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. 2022 Oct 12;11(20):6024.
doi: 10.3390/jcm11206024.

Quantitative Flow Ratio Is Related to Anatomic Left Main Stem Lesion Parameters as Assessed by Intravascular Imaging

Andrea Milzi  1 , Rosalia Dettori  1 , Richard Karl Lubberich  1 , Kathrin Burgmaier  2   3 , Nikolaus Marx  1 , Sebastian Reith  1 , Mathias Burgmaier  1   3
Affiliations

Quantitative Flow Ratio Is Related to Anatomic Left Main Stem Lesion Parameters as Assessed by Intravascular Imaging

Andrea Milzi et al. J Clin Med. .

Abstract

Introduction: Previously, an association between anatomic left main stem (LMS) lesion parameters, as described by intravascular ultrasound (IVUS) and fractional flow reserve (FFR), was shown. Quantitative flow ratio (QFR) is a novel, promising technique which can assess functional stenosis relevance based only on angiography. However, as little is known about the relationship between anatomic LMS parameters and QFR, it was thus investigated in this study. Methods: In 53 patients with LMS disease, we tested the association between anatomic assessment using OCT (n = 28) or IVUS (n = 25) on the one hand and functional assessment as determined by QFR on the other hand. LMS-QFR was measured using a dedicated approach, averaging QFR over left anterior descending (LAD) and circumflex (LCX) and manually limiting segment of interest to LMS. Results: The minimal luminal area of the LMS (LMS-MLA) as measured by intravascular imaging showed a consistent correlation with QFR (R = 0.61, p < 0.001). QFR could predict a LMS-MLA < 6 mm2 with very good diagnostic accuracy (AUC 0.919) and a LMS-MLA < 4.5 mm2 with good accuracy (AUC 0.798). Similar results were obtained for other stenosis parameters. Conclusions: QFR might be a valuable tool to assess LMS disease. Further studies focusing on patient outcomes are needed to further validate the effectiveness of this approach.

Keywords: coronary artery disease; coronary physiology; intravascular imaging; intravascular ultrasound; left main stem; optical coherence tomography; quantitative flow ratio.

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Conflict of interest statement

The authors declare no conflict of interest

Figures

Figure 1
Figure 1
Quantitative flow ratio in the evaluation of LMS disease. In (A), an angiographic view of a distal left main stem (LMS) stenosis is depicted (red arrow). In (B,C), respectively, a three-dimensional reconstruction of the vessel with quantitative flow ratio (QFR) measurement is shown for left anterior descending (LAD) and ramus circumflexus (LCx). LAD and LCX QFR distal to the last stenosis is reported for both vessels. Then, by manually limiting the segment of interest to the LMS only, the LMS-QFR is obtained from each QFR run; these values were averaged and used for further analysis.
Figure 2
Figure 2
Association between stenosis parameters of LMS and LMS-QFR. Association is shown for MLA (A), MLD (B) and %AS (C). Abbreviations: MLA = minimal lumen area, MLD = minimal lumen diameter, %AS = percent area stenosis.
Figure 3
Figure 3
Diagnostic efficiency of LMS-QFR in diagnosing relevant LMS disease. ROC curves depicting diagnostic efficiency of LMS-QFR in predicting anatomic severity of LMS disease, with LMS-MLA ≤ 6 mm2 (in (A)) and LMS-MLA ≤ 4.5 mm2 (in (B)), are depicted.
See this image and copyright information in PMC

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