Quantitative flow ratio and non-hyperemic pressure ratio in patients with intermediate coronary lesions

IF 2.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Revascularization Medicine Pub Date : 2026-09-01 Epub Date: 2025-12-24 DOI:10.1016/j.carrev.2025.12.021

Simone Finocchiaro, Maria Sara Mauro, Davide Sclofani, Marco Spagnolo, Antonio Greco, Davide Capodanno

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引用次数: 0

Abstract

Background

Quantitative flow ratio (QFR) is a recent, non-invasive method for functional coronary assessment, providing estimates of lesion-specific ischemia without the need for pressure wires or hyperemic agents. While its diagnostic concordance with fractional flow reserve (FFR) has been previously explored, data comparing QFR to non-hyperemic pressure ratios (NHPRs), such as instantaneous wave-free ratio (iwFR) and resting full-cycle ratio (RFR), remain limited.

Objectives

This study aimed to evaluate the diagnostic agreement between QFR and NHPRs in real-world patients undergoing physiological assessment for intermediate coronary stenoses.

Methods

Lesions from the CAST registry with available iwFR or RFR and analyzable angiograms for QFR computation were included. Ischemia was defined as NHPRs ≤0.89 or QFR ≤0.80. Diagnostic performance was assessed using sensitivity, specificity, predictive values, and ROC analysis (AUC via DeLong's method). Agreement was evaluated with Cohen's kappa and Bland-Altman analysis. McNemar's test assessed asymmetry in discordant pairs. Spearman's correlation and logistic univariate and multivariable regressions identified predictors of QFR-NHPRs discordance.

Results

A total of 174 lesions from 142 patients were included in the final analysis. QFR demonstrated a diagnostic accuracy of 79 %, with a sensitivity of 90 % and a negative predictive value of 82 %, in respect of NHPRs. Specificity and positive predictive value were 63 % and 78 %, respectively. The area under the ROC curve was 0.80 (95 % CI, 0.733–0.867). QFR underestimated ischemia in 14.9 % of lesions (false negatives), and overall diagnostic discordance with NHPRs occurred in 20.7 % of cases. Longer lesion length was independently associated with higher concordance (OR 0.95, 95 % CI 0.91–0.99, p = 0.012), while bifurcation lesions were predictors of discordance (OR 4.81, 95 % CI 1.30–21.12, p = 0.024).

Conclusions

QFR shows moderate concordance with NHPRs and may serve as a useful, wire-free alternative for excluding functionally significant stenoses. While it demonstrated high sensitivity, the risk of false negatives in certain anatomical subsets highlights the value of a cautious, individualized approach, possibly integrating QFR with invasive indices or imaging modalities in selected cases.

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中级冠状动脉病变患者的定量血流比和非充血压比。

背景：定量血流比（QFR）是一种最新的、无创的冠状动脉功能评估方法，可提供病变特异性缺血的估计，而不需要加压针或充血剂。虽然其诊断与分数血流储备（FFR）的一致性已经被探索过，但将QFR与非充血压比（nhpr），如瞬时无波比（iwFR）和静息全周期比（RFR）进行比较的数据仍然有限。目的：本研究旨在评估QFR和nhpr在现实世界中对中度冠状动脉狭窄进行生理评估的患者的诊断一致性。方法：包括CAST登记的病变，具有可用的iwFR或RFR和可分析的血管图像，用于计算QFR。以NHPRs≤0.89或QFR≤0.80定义缺血。采用敏感性、特异性、预测值和ROC分析（DeLong’s method的AUC）评估诊断效果。采用Cohen的kappa和Bland-Altman分析评估一致性。McNemar的测试评估了不一致配对的不对称性。Spearman相关和logistic单变量和多变量回归确定了qfr - nhpr不一致的预测因子。结果：142例患者共174个病灶纳入最终分析。QFR对nhpr的诊断准确率为79%，敏感性为90%，阴性预测值为82%。特异性为63%，阳性预测值为78%。ROC曲线下面积为0.80 （95% CI, 0.733 ~ 0.867）。QFR在14.9%的病变中低估了缺血（假阴性），20.7%的病例与nhpr的总体诊断不一致。较长的病变长度与较高的一致性独立相关（OR 0.95, 95% CI 0.91-0.99, p = 0.012），而分叉病变是不一致性的预测因子（OR 4.81, 95% CI 1.30-21.12, p = 0.024）。结论：QFR与nhpr有一定程度的一致性，可作为一种有用的、无导线的替代方法，用于排除功能显著的狭窄。虽然它显示出高灵敏度，但在某些解剖亚群中存在假阴性的风险，这突出了谨慎、个性化方法的价值，可能在选定的病例中将QFR与侵入性指标或成像方式结合起来。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Revascularization Medicine CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.30

自引率

5.90%

发文量

687

审稿时长

36 days

期刊介绍： Cardiovascular Revascularization Medicine (CRM) is an international and multidisciplinary journal that publishes original laboratory and clinical investigations related to revascularization therapies in cardiovascular medicine. Cardiovascular Revascularization Medicine publishes articles related to preclinical work and molecular interventions, including angiogenesis, cell therapy, pharmacological interventions, restenosis management, and prevention, including experiments conducted in human subjects, in laboratory animals, and in vitro. Specific areas of interest include percutaneous angioplasty in coronary and peripheral arteries, intervention in structural heart disease, cardiovascular surgery, etc.