Murray law-based quantitative flow ratio versus invasive fractional flow reserve in the left anterior descending coronary artery: impact of hydrostatic pressure correction and clinical implications - Report - MDSpire

Murray law-based quantitative flow ratio versus invasive fractional flow reserve in the left anterior descending coronary artery: impact of hydrostatic pressure correction and clinical implications

  • By

  • András Ágoston

  • Ádám Piricsi

  • Bettina Szekeres

  • Mátyás Magyari

  • Balázs Tar

  • Gábor T. Szabó

  • Csaba A. Dézsi

  • Zsolt Piroth

  • Zoltán Ruzsa

  • Gábor G. Tóth

  • Shengxian Tu

  • Zsolt Kőszegi

  • June 17, 2026

  • 0 min

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Clinical Report: Comparison of Murray Law-Based QFR and Invasive FFR

Overview

This study investigates the impact of hydrostatic pressure correction on the agreement between invasive fractional flow reserve (FFR) and Murray law-based quantitative flow ratio (μQFR) in the left anterior descending artery.

Background

Invasive FFR is the gold standard for assessing coronary lesions, yet its adoption is limited due to procedural complexities. Angiography-derived techniques like QFR offer a less invasive alternative, but discrepancies between QFR and FFR measurements have been noted. Understanding the impact of hydrostatic pressure on these measurements is crucial for accurate physiological assessments in coronary artery disease.

Data Highlights

MeasurementMean ValueStandard Deviation
Uncorrected FFR0.780.11
Hydrostatic Corrected FFR0.810.10
μQFR0.810.10

Key Findings

  • Hydrostatic correction increased the mean FFR from 0.78 to 0.81 (p < 0.0001).
  • The Pearson correlation between μQFR and FFR was high (r = 0.95, p < 0.0001) both before and after correction.
  • Bland–Altman analysis showed that hydrostatic correction eliminated the bias between FFR and μQFR (mean difference improved from +0.03 to 0.00).
  • ROC analysis indicated that uncorrected FFR <0.80 was best predicted by μQFR <0.84 (AUC 0.976).
  • Hydrostatic pressure-corrected FFR <0.80 corresponded to a μQFR threshold <0.78 (AUC 0.977).

Clinical Implications

The findings indicate that incorporating hydrostatic pressure correction in FFR measurements may enhance the accuracy of physiological assessments in coronary lesions.

Conclusion

Correcting FFR for hydrostatic pressure improves its agreement with μQFR.

Related Resources & Content

  1. Clinical Research in Cardiology, 2021 -- Quantitative Flow Ratio (QFR) Assesses the Functional Importance of Non-Culprit Lesions in Coronary Angiograms of Acute Myocardial Infarction Patients
  2. Basic Research in Cardiology, 2009 -- Quantifying Coronary Microvascular Resistance: Techniques for Human Assessment
  3. Frontiers in Cardiovascular Medicine, 2026 -- Stress cardiac magnetic resonance vs. fractional flow reserve–guided management for intermediate coronary stenosis: a single-center retrospective propensity-matched study with 12-month follow-up
  4. Pediatric Cardiology — Influence of 4D-Flow CMR Metrics on the Functional Assessment of Fontan Circulation
  5. 2024 ESC Chronic Coronary Syndromes guideline
  6. Angiography-Derived Physiology for Coronary Artery Disease Assessment: Expert Opinion From a SCAI Roundtable
  7. ESC GUIDELINES
  8. FAME 2 at 10 Years: Less Urgent Revascularization With FFR-Guided PCI | tctmd.com
  9. Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial - ScienceDirect
  10. Angiographic Quantitative Flow Ratio-Guided Coronary Intervention: 5-Year Follow-Up From the FAVOR III China Randomized Trial - ScienceDirect
  11. Quantitative flow ratio versus fractional flow reserve for coronary revascularisation guidance (FAVOR III Europe): a multicentre, randomised, non-inferiority trial - PubMed
  12. FAVOR III Europe: QFR-Guided Strategy vs. FFR-Guided Strategy in Patients With Intermediate Coronary Stenosis - American College of Cardiology
  13. FAST III: Novel Minimally Invasive vFFR Noninferior to FFR For Revascularization - American College of Cardiology
  14. ALL-RISE: AI-Supported Coronary Flow Assessment Performs Similarly to Gold-Standard Wire-Based Testing - American College of Cardiology
  15. Coronary Angiography‐Derived Murray Law‐Based Quantitative Flow Ratio (μQFR) After De Novo Drug‐Coated Balloon Angioplasty - Garin - 2025 - Catheterization and Cardiovascular Interventions - Wiley Online Library
  16. Impact of Hydrostatic Pressure Variations Caused by Height Differences in Supine and Prone Positions on Fractional Flow Reserve Values in the Coronary Circulation - PMC
  17. Coronary artery height differences and their effect on fractional flow reserve - PMC
  18. The Effect of Hydrostatic Pressure on Coronary Flow and Pressure-Based Indices of Coronary Stenosis Severity - PubMed
  19. Frontiers | Murray Law-based Quantitative Flow Ratio versus Invasive Fractional Flow Reserve in the Left Anterior Descending Coronary Artery Impact of Hydrostatic Pressure Correction and Clinical Implications

Original Source(s)

Murray law-based quantitative flow ratio versus invasive fractional flow reserve in the left anterior descending coronary artery: impact of hydrostatic pressure correction and clinical implications

  • by András Ágoston, Ádám Piricsi, Bettina Szekeres, Mátyás Magyari, Balázs Tar, Gábor T. Szabó, Csaba A. Dézsi, Zsolt Piroth, Zoltán Ruzsa, Gábor G. Tóth, Shengxian Tu, Zsolt Kőszegi

  • June 17, 2026

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