scholarly journals Incremental Diagnostic Value of CT Fractional Flow Reserve Using Subtraction Method in Patients with Severe Calcification: A Pilot Study

2021 ◽  
Vol 10 (19) ◽  
pp. 4398
Author(s):  
Yuki Kamo ◽  
Shinichiro Fujimoto ◽  
Yui O. Nozaki ◽  
Chihiro Aoshima ◽  
Yuko O. Kawaguchi ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Agatston Score ◽  
Subtraction Method ◽  
Fractional Flow ◽  
Predictive Values ◽  
Area Detector ◽  
Flow Reserve ◽  
Severe Calcification

Although on-site workstation-based CT fractional flow reserve (CT-FFR) is an emerging method for assessing vessel-specific ischemia in coronary artery disease, severe calcification is a significant factor affecting CT-FFR’s diagnostic performance. The subtraction method significantly improves the diagnostic value with respect to anatomic stenosis for patients with severe calcification in coronary CT angiography (CCTA). We evaluated the diagnostic capability of CT-FFR using the subtraction method (subtraction CT-FFR) in patients with severe calcification. This study included 32 patients with 45 lesions with severe calcification (Agatston score >400) who underwent both CCTA and subtraction CCTA using 320-row area detector CT and also received invasive FFR within 90 days. The diagnostic capabilities of CT-FFR and subtraction CT-FFR were compared. The sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) of CT-FFR vs. subtraction CT-FFR for detecting hemodynamically significant stenosis, defined as FFR ≤ 0.8, were 84.6% vs. 92.3%, 59.4% vs. 75.0%, 45.8% vs. 60.0%, and 90.5% vs. 96.0%, respectively. The area under the curve for subtraction CT-FFR was significantly higher than for CT-FFR (0.84 vs. 0.70) (p = 0.04). The inter-observer and intra-observer variabilities of subtraction CT-FFR were 0.76 and 0.75, respectively. In patients with severe calcification, subtraction CT-FFR had an incremental diagnostic value over CT-FFR, increasing the specificity and PPV while maintaining the sensitivity and NPV with high reproducibility.

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 <0.80. FFR <0.8 and iFR/RFR <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%), <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<0.001). The ROC area under the curve was 0.839 (0.751–0.928, p<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 >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

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.

Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve

2015 ◽  
Vol 84 (8) ◽  
pp. 1509-1515 ◽  
Author(s):  
Rui Wang ◽  
Matthias Renker ◽  
U. Joseph Schoepf ◽  
Julian L. Wichmann ◽  
Stephen R. Fuller ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Fractional Flow Reserve ◽  
Coronary Ct Angiography ◽  
Diagnostic Value ◽  
Fractional Flow ◽  
Coronary Ct ◽  
Flow Reserve

scholarly journals Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR—The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Juan Casanova-Sandoval ◽  
Diego Fernández-Rodríguez ◽  
Imanol Otaegui ◽  
Teresa Gil Jiménez ◽  
Marcos Rodríguez-Esteban ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Primary Objective ◽  
Grey Zone ◽  
Fractional Flow ◽  
Predictive Values ◽  
Hybrid Strategy ◽  
Flow Reserve

Background. The resting full‐cycle ratio (RFR) is a novel resting index which in contrast to the gold standard (fractional flow reserve (FFR)) does not require maximum hyperemia induction. The objectives of this study were to evaluate the agreement between RFR and FFR with the currently recommended thresholds and to design a hybrid RFR-FFR ischemia detection strategy, allowing a reduction of coronary vasodilator use. Materials and Methods. Patients subjected to invasive physiological study in 9 Spanish centers were prospectively recruited between April 2019 and March 2020. Sensitivity and specificity studies were made to assess diagnostic accuracy between the recommended levels of RFR ≤0.89 and FFR ≤0.80 (primary objective) and to determine the RFR “grey zone” in order to define a hybrid strategy with FFR affording 95% global agreement compared with FFR alone (secondary objective). Results. A total of 380 lesions were evaluated in 311 patients. Significant correlation was observed (R2 = 0.81; P < 0.001 ) between the two techniques, with 79% agreement between RFR ≤ 0.89 and FFR ≤ 0.80 (positive predictive value, 68%, and negative predictive value, 80%). The hybrid RFR-FFR strategy, administering only adenosine in the “grey zone” (RFR: 0.86 to 0.92), exhibited an agreement of over 95% with FFR, with high predictive values (positive predictive value, 91%, and negative predictive value, 92%), reducing the need for vasodilators by 58%. Conclusions. Dichotomous agreement between RFR and FFR with the recommended thresholds is significant but limited. The adoption of a hybrid RFR-FFR strategy affords very high agreement, with minimization of vasodilator use.

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

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