Effect of lesion characteristics on diagnostic performance of CT-derived fractional flow reserve: exploring the indications for application based on CT-FFR CHINA trial (Preprint)

2021 ◽  
Author(s):  
Na Zhao ◽  
Yang Gao ◽  
Bo Xu ◽  
Weixian Yang ◽  
Lei Song ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Coronary Calcification ◽  
Lesion Group ◽  
Lesion Length ◽  
Fractional Flow ◽  
Lesion Location ◽  
Flow Reserve ◽  
Bifurcation Lesions ◽  
Coronary Lesions ◽  
Sensitivity Specificity

BACKGROUND High diagnostic performance of coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR; CT-FFR) in identifying flow-limiting stenosis has been confirmed. CT-FFR is recommended to assess the hemodynamic significance of coronary lesions. However, the optimal indications of CT-FFR relies on its ability to discriminating ischemia in situations of different types of lesions. And the effect of lesion-dependent factors on determining the diagnostic accuracy of CT-FFR have not been comprehensively evaluated yet. OBJECTIVE We aimed to investigate the effect of lesion-related factors on the diagnostic performance of CT-FFR with computational fluid dynamics algorithm, to promote the clinical application of it. METHODS This multicenter prospective clinical trial enrolled 317 patients with 30%–90% stenosis undergoing CCTA and invasive FFR from 5 centers across China. All target lesions were assigned into different lesion characteristics (target vessels, lesion location, lesion length, bifurcation lesions, and coronary calcification) subgroups. Diagnostic performance (accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operating characteristics curve (AUC)) of CT-FFR identifying ischemia were calculated and compared in all sub-groups. RESULTS Three hundred and sixty-six target vessels from 317 patients (mean age: 59.3 ± 9.6 years) were analyzed. The overall vessel-based diagnostic accuracy, sensitivity, specificity, PPV, NPV, and AUC of CT-FFR were 87.2%, 86.4%, 88.8%, 86.9%, 88.4%, and 0.90. Absence of bifurcation lesion group possessed the higher NPV of CT-FFR than presence of bifurcation lesion group (92.8% vs. 78.9%, p = 0.006). Whereas there was no statistically significant difference in diagnostic performance of CT-FFR among different target vessels, lesion location, lesion length, and coronary calcification sub-groups (all p > 0.05). CONCLUSIONS This study supported CT-FFR as a powerful noninvasive functional assessment tool for coronary lesions with different lesion characteristics, involving target vessel, lesion location, lesion length, and coronary calcification. While the diagnostic performance of CT-FFR was negatively affected by the presence of bifurcation lesions. CLINICALTRIAL https://clinicaltrials.gov; Unique identifier: NCT03692936.

Differential influence of lesion length on fractional flow reserve in intermediate coronary lesions between each coronary artery

2019 ◽  
Vol 95 (6) ◽  
Author(s):  
Hiroki Shibutani ◽  
Kenichi Fujii ◽  
Koichiro Matsumura ◽  
Munemitsu Otagaki ◽  
Shun Morishita ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Lesion Length ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Lesions

P7 The impact of coronary calcification on diagnostic performance of workstation CT derived fractional flow reserve - a multicentre experience

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A R Ihdayhid ◽  
S Motoyama ◽  
S Fujimoto ◽  
M Isa ◽  
N Nerlekar ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Diagnostic Performance ◽  
Coronary Calcification ◽  
Pooled Analysis ◽  
Agatston Score ◽  
Fractional Flow ◽  
Reduced Order ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Impact

Abstract Background On-site workstation based computed tomography derived fractional flow reserve (CT-FFR) is an emerging method to assess the vessel specific ischaemia in coronary artery disease (CAD). The impact of coronary calcification on its diagnostic performance is unknown. Purpose To evaluate the impact of coronary calcification on the diagnostic performance of reduced-order CT-FFR at detecting vessel specific ischaemia. Methods This is a retrospective pooled analysis of 141 patients with suspected CAD enrolled from 3 global centres who underwent CT-coronary angiography (CTA), onsite CT-FFR and invasive FFR.  Coronary calcification was assessed by Agatston score (AS). The diagnostic performance of CT-FFR (≤0.8) and CTA (≥50%) in evaluation of vessel specific ischaemia (FFR ≤ 0.8) was assessed across AS quartiles (Q1-4). A comparison of diagnostic performance of the low to mid AS (Q1 to Q3) versus high AS (Q4) was performed. Results Mean age and median AS was 65.8 ± 9.9 and 327.3 (interquartile range = 78.5 – 798.1). Diagnostic accuracy, sensitivity and specificity of CT-FFR for low-mid AS (0-798) and high AS (799-4019) were 77.4% vs 82.9%; 78.9% vs 94.7%; 68.8% vs 76.5% respectively with no statistical difference between the two groups.  The AUC for ischaemia of CT-FFR in low to mid AS was comparable with AUC in the high AS (0.76 [95% CI: 0.66-0.86] vs 0.84 [0.69-0.99]; P = 0.397).  The AUC for ischemia for CT-FFR in both low to mid AS and high AS was significantly higher than for CTA (0.76 [0.66-0.86] vs 0.57 [0.50-0.64]; P = 0.003 and 0.84 [0.69-0.99] vs 0.48 [0.38-0.57]; P < 0.001 respectively). Conclusion On-site workstation CT-FFR demonstrated consistently high diagnostic performance in patients with high AS. Its diagnostic performance was superior when compared with significant stenosis assessment on CTA across all spectrum of Agatston scores.

