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. 2024 Jan 29:50:101349.
doi: 10.1016/j.ijcha.2024.101349. eCollection 2024 Feb.

Standardized angiographic projections allow evaluation of coronary artery side branches with quantitative flow ratio (QFR)

M Antoniadis  1 , M Blum  1 , M Ussat  1 , U Laufs  1 , K Lenk  1
Affiliations

Standardized angiographic projections allow evaluation of coronary artery side branches with quantitative flow ratio (QFR)

M Antoniadis et al. Int J Cardiol Heart Vasc. .

Abstract

Quantitative flow ratio (QFR) is a novel, software-based noninvasive method for the quantitative evaluation of coronary physiology. QFR results correlate with invasive FFR measurements in the three main epicardial coronary arteries. However, QFR data for the evaluation of coronary side branches (SB) are scarce. The evaluation of QFR-performance of SB was retrospective and prospective. Eighty-seven patients with suspected chronic coronary syndrome, who received angiography using routine core lab projections, were retrospectively analyzed. On the second part 37 patients, who received angiography using recommended standardized coronary angiography projections, were prospectively analyzed. Quantitative analysis was performed for SB with a maximum lumen diameter proximal of ≥2 mm based on quantitative coronary angiography (QCA) by two certified experts with the software QAngio XA 3D 3.2. Using routine projections, QFR computation in 55 % of the SB were obtained (123 out of 224). Using standardized projections, 85 % of SB were computed by QFR (64 out of 75; p < 0.001 vs routine projections). The fluoroscopy time for recommended projections was not significantly different as opposed to routine projections (3.75 ± 2.2 vs. 4.58 ± 3.00 min, p = 2.6986). Using the standardized projections was associated with a higher amount of contrast medium (53.44 ± 24.23 vs. 87.95 ± 43.73 ml, p < 0.01), longer overall procedure time (23.23 ± 16.35 vs. 36.14 ± 17.21 min, p < 0.01) and a higher dose area product (1152.28 ± 576.70 vs. 2540.68 ± 1774.07 cGycm2, p < 0.01). Our study shows that the blood flow of the vast majority of coronary SB can be determined non-invasively by QFR in addition to the main epicardial coronary arteries when standardized projections are used.

Keywords: Chronic coronary syndrome; Computational fluid dynamics; Coronary angiography and physiology; Coronary artery disease; Non-invasive imaging; QFR; Side branches.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Trial profile. CCS = chronic coronary syndrome; CABG = coronary artery bypass graft; CTO = chronic total occlusion; LVEF = left ventricular ejection fraction; GFR = glomerular filtration rate; MLD = maximum lumen diameter; SB = side branches; QFR = Quantitative Flow Ratio; Values are given as absolute number or as percentage (%).
Fig. 2
Fig. 2
A–C: QFR evaluability in overall of side branches using (a) routine projections and (b) recommended projections and as (c) routine projections vs. recommended projections with p-value in overall (all values are given in %). OM: obtuse marginal artery; DB: diagonal branch; IA: intermediate artery; PLB: posterolateral branch; PDA: posterior descending artery; Rout: routine projections; Rec: recommended projections.
Fig. 2
Fig. 2
A–C: QFR evaluability in overall of side branches using (a) routine projections and (b) recommended projections and as (c) routine projections vs. recommended projections with p-value in overall (all values are given in %). OM: obtuse marginal artery; DB: diagonal branch; IA: intermediate artery; PLB: posterolateral branch; PDA: posterior descending artery; Rout: routine projections; Rec: recommended projections.
Fig. 2
Fig. 2
A–C: QFR evaluability in overall of side branches using (a) routine projections and (b) recommended projections and as (c) routine projections vs. recommended projections with p-value in overall (all values are given in %). OM: obtuse marginal artery; DB: diagonal branch; IA: intermediate artery; PLB: posterolateral branch; PDA: posterior descending artery; Rout: routine projections; Rec: recommended projections.
Fig. 3
Fig. 3
Majority distribution in recommended projections per side branch in %. RAO: Right anterior oblique; CAU: Caudal; AP: Anterior posterior; CRA: Cranial; LAO: Left anterior oblique; OM: obtuse marginal artery; DB: diagonal branch; IA: intermediate artery; PLB: posterolateral branch; PDA: posterior descending artery.
Fig. 4
Fig. 4
A–D: Comparison of (A) the applied contrast in ml, of (B) fluoroscopy time in min, of (C) dosis area product in cGycm2 and of (D) the overall-procedure time in min between the 2 groups. Rout: routine projections; Rec: recommended projections.
Fig. 4
Fig. 4
A–D: Comparison of (A) the applied contrast in ml, of (B) fluoroscopy time in min, of (C) dosis area product in cGycm2 and of (D) the overall-procedure time in min between the 2 groups. Rout: routine projections; Rec: recommended projections.
Fig. 4
Fig. 4
A–D: Comparison of (A) the applied contrast in ml, of (B) fluoroscopy time in min, of (C) dosis area product in cGycm2 and of (D) the overall-procedure time in min between the 2 groups. Rout: routine projections; Rec: recommended projections.
Fig. 4
Fig. 4
A–D: Comparison of (A) the applied contrast in ml, of (B) fluoroscopy time in min, of (C) dosis area product in cGycm2 and of (D) the overall-procedure time in min between the 2 groups. Rout: routine projections; Rec: recommended projections.
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References

    1. Lawton J.S., Tamis-Holland J.E., Bangalore S., Bates E.R., Beckie T.M., Bischoff J.M., et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 2022;79:e21–e129. doi: 10.1016/j.jacc.2021.09.006. - DOI - PubMed
    1. Neumann F.-J., Sousa-Uva M., Ahlsson A., Alfonso F., Banning A.P., Benedetto U., et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur. Heart J. 2019;40:87–165. doi: 10.1093/eurheartj/ehy394. - DOI - PubMed
    1. Xaplanteris P., Fournier S., Pijls N.H.J., Fearon W.F., Barbato E., Tonino P.A.L., et al. Five-year outcomes with PCI guided by fractional flow reserve. N. Engl. J. Med. 2018;379:250–259. doi: 10.1056/NEJMoa1803538. - DOI - PubMed
    1. Davies J.E., Sen S., Dehbi H.-M., Al-Lamee R., Petraco R., Nijjer S.S., et al. Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N. Engl. J. Med. 2017;376:1824–1834. doi: 10.1056/NEJMoa1700445. - DOI - PubMed
    1. Toth G.G., Toth B., Johnson N.P., De Vroey F., Di Serafino L., Pyxaras S., et al. Revascularization decisions in patients with stable angina and intermediate lesions: results of the international survey on interventional strategy. Circ. Cardiovasc. Interv. 2014;7:751–759. doi: 10.1161/CIRCINTERVENTIONS.114.001608. - DOI - PubMed

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