The latest developments of Medis QFR®
November 2022 edition
Written by Prof. Hans Reiber on November 17, 2022
Given the regular posts of peer-reviewed scientific publications on the Medis QFR ®, it is clear that this angio-based solution for coronary physiology is extensively used in clinical research and practice. We would like to share these publications with you. So that you remain up to date about the research that is ongoing worldwide with this innovative solution, whereby each time new clinical applications are being tested, validated and tried out in particular populations. With its non-invasive nature, readily available, and broad applicability, we anticipate significant growth in its usage. This growth is supported by our constant quest for further automation.
In this new Medis QFR ® blog we are proud to share four publications with you:
Prognostic implications of QFR-derived residual disease patterns after stenting
Dr. N. Dai and co-authors under the supervision of Prof Junbo Ge, MD from Zhongshan hospital, Shanghai, China published a very interesting paper in JACC Interventions. They were interested in evaluating the clinical implications of residual disease patterns derived from the Quantitative Flow Ratio (QFR) pullback curve after PCI. In this retrospective study a total of 1607 vessels from 1335 patients were included.
From the QFR V2.0 post-PCI results, the following disease patterns were derived, being the PPG index and the dQFR/ds. Based on these patterns the patients were divided into 4 groups: predominant focal/diffuse (PPG) and with/without major gradients (dQFR/ds). Clinical outcome was the 2-year VOCO, which was lowest (1.4%) in the group with predominant focal and without major gradient, and the highest (8.5%) in the group with diffuse disease and with major gradients. The authors conclude that objective analysis of post-PCI pullbacks can identify those with increased risk of VOCO, and who may benefit from additional interventions, which is superior to visual interpretations.
For further read: J Am Coll Cardiol Intv 2022; 15: 1624-1634; doi.org/10.1016/j.jcin.2022.06.021
Diagnostic agreement of QFR with FFR in Latin-American population
In this publication Dr. M. Echavarŕia-Pinto from the Hospital General ISSSTE in Santiago de Querétaro in Mexico and co-authors tested the diagnostic accuracy of the QFR in a Latin-American population. This is new evidence as most of the QFR clinical evidence is on European and Asian populations. They carried out a retrospective study in a single centre in 66 patients and 90 vessels with intermediate severity (average % diameter stenosis 46.6% and median FFR=0.83) to assess the diagnostic accuracy of the Quantitative Flow Ratio against wire-based Fractional Flow Reserve.
The correlation of both the fixed-QFR as well as the contrast-QFR was strong. For the contrast-QFR they found a sensitivity of 85.2%, a specificity of 80.6% and an area-under-the-curve of 0.92. The authors concluded that the QFR was strongly associated with the FFR.
For further read: Int J Cardiovasc Img 2022; 38: 1423-1430; http://doi.org/10.1007/s10554-022-02547-6
QFR to predict long-term coronary artery bypass patency
Dr. C. Dowling and colleagues from the Monash Cardiovascular Research Centre in Melbourne, Australia under the supervision of Dr. Dennis Wong published a paper in the Int. J. Cardiovascular Imaging on the above topic.
This is a small prospective study on 22 patients with left main coronary artery disease who were undergoing CABG; a total of 65 vessels were included in the analysis. At a medium FU of 3.6 years, 12 grafts were occluded. The Quantitative Flow Ratio demonstrated a discriminatory power to predict graft occlusion (AuC=0.70). The risk of graft occlusion was higher in vessels with a QFR > 0.80. The conclusion is that QFR may predict long-term graft patency in patients undergoing CABG.
For further read: Int J Cardiovasc Img 2022; http://doi.org/10.1007/s10554-022-02699-5
Two-year Outcomes of the FAVOR III China Trial; QFR favorable status confirmed after two years.
Dr. Lei Song from Fuwai hospital, Bejing, China and many co-authors under the supervision of Dr. Greg Stone, presented these 2-year FU data at the TCT 2022 in Boston, and the results are accepted for publication in JACC. This is the 2-year FU of the FAVOR III China trial, in which eligible patients were randomized to a QFR-guided strategy or a standard angiography-guided strategy.
Among the 3825 randomized participants, the 2-year MACE occurred in 8.5% in the QFR-guided group and in 12.5% in the angiography-guided group, a difference of 32% in favor of the QFR-guided group. The benefits were most pronounced among patients in whom QFR assessment altered the planned revascularization strategy.
For further read: Angiographic Quantitative Flow Ratio-Guided Coronary Intervention: Two-Year Outcomes of the FAVOR III China Trial
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