Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis
Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis
复制标题
基于血管造影的定量流量比测量用于冠状动脉狭窄在线评估的诊断准确性
DOI：
10.1016/j.jacc.2017.10.035
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发表时间：
2017-12-26
影响因子：
24
通讯作者：
Hu, Shengshou
中科院分区：
文献类型：
--
作者：
Xu, Bo;Tu, Shengxian;Hu, Shengshou
背景技术定量血流比（QFR）是一种基于血管造影的新型方法，用于在无需压力线或诱导充血的情况下推导血流储备分数（FFR）。迄今为止，导管实验室在线评估 QFR 的准确性尚未得到充分检验。 目的 本研究的目的是评估 QFR 的诊断性能，用于诊断血流动力学显着的冠状动脉狭窄（根据视觉估计，FFR = 2 mm）。在冠状动脉造影期间以盲法在线评估 QFR、定量冠状动脉血管造影 (QCA) 和基于线的 FFR，并在独立核心实验室离线重新分析。主要终点是 QFR 将提高冠状动脉造影的诊断准确性，使得该估计的两侧 95% 置信区间 (CI) 的下限超过 75%。 结果 2017 年 6 月至 7 月期间，共有 308 名患者在 5 个中心连续入组。在线 QFR 和 FFR 结果均在 332 条被检查血管中的 328 条中获得。 QFR 的患者和血管水平诊断准确率分别为 92.4%（95% CI：88.9% 至 95.1%）和 92.7%（95% CI：89.3% 至 95.3%），均显着高于预先指定的目标值（p
BACKGROUND Quantitative flow ratio (QFR) is a novel angiography-based method for deriving fractional flow reserve (FFR) without pressure wire or induction of hyperemia. The accuracy of QFR when assessed online in the catheterization laboratory has not been adequately examined to date.OBJECTIVES The goal of this study was to assess the diagnostic performance of QFR for the diagnosis of hemodynamically significant coronary stenosis defined by FFR = 2 mm according to visual estimation. QFR, quantitative coronary angiography (QCA), and wire-based FFR were assessed online in blinded fashion during coronary angiography and re-analyzed offline at an independent core laboratory. The primary endpoint was that QFR would improve the diagnostic accuracy of coronary angiography such that the lower boundary of the 2-sided 95% confidence interval (CI) of this estimate exceeded 75%.RESULTS Between June and July 2017, a total of 308patients were consecutively enrolled at 5 centers. Online QFR and FFR results were both obtained in 328 of 332 interrogated vessels. Patient-and vessel-level diagnostic accuracy of QFR was 92.4%(95% CI: 88.9% to 95.1%) and 92.7%(95% CI: 89.3% to 95.3%), respectively, both of which were significantly higher than the pre-specified target value (p