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µFR ®. NUEVO SISTEMA DE FISIOLOGÍA CORONARIA

Carlos Cortés. MD. PhD.

Hospital Clínico Universitario de Valladolid

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Bech GJ. Circulation. 2001

Tonino PAL. N Engl J Med. 2009

De Bruyne B. N Engl J Med. 2012

Toth GG. Circ Cardiovasc Interv. 2014

Tebaldi M. JACC Cardiovasc Interv . 2018

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Götberg M. J Am Coll Cardiol 2017

Cortés C. 2020. Catheter Cardiovasc Interv.

QUANTITATIVE FLOW RATIO - QFR

Sensitivity

ROC

1- specificity

0

0,2

0,4

0,6

0,8

1

0

0,1

0,2

0,3

0,4

0,5

0,6

0,7

0,8

0,9

1

Symmetric SROC

AUC = 0,9445

	Not-Analysed	Absence of projections >25º	Overlap
Retrospectivos	24.49%	80.7%	19.3%
Prospectivos	3.07%	19.3%	69.2%

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QFR: Evidencia

QFR tiene la mayor evidencia en el área de FFR basadas en angiografía

Lancet [73] (IF=79.321) European Heart Journal [38-39,69-71] (IF=22.673) JACC [1] (IF=20.589) JACC Cardiol Imaging [46,68] (IF=12.74) JACC Cardiol Interv [3,5,19,26,30-32,64,72] (IF= 8.432) Eur J NuclMed Mol Imaging [6] (IF=7.081)	Circ Cardiovasc Imaging [4] (IF=5.691) Circ Cardiovasc Interv [5,16,26,40,41,61] (IF=5.493) Clin Res Cardiol [12] (IF=5.268) EHJ Cardiov. Imaging [13] (IF=4.841) JAHA [2,25,29] (IF=4.54) Am Heart J [35] (IF=4.153)	EuroIntervention [20,21,28,33,36,48,52,63] (IF= 3.993) Int J Cardio [10,15,18,23,24,34,47,59,62] (IF=3.229) J Clin Med [42] (IF=3.303) Plos One [54] (IF=2.806) Am J Cardiol [7,22] (IF=2.57) Adv in Med Sci [58] (IF=2.57)	Circ J [8,14] (IF=2.54) Open Heart [45] (IF=2.13) Catheter Cardiovasc Interv [27,43,49-51,53,55-57,66- 67] (IF=2.044) Int J Cardiovasc Imaging [37,60,65] (IF=1.969) Cardiol J [17] (IF=1.669) Coronary Artery Dis [9,44] (IF=1.335)

Validation studies

Prognostic trials

RCT & Review

Asano T^19,20
Hamaya R²¹
Spitaleri G¹⁶
Smit JM²²
iSTEMI²⁶
HAWKEYE³⁰
Kogame N³²
Ozaki Y³⁴
Lauri FM^36,52
Cerrato E⁵⁵
RESTORE QFR⁵⁹
Zhang R⁶¹
De Maria⁶⁵

Kirigaya H

70

Tanigaki, T²⁶
Westra J^27,66
Catherina L²⁸
ADVANCE³¹
Lauri FM³³
van Diemen PA⁴⁶
Strähl M⁴⁷
Rubimbura V⁴⁹
Erbay A⁵⁰
FAVOR Pilot³
Chang Y¹⁷
van Rosendael¹⁸
Mejía-Rentería²⁹

Tebaldi M

Sugiyama T⁵⁷
van Diemen⁶⁸

FAVOR III China^35,73,a
FAVOR III E/J^b
QVAS-FAVOR IV^c
欧洲PCR-EAPCI教科书^d
日本AMI专家共识：Ozaki Y^e
Tu S³⁸
Collet C³⁹
De Maria GL⁴⁰
Kogame N⁶⁴
Simone B⁷²

^aNCT03656848

^bNCT03729739 ^cNCT03977129

^dPART II, Volume I

^eCardiovasc Interv Ther

FAVOR II China¹
FAVOR II E/J²
FAVOR Pilot³
WIFI II⁴
Mejía-Rentería^5,13,48
Smit JM^6,7
Emori H^8,9
Barbara E¹⁰
Kołtowski¹²
Yazaki, K¹⁴
Stähli

