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Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series
, 2, 3, 3, 3, 3, 2, 13, 3, 2, 4, 3
Affiliations- Cardio Care Heart Centre, Ventura del Mar 11, 29660 Marbella, Spain
- Department of Cardiology, PLA General Hospital, Beijing, China
- Med-X Research Institute Shanghai Jiao Tong University, No. 1954, Hua Shan Road, 200030 Shanghai, China
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
Background: Evaluating prospectively the feasibility, accuracy and reproducibility of optical flow ratio (OFR), a novel method of computational physiology based on optical coherence tomography (OCT).
Methods and results: Sixty consecutive patients (76 vessels) underwent prospectively OCT, angiography- based quantitative flow ratio (QFR) and fractional flow ratio (FFR). OFR was computed offline in a central core-lab by analysts blinded to FFR. OFR was feasible in 98.7% of the lesions and showed excellent agreement with FFR (ICCa = 0.83, r = 0.83, slope = 0.80, intercept = 0.17, kappa = 0.84). The area under curve to predict an FFR ≤ 0.80 was 0.95, higher than for QFR (0.91, p = 0.115) and for minimal lumen area (0.64, p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 93%, 92%, 93%, 88%, 96%, 13.8, 0.1, respectively. Median time to obtain OFR was 1.07 (IQR: 0.98–1.16) min, with excellent intraobserver and interobserver reproducibility (0.97 and 0.95, respectively). Pullback speed had negligible impact on OFR, provided the same coronary segment were imaged (ICCa = 0.90, kappa = 0.697).
Conclusions: The prospective computation of OFR is feasible and reproducible in a real-world series,
resulting in excellent agreement with FFR, superior to other image-based methods.
Abstract
Background: Evaluating prospectively the feasibility, accuracy and reproducibility of optical flow ratio (OFR), a novel method of computational physiology based on optical coherence tomography (OCT).
Methods and results: Sixty consecutive patients (76 vessels) underwent prospectively OCT, angiography- based quantitative flow ratio (QFR) and fractional flow ratio (FFR). OFR was computed offline in a central core-lab by analysts blinded to FFR. OFR was feasible in 98.7% of the lesions and showed excellent agreement with FFR (ICCa = 0.83, r = 0.83, slope = 0.80, intercept = 0.17, kappa = 0.84). The area under curve to predict an FFR ≤ 0.80 was 0.95, higher than for QFR (0.91, p = 0.115) and for minimal lumen area (0.64, p < 0.001). Diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 93%, 92%, 93%, 88%, 96%, 13.8, 0.1, respectively. Median time to obtain OFR was 1.07 (IQR: 0.98–1.16) min, with excellent intraobserver and interobserver reproducibility (0.97 and 0.95, respectively). Pullback speed had negligible impact on OFR, provided the same coronary segment were imaged (ICCa = 0.90, kappa = 0.697).
Conclusions: The prospective computation of OFR is feasible and reproducible in a real-world series,
resulting in excellent agreement with FFR, superior to other image-based methods.
Keywords
optical flow ratio, optical coherence tomography, fractional flow reserve, coronary heart disease
About this articleTitle
Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series
Journal
Issue
Pages
350-361
Published online
2020-05-20
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2197
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1521
DOI
Pubmed
Bibliographic record
Cardiol J 2020;27(4):350-361.
Keywords
optical flow ratio
optical coherence tomography
fractional flow reserve
coronary heart disease
Authors
Juan Luis Gutiérrez-Chico
Yundai Chen
Wei Yu
Daixin Ding
Jiayue Huang
Peng Huang
Jing Jing
Miao Chu
Peng Wu
Feng Tian
Bo Xu
Shengxian Tu
References (27)- De Bruyne B, Pijls NHJ, Kalesan B, et al. Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012; 367(11): 991–1001.
- Tonino PAL, De Bruyne B, Pijls NHJ, et al. FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009; 360(3): 213–224.
- Bech GJ, De Bruyne B, Pijls NH, et al. Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis: a randomized trial. Circulation. 2001; 103(24): 2928–2934.
- Toth GG, Toth B, Johnson NP, 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(6): 751–759.
- Härle T, Zeymer U, Hochadel M, et al. Real-world use of fractional flow reserve in Germany: results of the prospective ALKK coronary angiography and PCI registry. Clin Res Cardiol. 2017; 106(2): 140–150.
- Lee HS, Lee JM, Nam CW, et al. Consensus document for invasive coronary physiologic assessment in Asia-Pacific countries. Cardiol J. 2019; 26(3): 215–225.
