Comparison of Coronary Angiographic-Derived and Intracoronary Imaging-Based Fractional Flow Reserve in Assessing Coronary Artery Stenosis Severity: A Systematic Review and Network Meta-Analysis

Abstract

Objective: This systematic review and network meta-analysis aimed to compare the accuracy of coronary angiographic-derived fractional flow reserve (Angio-FFR), optical coherence tomography (OCT)-FFR, and intravascular ultrasound (IVUS)-FFR in evaluating the severity of coronary artery stenosis.

Methods: PubMed, Embase, and Cochrane Library were searched from January 1, 2010 to April 1, 2024 for studies on the accuracy assessment of Angio-FFR, OCT-FFR, and IVUS-FFR. A network meta-analysis was performed with accuracy and analysis of variance models. The diagnostic performance was evaluated through absolute sensitivity (SEN), specificity (SPE), diagnostic dominance index (DDI), and diagnostic odds ratio (DOR), with the corresponding 95% confidence interval (CI).

Results: The analysis included 86 studies (16,552 lesions). Network meta-analysis showed that IVUS-FFR demonstrated the highest absolute SEN of 0.92 (0.91, 0.94), while OCT-FFR demonstrated the highest absolute SPE of 0.92 (0.91, 0.94). In comparison to Angio-FFR, intracoronary imaging (ICI)-FFR demonstrated superior diagnostic performance, with a DDI and DOR of 1.00 (95% CI: 0.99, 1.01) versus 0.96 (95% CI: 0.94, 0.98) and 79.18 (95% CI: 62.20, 92.35) versus 56.15 (95% CI: 52.86, 59.29), respectively. Furthermore, ICI-FFR demonstrated significantly greater overall accuracy than Angio-FFR, with a relative risk of 1.03 (95% CI: 1.01–1.04).

Conclusion: This comprehensive network meta-analysis establishes that ICI-FFR provides superior diagnostic performance for coronary artery stenosis assessment compared to Angio-FFR. These findings support the clinical value of ICI modalities in functional stenosis evaluation.

Keywords

coronary angiography / fractional flow reserve / intravascular ultrasound / network meta-analysis / optical coherence tomography

References

[1] M. Sousa-Uva, F. J. Neumann, A. Ahlsson, et al., “2018 ESC/EACTS Guidelines on Myocardial Revascularization,” European Journal of Cardio-Thoracic Surgery 55, no. 1 (2019): 4-90.

[2] M. Tebaldi, S. Biscaglia, M. Fineschi, et al., “Evolving Routine Standards in Invasive Hemodynamic Assessment of Coronary Stenosis: The Nationwide Italian SICI-GISE Cross-Sectional ERIS Study,” Circulation: Cardiovascular Interventions 11, no. 15 (2018): 1482-1491.

[3] C. Collet, Y. Onuma, J. Sonck, et al., “Diagnostic Performance of Angiography-Derived Fractional Flow Reserve: A Systematic Review and Bayesian Meta-Analysis,” European Heart Journal 39, no. 35 (2018): 3314-3321.

[4] H. Kirigaya, K. Okada, K. Hibi, et al., “Diagnostic Performance and Limitation of Quantitative Flow Ratio for Functional Assessment of Intermediate Coronary Stenosis,” Journal of Cardiology 77, no. 5 (2021): 492-499.

[5] L. Raber, G. S. Mintz, K. C. Koskinas, et al., “Clinical Use of Intracoronary Imaging. Part 1: Guidance and Optimization of Coronary Interventions. An Expert Consensus Document of the European Association of Percutaneous Cardiovascular Interventions,” EuroIntervention 14, no. 6 (2018): 656-677.

[6] W. Yu, J. Huang, D. Jia, et al., “Diagnostic Accuracy of Intracoronary Optical Coherence Tomography-Derived Fractional Flow Reserve for Assessment of Coronary Stenosis Severity,” EuroIntervention 15, no. 2 (2019): 189-197.

[7] W. Yu, T. Tanigaki, D. Ding, et al., “Accuracy of Intravascular Ultrasound-Based Fractional Flow Reserve in Identifying Hemodynamic Significance of Coronary Stenosis,” Circulation: Cardiovascular Interventions 14, no. 2 (2021): e009840.

