Abstract
BackgroundThe invasive fractional flow reserve has been considered the gold standard for identifying ischaemia-related stenosis in patients with suspected coronary artery disease. Determining non-invasive FFR based on coronary computed tomographic angiography datasets using computational fluid dynamics tends to be a demanding process. Therefore, the diagnostic performance of a simplified method for the calculation of FFRCTA requires further evaluation.ObjectivesThe aim of this study was to investigate the diagnostic performance of FFRCTA calculated based on a simplified method by referring to the invasive FFR in patient-specific coronary arteries and clinical decision-making.MethodsTwenty-nine subjects included in this study underwent CCTA before undergoing clinically indicated invasive coronary angiography for suspected coronary artery disease. Pulsatile flow simulation and a novel boundary condition were used to obtain FFRCTA based on the CCTA datasets. The Pearson correlation, Bland–Altman plots and the diagnostic performance of FFRCTA and CCTA stenosis were analyzed by comparison to the invasive FFR reference standard. Ischaemia was defined as an FFR or FFRCTA ≤0.80, and anatomically obstructive CAD was defined as a CCTA stenosis >50%.ResultsFFRCTA and invasive FFR were well correlated (r = 0.742, P = 0.001). Slight systematic underestimation was found in FFRCTA (mean difference 0.03, standard deviation 0.05, P = 0.001). The area under the receiver-operating characteristic curve was 0.93 for FFRCTA and 0.75 for CCTA on a per-vessel basis. Per-patient accuracy, sensitivity and specificity were 79.3, 93.7 and 61.5%, respectively, for FFRCTA and 62.1, 87.5 and 30.7%, respectively, for CCTA. Per-vessel accuracy, sensitivity and specificity were 80.6, 94.1 and 68.4%, respectively, for FFRCTA and 61.6, 88.2 and 36.8%, respectively, for CCTA.ConclusionsFFRCTA derived from pulsatile simulation with a simplified novel boundary condition was in good agreement with invasive FFR and showed better diagnostic performance compared to CCTA, suggesting that the simplified method has the potential to be an alternative and accurate way to assess the haemodynamic characteristics for coronary stenosis.
Highlights
The invasive fractional flow reserve has been considered the gold standard for identifying ischaemia-related stenosis in patients with suspected coronary artery disease
Twenty-nine subjects included in this study underwent Coronary computed tomographic angiography (CCTA) before undergoing clinically indicated invasive coronary angiography for suspected coronary artery disease
Ischaemia was defined as an fractional flow reserve (FFR) or F FRCTA ≤0.80, and anatomically obstructive Coronary artery disease (CAD) was defined as a CCTA stenosis >50%
Summary
The invasive fractional flow reserve has been considered the gold standard for identifying ischaemia-related stenosis in patients with suspected coronary artery disease. The presence of myocardial ischaemia is the most important risk factor for an adverse outcome, and the revascularization of ischaemia-related stenotic coronary lesions can improve patients’ functional status in the clinic [2]. Coronary revascularization is often performed based on semi-quantitative measures of stenosis during invasive coronary angiography (ICA) [3]. The relationship between coronary stenosis severity and myocardial ischaemia is unreliable. In lesions with stenosis 70%, only 9, 18 and 57% of lesions are ischaemia causing [4] This suggests that basing clinical treatment decisions on stenosis severity alone would result in unnecessary procedures; physiological information may be more important
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