- Gutiérrez-Chico JL, Regar E, Nüesch E, et al. Delayed coverage in malapposed and side-branch struts with respect to well-apposed struts in drug-eluting stents: in vivo assessment with optical coherence tomography. Circulation. 2011; 124(5): 612–623.
- Gutiérrez-Chico JL, Wykrzykowska J, Nüesch E, et al. Vascular tissue reaction to acute malapposition in human coronary arteries: sequential assessment with optical coherence tomography. Circ Cardiovasc Interv. 2012; 5(1): 20–29, S1.
- Gutiérrez-Chico JL, Alegría-Barrero E, Teijeiro-Mestre R, et al. Optical coherence tomography: from research to practice. Eur Heart J Cardiovasc Imaging. 2012; 13(5): 370–384.
- Ali ZA, Maehara A, Généreux P, et al. ILUMIEN III: OPTIMIZE PCI Investigators. Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial. Lancet. 2016; 388(10060): 2618–2628.
- Gonzalo N, Escaned J, Alfonso F, et al. Morphometric assessment of coronary stenosis relevance with optical coherence tomography: a comparison with fractional flow reserve and intravascular ultrasound. J Am Coll Cardiol. 2012; 59(12): 1080–1089.
- Li Y, Gutiérrez-Chico JL, Holm NR, et al. Impact of side branch modeling on computation of endothelial shear stress in coronary artery disease: coronary tree reconstruction by fusion of 3D angiography and OCT. J Am Coll Cardiol. 2015; 66(2): 125–135.
- Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018; 40(2): 87–165.
- Tian F, Yu W, Huang J, et al. First presentation of integration of intravascular optical coherence tomography and computational fractional flow reserve. Int J Cardiovasc Imaging. 2019; 35(4): 601–602.
- Yu W, Huang J, Jia D, et al. Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity. EuroIntervention. 2019; 15(2): 189–197.
- Huang J, Emori H, Ding D, et al. Comparison of diagnostic performance of intracoronary optical coherence tomography-based and angiography-based fractional flow reserve for evaluation of coronary stenosis. EuroIntervention. 2020 [Epub ahead of print].
- Tu S, Barbato E, Köszegi Z, et al. Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: a fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv. 2014; 7(7): 768–777.
- Tu S, Westra J, Yang J, et al. Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography: the international multicenter FAVOR pilot study. JACC Cardiovasc Interv. 2016; 9(19): 2024–2035.
- Prati F, Cera M, Ramazzotti V, et al. Safety and feasibility of a new non-occlusive technique for facilitated intracoronary optical coherence tomography (OCT) acquisition in various clinical and anatomical scenarios. EuroIntervention. 2007; 3(3): 365–370.
- Gutiérrez-Chico JL, Cortés C, Schincariol M, et al. A formula to calculate the contrast volume required for optimal imaging quality in optical coherence tomography with non-occlusive technique. Cardiol J. 2018; 25(5): 574–581.
- Xu B, Tu S, Qiao S, et al. Diagnostic accuracy of angiography-based quantitative flow ratio measurements for online assessment of coronary stenosis. J Am Coll Cardiol. 2017; 70(25): 3077–3087.
- Westra J, Andersen BK, Campo G, et al. Diagnostic performance of in-procedure angiography-derived quantitative flow reserve compared to pressure-derived fractional flow reserve: the FAVOR II Europe-Japan study. J Am Heart Assoc. 2018; 7(14).
- Karanasos A, Tu S, van Ditzhuijzen NS, et al. A novel method to assess coronary artery bifurcations by OCT: cut-plane analysis for side-branch ostial assessment from a main-vessel pullback. Eur Heart J Cardiovasc Imaging. 2015; 16(2): 177–189.
- Finet G, Gilard M, Perrenot B, et al. Fractal geometry of arterial coronary bifurcations: a quantitative coronary angiography and intravascular ultrasound analysis. EuroIntervention. 2008; 3(4): 490–498.
- Liao JJZ. Sample size calculation for an agreement study. Pharm Stat. 2010; 9(2): 125–132.
- Gutiérrez-Chico JL, Zhao S, Chatzizisis YS. Vorticity: At the crossroads of coronary biomechanics and physiology. Atherosclerosis. 2018; 273: 115–116.
- Gutierrez-Chico JL, Cortes C, Jaguszewski M, et al. A simplified formula to calculate fractional flow reserve in sequential lesions circumventing the measurement of coronary wedge pressure: The APIS-S pilot study. Cardiol J. 2019; 26(4): 310–321.
