Abstract
Detection of coronary ischemic lesions by fractional flow reserve (FFR) has been established as the gold standard. In recent years, novel computer based methods have emerged and they can provide simulation of FFR using coronary artery images acquired from coronary computed tomography angiography (FFRCT). This meta-analysis aimed to evaluate diagnostic performance of FFRCT using FFR as the reference standard. Databases of PubMed, Cochrane Library, EMBASE, Medion and Web of Science were searched. Seven studies met the inclusion criteria, including 833 stable patients (1377 vessels or lesions) with suspected or known coronary artery disease (CAD). The patient-based analysis showed pooled estimates of sensitivity, specificity and diagnostic odds ratio (DOR) for detection of ischemic lesions were 0.89 [95%confidence interval (CI), 0.85–0.93], 0.76 (95%CI, 0.64–0.84) and 26.21 (95%CI, 13.14–52.28). At a per-vessel or per-lesion level, the pooled estimates were as follows: sensitivity 0.84 (95%CI, 0.80–0.87), specificity 0.76 (95%CI, 0.67–0.83) and DOR 16.87 (95%CI, 9.41–30.25). Area under summary receiver operating curves was 0.90 (95%CI, 0.87–0.92) and 0.86 (95%CI, 0.83–0.89) at the two analysis levels, respectively. In conclusion, FFRCT technology achieves a moderate diagnostic performance for noninvasive identification of ischemic lesions in stable patients with suspected or known CAD in comparison to invasive FFR measurement.
Highlights
Less contrast agent used in comparison with Percutaneous coronary intervention (PCI) guided by invasive coronary angiography (ICA) alone[9]
Approved by the US Food and Drug Administration, FFRCT based on computational fluid dynamics allows for virtual assessment of “3-vessel Fractional flow reserve (FFR)” at any point within the coronary artery bed from typically acquired coronary computed tomography angiography (CCTA) imaging[21]
The anatomic severity and the estimated physiological significance of coronary stenosis was taken into account
Summary
Less contrast agent used in comparison with PCI guided by ICA alone[9]. FFR is an invasive method after all, bringing potential procedural risks for patients[4]. An alternative technique called noninvasive fractional flow reserve derived from coronary computed tomography angiography (FFRCT) has been developed[10]. Through utilization of computational fluid dynamics and coronary artery images acquired from coronary computed tomography angiography, FFRCT enables estimation of FFR value without the need for additional invasive imaging, modification of acquisition protocols, or extra administration of medication. Previous meta-analyses have evaluated the diagnostic performance of FFRCT both at the per-patient level and the per-vessel or per-lesion level as defined by the invasive FFR16,17. Results of new diagnostic accuracy tests for assessment of FFRCT have recently been published as full papers[19,20]. An updated meta-analysis was carried out to comprehensively search and review evidence available heretofore and derive reliable assessment of the diagnostic performances of FFRCT using a bivariate model as the method for pooling diagnostic measures
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