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The latest developments of Medis QFR® - March 2024

Reading time: 10 mins
Written on: March 18, 2024
Scientific Blogs
Medis QFR®
March 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 march edition of the Medis QFR® blog article we are proud to share five publications with you.
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Functional coronary angiography for the assessment of the epicardial vessels and the microcirculation.

Dr. D. Faria and co-authors under the leadership of Dr. J. Escaned, Hospital Clinico San Carlos, Madrid, Spain published this great paper in EuroIntervention. This state-of-the-art review performs a deep dive into the foundations and rationale behind functional coronary angiography indices derived from either invasive angiograms or those obtained with multi-slice CT. The currently available systems, the evidence supporting their use, and the specific clinical scenarios in which functional coronary angiography might facilitate patient management. Also, the rapidly growing application to the diagnosis of coronary microvascular function is discussed. This is a really great overview that is a must for those interested in this field.
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Standardized angiographic projections allow evaluation of coronary artery side branches with quantitative flow ratio (QFR)

Dr. M. Antoniadis and co-authors under the supervision of Dr. K. Lenk from the Dept of Cardiology at the Leipzig University Hospital in Germany published this very interesting paper in the International Journal of Cardiology, Heart and Vasculature. This is a combined retrospective (87 ptns) study on routine angiographic projections and prospective (37 ptns) study using standardized projections on the successful analysis of coronary side-branches with the QFR solution. Using the routine projections, QFR computations was possible in 55% of the side-branches, and in 85% in the standardized projections. The fluoroscopy times were not significantly different, while the standardized projections were associated with higher amounts of contrast medium, longer overall procedure time and a higher dose-are product. These were predominantly caused by obtaining high quality images for analysis and the higher frame speed (15 f/s). The authors conclude that the blood flow of the vast majority of coronary side-branches can be determined non-invasively by QFR in addition to the main epicardial coronary arteries when standardized projections are used.
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Consensus document on the clinical application of invasive functional coronary angiography from the Japanese Association of Cardiovascular Intervention and Therapeutics.

Dr. T. Asano from St Luke’s International hospital in Tokyo and co-authors from the Task Force of the Japanese Association of Cardiovascular Intervention and Therapeutics published this exciting paper in Cardiovascular Interventions and Applications. This is a great, very complete and timely overview on the various approaches of the angio-based FFR solutions, or as they authors propose to call these “Invasive functional coronary angiography (FCA)”, thereby excluding the CT-bases solutions. This Task Force was created to outline expert consensus on the clinical use of FCA. It advocates optimal clinical applications of FCA according to currently available evidence, while summarizing the concept, history, limitations, and future perspectives of FCA along with globally available software.
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Angiography-derived index of microcirculatory resistance to define the risk of early discharge in STEMI.

Dr. R. Scarcini from the Univ hospital in Verona, Italy and co-authors under the supervision of Dr. G.L. de Maria from the Oxford Heart Center in the UK published this exciting paper which may lead to early discharge of STEMI patients and in improvements in the healthcare expenses. Goal of this study was to find out whether non-hyperemic angio-derived IMR using the QFR-based NH-IMRangio solution could identify STEMI-patients at low risk of early cardiovascular complications (ECC). This is a retrospective analysis of 568 patients with STEMI. First, the NH-IMRangio was significantly correlated (r=0.607) with the wire-IMR, and demonstrated good accuracy in predicting ECC (AuC=0.766). ECC occurred more frequently in patients with NH-IMRangio ≥ 40 units, and < 40 units showed excellent negative predictive value (98.6%) in ruling out ECC. In summary, NH-IMRangio is a valuable risk-assessment tool in patients with STEMI; these guided strategies may contribute to safely shorten hospital stay and optimize resources utilization.
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Perfect wedding between patient with STEMI and angiography-derived indexes of coronary physiology

Dr. G. Campo, Dr. A. Erriquez and Dr. S. Biscaglia from the Cardiovascular Institute in Ferrara, Italy wrote this very nice Editorial on the paper by Scarcini et al. in Circ Cardiovascular Interventions. They iterate that the management of patients with STEMI could indeed become easier and better thanks to introduction and systematic application of angio-derived indexes of coronary physiology. The authors describe that the first goal of a STEMI patient will remain the stabilization and treatment of the culprit lesion. However, next, coronary artery angiography can be reanalyzed off-line with 2 different goals: (1) angiography-derived IMR in the culprit vessel, and (2) angio-derived FFR and angio-IMR in the non-culprit vessels. Patients having low values of angio-IMR and no flow-limiting non-culprit lesions do not require additional procedures and can be early discharged, and their prognosis will be good. For the other patients, angio-derived indexes will be integrated with clinical, laboratory, and angiographic information to tailor the treatment and optimize the prognosis.
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