[8] T. Takahashi, D. Shin, T. Kuno, et al., “Diagnostic Performance of Fractional Flow Reserve Derived From Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography: A Meta-Analysis,” Journal of Cardiology 80, no. 1 (2022): 1-8.

[9] V. N. Nyaga, M. Aerts, and M. Arbyn, “ANOVA Model for Network Meta-Analysis of Diagnostic Test Accuracy Data,” Statistical Methods in Medical Research 27, no. 6 (2018): 1766-1784.

[10] L. Mbuagbaw, B. Rochwerg, R. Jaeschke, et al., “Approaches to Interpreting and Choosing the Best Treatments in Network Meta-analyses,” Systematic Reviews 6, no. 1 (2017): 79.

[11] M. J. Page, J. E. McKenzie, P. M. Bossuyt, et al., “The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews,” Bmj 372 (2021): n71.

[12] P. F. Whiting, A. W. Rutjes, M. E. Westwood, et al., “QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies,” Annals of Internal Medicine 155, no. 8 (2011): 529-536.

[13] J. L. Gutiérrez-Chico, Y. Chen, W. Yu, et al., “Diagnostic Accuracy and Reproducibility of Optical Flow Ratio for Functional Evaluation of Coronary Stenosis in a Prospective Series,” Cardiology Journal 27, no. 4 (2020): 350-361.

[14] J. Huang, H. Emori, D. Ding, et al., “Diagnostic Performance of Intracoronary Optical Coherence Tomography-based versus Angiography-Based Fractional Flow Reserve for the Evaluation of Coronary Lesions,” EuroIntervention 16, no. 7 (2020): 568-576.

[15] Y. Sui, M. Yang, Y. Xu, N. Wu, and J. Qian, “Diagnostic Performance of Intravascular Ultrasound-Based Fractional Flow Reserve Versus Angiography-based Quantitative Flow Ratio Measurements for Evaluating Left Main Coronary Artery Stenosis,” Catheterization and Cardiovascular Interventions 99, no. S1 (2022): 1403-1409.

[16] I. Skalidis, N. Noirclerc, D. Meier, et al., “Head-to-Head Comparison of Two Angiography-Derived Fractional Flow Reserve Techniques in Patients With High-Risk Acute Coronary Syndrome: A Multicenter Prospective Study,” International Journal of Cardiology 399 (2024): 131663.

[17] C. Jin, A. Ramasamy, H. Safi, et al., “Diagnostic Accuracy of Quantitative Flow Ratio (QFR) and Vessel Fractional Flow Reserve (vFFR) Estimated Retrospectively by Conventional Radiation Saving X-Ray Angiography,” The International Journal of Cardiovascular Imaging 37, no. 5 (2021): 1491-1501.

[18] P. D. Morris, D. Ryan, A. C. Morton, et al., “Virtual Fractional Flow Reserve From Coronary Angiography: Modeling the Significance of Coronary Lesions: Results From the VIRTU-1 (VIRTUal Fractional Flow Reserve From Coronary Angiography) Study,” Circulation: Cardiovascular Interventions 6, no. 2 (2013): 149-157.

[19] S. Tu, E. Barbato, Z. Köszegi, et al., “Fractional Flow Reserve Calculation From 3-Dimensional Quantitative Coronary Angiography and TIMI Frame Count: A Fast Computer Model to Quantify the Functional Significance of Moderately Obstructed Coronary Arteries,” Circulation: Cardiovascular Interventions 7, no. 7 (2014): 768-777.

[20] M. Trobs, S. Achenbach, J. Rother, et al., “Comparison of Fractional Flow Reserve Based on Computational Fluid Dynamics Modeling Using Coronary Angiographic Vessel Morphology Versus Invasively Measured Fractional Flow Reserve,” American Journal of Cardiology 117, no. 1 (2016): 29-35.

[21] S. Tu, J. Westra, J. Yang, et al., “Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography: The International Multicenter FAVOR Pilot Study,” JACC: Cardiovascular Interventions 9, no. 19 (2016): 2024-2035.

[22] M. Pellicano, I. Lavi, B. De Bruyne, et al., “Validation Study of Image-Based Fractional Flow Reserve During Coronary Angiography,” Circulation: Cardiovascular Interventions 10, no. 9 (2017): e005259.