Effect of lesion length on fractional flow reserve in intermediate coronary lesions

2005 ◽  
Vol 150 (2) ◽  
pp. 338-343 ◽  
Author(s):  
David Brosh ◽  
Stuart T. Higano ◽  
Ryan J. Lennon ◽  
David R. Holmes ◽  
Amir Lerman
Keyword(s):  
Fractional Flow Reserve ◽  
Lesion Length ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Lesions

scholarly journals Diagnostic performance of virtual fractional flow reserve derived from routine coronary angiography using segmentation free reduced order (1-dimensional) flow modelling

2020 ◽  
Vol 9 ◽  
pp. 204800402096757
Author(s):  
Kevin Mohee ◽  
Jonathan P Mynard ◽  
Gauravsingh Dhunnoo ◽  
Rhodri Davies ◽  
Perumal Nithiarasu ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Fractional Flow ◽  
Conventional Angiography ◽  
Reduced Order ◽  
Flow Modelling ◽  
Flow Reserve ◽  
Coronary Lesions

Introduction Fractional flow reserve (FFR) improves assessment of the physiological significance of coronary lesions compared with conventional angiography. However, it is an invasive investigation. We tested the performance of a virtual FFR (1D-vFFR) using routine angiographic images and a rapidly performed reduced order computational model. Methods Quantitative coronary angiography (QCA) was performed in 102 with coronary lesions assessed by invasive FFR. A 1D-vFFR for each lesion was created using reduced order (one-dimensional) computational flow modelling derived from conventional angiographic images and patient specific estimates of coronary flow. The diagnostic accuracy of 1D-vFFR and QCA derived stenosis was compared against the gold standard of invasive FFR using area under the receiver operator characteristic curve (AUC). Results QCA revealed the mean coronary stenosis diameter was 44% ± 12% and lesion length 13 ± 7 mm. Following angiography calculation of the 1DvFFR took less than one minute. Coronary stenosis (QCA) had a significant but weak correlation with FFR (r = −0.2, p = 0.04) and poor diagnostic performance to identify lesions with FFR <0.80 (AUC 0.39, p = 0.09), (sensitivity – 58% and specificity – 26% at a QCA stenosis of 50%). In contrast, 1D-vFFR had a better correlation with FFR (r = 0.32, p = 0.01) and significantly better diagnostic performance (AUC 0.67, p = 0.007), (sensitivity – 92% and specificity - 29% at a 1D-vFFR of 0.7). Conclusions 1D-vFFR improves the determination of functionally significant coronary lesions compared with conventional angiography without requiring a pressure-wire or hyperaemia induction. It is fast enough to influence immediate clinical decision-making but requires further clinical evaluation.

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 &lt; 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 &gt; 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 &lt; 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 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.

Abstract 13372: Diagnostic Value of a Novel Coronary Computed Tomography Angiography-based Approach for Assessing Fractional Flow Reserve: Comparison with Invasive Measurement

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Stefan Baumann ◽  
Matthias Renker ◽  
Rui Wang ◽  
Felix G Meinel ◽  
Jeremy D Rier ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Coronary Computed Tomography Angiography ◽  
Diagnostic Value ◽  
Reference Standard ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Lesions ◽  
Invasive Measurement

Background: Noninvasive fractional flow reserve (FFR) from cCTA correlates well with invasive FFR and substantially improves the detection of obstructive CAD. However with current algorithms, CT-based FFR is derived off-site in an involved, time-consuming manner. We sought to investigate the diagnostic performance of a novel CT-based FFR algorithm (Siemens, Germany), developed for time-efficient in-hospital evaluation of hemodynamically indeterminate coronary lesions. Methods and Results: In a blinded fashion, CT-based FFR was assessed in 67 coronary lesions of 53 patients. Pressure guidewire-based FFR<0.80 served as the reference standard to define hemodynamically significant stenosis and assess the diagnostic performance of CT-based FFR compared to standard evaluation of cCTA (stenosis ≥50%). On a per-lesion and per-patient basis, CT-based FFR resulted in a sensitivity of 85% and 94%, specificity of 85% and 84%, positive predictive value of 71% and 71%, and negative predictive value of 93% and 97%. The area under the ROC curve on a per-lesion basis was significantly greater for CT-based FFR compared with standard evaluation of cCTA (0.92 vs. 0.72, p=0.0049). A similar trend, albeit not statistically significant, was observed on per-patient analysis (0.91 vs. 0.78, p=0.078). Mean total time for CT-based FFR was 37.5±13.8 min. Conclusions: The CT-based FFR algorithm evaluated here outperforms standard evaluation of cCTA for the detection of hemodynamically significant stenoses while allowing on-site application within clinically viable timeframes.

