The latest developments of Medis QFR® - June 2024

Reading time: 10 mins
Written on: June 3, 2024
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, tried-out in particular populations. In this June edition of the Medis QFR® blog article we are proud to share five publications with you.

Association between the insufficient improvement of the quantitative flow ratio and worsening outcomes in ST-segment elevated myocardial infarction: a multicenter prospective cohort study .

Dr. X. Guo and many co-authors under the supervsion of Dr. H. Dong from the Guangdong Cardiovascular Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China publised this paper in Quant Imaging Med Surgery. This was a prospective study including 515 STEMI patients who received primary PCI. The ΔQFR was calculated as post-PCI QFR – pre-stent QFR. Patients were divided into two groups: the lower ΔQFR-group (≤ 0.25; N=332), and the normal ΔQFR-group (>0.25; N=183). A lower ΔQFR was significantly associated with a higher incidence of MI/AHF (acute heart failure). Pre-stent angiographic microvascular resistance and the stent-to-vessel diameter ratio < 1.13 were independent predictors of a lower ΔQFR. The authors concluded that an insufficient improvement in the QFR contributes to worsening outcomes and might be a useful tool for risk stratification in STEMI.

Two facets of shear stress post drug coating balloon: angiography versus optical coherence tomography fusion approach.

Dr. Eric Poon from the University of Melbourne, Australia and co-authors under the supervision of Prof. P.W. Serruys from the University of Galway published a very interesting Case in the Section of Cardiovascular Imaging of Circ Cardiovascular Imaging. This is a case report providing novel insights into the implications of the local hemodynamic milieu on vessel wall healing following coated balloon therapy, particularly where a dissection had occurred. Given the complexity of the anatomy of the dissection, fusion of advanced intravascular OCT-imaging data with coronary angiography enabled realistic reconstructions of the lumen anatomy to assess the hemodynamic consequences.

Angiographic lesion morphology provides incremental value to generalize quantitative flow ratio for predicting myocardial ischemia.

Dr. J. Zhang and co-authors under the supervision of Prof. B. Lu from the Fuwai hospital, Chinese Academy of Medical Sciences in Bejing, China published this interesting paper in 2022 in Frontiers in Cardiovascular Medicine. This is a substudy of the CT-FFR China trial, including a total of 148 participants. QFR correctly classified 82.3% of the vessels against FFR with an AuC= 0.86. By combining lesion characteristics, the accuracy of the QFR increased with an AuC>0.90.The authors concluded that combined with angiographic lesion parameters, the QFR can be optimized for predicting myocardial ischemia in unselected patients.

Quantitative flow ratio versus fractional flow reserve for Heart Team decision-making in multi-vessel disease: the randomized, multicentre DECISION QFR trial.

Dr. Taku Asano from the St Luke’s International hospital in Tokyo, Japan and many co-authors under the leadership of Dr. Hitoshi Matsuo of Gifu Heart Center published this very interesting paper in EuroIntervention. The DECISION-QFR trial was a prospective, multicentre, randomised controlled trial including 248 patients from 10 sites, that aimed to investigate the feasibility of using QFR-based physiological data in decision-making for optimal treatment during Heart Team discussions. Two Heart Teams were randomly assigned either QFR- or FFR-based data of the included patients. They then discussed the optimal revascularisation mode PCI or CABG for each patient. The agreement between the two teams was 91.5%. The authors concluded that QFR provided feasible physiological data in Heart Team discussions to determine the optimal revascularisation strategy for MVD. Utilising QFR eliminates the need for invasive FFR measurement procedures across multiple vessels and reduces procedural time, thereby enhancing the overall practicality of the functional SS, which conventionally requires physiological assessment using a pressure wire. Also in this trial they included four patients (1.5%) who experienced complications during FFR measurement.

Leveraging QFR and SYNTAX score II 2020 to guide PCI versus CABG decisions in multivessel CAD – broadening QFR’s utility.

Dr. Serruys and Dr. Revaiah from CORRIB Research Centre for Advanced Imaging and Core Laboratory, University of Galway, Galway, Ireland wrote this excellent Editorial on the DECISION-QFR trial published in EuroIntervention by Dr. Asano. Dr. Serruys and Dr. Revaiah extensively describe the history and the values of the various Syntax scores. In the DECISION QFR trial, the mean predicted 10-year mortality risks after PCI, derived from the QFR-based SSII (SSIIQFR) and FFR-based SSII (SSIIFFR), were 35.0±20.8% and 35.2±20.9%, respectively. They also summarized the multiple already extensive arsenal of QFR. The authors expect that the parameters derived from QFR (preprocedural QFR, PPGi, QFR gradient per unit length [dQFR/ds], post-PCI QFR, etc.) can ultimately be incorporated in machine learning risk models to predict clinical outcomes.

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