[23] H. Emori, T. Kubo, T. Kameyama, et al., “Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction,” Circulation Journal 82, no. 3 (2018): 807-814.

[24] H. Emori, T. Kubo, T. Kameyama, et al., “Quantitative Flow Ratio and Instantaneous Wave-Free Ratio for the Assessment of the Functional Severity of Intermediate Coronary Artery Stenosis,” Coronary Artery Disease 29, no. 8 (2018): 611-617.

[25] B. Xu, S. Tu, S. Qiao, et al., “Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis,” Journal of the American College of Cardiology 70, no. 25 (2017): 3077-3087.

[26] K. Yazaki, M. Otsuka, S. Kataoka, et al., “Applicability of 3-Dimensional Quantitative Coronary Angiography-Derived Computed Fractional Flow Reserve for Intermediate Coronary Stenosis,” Circulation Journal: Official Journal of the Japanese Circulation Society 81, no. 7 (2017): 988-992.

[27] B. Tar, C. Jenei, C. A. Dezsi, et al., “Less Invasive Fractional Flow Reserve Measurement From 3-Dimensional Quantitative Coronary Angiography and Classic Fluid Dynamic Equations,” EuroIntervention 14, no. 8 (2018): 942-950.

[28] H. Mejia-Renteria, J. M. Lee, F. Lauri, et al., “Influence of Microcirculatory Dysfunction on Angiography-Based Functional Assessment of Coronary Stenoses,” Circulation: Cardiovascular Interventions 11, no. 8 (2018): 741-753.

[29] G. Spitaleri, M. Tebaldi, S. Biscaglia, et al., “Quantitative Flow Ratio Identifies Nonculprit Coronary Lesions Requiring Revascularization in Patients With ST-Segment-Elevation Myocardial Infarction and Multivessel Disease,” Circulation: Cardiovascular Interventions 11, no. 2 (2018): e006023.

[30] D. Ties, R. van Dijk, G. Pundziute, et al., “Computational Quantitative Flow Ratio to Assess Functional Severity of Coronary Artery Stenosis,” International Journal of Cardiology 271 (2018): 36-41.

[31] J. Westra, B. K. Andersen, G. Campo, et al., “Diagnostic Performance of in-Procedure Angiography-Derived Quantitative Flow Reserve Compared to Pressure-Derived Fractional Flow Reserve: The FAVOR II Europe-Japan Study,” Journal of the American Heart Association 7, no. 14 (2018): e009603.

[32] J. Westra, S. Tu, S. Winther, et al., “Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio during Invasive Coronary Angiography: The WIFI II Study (Wire-Free Functional Imaging II),” Circulation Cardiovascular Imaging 11, no. 3 (2018): e007107.

[33] R. Kornowski, H. Vaknin-Assa, A. Assali, G. Greenberg, O. Valtzer, and I. Lavi, “Online Angiography Image-Based FFR Assessment During Coronary Catheterization: A Single-Center Study,” Journal of Invasive Cardiology 30, no. 6 (2018): 224-229.

[34] W. F. Fearon, S. Achenbach, T. Engstrom, et al., “Accuracy of Fractional Flow Reserve Derived From Coronary Angiography,” Circulation 139, no. 4 (2019): 477-484.

[35] H. Omori, G. Witberg, Y. Kawase, et al., “Angiogram Based Fractional Flow Reserve in Patients With Dual/Triple Vessel Coronary Artery Disease,” International Journal of Cardiology 283 (2019): 17-22.

[36] J. M. Smit, M. El Mahdiui, A. R. van Rosendael, et al., “Comparison of Diagnostic Performance of Quantitative Flow Ratio in Patients With Versus Without Diabetes Mellitus,” American Journal of Cardiology 123, no. 10 (2019): 1722-1728.

[37] B. E. Stahli, A. Erbay, J. Steiner, et al., “Comparison of Resting Distal to Aortic Coronary Pressure With Angiography-Based Quantitative Flow Ratio,” International Journal of Cardiology 279 (2019): 12-17.

