Reproducibility of Quantitative Flow Ratio: The QREP Study.

Background Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography. Aims We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites. Methods We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of intra- and interobserver reproducibility. Key secondary analysis was identification of clinical and procedural characteristics predicting reproducibility. Results The intraobserver CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The interobserver CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low FFR were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03). Conclusions The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01±0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed with FFR.