scholarly journals TCT-175 Diagnostic performance of Fractional Flow Reserve derived from Computed Tomography compared to Invasive Coronary Angiography derived Fractional Flow Reserve

2017 ◽  
Vol 70 (18) ◽  
pp. B75
Author(s):  
Jai Parekh ◽  
Saurabh Aggarwal ◽  
Rohit Loomba ◽  
Gaurav Aggarwal ◽  
Ram Belbase ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Diagnostic Performance ◽  
Invasive Coronary Angiography ◽  
Fractional Flow ◽  
Flow Reserve

Impact of coronary calcium score and lesion characteristics on the diagnostic performance of machine-learning-based computed tomography-derived fractional flow reserve

2021 ◽  
Author(s):  
Hyun Jung Koo ◽  
Joon-Won Kang ◽  
Soo-Jin Kang ◽  
Jihoon Kweon ◽  
June-Goo Lee ◽  
...  
Keyword(s):  
Machine Learning ◽  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Diagnostic Performance ◽  
Lesion Length ◽  
Fractional Flow ◽  
Flow Reserve ◽  
The Impact

Abstract Aims To evaluate the impact of coronary artery calcium (CAC) score, minimal lumen area (MLA), and length of coronary artery stenosis on the diagnostic performance of the machine-learning-based computed tomography-derived fractional flow reserve (ML-FFR). Methods and results In 471 patients with coronary artery disease, computed tomography angiography (CTA) and invasive coronary angiography were performed with fractional flow reserve (FFR) in 557 lesions at a single centre. Diagnostic performances of ML-FFR, computational fluid dynamics-based CT-FFR (CFD-FFR), MLA, quantitative coronary angiography (QCA), and visual stenosis grading were evaluated using invasive FFR as a reference standard. Diagnostic performances were analysed according to lesion characteristics including the MLA, length of stenosis, CAC score, and stenosis degree. ML-FFR was obtained by automated feature selection and model building from quantitative CTA. A total of 272 lesions showed significant ischaemia, defined by invasive FFR ≤0.80. There was a significant correlation between CFD-FFR and ML-FFR (r = 0.99, P < 0.001). ML-FFR showed moderate sensitivity and specificity in the per-patient analysis. Diagnostic performances of CFD-FFR and ML-FFR did not decline in patients with high CAC scores (CAC > 400). Sensitivities of CFD-FFR and ML-FFR showed a downward trend along with the increase in lesion length and decrease in MLA. The area under the curve (AUC) of ML-FFR (0.73) was higher than those of QCA and visual grading (AUC = 0.65 for both, P < 0.001) and comparable to those of MLA (AUC = 0.71, P = 0.21) and CFD-FFR (AUC = 0.73, P = 0.86). Conclusion ML-FFR showed comparable results to MLA and CFD-FFR for the prediction of lesion-specific ischaemia. Specificities and accuracies of CFD-FFR and ML-FFR decreased with smaller MLA and long lesion length.

scholarly journals Real world utilization of CT derived fractional flow reserve in stable angina from contemporary practice: impact on downstream utilization of invasive coronary angiogram and clinical decision making

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ray ◽  
K Green ◽  
A Shamsi ◽  
A Mahmood ◽  
A Hatrick ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
Severe Disease ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Flow Reserve ◽  
Artery Disease

Abstract   Background/Introduction - Fractional flow reserve (FFR), a pressure wire-based index used during coronary angiography to assess the severity of potential coronary stenosis, is considered as the reference standard for evaluating the severity of stenosis in coronary artery disease (CAD). Recently, computed tomography angiography-derived fractional flow reserve (FFRct) has been recommended for evaluating functional severity of stenoses as it improves diagnostic accuracy and reduces the need for invasive coronary angiography. Purpose To determine whether non-invasive FFRct predicts severity of coronary artery disease and whether its addition improves efficiency of proceeding to revascularisation and invasive coronary angiography (ICA) compared to coronary computed tomography angiography (CTA) without FFR. Methods This observational retrospective single center study included two cohorts of patients who presented in a District General Hospital in UK. The first group consisted of all patients who underwent coronary CTA for chest pain from January 2013 to December 2014. The second cohort consisted of all patients who proceeded to have measurement of FFRct from April 2018 to June 2019 after routine coronary CTA for chest pain. The two groups showed similar demographics. FFRct was analysed using the software HeartFlow. We determined the agreement of FFRct (positive if <0.80) with stenosis on CTA and ICA (positive if >50% left main or >70% other coronary artery) and whether it correlated with need for revascularisation. We also assessed if adding FFRct <0.80 improved efficiency of referral to ICA, defined as decreased diagnosis of mild or moderate stenosis (<70%) and higher yield of severe disease (>70%). The two cohorts were compared to determine the above specific end-points. Results In the first cohort, data was collected for 915 patients. 240 (26.2%) of these patients proceeded to ICA, which showed severe disease in 31 (3.3%) patients needing revascularisation. In the second cohort of patients, 824 patients underwent coronary CTA and 201 (24.4%) proceeded to have FFRct measurements. 99 (49%) of these patients had a negative FFR and 65 (32%) patients had a positive result (<0.80). There was agreement between FFRct and invasive coronary angiography/stress echo in 44 (77%) patients, with regards to severity /revascularisation. The need for ICA was significantly reduced if coronary CTA and FFRct were both done (240/915; 26.2% vs 54/824; 6.5%: p value <0.00001). Conclusion Reserving ICA for patients with a positive FFRct (<0.80) could reduce the number of ICA after coronary CTA and augment the number of ICA leading to revascularisation. Use of FFRct as a gatekeeper to ICA will improve appropriate selection of patients referred and this in-turn will reduce the burden of complications associated with invasive procedures, reduce costs and ensure better utilization of Cath-lab resources. Funding Acknowledgement Type of funding source: None

