The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis

Artur Dziewierz; Łukasz Rzeszutko; Łukasz Niewiara; Jacek Legutko; Paweł Kleczyński

doi:10.5114/aic.2025.148118

eISSN: 1897-4295
ISSN: 1734-9338

Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej

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abstract:

Original paper

The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis

Artur Dziewierz

^{1, 2}

,

Łukasz Rzeszutko

^{1, 2}

,

Łukasz Niewiara

^{3, 4}

,

Jacek Legutko

^{3, 4}

,

Paweł Kleczyński

^{3, 4}

2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Clinical Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
Clinical Department of Interventional Cardiology, St. John Paul II Hospital, Krakow, Poland

Adv Interv Cardiol 2025; 21, 1 (79): 80–87

DOI: https://doi.org/10.5114/aic.2025.148118

Online publish date: 2025/03/04

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AMA

Dziewierz A, Rzeszutko Ł, Niewiara Ł, Legutko J, Kleczyński P. The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2025;21(1):80-87. doi:10.5114/aic.2025.148118.

APA

Dziewierz, A., Rzeszutko, Ł., Niewiara, Ł., Legutko, J.,  & Kleczyński, P. (2025). The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 21(1), 80-87. https://doi.org/10.5114/aic.2025.148118

Chicago

Dziewierz, Artur, Łukasz Rzeszutko, Łukasz Niewiara, Jacek Legutko,  and Paweł Kleczyński. 2025. "The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 21 (1): 80-87. doi:10.5114/aic.2025.148118.

Harvard

Dziewierz, A., Rzeszutko, Ł., Niewiara, Ł., Legutko, J.,  and Kleczyński, P. (2025). The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 21(1), pp.80-87. https://doi.org/10.5114/aic.2025.148118

MLA

Dziewierz, Artur et al. "The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 21, no. 1, 2025, pp. 80-87. doi:10.5114/aic.2025.148118.

Vancouver

Dziewierz A, Rzeszutko Ł, Niewiara Ł, Legutko J, Kleczyński P. The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2025;21(1):80-87. doi:10.5114/aic.2025.148118.

Introduction:
The accuracy of fractional flow reserve (FFR) and quantitative flow ratio (QFR) in assessing coronary artery disease in severe aortic stenosis (AS) patients may be affected by the severity of AS.

Aim:
We investigated the relationship between aortic valve area (AVA) and the diagnostic performance of QFR in this context.

Material and methods:
We analyzed 416 intermediate coronary lesions in 221 severe AS patients using FFR and QFR, categorizing them based on AVA into two groups: AVA < 0.5 cm² and AVA ≥ 0.5 cm².

Results:
In all, 47 (21.2%) patients had an AVA < 0.5 cm². The median FFR and QFR values were comparable between groups, with a high agreement rate: interclass coefficient of 0.96 (95% CI: 0.94 to 0.97) for AVA < 0.5 cm² and 0.97 (95% CI: 0.97 to 0.98) for AVA ≥ 0.5 cm². Concordance in detecting significant ischemia was 96.3% for AVA ≥ 0.5 cm² but dropped to 86.5% for AVA < 0.5 cm², with discrepancies mainly in cases where FFR was negative and QFR positive. Multivariable analysis showed AVA and %DS as independent predictors of discordance; AVA ≥ 0.5 cm² had an OR of 0.229 (95% CI: 0.095 to 0.548; p < 0.001), and each 1% increase in %DS increased the odds by 1.070 (95% CI: 1.034 to 1.107; p < 0.001).

Conclusions:
In severe AS, QFR closely correlates with FFR. However, patients with AVA < 0.5 cm² might exhibit a higher incidence of false-positive ischemia detection by QFR.

keywords:

The role of aortic valve area in the quantitative flow ratio–fractional flow reserve discrepancy in patients with coronary artery disease and severe aortic stenosis

Artur Dziewierz 1, 2 , Łukasz Rzeszutko 1, 2 , Łukasz Niewiara 3, 4 , Jacek Legutko 3, 4 , Paweł Kleczyński 3, 4

aortic stenosis, fractional flow reserve, quantitative flow ratio, functional assessment, discordance

Artur Dziewierz

^{1, 2}

,

Łukasz Rzeszutko

^{1, 2}

,

Łukasz Niewiara

^{3, 4}

,

Jacek Legutko

^{3, 4}

,

Paweł Kleczyński

^{3, 4}