[38] D. Hwang, K. H. Choi, J. M. Lee, et al., “Diagnostic Agreement of Quantitative Flow Ratio with Fractional Flow Reserve and Instantaneous Wave-Free Ratio,” Journal of the American Heart Association 8, no. 8 (2019): e011605.

[39] P. Kleczyński, A. Dziewierz, Ł. Rzeszutko, D. Dudek, and J. Legutko, “Is Quantitative Flow Ratio Enough to Accurately Assess Intermediate Coronary Stenosis? A Comparison Study With Fractional Flow Reserve,” Cardiology Journal 26, no. 6 (2019): 793-795.

[40] R. C. Gosling, P. D. Morris, D. A. Silva Soto, P. V. Lawford, D. R. Hose, and J. P. Gunn, “Virtual Coronary Intervention: A Treatment Planning Tool Based Upon the Angiogram,” JACC Cardiovascular Imaging 12, no. 5 (2019): 865-872.

[41] J. Li, Y. Gong, W. Wang, et al., “Accuracy of Computational Pressure-Fluid Dynamics Applied to Coronary Angiography to Derive Fractional Flow Reserve: FLASH FFR,” Cardiovascular Research 116, no. 7 (2020): 1349-1356.

[42] A. Erbay, J. Steiner, A. Lauten, U. Landmesser, D. M. Leistner, and B. E. Stähli, “Assessment of Intermediate Coronary Lesions by Fractional Flow Reserve and Quantitative Flow Ratio in Patients With Small-Vessel Disease,” Catheterization and Cardiovascular Interventions 96, no. 4 (2020): 743-751.

[43] F. M. Lauri, F. Macaya, H. Mejia-Renteria, et al., “Angiography-Derived Functional Assessment of Non-Culprit Coronary Stenoses in Primary Percutaneous Coronary Intervention,” EuroIntervention 15, no. 18 (2020): e1594-e1601.

[44] Y. Kanno, M. Hoshino, R. Hamaya, et al., “Functional Classification Discordance in Intermediate Coronary Stenoses Between Fractional Flow Reserve and Angiography-Based Quantitative Flow Ratio,” Open Heart 7, no. 1 (2020): e001179.

[45] O. H. Mehta, M. Hay, R. Y. Lim, et al., “Comparison of Diagnostic Performance Between Quantitative Flow Ratio, Non-Hyperemic Pressure Indices and Fractional Flow Reserve,” Cardiovascular Diagnosis and Therapy 10, no. 3 (2020): 442-452.

[46] H. Mejía-Rentería, L. Nombela-Franco, J. M. Paradis, et al., “Angiography-Based Quantitative Flow Ratio Versus Fractional Flow Reserve in Patients With Coronary Artery Disease and Severe Aortic Stenosis,” EuroIntervention 16, no. 4 (2020): e285-e292.

[47] P. Ely Pizzato, A. J. Samdani, and A. Vergara-Martel, “Feasibility of Coronary Angiogram-Derived Vessel Fractional Flow Reserve in the Setting of Standard of Care Percutaneous Coronary Intervention and Its Correlation With Invasive FFR,” International Journal of Cardiology 301 (2020): 45-49.

[48] C. Li, X. Leng, J. He, et al., “Diagnostic Performance of Angiography-Based Fractional Flow Reserve for Functional Evaluation of Coronary Artery Stenosis,” Frontiers in Cardiovascular Medicine 8 (2021): 714077.

[49] H. Ai, N. Zheng, L. Li, et al., “Agreement of Angiography-Derived and Wire-Based Fractional Flow Reserves in Percutaneous Coronary Intervention,” Frontiers in Cardiovascular Medicine 8 (2021): 654392.

[50] Y. Gong, B. Zheng, T. Yi, et al., “Coronary Angiography-Derived Contrast Fractional Flow Reserve,” Catheterization and Cardiovascular Interventions 99, no. 3 (2022): 763-771.

[51] H. Babakhani, P. Sadeghipour, and A. Tashakori Beheshti, “Diagnostic Accuracy of Two-Dimensional Coronary Angiographic-Derived Fractional Flow Reserve-Preliminary Results,” Catheterization and Cardiovascular Interventions 97, no. 4 (2021): E484-e494.

