Association between optical coherence tomography and functionally severe stenosis assessed by quantitative flow ratio in coronary intermediate lesions

Abstract

Background Stenosis severity for an intermediate coronary lesion (ICL) demands comprehensive assessment methods. The relationship between optical coherence tomography (OCT) and coronary stenosis evaluated by quantitative flow ratio (QFR) remains to be discussed. Objective To investigate the association between OCT parameters and coronary functionally significant stenosis identified by QFR in patients with ICL. Methods A total of 113 patients with 115 target vessels were assessed using both OCT and QFR measurements for ICL. ICL was defined as a coronary lesion according to visual estimation with a diameter stenosis between 50% and 90%. Functional relevance stenosis was considered severe when QFR ≤ 0.80. Results The mean age of the included patients was 62.2 years, and the overall median QFR was 0.82. The mean minimal lumen area (MLA) and area stenosis (AS) assessed by OCT were 3.11 mm2 and 68.4%, respectively. According to the cut-off value of QFR = 0.80, the vessels with hemodynamic ischemia (n = 55) or without ischemia (n = 60) were grouped. OCT-measured MLA and AS exhibited a moderate diagnostic value with an area under the curve (AUC) of 0.83 (95% CI 0.75 to 0.90) for MLA and 0.87 (95% CI 0.81 to 0.94) for AS, respectively. The optimal cutoff value exhibited by OCT-measured anatomical parameters for identifying coronary stenosis, represented by QFR ≤ 0.80 was 2.52 mm2 (sensitivity 71%, specificity 85%) for MLA and 69% (sensitivity 84%, specificity 78%) for AS. Subsequently, AS measured by QFR and OCT were evaluated using linear regression analysis, revealing a good correlation (r = 0.79, p<0.001). Conclusions Intraluminal anatomical parameters obtained by OCT showed moderate diagnostic value for predicting the functional ischemia evaluated by QFR. Additionally, QFR may offer a rapid and simple method to assess area stenosis in coronary intermediate lesions.