Clinical Scorecard: Evaluation of Donor Vessel Using Quantitative Flow Ratio in Patients with Chronic Total Occlusions

At a Glance

Key Highlights

• CTO affects approximately one-fourth of patients with obstructive coronary artery disease.
• QFR is a non-invasive method for assessing coronary artery function without pressure wire.
• The 2024 ESC Guidelines recommend QFR for evaluating intermediate lesions in multivessel coronary artery disease.
• Murray law-based QFR (µQFR) may improve feasibility in CTO patients by requiring only one angiographic projection.
• Both µQFR and 3D-QFR values ≤ 0.80 indicate functional ischemia.

Guideline-Based Recommendations

Diagnosis

• Use functional assessment for revascularization in stable coronary artery disease.

Management

• Implement QFR for evaluating the function of intermediate lesions.

Monitoring & Follow-up

• Assess collateral donor vessels using µQFR and 3D-QFR.

Risks

• Stenotic lesions in donor vessels may lead to ischemia.

Patient & Prescribing Data

336 patients with single-vessel CTO, mean age 60.8 years, predominantly male (81.2%).

QFR-guided revascularization reduces major cardiovascular events compared to angiography-guided methods.

Clinical Best Practices

• Conduct QFR assessments in patients with visible retrograde collateral flow.
• Ensure high-quality angiographic projections for accurate QFR analysis.
• Utilize µQFR in cases where obtaining multiple projections is challenging.

References

• 2024 ESC Guidelines
• FAVOR III China trial
• Murray law-based QFR study