[52] K. H. Choi, S. H. Lee, J. M. Lee, et al., “Clinical Relevance and Prognostic Implications of Contrast Quantitative Flow Ratio in Patients With Coronary Artery Disease,” International Journal of Cardiology 325 (2021): 23-29.

[53] M. Finizio, G. D. Melaku, Y. Kahsay, et al., “Comparison of Quantitative Flow Ratio and Invasive Physiology Indices in a Diverse Population at a Tertiary United States Hospital,” Cardiovascular Revascularization Medicine: Including Molecular Interventions 32 (2021): 1-4.

[54] K. Y. Lee, B. H. Hwang, M. J. Kim, et al., “Influence of Lesion and Disease Subsets on the Diagnostic Performance of the Quantitative Flow Ratio in Real-World Patients,” Scientific Reports 11, no. 1 (2021): 2995.

[55] C. Liontou, H. Mejía-Rentería, F. Lauri, et al., “Quantitative Flow Ratio for Functional Evaluation of In-Stent Restenosis,” EuroIntervention 17, no. 5 (2021): 396-398.

[56] A. Milzi, R. Dettori, N. Marx, S. Reith, and M. Burgmaier, “Quantitative Flow Ratio (QFR) Identifies Functional Relevance of Non-Culprit Lesions in Coronary Angiographies of Patients With Acute Myocardial Infarction,” Clinical Research in Cardiology 110, no. 10 (2021): 1659-1667.

[57] M. Tebaldi, S. Biscaglia, A. Erriquez, et al., “Comparison of Quantitative Flow Ratio, Pd/Pa and Diastolic Hyperemia-Free Ratio versus Fractional Flow Reserve in Non-Culprit Lesion of Patients With Non ST-Segment Elevation Myocardial Infarction,” Catheterization and Cardiovascular Interventions 98, no. 6 (2021): 1057-1065.

[58] J. Peper, R. W. van Hamersvelt, B. Rensing, et al., “Diagnostic Performance and Clinical Implications for Enhancing a Hybrid Quantitative Flow Ratio-FFR Revascularization Decision-Making Strategy,” Scientific Reports 11, no. 1 (2021): 6425.

[59] K. Masdjedi, L. J. C. van Zandvoort, M. M. Balbi, et al., “Validation of a Three-Dimensional Quantitative Coronary Angiography-Based Software to Calculate Fractional Flow Reserve: The FAST Study,” EuroIntervention 16, no. 7 (2021): 591-599.

[60] N. Mileva, S. Nagumo, E. Gallinoro, et al., “Validation of Coronary Angiography-Derived Vessel Fractional Flow Reserve in Heart Transplant Patients With Suspected Graft Vasculopathy,” Diagnostics (Basel, Switzerland) 11, no. 10 (2021): 1750.

[61] T. Neleman, K. Masdjedi, L. J. C. Van Zandvoort, et al., “Extended Validation of Novel 3D Quantitative Coronary Angiography-Based Software to Calculate vFFR: The FAST EXTEND Study,” JACC Cardiovascular Imaging 14, no. 2 (2021): 504-506.

[62] S. Tu, D. Ding, Y. Chang, C. Li, W. Wijns, and B. Xu, “Diagnostic Accuracy of Quantitative Flow Ratio for Assessment of Coronary Stenosis Significance From a Single Angiographic View: A Novel Method Based on Bifurcation Fractal Law,” Catheterization and Cardiovascular Interventions 97, no. Suppl 2 (2021): 1040-1047.

[63] J. Jiang, L. Tang, C. Du, et al., “Diagnostic Performance of AccuFFRangio in the Functional Assessment of Coronary Stenosis Compared With Pressure Wire-Derived Fractional Flow Reserve,” Quantitative Imaging in Medicine and Surgery 12, no. 2 (2022): 949-958.

[64] H. Wienemann, C. Ameskamp, H. Mejía-Rentería, et al., “Diagnostic Performance of Quantitative Flow Ratio Versus Fractional Flow Reserve and Resting Full-Cycle Ratio in Intermediate Coronary Lesions,” International Journal of Cardiology 362 (2022): 59-67.

[65] K. Masdjedi, N. Tanaka, E. Van Belle, et al., “Vessel Fractional Flow Reserve (vFFR) for the Assessment of Stenosis Severity: The FAST II Study,” EuroIntervention 17, no. 18 (2022): 1498-1505.

