Sex Differences in Murray Law-Based Quantitative Flow Ratio Among Patients With Intermediate Coronary Lesions.
Wenjie ZuoRenhua SunZhenjun JiPengfei ZuoXiaoguo ZhangRong HuangZaixiao TaoShengxian TuYongjun LiGenshan MaPublished in: Journal of the American Heart Association (2023)
Background The Murray law-based quantitative flow ratio (μQFR) is a novel technique that simulates fractional flow reserve (FFR) from a single angiographic view. However, the impact of sex differences on the diagnostic performance of μQFR has not been investigated. Methods and Results In this study, FFR and μQFR were assessed in 497 intermediate stenoses (30%-70% by visual estimation) from 460 patients (34.3% female). Physiological significance was defined as FFR ≤0.80 or μQFR ≤0.80. After adjusting for potential confounders, female sex was independently associated with higher FFR ( P =0.048 and 0.026, respectively) and μQFR ( P =0.001 for both) in both fully adjusted and stepwise backward models. μQFR provided superior diagnostic accuracy compared with angiography alone for detecting FFR ≤0.80 in both women (area under the curve, 0.93 [95% CI, 0.88-0.97] versus 0.80 [95% CI, 0.73-0.86]; P =0.001) and men (area under the curve, 0.88 [95% CI, 0.84-0.92] versus 0.73 [95% CI, 0.68-0.78]; P <0.001), with comparable performance between the sexes ( P =0.175). In the multivariable analysis, sex was not a significant factor contributing to the overall disagreement between FFR and μQFR. Conclusions Regardless of angiographic stenosis severity, women tend to have higher FFR and μQFR values than men. Furthermore, μQFR performs similarly well in both sexes and offers improved diagnostic accuracy over angiography alone, indicating its potential as a reliable, wire-free tool to identify functional ischemia.
Keyphrases
- polycystic ovary syndrome
- optical coherence tomography
- end stage renal disease
- computed tomography
- coronary artery disease
- heart failure
- type diabetes
- chronic kidney disease
- ejection fraction
- insulin resistance
- prognostic factors
- peritoneal dialysis
- mass spectrometry
- risk assessment
- aortic valve
- metabolic syndrome
- climate change
- transcatheter aortic valve replacement