Noninvasive FFR derived from CCTA showed higher diagnostic accuracy (84.3% vs 58.5%) and AUC (0.90 vs 0.75, p=0.001) than CCTA stenosis for detecting ischemia-causing coronary lesions.
Cross-Sectional (n=103)
Does noninvasive FFR computed from CCTA accurately identify ischemia-causing coronary stenoses compared to invasive FFR in patients with suspected or known CAD?
Noninvasive FFR derived from CCTA provides high diagnostic performance for detecting and excluding ischemia-causing coronary lesions, outperforming standard CCTA stenosis assessment.
Effect estimate: AUC 0.90
Absolute Event Rate: 84.3% vs 58.5%
p-value: p=0.001
OBJECTIVES: The aim of this study was to determine the diagnostic performance of a new method for quantifying fractional flow reserve (FFR) with computational fluid dynamics (CFD) applied to coronary computed tomography angiography (CCTA) data in patients with suspected or known coronary artery disease (CAD). BACKGROUND: Measurement of FFR during invasive coronary angiography is the gold standard for identifying coronary artery lesions that cause ischemia and improves clinical decision-making for revascularization. Computation of FFR from CCTA data (FFR(CT)) provides a noninvasive method for identifying ischemia-causing stenosis; however, the diagnostic performance of this new method is unknown. METHODS: Computation of FFR from CCTA data was performed on 159 vessels in 103 patients undergoing CCTA, invasive coronary angiography, and FFR. Independent core laboratories determined FFR(CT) and CAD stenosis severity by CCTA. Ischemia was defined by an FFR(CT) and FFR ≤0.80, and anatomically obstructive CAD was defined as a CCTA with stenosis ≥50%. Diagnostic performance of FFR(CT) and CCTA stenosis was assessed with invasive FFR as the reference standard. RESULTS: Fifty-six percent of patients had ≥1 vessel with FFR ≤0.80. On a per-vessel basis, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 84.3%, 87.9%, 82.2%, 73.9%, 92.2%, respectively, for FFR(CT) and were 58.5%, 91.4%, 39.6%, 46.5%, 88.9%, respectively, for CCTA stenosis. The area under the receiver-operator characteristics curve was 0.90 for FFR(CT) and 0.75 for CCTA (p = 0.001). The FFR(CT) and FFR were well correlated (r = 0.717, p < 0.001) with a slight underestimation by FFR(CT) (0.022 ± 0.116, p = 0.016). CONCLUSIONS: Noninvasive FFR derived from CCTA is a novel method with high diagnostic performance for the detection and exclusion of coronary lesions that cause ischemia.
“It is an impressive first step into what needs to follow, the painstakingly detailed workup of whether this method will translate into clinical benefit when applied to a broader scale and which patient groups are the ones to most likely benefit from this additional analysis.”
Koo et al. (2011) conducted a cross-sectional in Suspected or known coronary artery disease (n=103). FFR(CT) vs. CCTA stenosis was evaluated on Diagnostic accuracy for identifying ischemia-causing stenosis (invasive FFR ≤0.80) (AUC 0.90, p=0.001). Noninvasive FFR derived from CCTA showed higher diagnostic accuracy (84.3% vs 58.5%) and AUC (0.90 vs 0.75, p=0.001) than CCTA stenosis for detecting ischemia-causing coronary lesions.
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