Abstract 1634: Validation of 64-Slice Multi-Detector Computed Tomography Coronary Angiography Against Invasive Hemodynamic Measurements of Fractional Flow Reserve in the Detection of Non-Flow-Limiting Coronary Stenoses

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kamran Akram ◽  
Robert O’Donnell ◽  
Jennifer LaCorte ◽  
Charles Brown ◽  
Szilard Voros
Keyword(s):  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Area Under The Curve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Minimal Lumen Area ◽  
Coronary Stenoses ◽  
Artery Disease ◽  
Sensitivity Specificity ◽  
Hemodynamic Measurements

Introduction. Multi-detector CT coronary angiography (CorCTA) has been introduced for coronary artery disease (CAD) detection and been validated against invasive angiography (XRA) and intravascular ultrasound (IVUS). However, the diagnostic accuracy of CorCTA-derived area stenosis (%AS), diameter stenosis (%DS), minimal lumen area (MLA) and minimal lumen diameter (MLD) have not been previously validated against fractional flow reserve (FFR). Methods. Twenty consecutive patients enrolled in a study of non-obstructive CAD underwent CorCTA and invasive FFR measurements within 2 weeks. Patients without prior CAD with visual intermediate stenoses (40–70%) by either XRA or CorCTA were eligible. CorCTA was performed on a 64-slice scanner. %AS, %DS, MLA and MLD were measured quantitatively with commercial software (SurePlaque; Vital Images). FFR was determined by averaging 3 independent measurements after intracoronary injection of adenosine. Statistical analysis was done using Analyse-It software. Results. CorCTA-derived values (mean±SD) in the group were as follows: %AS=43.8±21.3%, %DS=58.9±21.4%, MLA=3.9±3.0mm 2 , MLD=1.4±0.8mm, FFR=0.89±0.09. Two patients had flow-limiting stenoses by FFR. Table shows the area under the curve (AUC), optimal cutpoint, sensitivity, specificity, PPV and NPV for the parameters to predict non-flow-limiting FFR. All parameters performed well in predicting non-flow-limiting FFR as expressed by the AUC; these were highly significant. Values below stenosis cutpoints (%AS<60%, %DS<77%) and MLA>3.0 mm 2 , MLD>0.89 mm reliably excluded flow-limiting stenoses. Cutpoints were higher for %DS vs %AS (77% vs. 60%). Conclusions. To our knowledge, this is the first study to compare CorCTA to FFR. %AS, %DS, MLA and MLD performed very well in excluding hemodynamically significant stenoses. While%DS and MLD by CorCTA tend to overestimate the significance of stenosis, %AS and MLA correlate well to similar values derived from IVUS. Accuracy of CorCTA in Excluding Flow Limiting Stenoses As Measured by FFR

scholarly journals Feasibility of virtual fractional flow reserve derived from coronary angiography and its correlation with invasive functional assessment

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Mano ◽  
V Ferreira ◽  
R Ramos ◽  
E Oliveira ◽  
A Santana ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Functional Assessment ◽  
Invasive Coronary Angiography ◽  
Area Under The Curve ◽  
Fractional Flow ◽  
Predictive Values ◽  
Flow Reserve ◽  
Tertiary Center

Abstract Introduction Invasive functional assessment (iFA) of coronary artery disease (CAD) needs expensive devices, has potential procedure-related complications and is still underutilized. Virtual Fractional Flow Reserve (vFFR) derived from invasive coronary angiography (ICA) has the potential to overcome these limitations. Purpose To investigate the feasibility of vFFR analysis and its correlation with iFA (iFR, RFR or FFR). Methods Retrospective analysis of consecutive patients (pts) who underwent iFA in a tertiary center between 2019 and 2020. vFFR was calculated using a dedicated software (CAAS Workstation 8.4) based on standard non-hyperaemic coronary angiograms acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance and accuracy of vFFR were evaluated. vFFR was considered positive when &lt;0.80. FFR &lt;0.8 and iFR/RFR &lt;0.90 were classified as positive according to current clinical standards. Results Out of 113 coronary arteries of 102 pts, vFFR was successfully analysed in 106 (94%). Reasons for vFFR analysis failure were: vessel projection overlap (48%), &lt;2 angiographic projections (28%) and table movement while acquisition (24%). From 106 coronary arteries of 95 pts with analysable vFFR (78% male, mean age 67.8±9.7 years), 90 (85%) showed agreement with the respective iFA result. The vFFR predicted which lesions were physiologically significant and which were not with accuracy, sensitivity, specificity, positive and negative predictive values of 73%, 73%, 83%, 53%, and 92% respectively. The mean difference between vFFR and iFA were −0.0484±0.096 and Pearson's correlation coefficient was 0.533 (p&lt;0.001). The ROC area under the curve was 0.839 (0.751–0.928, p&lt;0.001). Conclusion FFR were feasible in 94% of cases analysed retrospectively. As compared to gold-standard iFA, vFFR had an overall moderate accuracy in detecting ischemia-producing lesions and a negative predictive value &gt;90%. vFFR has the potential to substantially simplify physiological coronary lesion assessment and thus improve its current uptake. FUNDunding Acknowledgement Type of funding sources: None. Bland-Altman plot between vFFR and IFA

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 &lt;0.80) with stenosis on CTA and ICA (positive if &gt;50% left main or &gt;70% other coronary artery) and whether it correlated with need for revascularisation. We also assessed if adding FFRct &lt;0.80 improved efficiency of referral to ICA, defined as decreased diagnosis of mild or moderate stenosis (&lt;70%) and higher yield of severe disease (&gt;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 (&lt;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 &lt;0.00001). Conclusion Reserving ICA for patients with a positive FFRct (&lt;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 Diagnostic performance of wireless fractional flow reserve: a meta-analysis

2021 ◽  
Author(s):  
Wen Pan ◽  
Qing-Jun Liu
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Likelihood Ratio ◽  
Fractional Flow Reserve ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease ◽  
Sensitivity Specificity

IntroductionThe aim of this study was to evaluate diagnostic performance of wireless fractional flow reserve (FFR) used in patients with coronary artery disease (CAD).Material and methodsPubMed, Cochrane Library, Embase and Clinical trial.gov databases were searched by computer search and manual retrieval. The search terms included fractional flow reserve, quantitative coronary angiography, computational fluid dynamics and coronary artery disease. The meta-analysis was conducted with Stata12.0. Clinical outcomes included accuracy, sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (–LR), diagnostic odds ratio (DOR) and area under the receiver operating curve.ResultsNine studies comprising 2052 vessels were included in the present meta-analysis. The sensitivity, specificity, +LR, –LR, DOC and accuracy were 87% (95% CI: 83–94%), 88% (95% CI: 82–92%), 7.28 (95% CI: 4.78–11.08), 0.14 (95% CI: 0.10–0.21), 50.69 (95% CI: 25.22–101.88) and 0.94 (95% CI: 0.91–0.96) respectively. No significant publication bias was detected.ConclusionsThis meta-analysis suggests that the clinical performance such as accuracy, sensitivity and specificity of wireless FFR is good to detect stenotic lesions with pressure-wire measured FFR as a reference.

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