Diagnostic reliability of quantitative flow ratio for detection of myocardial ischemia compared with other angiographic and experience-dependent visual predicted indices

Abstract Background Quantitative flow ratio (QFR) is an image-based virtual fractional flow reserve (FFR) computed by three dimensional quantitative coronary angiography (3D-QCA) and estimated flow velocity. Several studies have reported that QFR had a good diagnostic performance as compared with wire-based FFR or instantaneous wave-free ratio (iFR). Purpose We compared the diagnostic reliability of QFR for detection of myocardial ischemia with other angiographic and visual predicted indices. Methods In 301 coronary lesions (263 patients) from our QFR database for previously-reported two studies, the diagnostic reliability of QFR, several angiographic and visual predicted indices were investigated using ROC analysis as reference of FFR≤0.8 or iFR≤0.89. Visual predicted FFR were estimated by 3 physicians (25-year experienced expert, 10-year experienced senior physician and 3-year experienced trainee) blinded to other indices. Results Area under the curve (AUC) of each index in ROC analysis is shown in Table. Conclusion QFR was reliable index detecting myocardial ischemia compared with other angiographic and experience-dependent visual predicted indices. Diagnostic performance of each index for FFR ≤080 and iFR ≤0.89 for FFR ≤0.80 for iFR≤0.89 n AUC n AUC 3D-QCA Min. lumen diam. 220 0.74 156 0.69 % Diam stenosis 220 0.73 156 0.66 % Area stenosis 220 0.67 156 0.64 QFR 220 0.92 156 0.91 Visual predicted FFR by expert physician 69 0.82 69 0.77 by senior physician 69 0.72 69 0.68 by trainee 69 0.68 69 0.55 Funding Acknowledgement Type of funding source: None