What question did this study set out to answer?

To evaluate the diagnostic performance of CT-derived fractional flow reserve compared with standard coronary CTA, SPECT, and PET for detecting myocardial ischemia.

May 1, 2026Journal of the American College of CardiologyOpen Access

Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis

Q: What are the key findings of this study?

FFRCT yielded a significantly greater per-vessel AUC for identifying ischemia-causing lesions (0.94) compared to coronary CTA (0.83), SPECT (0.70), and PET (0.87) (p<0.01 for all).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: suspected stable CAD (n=208). Intervention: Fractional flow reserve from coronary CTA (FFRCT) vs. Coronary CTA, SPECT, and PET. Primary outcome: Identification of ischemia-causing lesions (per-vessel AUC) (p=< 0.01).

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Key result

FFRCT outperforms CTA, SPECT, and PET for detecting ischemia-causing lesions with an AUC of 0.94.

P<0.01
n=208

Why the study?

FFRCT has emerged as a promising noninvasive test to assess hemodynamic severity of CAD but has not yet been compared with traditional functional imaging for ischemia diagnosis.

Does FFRCT improve diagnostic accuracy for ischemia-causing lesions compared to coronary CTA, SPECT, and PET in patients with suspected stable CAD?

Population

208 patients with suspected stable CAD

Comparison

FFRCT vs coronary CTA, SPECT, and PET

Design

Prospective subanalysis with core laboratory image interpretation

Authors

RDRoel S. DriessenAmsterdam University Medical Centers IDIbrahim DanadCardiac Imaging WSWijnand J. StuijfzandUppsala University

Discussion

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Implication

FFRCT demonstrates superior diagnostic performance for vessel-specific ischemia compared to standard coronary CTA, SPECT, and PET, provided the CTA images are evaluable.

Key Points

To evaluate the diagnostic performance of CT-derived fractional flow reserve compared with standard coronary CTA, SPECT, and PET for detecting myocardial ischemia.
Analyzed 208 prospectively enrolled patients with suspected stable coronary artery disease who underwent 256-slice coronary CTA, 99mTc-tetrofosmin SPECT, [15O]H2O PET, and 3-vessel invasive FFR.
Derived FFRCT retrospectively from coronary CTA datasets, comparing each modality blindly against an invasive reference standard of FFR ≤0.80.
FFRCT was analyzable in 505 of 612 vessels (83%), yielding a per-vessel sensitivity of 90%, specificity of 86%, and accuracy of 87% (per-patient: 96%, 63%, and 78%, respectively).
Per-vessel area under the ROC curve (AUC) for FFRCT was 0.94, outperforming coronary CTA (AUC 0.83; p < 0.01), SPECT (AUC 0.70; p < 0.01), and PET (AUC 0.87; p < 0.01).
Per-patient AUC for FFRCT was 0.92, exceeding CTA (AUC 0.81; p < 0.01) and SPECT (AUC 0.75; p < 0.01) but comparable to PET (AUC 0.91; p = 0.56); in intention-to-diagnose analysis, PET demonstrated the highest per-vessel AUC (0.90 vs. 0.79 for FFRCT; p = 0.005).

Study Design

Type

Observational (n=208)

Structured PICO

Does FFRCT improve diagnostic accuracy for ischemia-causing lesions compared to coronary CTA, SPECT, and PET in patients with suspected stable CAD?

Population

208 patients with suspected stable CAD who underwent coronary CTA, SPECT, PET, and invasive FFR measurements to evaluate diagnostic performance.

Exposure

Fractional flow reserve computation from coronary computed tomography angiography datasets (FFRCT) derived retrospectively from 256-slice coronary CTA images

Comparator

Coronary CTA, 99mTc-tetrofosmin SPECT, and [15O]H2O PET, with routine 3-vessel invasive FFR measurements (FFR ≤0.80) as the reference standard

Outcome

Diagnostic performance (AUC, accuracy, sensitivity, specificity) for identification of ischemia-causing lesionssurrogate

Main Result

p-value: p=< 0.01

FFRCT demonstrates superior diagnostic performance for vessel-specific ischemia compared to standard coronary CTA, SPECT, and PET, provided the CTA images are evaluable.

Limitations

Only 83% of vessels could be evaluated with FFRCT

Cite This Study

Driessen et al. (2019) conducted an observational in suspected stable CAD (n=208). Fractional flow reserve from coronary CTA (FFRCT) vs. Coronary CTA, SPECT, and PET was evaluated on Identification of ischemia-causing lesions (per-vessel AUC) (p=< 0.01). FFRCT yielded a significantly greater per-vessel AUC for identifying ischemia-causing lesions (0.94) compared to coronary CTA (0.83), SPECT (0.70), and PET (0.87) (p<0.01 for all).

synapsesocial.com/papers/69f518f8a1676a5934daefc9 https://doi.org/10.1016/j.jacc.2018.10.056

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Implication

FFRCT demonstrates superior diagnostic performance for vessel-specific ischemia compared to standard coronary CTA, SPECT, and PET, provided the CTA images are evaluable.

Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

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