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Diagnostic performance of quantitative flow ratio in non-ST elevation acute coronary syndromes in comparison to non-hyperemic pressure ratios: a prospective study

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Abstract

Quantitative flow ratio (QFR) is a new angiography-based coronary physiology tool aimed to evaluate functional relevance of intermediate coronary lesions. Aim of the study is to assess diagnostic performance of QFR in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in comparison to currently used non-hyperaemic pressure ratios (NHPRs). In this prospective, single-centre study, coronary physiology of intermediate coronary stenoses of non-culprit vessels in patients presenting with NSTE-ACS was evaluated using NHPRs (iFR, DFR or RFR). Subsequently, QFR was computed offline by a QFR analyst blinded to the NHPR results. Diagnostic performance of QFR was assessed in comparison to NHPRs as reference standard. A total of 60 vessels with intermediate coronary stenoses was investigated. The NHPRs were used as follows: RFR 38%, DFR 47% and iFR 15% of the cases. The NHPR result was positive, showing significant lesion, in 19 cases. A significant correlation was found between NHPR and QFR (r = 0.84, p < 0.001). Classification agreement of the two methods (95%) and diagnostic performance of QFR in comparison to NHPR (AUC: 0.962 [0.914–1.00]) were both high. Sensitivity, specificity, positive and negative predictive value of QFR in comparison to NHPR were 84.2%, 100%, 100% and 93.2% respectively. QFR has high diagnostic performance in detecting functionally significant lesions of non-culprit arteries in patients with NSTE-ACS and multivessel disease. Due to its high negative predictive value, it can be used to safely avoid unnecessary invasive physiological assessment of these lesions.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. 1st Cardiology Department, Evaggelismos General Hospital, Ipsilantou Str. 45-47, 10676, Athens, Greece

    Catherine Liontou, Vasiliki Kalogera, Dimitrios Oikonomou, Dimitrios Stalikas, Loukas Pappas & Konstantinos Triantafyllou

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  1. Catherine Liontou
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  2. Vasiliki Kalogera
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  3. Dimitrios Oikonomou
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  4. Dimitrios Stalikas
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dr. CL, Dr. KT, Dr. VK, Dr. DO, Dr. LP and Dr. DS. The first draft of the manuscript was written by Dr. CL and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Catherine Liontou.

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The authors declare no competing interests. The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the hospital (12-17-2020/597).

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The authors affirm that human research participants provided informed consent for publication of the images in Fig. 1.

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Informed consent was obtained from all individual participants included in the study.

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Liontou, C., Kalogera, V., Oikonomou, D. et al. Diagnostic performance of quantitative flow ratio in non-ST elevation acute coronary syndromes in comparison to non-hyperemic pressure ratios: a prospective study. Int J Cardiovasc Imaging 39, 2567–2574 (2023). https://doi.org/10.1007/s10554-023-02967-y

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