scholarly journals Diagnostic accuracy of on-site coronary computed tomography-derived fractional flow reserve in the diagnosis of stable coronary artery disease

2021 ◽  
Author(s):  
J. Peper ◽  
J. Schaap ◽  
B. J. W. M. Rensing ◽  
J. C. Kelder ◽  
M. J. Swaans
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Fractional Flow Reserve ◽  
Diagnostic Performance ◽  
Reference Standard ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease

Abstract Purpose Invasive fractional flow reserve (FFR), the reference standard for identifying significant coronary artery disease (CAD), can be estimated non-invasively by computed tomography-derived fractional flow reserve (CT-FFR). Commercially available off-site CT-FFR showed improved diagnostic accuracy compared to coronary computed tomography angiography (CCTA) alone. However, the diagnostic performance of this lumped-parameter on-site method is unknown. The aim of this cross-sectional study was to determine the diagnostic accuracy of on-site CT-FFR in patients with suspected CAD. Methods A total of 61 patients underwent CCTA and invasive coronary angiography with FFR measured in 88 vessels. Significant CAD was defined as FFR and CT-FFR below 0.80. CCTA with stenosis above 50% was regarded as significant CAD. The diagnostic performance of both CT-FFR and CCTA was assessed using invasive FFR as the reference standard. Results Of the 88 vessels included in the analysis, 34 had an FFR of ≤ 0.80. On a per-vessel basis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 91.2%, 81.4%, 93.6%, 75.6% and 85.2% for CT-FFR and were 94.1%, 68.5%, 94.9%, 65.3% and 78.4% for CCTA. The area under the receiver operating characteristic curve was 0.91 and 0.85 for CT-FFR and CCTA, respectively, on a per-vessel basis. Conclusion On-site non-invasive FFR derived from CCTA improves diagnostic accuracy compared to CCTA without additional testing and has the potential to be integrated in the current clinical work-up for diagnosing stable CAD.

scholarly journals Computed Tomography-Derived Fractional Flow Reserve for the Diagnosis of Coronary Artery Disease

2021 ◽  
Vol 1 (11) ◽  
Author(s):  
Yi-Sheng Chao ◽  
Jennifer Horton
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Adult Patients ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease ◽  
Stable Chest Pain

Computed tomography-derived fractional flow reserve (CT-FFR) may predict coronary artery disease or flow-limiting stenosis in adult patients with stable chest pain better than coronary CT angiography alone, based on the relevant studies in 2 systematic reviews. CT-FFR is associated with a decreased need for invasive coronary angiography and revascularization in adult patients with stable chest pain, based on findings from 1 systematic review. In the US settings, CT-FFR was dominant (i.e., less costly and more effective) compared to stress testing for the evaluation of low-risk stable chest pain, based on findings from 1 cost-effectiveness study.

scholarly journals Prognostic value of computed tomography derived fractional flow reserve

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A I Ahmed ◽  
Y Han ◽  
T Alnabelsi ◽  
M Al Rifai ◽  
F Nabi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Prognostic Value ◽  
Tertiary Care ◽  
Fractional Flow ◽  
Cardiac Computed Tomography Angiography ◽  
Flow Reserve ◽  
Artery Disease

Abstract Introduction Cardiac computed tomography angiography (CCTA) derived fractional flow reserve (FFRCT) has been shown to add incremental diagnostic value by providing functional severity of coronary lesion in patients with coronary artery disease (CAD). Purpose We aimed to assess the prognostic value of FFRCT in patients with suspected CAD. Methods Consecutive patients who had clinically indicated CCTA and FFRCT determination at a tertiary care cardiology practice were included. FFRCT was determined off-site using computational flow dynamics. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and late percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) 90-days after imaging test.) Results A total of 667 patients with at least Coronary Artery Disease Reporting & Data System (CAD-RADS) 2 were included. Mean age was 68±10 years, 37% were women, 73% had hypertension, 12% had diabetes and 61% had dyslipidemia. More than half (57%) of the patients had moderate (CAD-RADS 3) stenosis. FFRCT<0.8 was found in 59% of patients, with increasing percent across categories of CAD-RADS. After a median follow-up of 9 months, 52 patients (7.2%, 6.7 events per 1000 person-year) experienced a MACE. In multivariable Cox regression models adjusted for age and sex, FFRCT <0.8 significantly predicted outcomes (HR 2.48 95% CI 1.26–4.87 p=0.008). Sensitivity analysis using lower thresholds of FFRCT failed to show similar results in intermediate stenosis. Conclusion Our results suggest that in a real-world cohort of patients with suspected CAD, FFRCT can identify patients at higher risk of incident cardiovascular outcomes. FUNDunding Acknowledgement Type of funding sources: None.

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