Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses

Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional fl...

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Bibliographic Details
Published in:	The American journal of cardiology 2018-01, Vol.121 (1), p.9-13
Main Authors:	Donnelly, Patrick M., Kolossváry, Márton, Karády, Júlia, Ball, Peter A., Kelly, Stephanie, Fitzsimons, Donna, Spence, Mark S., Celeng, Csilla, Horváth, Tamás, Szilveszter, Bálint, van Es, Hendrik W., Swaans, Martin J., Merkely, Béla, Maurovich-Horvat, Pál
Format:	Article
Language:	eng
Subjects:	Adenosine Aged Algorithms Angiography Arteriosclerosis Atherosclerosis Cardiology Computation Computed tomography Computer simulation Coronary Angiography Coronary artery Coronary Stenosis - diagnostic imaging Coronary Stenosis - physiopathology Coronary vessels Diagnostic systems Feasibility studies Female Fluid dynamics Fractional Flow Reserve, Myocardial - physiology Heart rate Humans International conferences Ischemia Lesions Male Medical imaging Middle Aged Multidetector Computed Tomography Onsite Patients Predictive Value of Tests Prospective Studies Readers Reproducibility of Results ROC Curve Segmentation Simulation Software Stenosis Veins & arteries
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Summary:	Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64.6 ± 8.9 years, 34% female) with 60 coronary atherosclerotic lesions who underwent coronary CTA and invasive coronary angiography in 2 centers. An FFR value ≤0.8 was considered significant. Coronary CTA scans were evaluated by 2 expert readers, who manually adjusted the semiautomated coronary lumen segmentations for effective diameter stenosis (EDS) assessment and on-site CT-FFR simulation. The mean CT-FFR value was 0.77 ± 0.15, whereas the mean EDS was 43.6 ± 16.9%. The sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR versus EDS with a cutoff of 50% were the following: 91%, 72%, 63%, and 93% versus 52%, 87%, 69%, and 77%, respectively. The on-site CT-FFR demonstrated significantly better diagnostic performance compared with EDS (area under the curve 0.89 vs 0.74, respectively, p
ISSN:	0002-9149 1879-1913