Correlation and Agreement of Quantitative Flow Ratio With Fractional Flow Reserve in Saphenous Vein Grafts

BACKGROUND: The applicability of quantitative flow ratio (QFR), a nonhyperemic, invasive coronary angiography-derived computation of fractional flow reserve (FFR), has not been studied in coronary artery bypass grafts. We sought to explore the correlation and diagnostic agreement between QFR and FFR in saphenous vein grafts (SVGs). METHODS AND RESULTS: A total of 129 prospectively included patients (mean age 73±8 years, 84% male) with prior coronary artery bypass grafting underwent invasive coronary angiography and pressure-derived functional assessment in 150 nonoccluded SVGs. QFR dedicated angiography images of the SVGs were acquired and used for offline QFR computation. The diagnostic performance of QFR was compared with 2-dimensional quantitative coronary angiography, using FFR as a reference. A threshold of ≤0.80 was used to define functional significance. QFR was successfully computed in 140 (93%) SVGs. We found a significant correlation between QFR and FFR (r=0.72, P<0.001). FFR indicated significant disease in 43 (31%) SVGs, whereas QFR analysis showed significant lesions in 53 (38%) bypass grafts. QFR exhibited a higher sensitivity and diagnostic accuracy compared with angiographic lesion assessment (84% versus 63%, P=0.030 and 83% versus 74%, P=0.036, respectively), whereas specificity did not differ (82% versus 79%, P=0.466). Lastly, QFR demonstrated a higher area under the receiver operating curve than quantitative coronary angiography (0.90 versus 0.82, P=0.008) for the detection of FFR-defined significant vein graft disease. CONCLUSIONS: This study shows the potential applicability of contemporary QFR computation in venous bypass grafts with a moderate correlation and good diagnostic accuracy compared with functional assessment using FFR.