Why the study?
Existing CCTA-derived FFR and quantitative flow ratio have accuracy and efficiency limitations, prompting evaluation of an AI-assisted method integrating CCTA and invasive angiography.
Does FFRCT-angio accurately identify ischemic lesions compared to invasive FFR in patients with stable coronary artery disease?
Does FFRCT-angio accurately identify ischemic lesions compared to invasive FFR in patients with stable coronary artery disease?
FFRCT-angio, integrating CCTA and invasive angiography with AI, demonstrates excellent diagnostic performance for identifying ischemic lesions in stable CAD, offering a potential alternative to invasive FFR.
FFRCT-angio may aid ischemia detection in stable CAD; leaves open prospective validation before replacing invasive FFR.
Background and objectives The hemodynamic evaluation of coronary stenoses undergoes a transition from wire-based invasive measurements to image-based computational assessments. However, fractional flow reserve (FFR) values derived from coronary CT angiography (CCTA) and angiography-based quantitative flow ratio have certain limitations in accuracy and efficiency, preventing their widespread use in routine practice. Hence, we aimed to investigate the diagnostic performance of FFR derived from the integration of CCTA and invasive angiography (FFRCT-angio) with artificial intelligence assistance in patients with stable coronary artery disease (CAD). Methods Forty stable CAD patients with 67 target vessels (50%–90% diameter stenosis) were included in this single-center retrospective study. All patients underwent CCTA followed by coronary angiography with FFR measurement within 30 days. Both CCTA and angiographic images were combined to generate a three-dimensional reconstruction of the coronary arteries using artificial intelligence. Subsequently, functional assessment was performed through a deep learning algorithm. FFR was used as the reference. Results FFRCT-angio values were significantly correlated with FFR values (r = 0.81, P < 0.001, Spearman analysis). Per-vessel diagnostic accuracy of FFRCT-angio was 92.54%. Sensitivity and specificity in identifying ischemic lesions were 100% and 88.10%, respectively. Positive predictive value and negative predictive value were 83.33% and 100%, respectively. Moreover, the diagnostic performance of FFRCT-angio was satisfactory in different target vessels and different segment lesions. Conclusions FFRCT-angio exhibits excellent diagnostic performance of identifying ischemic lesions in patients with stable CAD. Combining CCTA and angiographic imaging, FFRCT-angio may represent an effective and practical alternative to invasive FFR in selected patients.
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Xue et al. (2022) studied this question.