Physiological benefits evaluated by quantitative flow ratio in patients with reduced left ventricular ejection fraction

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RESEARCH ARTICLE

Open Access

Physiological benefits evaluated by quantitative flow ratio in patients with reduced left ventricular ejection fraction who underwent percutaneous coronary intervention Jiaxin Zhong1,2,3†, Qin Chen1,2,3†, Long Chen1,2,3, Zhen Ye1,2,3, Huang Chen1,2,3, Jianmin Sun1,2,3, Juchang Hong1,2,3, Mingfang Ye1,2,3, Yuanming Yan1,2,3, Lianglong Chen1,2,3* and Yukun Luo1,2,3* 

Abstract  Background:  To explore the clinical benefits of revascularization in patients with different levels of left ventricular ejection fraction (LVEF) from the perspective of quantitative flow ratio (QFR). Methods:  Patients who underwent successful percutaneous coronary intervention (PCI) and one-year angiographic follow-up were retrospectively screened and computed by QFR analysis. Based on their LVEF, 301 eligible patients were classified into reduced LVEF (≤ 50%, n = 48) and normal LVEF (> 50%, n = 253) groups. Pre-PCI QFR, post-PCI QFR, follow-up QFR, late lumen loss (LLL), LVEF and major adverse cardiovascular and cerebrovascular events (MACCEs) at one year were compared between groups. Results:  The reduced LVEF group had a lower mean pre-PCI QFR than the normal LVEF group (0.67 ± 0.16 vs. 0.73 ± 0.15, p = 0.004), but no significant difference was found in the post-PCI or one-year follow-up QFR. No association was found between LVEF and QFR at pre-PCI or follow-up. The reduced LVEF group had greater increases in QFR (0.27 ± 0.18 vs. 0.22 ± 0.15, p = 0.043) and LVEF (6.05 ± 9.45% vs. − 0.37 ± 8.11%, p  50%) according to a threshold of 50% of the pre-PCI LVEF value. This study was approved by the Ethics Committee of Union Hospital, Fujian Medical University (No. 2020KY098). Patient population

The study population is composed of adults who underwent coronary angiography with PCI and DES implantation. Patients diagnosed with stable angina, unstable angina, or post-acute myocardial infarction (≥ 72  h) were eligible for enrolment when the angiographic inclusion criteria were met. In addition, the indications for QFR computation were as follows: (1) diameter stenosis (DS) between 50–90% (visual assessment) due to at least one lesion, and (2) reference vessel diameter size ≥ 2.5  mm (visual assessment). Patients with any of the following clinical characteristics were excluded: (1) acute myocardial infarction (AMI) within 72  h; (2) lack of angiographic follow-up; and (3) unavailable LVEF data. Patients were further excluded if the QFR computation was no possible: (1) only one lesion with DS% > 90% and Thrombolysis in myocardial infarction (TIMI) grade