Optimized interpretation of fractional flow reserve derived from computed tomography: Comparison of three interpretation methods |
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| Institution: | 1. Department of Radiology, Iwate Medical University, 19-1, Uchimaru, Morioka, #0208505, Japan;2. Division of Cardiology, Department of Internal Medicine, Iwate Medical University, 19-1, Uchimaru, Morioka, #0208505, Japan;3. Department of Diagnostic Radiology, Tohoku University, 1-1, Seiryo, Sendai, Miyagi, #9808574, Japan;1. Cardiology Clinics, Afyonkarahisar Dinar State Hospital, Afyonkarahisar, Turkey;2. Department of Cardiology, Selcuk University Faculty of Medicine, Konya, 42090, Turkey;3. Department of Basic Medical Sciences, Adnan Menderes University Faculty of Medicine, Aydin, Turkey;4. Department of Radiology, Kayseri Training and Research Hospital, Kayseri, Turkey;5. Department of Radiology, Yozgat State Hospital, Yozgat, Turkey;6. Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey;7. Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey;1. Department of Cardiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Skejby, 8200 Aarhus N, Denmark;2. Harrington Heart and Vascular Institute, Case Medical Center, Cleveland, OH, USA;3. Department of Cardiology, Golden Jubilee National Hospital, Glasgow, Scotland;4. Department of Radiology, St. Paul''s Hospital, Vancouver, BC, Canada;5. Department of Cardiology, University of Erlangen, Erlangen, Germany;1. Stanford University School of Medicine, Division of Cardiovascular Medicine and the Department of Radiology, Stanford, CA, USA;2. Stanford University School of Medicine, Cardiovascular Medicine, Room H2157, 300 Pasteur Drive, Stanford, CA, USA;1. Heart & Vascular Center, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Drive Charleston, SC 29425-2260, USA;2. Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China;3. Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany;4. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany;5. Departments of Radiological Sciences, Oncology, and Pathology, University of Rome “Sapienza”-Polo Pontino, Latina, Viale Regina Elena, 324-00161 Roma, Italy;6. First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany |
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| Abstract: | BackgroundAn optimal system for interpreting fractional flow reserve (FFR) values derived from CT (FFRCT) is lacking. We sought to evaluate performance of three FFRCT measurements in detecting ischemia by comparing them with invasive FFR.MethodsFor 73 vessels in 50 patients who underwent coronary CT angiography (CCTA) and FFRCT analysis followed by invasive FFR, the greatest diameter stenosis on CCTA, FFRCT difference between distal and proximal to the stenosis (ΔFFRCT), FFRCT 2 cm distal to the stenosis (lesion-specific FFRCT), and the lowest FFRCT in distal vessel tip were calculated. Significant obstruction (≥50% diameter stenosis) and ischemia (lesion-specific FFRCT ≤0.80, the lowest FFRCT ≤0.80, or ΔFFRCT ≥0.12 based on the greatest Youden index) were compared with invasive FFR (≤0.80).ResultsForty (55%) vessels demonstrated ischemia during invasive FFR. On multivariable generalized estimating equations, ΔFFRCT (odds ratio OR] 10.2, p < 0.01) remained a predictor of ischemia over CCTA (OR 2.9), lesion-specific FFRCT (OR 3.1), and the lowest FFRCT (OR 0.9) (p > 0.05 for all). Area under the curve (AUC) of ΔFFRCT (0.86) was higher than CCTA (0.66), lesion-specific FFRCT (0.71), and the lowest FFRCT (0.65) (p < 0.01 for all). Addition of each FFRCT measure to CCTA showed improvement of AUC and significant net reclassification improvement (NRI): ΔFFRCT (AUC 0.84, NRI 1.24); lesion-specific FFRCT (AUC 0.77, NRI 0.83); and the lowest FFRCT (AUC 0.76, NRI 0.59) (p < 0.01 for all).ConclusionsCompared with diameter stenosis, ΔFFRCT, lesion-specific FFRCT, and the lowest FFRCT improved ischemia discrimination and reclassification, with ΔFFRCT being superior in identifying and discriminating ischemia. |
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| Keywords: | Coronary artery disease Fractional flow reserve Coronary computed tomography angiography Fractional flow reserve derived from computed tomography |
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