Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters

• DOI: 10.1007/s10554-023-02974-z
• Publication Date: 2023-10-23T09:01:58Z
• Authors: Nozomi Kotoku; Kai Ninomiya; Daixin Ding; Neil O’Leary; Akihiro Tobe; Kotaro Miyashita; Shinichiro Masuda; Shigetaka Kageyama; Scot Garg; Jonathon A. Leipsic; Saima Mushtaq; Daniele Andreini; Kaoru Tanaka; Johan de Mey; William Wijns; Shengxian Tu; Nicolo Piazza; Yoshinobu Onuma; Patrick W. Serruys
• Keywords: Fractional Flow Reserve; Computed tomographic angiography; Concordance; Circumflex

Abstract Murray law-based quantitative flow ratio (µQFR) assesses fractional reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised suboptimal projections. FFR CT is well-validated non-invasive method measuring from coronary computed tomographic angiography (CCTA). We evaluated µQFR left main (LM) bifurcations, impact optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance . In 300 patients three-vessel disease, values were compared at distal LM, proximal anterior descending artery (pLAD) circumflex (pLCX). The optimal viewing angle LM was defined on CCTA by 3-dimensional coordinates converted into 2-dimensional view. best projection considered closest angulation CCTA. successfully 805 projections, sensitivity 88.2% (95% CI 76.1–95.6) 84.8% (71.1–93.7), specificity 96.8% (93.8–98.6) 97.2% (94.4–98.9), pLAD pLCX, respectively, regard AUC for predicting ≤ 0.80 tended improved versus projections (0.94 vs. 0.89 [p = 0.048] pLAD; 0.94 0.88 0.075] pLCX). Computation bifurcations showed high post-hoc analysis angiograms obtained clinical purposes. influences performance physiological assessment