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Comparison of Flow Ratio Derived From IVUS With CAG in Complex Lesions: Correlation With FFR
Rende Xu1, Zhe Wang2, Congcong Pan1
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China; State Key Laboratory of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Insights
Ultrasonic flow ratio (UFR) demonstrated higher diagnostic accuracy than quantitative flow ratio (QFR) in assessing complex coronary lesions compared to fractional flow reserve (FFR). UFR shows potential as a complementary tool for functional assessment in coronary artery disease.
Area of Science:
- Cardiology
- Medical Imaging
- Interventional Cardiology
Background:
- Accurate assessment of coronary artery disease is crucial for treatment decisions, especially in complex lesions.
- Fractional flow reserve (FFR) is the gold standard but invasive; noninvasive alternatives like quantitative flow ratio (QFR) and ultrasonic flow ratio (UFR) are promising.
- Complex coronary lesions require precise functional evaluation to guide revascularization strategies.
Purpose of the Study:
- To compare the diagnostic performance of UFR derived from intravascular ultrasound (IVUS) and QFR from coronary angiography against FFR.
- To evaluate the accuracy of UFR and QFR in assessing complex coronary lesions.
Main Methods:
- Retrospective multicenter study of 217 patients (220 vessels) with available IVUS and FFR data.
- UFR calculated from IVUS imaging; QFR calculated from coronary angiography.
- Analysis included correlation, agreement, sensitivity, specificity, and receiver operating characteristic (ROC) curves.
Main Results:
- UFR showed a stronger correlation with FFR (r=0.79) than QFR (r=0.68).
- UFR had a higher area under the ROC curve (0.91) compared to QFR (0.86).
- UFR outperformed QFR in complex lesions, particularly in bifurcations and heavily calcified lesions, where QFR accuracy decreased significantly.
Conclusions:
- UFR demonstrated numerically higher diagnostic accuracy than QFR in complex coronary lesions in this hypothesis-generating study.
- UFR may serve as a valuable complementary tool for functional assessment of coronary artery disease.
- Larger prospective studies are needed to validate these findings and confirm UFR superiority.
Background:
Accurate evaluation of coronary artery disease is critical for guiding treatment decisions, particularly in complex coronary lesions. Fractional flow reserve (FFR) remains the gold standard for assessing lesion-specific ischemia but is invasive and requires pharmacological hyperemia. Noninvasive alternatives, such as quantitative flow ratio (QFR) from coronary angiography and ultrasonic flow ratio (UFR) from intravascular ultrasound (IVUS), offer promising diagnostic approaches.
Objectives:
This study aimed to compare the diagnostic performance of UFR and QFR against FFR in assessing complex coronary lesions.
Methods:
This retrospective multicenter study included 217 patients (220 vessels) who underwent IVUS and FFR. UFR was derived from IVUS imaging, and QFR was calculated using coronary angiography data. Correlation, agreement, and diagnostic metrics (sensitivity, specificity) were analyzed, with receiver operating characteristic curves assessing accuracy.
Results:
UFR demonstrated stronger correlation with FFR (r = 0.79; 95% CI: 0.74-0.84; P < 0.001) compared with QFR (r = 0.68; 95% CI: 0.60-0.74; P < 0.001). UFR also showed better diagnostic performance, with an area under the receiver operating characteristic curve of 0.91 (95% CI: 0.86-0.94) compared with QFR's 0.86 (95% CI: 0.81-0.90). In complex lesions (diffuse, bifurcation, calcified), UFR consistently outperformed QFR, particularly in bifurcation and lesions heavily calcified, where QFR accuracy dropped significantly (72.5% vs 86.8%, P = 0.001).
Conclusions:
In this retrospective hypothesis-generating study, UFR showed numerically higher diagnostic accuracy than QFR in complex coronary lesions. These findings suggest UFR may have potential as a complementary tool for functional assessment, but definitive conclusions about superiority require validation in larger prospective studies. (Comparison of UFR With QFR in Stable Coronary Artery Disease; NCT06322355).
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