Frontiers in Cardiovascular Medicine (Oct 2021)

Diagnostic Performance of Fractional Flow Reserve From CT Coronary Angiography With Analytical Method

  • Jun-Mei Zhang,
  • Jun-Mei Zhang,
  • Huan Han,
  • Ru-San Tan,
  • Ru-San Tan,
  • Ping Chai,
  • Ping Chai,
  • Jiang Ming Fam,
  • Lynette Teo,
  • Lynette Teo,
  • Chee Yang Chin,
  • Ching Ching Ong,
  • Ching Ching Ong,
  • Ris Low,
  • Gaurav Chandola,
  • Shuang Leng,
  • Shuang Leng,
  • Weimin Huang,
  • John C. Allen,
  • Lohendran Baskaran,
  • Lohendran Baskaran,
  • Ghassan S. Kassab,
  • Adrian Fatt Hoe Low,
  • Mark Yan-Yee Chan,
  • Mark Yan-Yee Chan,
  • Koo Hui Chan,
  • Koo Hui Chan,
  • Poay Huan Loh,
  • Poay Huan Loh,
  • Aaron Sung Lung Wong,
  • Aaron Sung Lung Wong,
  • Swee Yaw Tan,
  • Swee Yaw Tan,
  • Terrance Chua,
  • Terrance Chua,
  • Soo Teik Lim,
  • Soo Teik Lim,
  • Liang Zhong,
  • Liang Zhong

DOI
https://doi.org/10.3389/fcvm.2021.739633
Journal volume & issue
Vol. 8

Abstract

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The aim of this study was to evaluate a new analytical method for calculating non-invasive fractional flow reserve (FFRAM) to diagnose ischemic coronary lesions. Patients with suspected or known coronary artery disease (CAD) who underwent computed tomography coronary angiography (CTCA) and invasive coronary angiography (ICA) with FFR measurements from two sites were prospectively recruited. Obstructive CAD was defined as diameter stenosis (DS) ≥50% on CTCA or ICA. FFRAM was derived from CTCA images and anatomical features using analytical method and was compared with computational fluid dynamics (CFD)-based FFR (FFRB) and invasive ICA-based FFR. FFRAM, FFRB, and invasive FFR ≤ 0.80 defined ischemia. A total of 108 participants (mean age 60, range: 30–83 years, 75% men) with 169 stenosed coronary arteries were analyzed. The per-vessel accuracy, sensitivity, specificity, and positive predictive and negative predictive values were, respectively, 81, 75, 86, 81, and 82% for FFRAM and 87, 88, 86, 83, and 90% for FFRB. The area under the receiver operating characteristics curve for FFRAM (0.89 and 0.87) and FFRB (0.90 and 0.86) were higher than both CTCA- and ICA-derived DS (all p < 0.0001) on per-vessel and per-patient bases for discriminating ischemic lesions. The computational time for FFRAM was much shorter than FFRB (2.2 ± 0.9 min vs. 48 ± 36 min, excluding image acquisition and segmentation). FFRAM calculated from a novel and expeditious non-CFD approach possesses a comparable diagnostic performance to CFD-derived FFRB, with a significantly shorter computational time.

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