Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategy
Abstract Invasive fractional flow reserve (FFR) adoption remains low mainly due to procedural and operator related factors as well as costs. Alternatively, quantitative flow ratio (QFR) achieves a high accuracy mainly outside the intermediate zone without the need for hyperaemia and wire-use. We aim...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2021-03-01
|
| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-85933-9 |
| _version_ | 1818752165462671360 |
|---|---|
| author | Joyce Peper Robbert W. van Hamersvelt Benno J. W. M. Rensing Jan-Peter van Kuijk Michiel Voskuil Jurriën M. ten Berg Jeroen Schaap Johannes C. Kelder Diederick E. Grobbee Tim Leiner Martin J. Swaans |
| author_facet | Joyce Peper Robbert W. van Hamersvelt Benno J. W. M. Rensing Jan-Peter van Kuijk Michiel Voskuil Jurriën M. ten Berg Jeroen Schaap Johannes C. Kelder Diederick E. Grobbee Tim Leiner Martin J. Swaans |
| author_sort | Joyce Peper |
| collection | DOAJ |
| description | Abstract Invasive fractional flow reserve (FFR) adoption remains low mainly due to procedural and operator related factors as well as costs. Alternatively, quantitative flow ratio (QFR) achieves a high accuracy mainly outside the intermediate zone without the need for hyperaemia and wire-use. We aimed to determine the diagnostic performance of QFR and to evaluate a QFR–FFR hybrid strategy in which FFR is measured only in the intermediate zone. This retrospective study included 289 consecutive patients who underwent invasive coronary angiography and FFR. QFR was calculated for all vessels in which FFR was measured. The QFR–FFR hybrid approach was modelled using the intermediate zone of 0.77–0.87 in which FFR-measurements are recommended. The sensitivity, specificity, and accuracy on a per vessel-based analysis were 84.6%, 86.3% and 85.6% for QFR and 88.0%, 92.9% and 90.3% for the QFR–FFR hybrid approach. The diagnostic accuracy of QFR–FFR hybrid strategy with invasive FFR measurement was 93.4% and resulted in a 56.7% reduction in the need for FFR. QFR has a good correlation and agreement with invasive FFR. A hybrid QFR–FFR approach could extend the use of QFR and reduces the proportion of invasive FFR-measurements needed while improving accuracy. |
| first_indexed | 2024-12-18T04:47:08Z |
| format | Article |
| id | doaj.art-ba5d4a9fa0b04779917f8b489e265037 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-18T04:47:08Z |
| publishDate | 2021-03-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-ba5d4a9fa0b04779917f8b489e2650372022-12-21T21:20:33ZengNature PortfolioScientific Reports2045-23222021-03-0111111010.1038/s41598-021-85933-9Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategyJoyce Peper0Robbert W. van Hamersvelt1Benno J. W. M. Rensing2Jan-Peter van Kuijk3Michiel Voskuil4Jurriën M. ten Berg5Jeroen Schaap6Johannes C. Kelder7Diederick E. Grobbee8Tim Leiner9Martin J. Swaans10Department of Cardiology, St. Antonius HospitalDepartment of Radiology, University Medical Centre UtrechtDepartment of Cardiology, St. Antonius HospitalDepartment of Cardiology, St. Antonius HospitalDepartment of Cardiology, University Medical Centre UtrechtDepartment of Cardiology, St. Antonius HospitalDepartment of Cardiology, Amphia HospitalDepartment of Cardiology, St. Antonius HospitalJulius Centre for Health Sciences and Primary Care, University Medical Centre UtrechtDepartment of Radiology, University Medical Centre UtrechtDepartment of Cardiology, St. Antonius HospitalAbstract Invasive fractional flow reserve (FFR) adoption remains low mainly due to procedural and operator related factors as well as costs. Alternatively, quantitative flow ratio (QFR) achieves a high accuracy mainly outside the intermediate zone without the need for hyperaemia and wire-use. We aimed to determine the diagnostic performance of QFR and to evaluate a QFR–FFR hybrid strategy in which FFR is measured only in the intermediate zone. This retrospective study included 289 consecutive patients who underwent invasive coronary angiography and FFR. QFR was calculated for all vessels in which FFR was measured. The QFR–FFR hybrid approach was modelled using the intermediate zone of 0.77–0.87 in which FFR-measurements are recommended. The sensitivity, specificity, and accuracy on a per vessel-based analysis were 84.6%, 86.3% and 85.6% for QFR and 88.0%, 92.9% and 90.3% for the QFR–FFR hybrid approach. The diagnostic accuracy of QFR–FFR hybrid strategy with invasive FFR measurement was 93.4% and resulted in a 56.7% reduction in the need for FFR. QFR has a good correlation and agreement with invasive FFR. A hybrid QFR–FFR approach could extend the use of QFR and reduces the proportion of invasive FFR-measurements needed while improving accuracy.https://doi.org/10.1038/s41598-021-85933-9 |
| spellingShingle | Joyce Peper Robbert W. van Hamersvelt Benno J. W. M. Rensing Jan-Peter van Kuijk Michiel Voskuil Jurriën M. ten Berg Jeroen Schaap Johannes C. Kelder Diederick E. Grobbee Tim Leiner Martin J. Swaans Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategy Scientific Reports |
| title | Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategy |
| title_full | Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategy |
| title_fullStr | Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategy |
| title_full_unstemmed | Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategy |
| title_short | Diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio–FFR revascularization decision-making strategy |
| title_sort | diagnostic performance and clinical implications for enhancing a hybrid quantitative flow ratio ffr revascularization decision making strategy |
| url | https://doi.org/10.1038/s41598-021-85933-9 |
| work_keys_str_mv | AT joycepeper diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT robbertwvanhamersvelt diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT bennojwmrensing diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT janpetervankuijk diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT michielvoskuil diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT jurrienmtenberg diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT jeroenschaap diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT johannesckelder diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT diederickegrobbee diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT timleiner diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy AT martinjswaans diagnosticperformanceandclinicalimplicationsforenhancingahybridquantitativeflowratioffrrevascularizationdecisionmakingstrategy |