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Meta-Analysis
. 2019 Nov 1;94(5):693-701.
doi: 10.1002/ccd.28283. Epub 2019 Apr 9.

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient-data meta-analysis

Jelmer Westra  1 , Shengxian Tu  2 , Gianluca Campo  3   4 , Shubin Qiao  5 , Hitoshi Matsuo  6 , Xinkai Qu  7 , Lukasz Koltowski  8 , Yunxiao Chang  2 , Tommy Liu  9 , Junqing Yang  10 , Birgitte Krogsgaard Andersen  1 , Ashkan Eftekhari  1 , Evald Høj Christiansen  1 , Javier Escaned  11 , William Wijns  12 , Bo Xu  5 , Niels Ramsing Holm  1
Affiliations
Meta-Analysis

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient-data meta-analysis

Jelmer Westra et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: We aimed to provide robust performance estimates for quantitative flow ratio (QFR) in assessment of intermediary coronary lesions.

Background: Angiography-based functional lesion assessment by QFR may appear as a cost saving and safe approach to expand the use of physiology-guided percutaneous coronary interventions. QFR was proven feasible and showed good diagnostic performance in mid-sized off-line and on-line studies with fractional flow reserve (FFR) as reference standard.

Methods: We performed a collaborative individual patient-data meta-analysis of all available prospective studies with paired assessment of QFR and FFR using the CE-marked QFR application. The main outcome was agreement of QFR and FFR using a two-step analysis strategy with a multilevel mixed model accounting for study and center level variation.

Results: Of 16 studies identified, four studies had prospective enrollment and provided patient level data reaching a total of 819 patients and 969 vessels with paired FFR and QFR: FAVOR Pilot (n = 73); WIFI II (n = 170); FAVOR II China (n = 304) and FAVOR II Europe-Japan (n = 272). We found an overall agreement (mean difference 0.009 ± 0.068, I2 = 39.6) of QFR with FFR. The diagnostic performance was sensitivity 84% (95%CI: 77-90, I2 = 70.1), specificity 88% (95%CI: 84-91, I2 = 60.1); positive predictive value 80% (95%CI: 76-85, I2 = 33.4), and negative predictive value 95% (95%CI: 93-96, I2 = 75.9).

Conclusions: Diagnostic performance of QFR was good with FFR as reference in this meta-analysis of high quality studies. QFR could provide an easy, safe, and cost-effective solution for functional evaluation of coronary artery stenosis.

Keywords: coronary artery disease; fractional flow reserve; quantitative coronary angiography; quantitative flow ratio.

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