Spitaleri, G¹⁶
Zhang, Y²³

Tie, D

Hwang, D²⁵
Huang J⁶³
Lenk K⁶⁷

Safi H³⁷
Kanno Y⁴¹
Buono⁴²
Sheng X⁴³
Qi Q⁴⁴
Yoshinori K⁴⁵
Lee SH⁵¹
Saito Y⁵³
Engel LC⁵⁴
Kleczynski P⁵⁸
Tang J⁶⁰
Choi KH⁶²
Lee SH⁶⁹
Peper J

71

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FAVOR III-China

5

IF: 79.321

Xu, B. Lancet 2021

1-year MACE: 35%

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The History of QFR

2021

2^ndGen

μFR

Tu et al. Catheter Cardiovasc Interv 2021

Prototype of QFR, FFR_QCAwas developed. Indicated the emerging of the world first angiography-based FFR technology.

2014

Prototype

FFRqca

Tu et al. JACC Cardiovasc

Interv 2014, 7:768-777

Shengxian Tu

PhD. FESC, FACC

Professor of BioMedical Engineering, Shanghai Jiao Tong University

Co-founder of Pulse Medical Company

μFR, the world first Murray law based single projection angiography-based FFR solution was developed and commercialized by Pulse.

2016

1^stGen QFR

Tu et al. JACC Cardiovasc Interv

2016, 9:2024–35

1st Gen of QFR algo was commercialized by Pulse Medical (China) and Medis (Netherlands).

Inventor of QFR/ UFR/ OFR/ CT-QFR

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Nueva generación QFR: μFR

Murray bifurcation fractal law-based QFR

Standard Angiogram

Data transferred

One or two angiographic view

images runs with angle difference

≥15°

AngioPlus Core

Auto flow velocity calculation

1 angiographic view Main & bifurcation 2D QFR

2 angiographic views

Main & bifurcation 3D QFR

AngioPlus Core

(Shanghai Pulse Medical Technology Inc.)

LM Bifurcation Lesion

μQFR_LAD=0.40

μQFR_Lcx=0.81

Tu S,. Catheter Cardiovasc Interv 2021;97

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1^stGen: QFR

Contour segmentation

Reference

Vessel

Flow Velocity

QFR algo,

the same with 1^stgen

QFR algo

Intelligent algo based auto flow velocity
0 time consuming

Murray law based step down

reference diameter.

Much accuracy than 1^stgen

Intelligent algo based SMART- Contouring tech
Main vessel & side branches

Manual frame counting
Time consuming
Analyzer dependent

Analysis Time cost: <₁min

Analysis Time cost: _3~5min

1

2

3

FFR calculation

algo

₄based on QFR

2^ndGen: μFR

Straight line, Reduced accuracy in some types of bifurcation lesions

Traditional algo based main vessel Seg.
Manual correction

required in most cases

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Correlación entre μFR y 3D-QFR

Cortés C. Cardiology J 2022

	Not-Analysed	Absence of projections >25º	Overlap
3D-QFR	12.4%	4.1%	8.2%
μQFR	0%	0%	0%

ICCa 0.996 (CI95% 0.993-0.997)

Lin’s coefficient 0.996 (95% CI: 0.993 – 0.997)

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Hay vida más allá del epicardio….

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IMR derivado de Angiografía

Fernández‐Peregrina E. Catheter Cardiovasc Interv. 2022

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AMR: angiographic microcirculatory resistance

10

Fang Y, J. Pers Med. 2022

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Radial Wall Strain (RWS_MAX)

Tu, EuroPCR 2022

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Conclusiones

uFR es la nueva generación de fisiología coronaria basada en la angiografía, un paso más en la tecnología QFR
Posibilidad de realización con una sola proyección con incremento de la capacidad de análisis sobre todo en estudios retrospectivos
Detección automática del flujo coronario
Diámetro de referencia basado en la Ley de Murray
Cálculo de AMR y RWS