scholarly journals Diagnostic Performance of Angiography-Based Fractional Flow Reserve for Functional Evaluation of Coronary Artery Stenosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Changling Li ◽  
Xiaochang Leng ◽  
Jingsong He ◽  
Yongqing Xia ◽  
Wenbing Jiang ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Sensitivity Specificity

Background: A new method for calculating fraction flow reserve (FFR) without pressure-wire (angiography-derived FFR) based on invasive coronary angiography (ICA) images can be used to evaluate the functional problems of coronary stenosis.Objective: The aim of this study was to assess the diagnostic performance of a novel method of calculating the FFR compared to wire-based FFR using retrospectively collected data from patients with stable angina.Methods: Three hundred patients with stable angina pectoris who underwent ICA and FFR measurement were included in this study. Two ICA images with projections &gt;25° apart at the end-diastolic frame were selected for 3D reconstruction. Then, the contrast frame count was performed in an angiographic run to calculate the flow velocity. Based on the segmented vessel, calculated velocity, and aortic pressure, AccuFFRangio distribution was calculated through the pressure drop equation.Results: Using FFR ≤ 0.8 as a reference, we evaluated AccuFFRangio performance for 300 patients with its accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Comparison of AccuFFRangio with wire-measured FFR resulted in an area under the curve (AUC) of 0.954 (per-vessel, p &lt; 0.0001). Accuracy for AccuFFRangio was 93.7% for Pa set from measurement and 87% for Pa = 100 mmHg in this clinical study. Overall sensitivity, specificity, PPV, and NPV for per-vessel were 90, 95, 86.7, 96.3, and 57.5, 97.7, 90.2, 86.3%, respectively. Overall accuracy, sensitivity, specificity, PPV, and NPV for 2-dimensional (2D) quantitative coronary angiography (QCA) were 63.3, 42.5, 70.9, 34.7, and 77.2%, respectively. The average processing time of AccuFFRangio was 4.30 ± 1.87 min.Conclusions: AccuFFRangio computed from coronary ICA images can be an accurate and time-efficient computational tool for detecting lesion-specific ischemia of coronary artery stenosis.

Abstract 17162: Prediction of Functional Severity of Coronary Bifurcation Lesions by Means of Angiographically-Derived Score

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dobirn Vassilev ◽  
Niya Mileva ◽  
Pavel Nikolov ◽  
Georgi Dimitrov ◽  
Kiril Karamfiloff ◽  
...  
Keyword(s):  
Functional Significance ◽  
Hemodynamic Instability ◽  
Side Branch ◽  
Lesion Length ◽  
Syntax Score ◽  
Fractional Flow ◽  
St Segment Elevation ◽  
Flow Reserve ◽  
Bifurcation Lesion ◽  
Bifurcation Lesions

Background: There is uncertainty about relation between clinical and angiographic characteristics and functional significance of bifurcation stenosis. Methods: We analysed patients from FIESTA registry (ClinicalTrials.gov:NCT01724957). Subjects (>18 years) with stable angina, bifurcation lesions with diameter ≥2.5mm and ≤4.5 mm, SB diameter≥2.0 mm were included. We excluded patients with ST-segment elevation myocardial infarction, left main disease, hemodynamic instability. Provisional stenting was the default strategy in all patients. Fractional flow reserve(FFR) was performed using the PrimeWire or PrimeWire Prestige(Volcano Corp., USA). Bifurcation lesion with FFR above 0.80 were deferred from PCI. Results: A total of 171 patients, mean age 67±10 years, 66% males were included in the analysis. Of them 78(46%) had functionally significant bifurcation lesion (FSL) versus 93(54%) with non-significant lesion (nFSL). There were no differences (FSLvs.nFSL) in baseline characteristics: dyslipidemia(88%vs96%), diabetes(44%vs.32%), smoking (52%vs40%), past MI (24%vs15%), previous PCI(54%vs49%), atrial fibrillation (17%vs29%), peripheral artery disease (10%vs9%), renal failure(29%vs31%) –all p>0.05. On logistic-regression analysis independent predictors of functional significance were: SYNTAX score≥11 (OR=5.523,CI:1.666-18.311,p=.005), lesion length≥25mm (OR=21.737,CI:4.963-95.202,p<.001),MV%DS≥55%(OR=9.535,CI:2.508-34.883,p=.001) and MB%DS≥65% (OR=12.927,CI:3.015-55.418,p=.001). We created score for prediction of functional significance of bifurcation lesion with the following parameters: SYNTAX ≥11 gives 1 point, SB BARI≥12%- 1 point, MV%DS ≥55%- 1.5 point, MB%DS≥65%- 2 points, lesion length ≥25 mm – 3 points. The overall performance of the score was excellent with AUC=.960, p<.001. With a cut-off value ≥4.5 points it has sensitivity of 90%, specificity 91%, accuracy 90%, p<.001. Conclusion: Different degree of stenosis in proximal main vessel and distal side branch, lesion length, SB myocardium territory and SYNTAX score are significant predictors of functional severity of bifurcation lesion. A score based on those parameters was developed with excellent discriminatory ability.

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