scholarly journals Validation of the diagnostic performance of ‘HeartMedi V.1.0’, a novel CT-derived fractional flow reserve measurement, for patients with coronary artery disease: a study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037780
Author(s):  
Soo-Hyun Kim ◽  
Si-Hyuck Kang ◽  
Woo-Young Chung ◽  
Chang-Hwan Yoon ◽  
Sang-Don Park ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Invasive Coronary Angiography ◽  
Fractional Flow ◽  
Non Invasive ◽  
Link Type ◽  
Flow Reserve

IntroductionCoronary CT angiography (CCTA) is widely used for non-invasive coronary artery evaluation, but it is limited in identifying the nature of functional characteristics that cause ischaemia. Recent computational fluid dynamic (CFD) techniques applied to CCTA images permit non-invasive computation of fractional flow reserve (FFR), a measure of lesion-specific ischaemia. However, this technology has limitations, such as long computational time and the need for expensive equipment, which hinder widespread use.Methods and analysisThis study is a prospective, multicentre, comparative and confirmatory trial designed to evaluate the diagnostic performance of HeartMedi V.1.0, a novel CT-derived FFR measurement for the detection of haemodynamically significant coronary artery stenoses identified by CCTA, based on invasive FFR as a reference standard. The invasive FFR values ≤0.80 will be considered haemodynamically significant. The study will enrol 184 patients who underwent CCTA, invasive coronary angiography and invasive FFR. Computational FFR (c-FFR) will be analysed by CFD techniques using a lumped parameter model based on vessel length method. Blinded core laboratory interpretation will be performed for CCTA, invasive coronary angiography, invasive FFR and c-FFR. The primary objective of the study is to compare the area under the receiver–operator characteristic curve between c-FFR and CCTA to non-invasively detect the presence of haemodynamically significant coronary stenosis. The secondary endpoints include diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value and correlation of c-FFR with invasive FFR.Ethics and disseminationThe study has ethic approval from the ethics committee of Seoul National University Bundang Hospital (E-1709/420-001) and informed consent will be obtained for all enrolled patients. The result will be published in a peer-reviewed journal.Trial registration numberKCT0002725; Pre-results.

Fractional flow reserve derived from coronary computed tomography: where are we now and where are we heading?

2020 ◽  
Author(s):  
Lavinia Gabara ◽  
Jonathan Hinton ◽  
Thomas Russell Gilpin ◽  
Nick Curzen
Keyword(s):  
Computed Tomography ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Computed Tomography Coronary Angiography ◽  
Future Research ◽  
Fractional Flow ◽  
Clinical Events ◽  
Flow Reserve ◽  
Invasive Angiography ◽  
Physiological Assessment

Computed tomography coronary angiography is emerging as the preferred diagnostic tool for patients with chest pain. Additional knowledge of the extent and distribution of myocardial ischemia enables tailored patient management. Computed tomography-derived fractional flow reserve (FFRCT) employs computed tomography coronary angiography raw data processed via complex computational fluid dynamics and produces a surrogate of the invasive fractional flow reserve (FFR) thus delivering anatomical and physiological assessment in a single test. FFRCT has been extensively validated against invasive FFR and observational clinical studies have consistently demonstrated its utility as gatekeeper to invasive angiography while also reducing downstream clinical events and costs. Novel workstation-based models of estimating FFR are now being tested. Ongoing and future research results will define their role in clinical practice.

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