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

Patrick M. Donnelly, Márton Kolossváry, Júlia Karády, Peter A. Ball, Stephanie Kelly, Donna Fitzsimons, Mark S. Spence, Csilla Celeng, Tamás Horváth, Bálint Szilveszter, Hendrik W. van Es, Martin J. Swaans, Béla Merkely, Pál Maurovich-Horvat*

*Corresponding author for this work

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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 <0.001). The CT-FFR areas under the curve of the 2 readers did not show any significant difference (0.89 vs 0.88, p = 0.74). In conclusion, on-site CT-FFR simulation is feasible and has better diagnostic performance than anatomic stenosis assessment. Furthermore, the diagnostic performance of the on-site CT-FFR simulation algorithm does not depend on the readers’ semiautomated lumen segmentation adjustments.

Original languageEnglish
Pages (from-to)9-13
JournalAmerican Journal of Cardiology
Volume121
Issue number1
Early online date10 Oct 2017
DOIs
Publication statusPublished - 01 Jan 2018

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Donnelly, P. M., Kolossváry, M., Karády, J., Ball, P. A., Kelly, S., Fitzsimons, D., Spence, M. S., Celeng, C., Horváth, T., Szilveszter, B., van Es, H. W., Swaans, M. J., Merkely, B., & Maurovich-Horvat, P. (2018). Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses. American Journal of Cardiology, 121(1), 9-13. https://doi.org/10.1016/j.amjcard.2017.09.018