Noninvasive FFR derived from coronary CTA demonstrated higher diagnostic accuracy for identifying myocardial ischemia compared to standard coronary CTA (AUC 0.90 vs 0.81; p=0.0008).
Observational (n=254)
Blinded
Yes
Does FFR(CT) improve diagnostic accuracy for myocardial ischemia compared to coronary CTA in patients with suspected stable CAD?
FFR(CT) provides high diagnostic accuracy and significantly improves specificity for detecting hemodynamically significant CAD compared to standard coronary CTA.
Effect estimate: AUC (95% CI 0.87 to 0.94)
Absolute Event Rate: 0.9% vs 0.81%
p-value: p=0.0008
OBJECTIVES: The goal of this study was to determine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from standard acquired coronary computed tomography angiography (CTA) datasets (FFR(CT)) for the diagnosis of myocardial ischemia in patients with suspected stable coronary artery disease (CAD). BACKGROUND: FFR measured during invasive coronary angiography (ICA) is the gold standard for lesion-specific coronary revascularization decisions in patients with stable CAD. The potential for FFR(CT) to noninvasively identify ischemia in patients with suspected CAD has not been sufficiently investigated. METHODS: This prospective multicenter trial included 254 patients scheduled to undergo clinically indicated ICA for suspected CAD. Coronary CTA was performed before ICA. Evaluation of stenosis (>50% lumen reduction) in coronary CTA was performed by local investigators and in ICA by an independent core laboratory. FFR(CT) was calculated and interpreted in a blinded fashion by an independent core laboratory. Results were compared with invasively measured FFR, with ischemia defined as FFR(CT) or FFR ≤0.80. RESULTS: The area under the receiver-operating characteristic curve for FFR(CT) was 0.90 (95% confidence interval CI: 0.87 to 0.94) versus 0.81 (95% CI: 0.76 to 0.87) for coronary CTA (p = 0.0008). Per-patient sensitivity and specificity (95% CI) to identify myocardial ischemia were 86% (95% CI: 77% to 92%) and 79% (95% CI: 72% to 84%) for FFR(CT) versus 94% (86 to 97) and 34% (95% CI: 27% to 41%) for coronary CTA, and 64% (95% CI: 53% to 74%) and 83% (95% CI: 77% to 88%) for ICA, respectively. In patients (n = 235) with intermediate stenosis (95% CI: 30% to 70%), the diagnostic accuracy of FFR(CT) remained high. CONCLUSIONS: FFR(CT) provides high diagnostic accuracy and discrimination for the diagnosis of hemodynamically significant CAD with invasive FFR as the reference standard. When compared with anatomic testing by using coronary CTA, FFR(CT) led to a marked increase in specificity. (HeartFlowNXT-HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography HFNXT; NCT01757678).
“Fractional flow reserve non-invasively calculated from coronary CTA data sets matches closely with invasively measured FFR and allows for identification of patients with hemodynamically significant coronary lesions with good accuracy. When compared to both coronary CTA and ICA, FFR-CT led to a significant reduction in the proportion of false-positive results. The addition of FFR-CT to coronary CTA allows for a comprehensive anatomic and functional assessment of coronary artery disease.”
Nørgaard et al. (Fri,) conducted a observational in Suspected stable coronary artery disease (CAD) (n=254). Noninvasive fractional flow reserve derived from coronary CTA (FFR(CT)) vs. Coronary CTA was evaluated on Area under the receiver-operating characteristic curve for identifying myocardial ischemia (AUC, 95% CI 0.87 to 0.94, p=0.0008). Noninvasive FFR derived from coronary CTA demonstrated higher diagnostic accuracy for identifying myocardial ischemia compared to standard coronary CTA (AUC 0.90 vs 0.81; p=0.0008).