Abstract
PurposeInvasive fractional flow reserve (FFR), the reference standard for identifying significant coronary artery disease (CAD), can be estimated non-invasively by computed tomography-derived fractional flow reserve (CT-FFR). Commercially available off-site CT-FFR showed improved diagnostic accuracy compared to coronary computed tomography angiography (CCTA) alone. However, the diagnostic performance of this lumped-parameter on-site method is unknown. The aim of this cross-sectional study was to determine the diagnostic accuracy of on-site CT-FFR in patients with suspected CAD.MethodsA total of 61 patients underwent CCTA and invasive coronary angiography with FFR measured in 88 vessels. Significant CAD was defined as FFR and CT-FFR below 0.80. CCTA with stenosis above 50% was regarded as significant CAD. The diagnostic performance of both CT-FFR and CCTA was assessed using invasive FFR as the reference standard.ResultsOf the 88 vessels included in the analysis, 34 had an FFR of ≤ 0.80. On a per-vessel basis, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 91.2%, 81.4%, 93.6%, 75.6% and 85.2% for CT-FFR and were 94.1%, 68.5%, 94.9%, 65.3% and 78.4% for CCTA. The area under the receiver operating characteristic curve was 0.91 and 0.85 for CT-FFR and CCTA, respectively, on a per-vessel basis.ConclusionOn-site non-invasive FFR derived from CCTA improves diagnostic accuracy compared to CCTA without additional testing and has the potential to be integrated in the current clinical work-up for diagnosing stable CAD.
Highlights
Wire-based fractional flow reserve (FFR) is generally accepted to be the reference standard for the physiological assessment of lesion-specific ischaemia [1]
This study demonstrated the feasibility of onsite non-invasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) for patients with stable coronary artery disease (CAD)
FFR, the ratio of maximal pressure distal to a stenosis divided by the pressure proximal to a stenosis, is useful as an additional test to anatomical assessment by invasive coronary angiography (ICA) for the diagnosis of coronary artery disease (CAD) requiring revascularisation [2]
Summary
Wire-based fractional flow reserve (FFR) is generally accepted to be the reference standard for the physiological assessment of lesion-specific ischaemia [1]. FFR, the ratio of maximal pressure distal to a stenosis divided by the pressure proximal to a stenosis, is useful as an additional test to anatomical assessment by invasive coronary angiography (ICA) for the diagnosis of coronary artery disease (CAD) requiring revascularisation [2]. Non-invasive testing for the detection of CAD in patients with complaints of stable chest pain and a low or intermediate probability of CAD, such as coronary computed tomography angiography (CCTA) using anatomical information, is performed [1]. CCTA tends to overestimate stenosis severity mainly in the presence of calcified plaque, leading to a high proportion of patients without haemodynamically significant CAD unnecessarily undergoing ICA and further treatment
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