open access

Vol 27, No 4 (2020)
Original articles — Interventional cardiology
Published online: 2020-05-20
Get Citation

Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series

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
DOI: 10.5603/CJ.a2020.0071
·
Pubmed: 32436590
·
Cardiol J 2020;27(4):350-361.

open access

Vol 27, No 4 (2020)
Original articles — Interventional cardiology
Published online: 2020-05-20

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.

Get Citation

Keywords

optical flow ratio, optical coherence tomography, fractional flow reserve, coronary heart disease

About this article
Title

Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series

Journal

Cardiology Journal

Issue

Vol 27, No 4 (2020)

Pages

350-361

Published online

2020-05-20

DOI

10.5603/CJ.a2020.0071

Pubmed

32436590

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)
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2018; 40(2): 87–165.
  14. 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.
  15. 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.
  16. 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].
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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).
  23. 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.
  24. 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.
  25. Liao JJZ. Sample size calculation for an agreement study. Pharm Stat. 2010; 9(2): 125–132.
  26. Gutiérrez-Chico JL, Zhao S, Chatzizisis YS. Vorticity: At the crossroads of coronary biomechanics and physiology. Atherosclerosis. 2018; 273: 115–116.
  27. 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.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl