Key result
AccuiFRct demonstrated high diagnostic performance for detecting ischemia-causing coronary stenosis, achieving an AUC of 0.89 and 81% diagnostic accuracy compared to invasive iFR.
Why the study?
A new method (AccuiFRct) using deep learning and computational fluid dynamics to calculate iFR from CCTA has been proposed, but its diagnostic performance using iFR as reference needed thorough assessment.
Does AccuiFRct accurately predict invasive iFR and FFR in patients with stable coronary artery disease?
Observational (n=36)
Blinded analysis
No
Does AccuiFRct accurately predict invasive iFR and FFR in patients with stable coronary artery disease?
Effect estimate: AUC 0.89 (95% CI 0.74-0.97)
Absolute Event Rate: 0.89% vs 0.68%
p-value: p=<0.001
AccuiFRct, a novel noninvasive index derived from CCTA using deep learning and computational fluid dynamics, demonstrates good diagnostic accuracy for detecting hemodynamically significant coronary stenosis compared to invasive iFR.
BACKGROUND AND OBJECTIVES: Both fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are widely used to evaluate ischemia-causing coronary lesions. A new method of CT-iFR, namely AccuiFRct, for calculating iFR based on deep learning and computational fluid dynamics (CFD) using coronary computed tomography angiography (CCTA) has been proposed. In this study, the diagnostic performance of AccuiFRct was thoroughly assessed using iFR as the reference standard. METHODS: Data of a total of 36 consecutive patients with 36 vessels from a single-center who underwent CCTA, invasive FFR, and iFR were retrospectively analyzed. The CT-derived iFR values were computed using a novel deep learning and CFD-based model. RESULTS: Mean values of FFR and iFR were 0.80 ± 0.10 and 0.91 ± 0.06, respectively. AccuiFRct was well correlated with FFR and iFR (correlation coefficients, 0.67 and 0.68, respectively). The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of AccuiFRct ≤ 0.89 for predicting FFR ≤ 0.80 were 78%, 73%, 81%, 73%, and 81%, respectively. Those of AccuiFRct ≤ 0.89 for predicting iFR ≤ 0.89 were 81%, 73%, 86%, 79%, and 82%, respectively. AccuiFRct showed a similar discriminant function when FFR or iFR were used as reference standards. CONCLUSION: AccuiFRct could be a promising noninvasive tool for detection of ischemia-causing coronary stenosis, as well as facilitating in making reliable clinical decisions.
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Zhang et al. (2022) conducted an observational in Stable coronary artery disease (n=36). AccuiFRct (CT-derived instantaneous wave-free ratio) vs. Diameter stenosis ≥ 50% was evaluated on Area under the curve (AUC) for predicting iFR ≤ 0.89 (AUC 0.89, 95% CI 0.74-0.97, p=<0.001). AccuiFRct demonstrated high diagnostic performance for detecting ischemia-causing coronary stenosis, achieving an AUC of 0.89 and 81% diagnostic accuracy compared to invasive iFR.
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