
- Murray law-based QFR (μQFR) exhibited the highest diagnostic performance (AUC 0.97, adjusted pooled DOR 126.25) among evaluated modes.
Conclusions:
- Angiography-derived QFR is a highly accurate tool for assessing the functional significance of coronary stenoses.
- QFR serves as a reliable non-invasive alternative to invasive FFR.
- μQFR represents the most effective QFR method currently available for clinical application.
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