[66] F. Aminfar, B. Honton, P. Meyer, et al., “Quantitative Flow Ratio Analysis by Paramedical Compared With Medical Users,” Journal of Invasive Cardiology 34, no. 4 (2022): E281-E285.

[67] J. Ando, K. Otani, T. Redel, et al., “Agreement Between Single Plane and Biplane Derived Angiographic Fractional Flow Reserve in Patients With Intermediate Coronary Artery Stenosis,” Heart and Vessels 37, no. 4 (2022): 549-554.

[68] L. de Moura Santos, W. Borges Carvalho, M. H. Ribeiro, et al., “Offline Assessment of the Quantitative Flow Ratio: Is It Useful in Clinical Practice?,” Journal of Invasive Cardiology 34, no. 8 (2022): E620-e626.

[69] C. Dowling, M. Michail, J. M. Zhang, et al., “Diagnostic Performance of Quantitative Flow Ratio, Non-Hyperaemic Pressure Indices and Fractional Flow Reserve for the Assessment of Coronary Lesions in Severe Aortic Stenosis,” Cardiovasc Diagn Ther 12, no. 3 (2022): 314-324.

[70] M. Echavarría-Pinto, T. P. Van de Hoef, N. Pacheco-Beltran, et al., “Diagnostic Agreement of Quantitative Flow Ratio With Fractional Flow Reserve in a Latin-American Population,” International Journal of Cardiovascular Imaging 38, no. 7 (2022): 1423-1430.

[71] G. Kasinadhuni, A. Batta, A. A. Gawalkar, S. Budakoty, A. Gupta, and R. Vijayvergiya, “Validity and Correlation of Quantitative Flow Ratio With Fractional Flow Reserve for Assessment of Intermediate Coronary Lesions,” Acta Cardiologica 78 (2022): 91-98.

[72] P. Kleczynski, A. Dziewierz, L. Rzeszutko, D. Dudek, and J. Legutko, “Quantitative Flow Ratio for Evaluation of Borderline Coronary Lesions in Patients With Severe Aortic Stenosis,” Revista Espanola De Cardiologia (English Ed) 75, no. 6 (2022): 472-478.

[73] J. Zhang, N. Zhao, B. Xu, et al., “Angiographic Lesion Morphology Provides Incremental Value to Generalize Quantitative Flow Ratio for Predicting Myocardial Ischemia,” Frontiers in Cardiovascular Medicine 9 (2022): 872498.

[74] S. Fezzi, D. Ding, R. Scarsini, et al., “Integrated Assessment of Computational Coronary Physiology From a Single Angiographic View in Patients Undergoing TAVI,” Circulation: Cardiovascular Interventions 16, no. 10 (2023): e013185.

[75] C. Li, Y. Hu, J. Wang, et al., “Are Baseline Conditions of Coronary Arteries Sufficient for Calculating Angio-Based Index of Microcirculatory Resistance and Fractional Flow Reserve?,” Quantitative Imaging in Medicine and Surgery 13, no. 9 (2023): 6215-6227.

[76] H. Liang, Q. Zhang, Y. Gao, et al., “Diagnostic Performance of Angiography-Derived Fractional Flow Reserve Analysis Based on Bifurcation Fractal Law for Assessing Hemodynamic Significance of Coronary Stenosis,” European Radiology 33, no. 10 (2023): 6771-6780.

[77] R. Lopez-Palop, P. Carrillo, G. Leithold, et al., “Accuracy of the Angiography-Based Quantitative Flow Ratio in Intermediate Left Main Coronary Artery Lesions and Comparison With Visual Estimation,” International Journal of Cardiology 383 (2023): 8-14.

[78] H. Omori, Y. Kawase, T. Mizukami, et al., “Diagnostic Accuracy of Artificial Intelligence-Based Angiography-Derived Fractional Flow Reserve Using Pressure Wire-Based Fractional Flow Reserve as a Reference,” Circulation Journal: Official Journal of the Japanese Circulation Society 87, no. 6 (2023): 783-790.

