Background
Non-invasive computed tomography (CT)-derived fractional flow reserve (FFRCT) is computed from standard coronary CT angiography (CTA) datasets and provides accurate
vessel-specific ischaemia assessment of coronary artery disease (CAD). To date, the
technique and its diagnostic performance has not been verified in the Australian clinical
context. The aim of this study was to describe and compare the diagnostic performance
of FFRCT and CTA for the detection of vessel-specific ischaemia as determined by invasive
fractional flow reserve (FFR) in the Australian patient population.
Methods
One-hundred-and-nine patients (219 vessels) referred for clinically mandated invasive
angiography were retrospectively assessed. Each patient underwent research mandated
CTA and FFRCT within 3 months of invasive angiography and invasive FFR assessment. Independent
core laboratory assessments were made to determine visual CTA stenosis, FFRCT and invasive FFR values. FFRCT values were matched with the corresponding invasive FFR measurement taken at the
given wire position. Visual CTA stenosis ≥50%, FFRCT values ≤0.8 and invasive FFR values ≤0.8 were considered significant for ischaemia.
Results
Per vessel accuracy, sensitivity, specificity, positive predictive value and negative
predictive value of FFRCT were 80.4%, 80.0%, 80.6%, 64.9% and 90.0% respectively. Corresponding values for
CTA were 75.1%, 87.1%, 69.2%, 58.1% and 91.7% respectively. In receiver operating
characteristic curve analysis, FFRCT demonstrated superior area under the curve (AUC) compared with CTA in both per vessel
(0.87 vs 0.77, p=0.004) and per patient analysis (0.86 vs 0.74, p=0.011). Per vessel
AUC of combined CTA and FFRCT was superior to CTA alone (0.89 vs 0.77, p<0.0001).
Conclusion
In this cohort of Australian patients, the diagnostic performance of FFRCT was found to be comparable to existing international literature, with demonstrated
improvement in performance compared with CTA alone for the detection of vessel-specific
ischaemia.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnostic accuracy of 64-slice computed tomography coronary angiography: a prospective, multicenter, multivendor study.J Am Coll Cardiol. 2008; 52: 2135-2144
- Outcomes of anatomical versus functional testing for coronary artery disease.N Engl J Med. 2015; 372: 1291-1300
- Coronary CT angiography and 5-year risk of myocardial infarction.N Engl J Med. 2018; 379: 924-933
- Recent-onset chest pain of suspected cardiac origin: assessment and diagnosis.NICE Guidelines, 2010 (Available from)https://www.nice.org.uk/Guidance/CG95Date accessed: April 20, 2022
- 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes.Eur Heart J. 2020; 41: 407-477
- Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis.J Am Coll Cardiol. 2013; 61: 2233-2241
- Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study.J Am Coll Cardiol. 2011; 58: 1989-1997
- Diagnostic accuracy of fractional flow reserve from anatomic CT angiography.JAMA. 2012; 308: 1237-1245
- Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps).J Am Coll Cardiol. 2014; 63: 1145-1155
- Prognostic value and risk continuum of noninvasive fractional flow reserve derived from coronary CT angiography.Radiology. 2019; 292: 343-351
- 1-year impact on medical practice and clinical outcomes of FFRCT: The ADVANCE Registry.JACC Cardiovasc Imaging. 2020; 13: 97-105
- Centers for Medicare and Medicaid Services. Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease. Local Coverage Determination. 2021; L38839.(Available from)https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=38613Date accessed: April 20, 2022
NICE. HeartFlow FFRCT for estimating fractional flow reserve from coronary CT angiography. NICE Guidelines. 2017. Available from: https://www.nice.org.uk/guidance/mtg32. [accessed 20.4.22].
- Combined CT coronary angiography and stress myocardial perfusion imaging for hemodynamically significant stenoses in patients with suspected coronary artery disease.JACC Cardiovasc Imaging. 2012; 5: 1097-1111
- Computed tomography stress myocardial perfusion imaging in patients considered for revascularization: a comparison with fractional flow reserve.Eur Heart J. 2012; 33: 67-77
- SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee.J Cardiovasc Comput Tomogr. 2009; 3: 190-204
- Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach.Biometrics. 1988; 44: 837-845
- Comparison of coronary computed tomography angiography, fractional flow reserve, and perfusion imaging for ischemia diagnosis.J Am Coll Cardiol. 2019; 73: 161-173
- Clinical outcomes of fractional flow reserve by computed tomographic angiography-guided diagnostic strategies vs. usual care in patients with suspected coronary artery disease: the prospective longitudinal trial of FFR(CT): outcome and resource impacts study.Eur Heart J. 2015; 36: 3359-3367
- Noninvasive FFR derived from coronary CT angiography: management and outcomes in the PROMISE Trial.JACC Cardiovasc Imaging. 2017; 10: 1350-1358
- Real-world clinical utility and impact on clinical decision-making of coronary computed tomography angiography-derived fractional flow reserve: lessons from the ADVANCE Registry.Eur Heart J. 2018; 39: 3701-3711
- 1-year outcomes of FFRCT-guided care in patients with suspected coronary disease: the PLATFORM Study.J Am Coll Cardiol. 2016; 68: 435-445
- Central core laboratory versus site interpretation of coronary CT angiography: agreement and association with cardiovascular events in the PROMISE trial.Radiology. 2018; 287: 87-95
- Importance of diffuse atherosclerosis in the functional evaluation of coronary stenosis in the proximal-mid segment of a coronary artery by myocardial fractional flow reserve measurements.Am J Cardiol. 2011; 108: 483-490
- A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension.Eur Heart J. 2011; 32: 1316-1330
Article info
Publication history
Published online: April 29, 2022
Accepted:
March 30,
2022
Received in revised form:
November 16,
2021
Received:
September 23,
2020
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
