Why the study?
CT-FFR and IVUS-FFR are both image-based functional assessment methods, but their calculation algorithms differ substantially, warranting a comparison of their diagnostic performance against invasive FFR.
Do IVUS-FFR and CT-FFR accurately assess functional severity of coronary artery disease compared to invasive FFR in patients with known or suspected CAD?
Observational (n=40)
Do IVUS-FFR and CT-FFR accurately assess functional severity of coronary artery disease compared to invasive FFR in patients with known or suspected CAD?
Effect estimate: AUC 0.960 (95% CI 0.833-0.997)
p-value: p=<0.001
Both IVUS-FFR and CT-FFR demonstrate strong diagnostic performance for the functional assessment of coronary artery disease when compared to invasive FFR.
May support noninvasive ischemia assessment with IVUS-FFR; hypothesis-generating pending larger prospective validation.
Background: Coronary computed tomography-derived fractional reserve fraction (CT-FFR) and intravascular ultrasound-derived fractional reserve fraction (IVUS-FFR) are methods of functional assessment based on coronary imaging; however, the calculation algorithms are substantially different between them. The aim of this study was to compare diagnostic performance between CT-FFR and IVUS-FFR using invasive fractional flow reserve (FFR) as the reference standard. Method: Our retrospective study enrolled 40 patients (41 lesions) with known or suspected coronary artery disease (CAD) between January 2020 and July 2021. Patients who completed coronary CT angiography (CCTA) within six months underwent intravascular ultrasound (IVUS) and fractional flow reserve (FFR) evaluation. We used a novel CFD-based model (AccuFFRct, ArteryFlow Technology Co., Ltd., Hangzhou, China) to compute the CT-FFR values, and a novel software (AccuFFRivus, ArteryFlow Technology Co., Ltd., Hangzhou, China) to calculate the IVUS-FFR values coupled with angiography. The diagnostic performance of CT-FFR and IVUS-FFR was evaluated using invasive FFR≤0.8 as the reference standard. Result: AccuFFRivus demonstrated a strong correlation with invasive FFR (R=0.7913, P<0.0001), and AccuFFRct was also highly associated with invasive FFR (R=0.6296, P<0.0001). Both AccuFFRivus and AccuFFRct showed good agreement with FFR. The area under the ROC curve was 0.960 (95%CI:0.833-0.997, P<0.001) for AccuFFRivus and 0.897 (95%CI:0.740-0.974, P<0.05) for AccuFFRct. A critical value of 0.80 for AccuFFRivus predicted FFR≤0.80 with high sensitivity (96.6%), specificity (85.7%), and the Youden index (0.823). AccuFFRct with predicted FFR≤0.80 demonstrated good diagnostic performance (sensitivity 89.7%, specificity 85.7% and Youden index 0.754). Conclusions: IVUS-FFR may also become a new clinically meaningful functional evaluation method for diagnosing myocardial ischemia and may be as important as CT-FFR, Angio-FFR, OCT-FFR, and invasive FFR in the future as a method for evaluating coronary artery disease.
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Huang et al. (2023) conducted an observational in Coronary artery disease (n=40). IVUS-FFR and CT-FFR vs. Invasive FFR was evaluated on Diagnostic performance using invasive FFR≤0.8 as the reference standard (AUC 0.960, 95% CI 0.833-0.997, p=<0.001).
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