[79] W. Wang, Y. Hu, P. Xiang, et al., “The Diagnostic Performance of AccuFFRangio for Evaluating Coronary Artery Stenosis Under Different Computational Conditions,” Quantitative Imaging in Medicine and Surgery 13, no. 4 (2023): 2496-2506.

[80] G. Yang, L. Li, X. Peng, et al., “Accuracy and Reproducibility of Coronary Angiography-Derived Fractional Flow Reserve in the Assessment of Coronary Lesion Severity,” International Journal of General Medicine 16 (2023): 3805-3814.

[81] W. Zuo, R. Sun, Y. Xu, et al., “Impact of Calcification on Murray Law-based Quantitative Flow Ratio for Physiological Assessment of Intermediate Coronary Stenoses,” Cardiology Journal 31(2023): 205-214.

[82] H. Zafar, F. Sharif, and M. J. Leahy, “Feasibility of Intracoronary Frequency Domain Optical Coherence Tomography Derived Fractional Flow Reserve for the Assessment of Coronary Artery Stenosis,” International Heart Journal 55, no. 4 (2014): 307-311.

[83] J. Ha, J. S. Kim, J. Lim, et al., “Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery,” Circulation: Cardiovascular Interventions 9, no. 8 (2016): e003613.

[84] S. J. Jang, J. M. Ahn, B. Kim, et al., “Comparison of Accuracy of One-Use Methods for Calculating Fractional Flow Reserve by Intravascular Optical Coherence Tomography to That Determined by the Pressure-Wire Method,” American Journal of Cardiology 120, no. 11 (2017): 1920-1925.

[85] K. E. Lee, S. H. Lee, E. S. Shin, and E. B. Shim, “A Vessel Length-based Method to Compute Coronary Fractional Flow Reserve From Optical Coherence Tomography Images,” Biomedical Engineering Online [Electronic Resource] 16, no. 1 (2017): 83.

[86] F. Seike, T. Uetani, K. Nishimura, et al., “Intracoronary Optical Coherence Tomography-Derived Virtual Fractional Flow Reserve for the Assessment of Coronary Artery Disease,” American Journal of Cardiology 120, no. 10 (2017): 1772-1779.

[87] H. Emori, T. Kubo, Y. Shiono, et al., “Comparison of Optical Flow Ratio and Fractional Flow Ratio in Stent-Treated Arteries Immediately After Percutaneous Coronary Intervention,” Circulation Journal: Official Journal of the Japanese Circulation Society 84, no. 12 (2020): 2253-2258.

[88] W. Pan, W. Wei, Y. Hu, et al., “Diagnostic Accuracy of a Novel Optical Coherence Tomography-Based Fractional Flow Reserve Algorithm for Assessment of Coronary Stenosis Significance,” Cardiol J (2023).

[89] A. Jeremias, A. Maehara, M. Matsumura, et al., “Optical Coherence Tomography-Based Functional Stenosis Assessment: FUSION-A Prospective Multicenter Trial,” Circulation: Cardiovascular Interventions 17, no. 4 (2024): e013702.

[90] F. Seike, T. Uetani, K. Nishimura, et al., “Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia,” Circulation Journal: Official Journal of the Japanese Circulation Society 82, no. 3 (2018): 815-823.

[91] C. G. Bezerra, A. Hideo-Kajita, C. A. Bulant, et al., “Coronary Fractional Flow Reserve Derived From Intravascular Ultrasound Imaging: Validation of a New Computational Method of Fusion Between Anatomy and Physiology,” Catheterization and Cardiovascular Interventions 93, no. 2 (2019): 266-274.

[92] P. K. Siogkas, M. I. Papafaklis, L. Lakkas, et al., “Virtual Functional Assessment of Coronary Stenoses Using Intravascular Ultrasound Imaging: A Proof-of-Concept Pilot Study,” Heart, Lung and Circulation 28, no. 4 (2019): e33-e36.

[93] J. Jiang, L. Feng, C. Li, et al., “Fractional Flow Reserve for Coronary Stenosis Assessment Derived From Fusion of Intravascular Ultrasound and X-Ray Angiography,” Quantitative Imaging in Medicine and Surgery 11, no. 11 (2021): 4543-4555.

