The latest developments of Medis QFR® - February 2026

Home > The latest developments of Medis QFR® – February 2026

The latest developments of Medis QFR® - February 2026

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Written on: February 19, 2026

As we move further into 2026, the momentum behind QFR® continues to accelerate. What was once emerging is now firmly part of routine clinical decision-making when applied with the right standards and expertise. The focus in the field has shifted beyond algorithms alone to reproducibility, image quality, workflow integration, and structured training. At Medis, we continue to advance AI-driven insights, simplify workflows, and strengthen guidance to ensure consistent, reliable results — supporting the confident, global adoption of physiology-guided care.

Vessel-oriented analysis on the relationship between Quantitative-Flow Ratio and mortality in patients with severe aortic stenosis and intermediate coronary lesions.

Dr I Colaiori from the Division of Cardiology, Santa Maria Coretti hospital in Latina, Italy and many co-authors from Italy under the supervision of Dr V Guiducci from the S. Maria Hospital in Reggio Emilia, Italy published this interesting paper in Catheterization and Cardiovascular Interventions (CCI). This is a retrospective analysis of angiographic data in 280 TAVR patients with severe AS treated with TAVR in four Italian centers. Angiographic CAD was defined by a diameter stenosis ≥ 50%, functional CAD by a Medis QFR ≤ 0.80; the outcome was mortality at 3 years. Overall, 635 lesions were included. Angiographic CAD was evident in 165 (26.0%), functional CAD in 71 (11.2%). Angiography/QFR mismatch occurred in 22.5%, mostly in large vessels and lesions located in the proximal left anterior descending (LAD). QFR ≤ 0.80 was an independent predictor of death (HR 2.91). At the vessel analysis, LAD QFR‐positive lesions showed a stronger association with death events, when compared both with QFR negative lesions and non‐LAD QFR‐positive lesions. The authors concluded that QFR leads to a significant reclassification of CAD rates at the vessel‐level and shows a significant prognostic value in patients undergoing TAVR

Comprehensive diagnosis of myocardial ischemia of obstructive and nonobstructive origin with a wire-free diagnostic strategy.

Dr M Lombardi, Dept of Internal Medicine, University of Genova, Italy is the first author on this interesting paper written with multiple co-authors under the leadership of Dr Javier Escaned, Hospital San Carlos in Madrid Spain. This is a subanalysis of the multicenter prospective AID-ANGIO study evaluating the impact of a wire-free advanced invasive diagnostic (AID) strategy in the diagnostic workflow of patients with chronic coronary syndrome (CCS) admitted to the cath lab. The wire-free strategy combined Medis QFR and QFR-IMR with acetylcholine testing. A total of 215 vessels in 182 patients were investigated using FFR or RFR, and subsequently analyzed for QFR. The AUC of QFR predicting FFR≤0.80 or RFR≤0.89 was 0.93, whereas the sensitivity, specificity, positive predictive value, and negative predictive value of QFR were 0.81, 0.98, 0.96, and 0.90, respectively. The AUC of Angio-IMR predicting IMR≥25 was 0.91, whereas the sensitivity, specificity, positive predictive value, and negative predictive value of Angio-IMR were 0.97, 0.78, 0.58, and 0.98, respectively The wire-free AID strategy identified a cause of myocardial ischemia in 84.3% of patients, representing a 2-fold increase in the identification of a cause of myocardial ischemia, compared with coronary angiography alone (P<0.0001). In addition, the wire-free AID strategy demonstrated substantial agreement compared with the wire-based AID strategy (Cohen κ 0.78). The wire-free AID strategy led to a change in the initial therapeutic plan in 55.3% of patients compared with coronary angiography. Nevertheless, the wire-free AID strategy maintained good concordance with the wire-based AID strategy (16.8% of therapeutic changes). The authors conclude very importantly that this study supports the clinical utility of a wire-free AID strategy in patients with CCS, demonstrating its potential to improve diagnostic yield and guide clinical decision-making compared with coronary angiography alone.

Clinical significance of the difference between fractional flow reserve and quantitative flow ratio.

Dr T Mineo from the Dept of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital and co-authors under the supervision of Dr T Kakuta, Dept of Cardiology at the Tsuchiura Kyodo General Hospital published this interesting paper on this selected feature from both wire-based and angio-based coronary physiology. This is a retrospective study including a total of 301 patients in whom both FFR and Medis QFR were measured. Of interest in this study was the difference between the QFR and the FFR values (QFR-FFR). The patients were divided into 3 equal groups based on the QFR-FFR: low, middle and high differences. The lower group was associated with diffuse disease based on the PPG-index, a higher index of microcirculatory resistance based on invasive measurements, a lower microvascular resistance reserve, reduced post-PCI coronary flow reserve, while the post-PCI FFR values were similar across the tertiles. MACE occurred more frequently in patients with delta QFR-FFR less than -0.06, and this difference was identified as an independent predictor of MACE. The authors concluded that Pre-PCI delta QFR-FFR correlates with microvascular dysfunction and diffuse disease patterns. The QFR-FFR has potential as a risk stratification tool, which should be tested in prospective trials.

Angiography-derived physiology for coronary artery disease assessment: expert opinion from a SCAI Roundtable.

Dr E Shlofmitz from St. Francis Hospital Heart Centerand multiple KOLs in the field of coronary physiology under the senior authorship of Dr WF Fearon, published this Expert opinion on angio-derived physiology in the Journal of the Society of Coronary Angiography and Interventions. The field of angio-derived physiology (ADP) is an emerging technique that offers streamlined, wire-free assessment of epicardial coronary physiology. This paper was published based on a Round Table discussion organized by SCAI and supported by an unrestricted grant from CathWorks and Medtronic. It covers in detail the evidences, advantages and limitations of three ADP systems currently available in the USA, being the FFRangio system by Cathworks, the QFR by Medis Medical Imaging and the CAAS vFFR by Pie Medical. In addition to the description of these three systems, it provides great overviews of the key points of the roles of the ADP systems, of the clinical and potential applications in Table 1, as well as the required efforts to overcome potential barriers. It also emphasizes for ADP systems in general, that the accuracy of the systems relies heavily on the quality of angiographic images, and that by using such systems in a hospital the quality of the angiographic data gradually improves, as the users will see the advantages of following the guidelines, such as avoiding poor vessel opacification, vessel overlap, foreshortening, etc. It is the opinion of the authors that with continued refinements of the systems and the wider implementation, ADP has the potential to improve patient outcomes and optimize procedural decision-making.

Angina after percutaneous coronary interventions

Dr M Lombardi from the Hospital Clinico San Carlos, Madrid and the University of Genova, Italy and co-authors under the leadership of Dr J Escaned, Madrid published this very thorough paper in the European Heart Journal. This is an excellent, very extensive review paper that provides a contemporary perspective on the problem of post-PCI angina, covering all the possible causes, being microvascular derangement, myocardial bridging, stent failure, dissection, residual flow-limiting disease post-PCI, CAD progression and epicardial spasm. In the paper the opportunities of new functional coronary angiographic tools are also explored. Such as the case illustrated in Figure 3 of the paper, in which the assessment of the virtual or Residual QFR prior to the PCI, can support the interventional cardiologist in the decision, which of serial lesions should be treated to obtain a post-PCI with a QFR value > 0.90. Similarly, the assessment of the index of microcirculatory resistance from the angiograms, without the need for extensive instrumentation, drug administration and a lengthy procedure, is also an area of active research. Finally, the authors provide a practical workflow for patients with suspected post-PCI angina.

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