Quantitative Flow Ratio Is Associated with Extent and Severity of Ischemia in Non-Culprit Lesions of Patients with Myocardial Infarction

Figures

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  Figure 1. Exemplificative analysis of angiography, QFR and CMR images. In (A), angiographic image of a STEMI patient with occlusion of RCA (not shown) and non-culprit, intermediate stenosis of the LAD (marked with a white arrow) is shown. In (B), QFR analysis of the hemodynamic relevance of the non-culprit LAD stenosis is shown. In (C), a contrast enhanced first pass perfusion imaging of the mid-ventricular layer with myocardial ischemia of the anteroseptal/septal segments is presented. In (D), schematized analysis of this CMR image is shown. Here, myocardial area is delimited by the brown border, ischemic area is shown in yellow; signal intensity of ischemia was measured in the center (orange) of the ischemic area, signal intensity of remote myocardium was measured in the non-ischemic area (blue); circumferential extent of ischemia (red) corresponded to the angle of ischemia with vertex at the center of the AHA 16 segment model.

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  Figure 2. QFR is associated with extent of myocardial ischemia in CMR. Throughout predefined groups of QFR, the distribution of parameters assessing extent of ischemia was significantly different (p < 0.001 for all three parameters); relevant differences in the pairwise comparison are reported with an asterisk (* for p < 0.001).

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  Figure 3. Graphic illustration of the association of intensity of myocardial ischemia index and QFR value of the respective non-culprit lesion. A bar graph illustrates the correlation between relative intensity of myocardial ischemia and QFR-groups (* for p < 0.001).

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  Figure 4. QFR predicts myocardial ischemia ≥10% with good diagnostic efficiency. AUC = area under the curve.