[94] W. Huang, J. Zhang, L. Yang, et al., “Accuracy of Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve (FFR) and FFR Derived From Computed Tomography for Functional Assessment of Coronary Artery Disease,” Biomedical Engineering Online [Electronic Resource] 22, no. 1 (2023): 64.

[95] D. Yong, C. Minjie, Z. Yujie, et al., “Diagnostic Performance of IVUS-FFR Analysis Based on Generative Adversarial Network and Bifurcation Fractal Law for Assessing Myocardial Ischemia,” Frontiers in Cardiovascular Medicine 10 (2023): 1155969.

[96] Y. Sui, M. Yang, Y. Xu, N. Wu, and J. Qian, “Diagnostic Performance of Intravascular Ultrasound-Based Fractional Flow Reserve Versus Angiography-based Quantitative Flow Ratio Measurements for Evaluating Left Main Coronary Artery Stenosis,” Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions 99, no. Suppl 1 (2022): 1403-1409.

[97] Y. Fan, S. Fezzi, P. Sun, et al., “In Vivo Validation of a Novel Computational Approach to Assess Microcirculatory Resistance Based on a Single Angiographic View,” Journal of Personalized Medicine 12, no. 11 (2022): 1798.

[98] H. Hong, C. Li, J. L. Gutierrez-Chico, et al., “Radial Wall Strain: A Novel Angiographic Measure of Plaque Composition and Vulnerability,” EuroIntervention 18, no. 12 (2022): 1001-1010.

[99] B. Xu, S. Tu, L. Song, et al., “Angiographic Quantitative Flow Ratio-guided Coronary Intervention (FAVOR III China): A Multicentre, Randomised, Sham-controlled Trial,” Lancet (London, England) 398, no. 10317 (2021): 2149-2159.

[100] Y. Li, J. L. Gutiérrez-Chico, N. R. Holm, et al., “Impact of Side Branch Modeling on Computation of Endothelial Shear Stress in Coronary Artery Disease: Coronary Tree Reconstruction by Fusion of 3D Angiography and OCT,” Journal of the American College of Cardiology 66, no. 2 (2015): 125-135.

[101] E. Kedhi, B. Berta, T. Roleder, et al., “Thin-cap Fibroatheroma Predicts Clinical Events in Diabetic Patients With Normal Fractional Flow Reserve: The COMBINE OCT-FFR Trial,” European Heart Journal 42, no. 45 (2021): 4671-4679.

[102] J. Q. Mol, R. Volleberg, A. Belkacemi, et al., “Fractional Flow Reserve-Negative High-Risk Plaques and Clinical Outcomes After Myocardial Infarction,” JAMA Cardiology 8, no. 11 (2023): 1013-1021.

[103] E. M. Groves, A. H. Seto, and M. J. Kern, “Invasive Testing for Coronary Artery Disease: FFR, IVUS, OCT, NIRS,” Cardiology Clinics 32, no. 3 (2014): 405-417.

[104] F. Burzotta, A. M. Leone, C. Aurigemma, et al., “Fractional Flow Reserve or Optical Coherence Tomography to Guide Management of Angiographically Intermediate Coronary Stenosis: A Single-Center Trial,” JACC: Cardiovascular Interventions 13, no. 1 (2020): 49-58.

[105] C. Yang, Y. G. Sui, J. Y. Shen, et al., “Diagnostic Performance of Ultrasonic Flow Ratio Versus Quantitative Flow Ratio for Assessment of Coronary Stenosis,” International Journal of Cardiology 400 (2024): 131765.

[106] V. S. Schneider, F. Bohm, K. Blum, et al., “Impact of Real-time Angiographic Co-Registered Optical Coherence Tomography on Percutaneous Coronary Intervention: The OPTICO-integration II Trial,” Clinical Research in Cardiology 110, no. 2 (2021): 249-257.

[107] D. Ding, S. Tu, Y. Li, et al., “Quantitative Flow Ratio Modulated by Intracoronary Optical Coherence Tomography for Predicting Physiological Efficacy of Percutaneous Coronary Intervention,” Catheterization and Cardiovascular Interventions 102, no. 1 (2023): 36-45.

RIGHTS & PERMISSIONS

2025 The Author(s). Journal of Evidence-Based Medicine published by Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.