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Quantitative flow ratio for assessment of donor vessel in patients with chronic total occlusions
Xinjian Li1,2,3,4, Juntao Duan1,2,3,4, Lin Mi1,2,3,4
1Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China.
Insights
Murray-law based quantitative flow ratio (µQFR) shows good agreement with 3D-QFR for assessing donor vessels in chronic total occlusion (CTO) patients. This simplifies functional assessment in complex coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Chronic total occlusion (CTO) presents a complex challenge in coronary artery disease, characterized by complete blockages and collateral circulation.
- Donor vessels supplying collateral flow in CTO patients are susceptible to functional ischemia, necessitating accurate assessment.
- Quantitative flow ratio (QFR) offers angiography-based functional assessment, with single-projection µQFR improving applicability.
Purpose of the Study:
- To evaluate the agreement between single-projection Murray-law based quantitative flow ratio (µQFR) and three-dimensional quantitative flow ratio (3D-QFR).
- To assess the functional status of donor vessels in patients with chronic total occlusion (CTO).
Main Methods:
- A retrospective, single-center study included 336 patients with single-vessel CTO lesions.
- Both µQFR and 3D-QFR were employed to functionally assess the predominant collateral donor artery.
- Data were collected between January 2015 and June 2023.
Main Results:
- A strong correlation was observed between µQFR and 3D-QFR (r=0.947, p<0.001).
- The diagnostic accuracy of µQFR in estimating 3D-QFR was high at 96.1%.
- Receiver operating characteristic (ROC) curve analysis yielded an area under the curve (AUC) of 0.984 for µQFR.
Conclusions:
- µQFR demonstrates good correlation and agreement with 3D-QFR for functional assessment of donor vessels in CTO patients.
- This suggests µQFR is a reliable method for evaluating donor vessel function in this patient group.
Background:
Chronic total occlusion (CTO) is a challenging subset of coronary artery disease characterized by complete vessel obstruction and development of collateral circulation. In CTO patients, donor vessels supplying collateral flow may be at risk of functional ischemia. Functional assessment of these donor vessels can provide valuable insights into the ischemic status. Quantitative flow ratio (QFR) is an angiography-based method for the functional assessment of coronary arteries and Murray-law based QFR (µQFR) requires only a single coronary projection, enhancing its applicability. This study primarily aims to investigate the agreement between µQFR and 3D-QFR for functional assessment of donor vessels in CTO patients.
Methods:
This single-center retrospective study enrolled patients with a single-vessel CTO lesion between January 2015 and June 2023. Both µQFR and 3D-QFR were used to assess the function of the predominant collateral donor artery following standard protocol.
Results:
A total of 336 CTO patients were included. There was a good correlation between µQFR and 3D-QFR (r = 0.947, p < 0.001). The diagnostic accuracy was 96.1% (95% CI, 93.5%-97.9%). ROC curve analysis revealed an AUC of 0.984 (95% CI, 0.971-0.997) for µQFR in estimating 3D-QFR.
Conclusions:
µQFR has good correlation and agreement with standard 3D-QFR for the functional assessment of donor vessels in CTO patients.
