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Background: Quantitative flow ratio (QFR) virtual angioplasty with pre-PCI residual QFR showed better results compared with an angiographic approach to assess post-PCI functional results. However, correlation with pre-PCI residual QFR and post-PCI fractional flow reserve (FFR) is lacking. Methods: A multicenter prospective study including consecutive patients with angiographically 50–90% coronary lesions and positive QFR results. All patients were evaluated with QFR, hyperemic and non-hyperemic pressure ratios (NHPR) before and after the index PCI. Pre-PCI residual QFR (virtual angioplasty) was calculated and compared with post-PCI fractional flow reserve (FFR), QFR and NHPR. Results: A total of 84 patients with 92 treated coronary lesions were included, with a mean age of 65.5 ± 10.9 years and 59% of single vessel lesions being the left anterior descending artery in 69%. The mean vessel diameter was 2.82 ± 0.41 mm. Procedural success was achieved in all cases, with a mean number of implanted stents of 1.17 ± 0.46. The baseline QFR value was 0.69 ± 0.12 and baseline FFR and NHPR were 0.73 ± 0.08 and 0.82 ± 0.11, respectively. Mean post-PCI FFR increased to 0.87 ± 0.05 whereas residual QFR had been estimated as 0.95 ± 0.05, showing poor correlation with post-PCI FFR (0.163; 95% CI:0.078–0.386) and low diagnostic accuracy (30.9%, 95% CI:20–43%). Conclusions: In this analysis, the results of QFR-based virtual angioplasty did not seem to accurately correlate with post-PCI FFR.

BackgroundMicroRNAs (miRNAs) are noncoding RNAs involved in post-transcriptional genetic regulation with a proposed role in intercellular communication. miRNAs are considered promising biomarkers in ischemic heart disease. Invasive physiological evaluation allows a precise assessment of each affected coronary compartment. Although some studies have associated the expression of circulating miRNAs with invasive physiological indexes, their global relationship with coronary compartments has not been assessed. Here, we will evaluate circulating miRNAs profiles according to the coronary pattern of the vascular compartment affectation.Study and designThis is an investigator-initiated, multicentre, descriptive study to be conducted at three centres in Spain (NCT05374694). The study will include one hundred consecutive patients older than 18 years with chest pain of presumed coronary cause undergoing invasive physiological evaluation, including fractional flow reserve (FFR) and index of microvascular resistance (IMR). Patients will be initially classified into four groups, according to FFR and IMR: macrovascular and microvascular affectation (FFR≤0.80 / IMR≥25), isolated macrovascular affectation (FFR≤0.80 / IMR0.80 / IMR ≥25) and normal coronary indexes (FFR>0.80 / IMRConclusionsThe results of this study will identify miRNA profiles associated with patterns of coronary affectation and will contribute to a better understanding of the mechanistic pathways of coronary pathology.

To the Editor, Revascularization of a coronary chronic total occlusion (CTO) is indicated in patients with refractory angina, after treatment of non-CTO lesion.1 Observational studies have suggested that when intermediate stenosis is present in an artery providing collaterals to a CTO (“donor artery”), its fractional flow reserve (FFR) value increases after percutaneous coronary intervention (PCI) of the CTO.2 Quantitative flow ratio (QFR) has demonstrated excellent correlation with FFR in several settings.3,4 The purpose of this study was to determine the ability of QFR to predict the severity of intermediate lesions in donor arteries as compared to its value after CTO-PCI and, also, as compared to FFR. A retrospective analysis of a prospective registry was performed. Patients who underwent successful CTO-PCI and had a concomitant intermediate stenosis (between 30% to 70% on visual estimation) in...

Sr. Editor: La revascularización de una oclusión coronaria total crónica (OTC) está indicada en pacientes con angina refractaria tras el tratamiento de otras eventuales lesiones de tipo no OTC1. Los estudios observacionales sugieren que ante una estenosis intermedia localizada en una arteria que aporta colaterales a un OTC (“arteria donante”), los valores de la reserva fraccional de flujo (RFF) aumentan tras la intervención coronaria percutánea (ICP) de la OTC2. El cociente de flujo cuantitativo (CFC) ha demostrado una excelente correlación con la RFF en varios contextos3,4. El propósito de este estudio fue determinar la capacidad del CFC para predecir la gravedad de lesiones intermedias en arterias donantes y comparar dicha capacidad con el valor de este tras la ICP-OTC y con la RFF. Se realizó un análisis retrospectivo de un registro prospectivo que incluyó a pacientes tratados con éxito de una ICP-OTC con estenosis intermedia concomitante (entre el 30-70% según estimación visual) en la arteria donante. Las mediciones de la RFF, obtenidas a través del protocolo estándar antes de iniciar la ICP-OTC y tras completarla, se pudo calcular para todos los participantes y el índice de resistencia microcirculatoria (IMR) para el 72,7% de estos. Se empleó adenosina intracoronaria para inducir hiperemia. El...