Abstract

JACC

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TCTAP A-073

Murray Law-Based Quantitative Flow Ratio for Assessment of Left Main Bifurcation Derived From a Single Fluoroscopic Angiographic View as Compared to FFRCT

By Nozomi Kotoku, Daixin Ding, Kai Ninomiya, Shinichiro Masuda, Shigetaka Kageyama, William Wijns, Shengxian Tu, Yoshinobu Onuma, Patrick W. Serruys

Presenter

Nozomi Kotoku

Authors

Nozomi Kotoku1, Daixin Ding1, Kai Ninomiya1, Shinichiro Masuda1, Shigetaka Kageyama1, William Wijns1, Shengxian Tu2, Yoshinobu Onuma1, Patrick W. Serruys1

Affiliation

National University of Ireland, Galway, Ireland1, Shanghai Jiao Tong University, China2
View Study Report
TCTAP A-073
Physiologic Lesion Assessment

Murray Law-Based Quantitative Flow Ratio for Assessment of Left Main Bifurcation Derived From a Single Fluoroscopic Angiographic View as Compared to FFRCT

Nozomi Kotoku1, Daixin Ding1, Kai Ninomiya1, Shinichiro Masuda1, Shigetaka Kageyama1, William Wijns1, Shengxian Tu2, Yoshinobu Onuma1, Patrick W. Serruys1

National University of Ireland, Galway, Ireland1, Shanghai Jiao Tong University, China2

Background

In patients with complex coronary artery disease, the presence or absence of left main disease is an important prognostic factor in assessing the risk balance between percutaneous coronary intervention and coronary artery bypass grafting. Functional assessment of coronary stenosis has become standard of care to evaluate the significance of coronary stenosis and to justify the performance of percutaneous coronary intervention in the contemporary practice. Imaging-derived physiological assessment based on angiography or multi-slice computed tomography is a good alternative to wire-based pressure measurement since imaging based functional assessment is associated with less invasiveness, shorter procedural time, and cost-effective practice. FFRCT is a well-established method based on three-dimensional reconstruction of coronary artery derived from noninvasive coronary computed tomography angiography. The Murray law-based quantitative flow reserve (µQFR) is a novel computational method of invasive angiography relying on a single angiographic view that takes into account side branches diameters to compute fractal flow division. The aim of the current analysis is to evaluate in patients with complex coronary artery disease the feasibility of µQFR in left main bifurcation and its diagnostic concordance with FFRCT.

Methods

In 89 consecutive left main bifurcations, FFRCT and µQFR were measured at 3 fiducial landmark points: i) point of left main bifurcation (POB); ii) proximal left anterior descending artery (LAD) 10 mm distal to POB; ii) proximal left circumflex artery (LCX) 10 mm distal to POB.

Results

Eighty-nine left main bifurcations were analysed with both FFRCT and µQFR (Figure 1). Single view µQFR was analyzable in 100%. Correlation and agreement between µQFR and FFRCT are shown in Figure 2 and Figure 3. The Spearman’s correlation coefficient showed  moderate correlations at POB (r = 0.662, p < 0.001), LAD (r = 0.653, p < 0.001) and LCX (r = 0.692, p < 0.001).


Conclusion

To evaluate in patients with complex coronary artery disease the feasibility of µQFR in left main bifurcation and its diagnostic concordance with FFRCT, the full analysis of > 250 patients will be presented at the time of the meeting.

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