Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry |
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| Institution: | 1. Department of Radiology, St. Paul''s Hospital and University of British Columbia, Vancouver, British Columbia, Canada;2. Department of Radiology, Iwate Medical University Hospital, Iwate, Japan;3. Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan;4. Department of Cardiology, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK;5. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan;6. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark;7. Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA;8. Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA;9. Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA;10. Centro Cardiologico Monzino, IRCCS, Milan, Italy;11. Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan;12. Cardiac Research Unit, Institute of Regional Health Research, University Hospital of Southern DK, Esbjerg and University of Southern DK, Denmark;13. Department of Cardiology, Aichi Medical University, Aichi, Japan;14. Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA;15. Department of Cardiology, Odense University Hospital, Denmark;p. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium;q. Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy;r. Division of Cardiology, Loyola University Chicago, Chicago, IL, USA;s. HeartFlow Inc., Redwood City, CA, USA;t. Department of Cardiology, University Hospital of Lausanne, Lausanne, CH, USA;u. Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan;v. Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands;w. Department of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA;x. Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia |
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| Abstract: | BackgroundThe role of change in fractional flow reserve derived from CT (FFRCT) across coronary stenoses (ΔFFRCT) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown.ObjectivesTo investigate the incremental value of ΔFFRCT in predicting early revascularization and improving efficiency of catheter laboratory utilization.MaterialsPatients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Stenosis severity was assessed as per CAD-Reporting and Data System (CAD-RADS), and lesion-specific FFRCT was measured 2 ?cm distal to stenosis. ΔFFRCT was manually measured as the difference of FFRCT across visible stenosis.ResultsOf 4730 patients (66 ?± ?10 years; 34% female), 42.7% underwent ICA and 24.7% underwent early revascularization. ΔFFRCT remained an independent predictor for early revascularization (odds ratio per 0.05 increase 95% confidence interval], 1.31 1.26–1.35]; p ?< ?0.001) after adjusting for risk factors, stenosis features, and lesion-specific FFRCT. Among the 3 models (model 1: risk factors ?+ ?stenosis type and location ?+ ?CAD-RADS; model 2: model 1 ?+ ?FFRCT; model 3: model 2 ?+ ?ΔFFRCT), model 3 improved discrimination compared to model 2 (area under the curve, 0.87 0.86–0.88] vs 0.85 0.84–0.86]; p ?< ?0.001), with the greatest incremental value for FFRCT 0.71–0.80. ΔFFRCT of 0.13 was the optimal cut-off as determined by the Youden index. In patients with CAD-RADS ≥3 and lesion-specific FFRCT ≤0.8, a diagnostic strategy incorporating ΔFFRCT >0.13, would potentially reduce ICA by 32.2% (1638–1110, p ?< ?0.001) and improve the revascularization to ICA ratio from 65.2% to 73.1%.ConclusionsΔFFRCT improves the discrimination of patients who underwent early revascularization compared to a standard diagnostic strategy of CCTA with FFRCT, particularly for those with FFRCT 0.71–0.80. ΔFFRCT has the potential to aid decision-making for ICA referral and improve efficiency of catheter laboratory utilization. |
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| Keywords: | Coronary artery disease (CAD) Fractional flow reserve (FFR) Coronary computed tomography angiography (CCTA) |
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