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Validation of quantitative flow reserve and residual quantitative flow reserve to predict fractional flow reserve post stenting from the DOCTORS study population

Session Assessment of residual risk after percutaneous coronary intervention

Speaker Julien Adjedj

Congress : ESC Congress 2019

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Circulation, Flow, and Flow Reserve
  • Session type : Moderated Posters
  • FP Number : P1250

Authors : BG Guillon (Besancon,FR), VR Rubimbura (Lausanne,CH), SF Fournier (Lausanne,CH), NA Amabile (Paris,FR), CCP Chi Pan (Lausanne,CH), NC Combaret (Clermont-Ferrand,FR), EE Eeckhout (Lausanne,CH), JS Silvain (Paris,FR), W Wijns (Galway,IE), F Schiele (Besancon,FR), O Muller (Lausanne,CH), N Meneveau (Besancon,FR), J Adjedj (Lausanne,CH)

Authors:
BG Guillon1 , VR Rubimbura2 , SF Fournier2 , NA Amabile3 , CCP Chi Pan2 , NC Combaret4 , EE Eeckhout2 , JS Silvain5 , W Wijns6 , F Schiele1 , O Muller2 , N Meneveau1 , J Adjedj2 , 1Regional University Hospital Jean Minjoz - Besancon - France , 2University Hospital Centre Vaudois (CHUV) - Lausanne - Switzerland , 3Institut Mutualiste Montsouris - Paris - France , 4University Hospital Gabriel Montpied - Clermont-Ferrand - France , 5Hospital Pitie-Salpetriere - Paris - France , 6National University of Ireland - Galway - Ireland ,

Citation:

Background

Quantitative flow reserve (QFR) is a computation of fractional flow reserve (FFR) based on angiography without use of a pressure wire. The ability to predict post-PCI FFR using residual QFR after virtual stenting (pre-PCI), and using QFR (post-PCI) remains unknown. We sought to evaluate the correlation and diagnosis accuracy of residual QFR and post-PCI QFR to predict post-PCI FFR.

Methods

From the DOCTORS (Does Optical Coherence Tomography Optimize Results of Stenting) study population, we blindly analyzed the following from angiography, and compared them to post-PCI FFR: pre-PCI residual contrast QFR (cQFR) and fixed QFR (fQFR), and post-PCI cQFR and fQFR.

Results

93 post-PCI QFR measurements and 84 residual QFR measurements were compared to post-PCI FFR measurements in 93 patients. Compared to the post-PCI FFR mean value of 0.92 ± 0.05, mean values of residual cQFR, residual fQFR, post-PCI cQFR and post-PCI fQFR were, respectively: 0.94 ± 0.05, 0.93 ± 0.05, 0.93 ± 0.06 and 0.93 ± 0.05 (p values >0.05 for all pairs except for residual cQFR versus FFR (p=0.01)). Pearson correlation coefficients of residual cQFR, residual fQFR, post-PCI cQFR and post-PCI fQFR compared with post-PCI FFR were, respectively: 0.62, (95% CI: 0.46-0.73); 0.61, (95% CI: 0.45-0.73); 0.75, (95% CI: 0.64-0.83) and 0.73, (95% CI: 0.62-0.81). Area under the curves for these indices with a post-PCI FFR cutoff value of 0.90 were, respectively: 0.79, 0.78, 0.85 and 0.84.

Conclusions

cQFR and fQFR correlated well and had similar diagnostic performance. Pre-PCI QFR analysis with virtual PCI, and post-PCI QFR analysis, correlated well with post-PCI FFR, and had similar diagnostic accuracy. Further studies are needed to prospectively validate a QFR-guided PCI strategy.

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