ISSN 2996-8215
International Journal of Cardiology | Vol. 3, No. 5, May 2012 | pp. 33–40
DOI: 10.46882/2012/IJC/000038
Original Research Article
Diagnostic Performance of Fractional Flow Reserve derived from Computed Tomography Coronary Angiography
Kenji Takahashi¹, Satoshi Yamada¹, Kazuo Sato²
¹Department of Cardiovascular Imaging, Tokyo Heart Center, Tokyo, Japan
²Division of Cardiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
Abstract:
Computed tomography coronary angiography (CTCA) is established for ruling out coronary artery disease (CAD), but it lacks the capacity to assess the hemodynamic significance of anatomical stenoses. Fractional flow reserve derived from standard CTCA datasets (FFR-CT) utilizes computational fluid dynamics to non-invasively estimate blood flow. This prospective study evaluated the diagnostic performance of FFR-CT in identifying ischemia-producing lesions, using invasive FFR as the reference standard. We evaluated 115 symptomatic patients with intermediate coronary lesions (30% to 70% stenosis on CTCA) who were scheduled for invasive coronary angiography and FFR. FFR-CT was computed off-line using specialized fluid software. Ischemia was defined as an invasive FFR less than or equal to 0.80. On a vessel-based analysis (142 vessels total), invasive FFR confirmed ischemia in 45 vessels (31.7%). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FFR-CT were 88.9% (95% CI: 75.9%–96.3%), 86.6% (95% CI: 78.2%–92.7%), 75.5% (95% CI: 61.7%–86.2%), and 94.4% (95% CI: 87.5%–98.2%), respectively. The area under the receiver operating characteristic curve (AUC) for FFR-CT was significantly higher than that of anatomical CTCA stenosis assessment alone (0.91 vs. 0.74, p < 0.001). No severe technical software artifacts prevented successful FFR-CT computation. FFR-CT provides excellent diagnostic accuracy and a high negative predictive value for identifying hemodynamically significant coronary stenoses, potentially reducing the rates of unnecessary diagnostic invasive coronary angiograms in patients with intermediate lesions.
Keywords: Fractional flow reserve, Computed tomography coronary angiography, Computational fluid dynamics, Myocardial ischemia, Diagnostic accuracy
Received: February 14, 2012; Revised: March 28, 2012; Accepted: April 14, 2012; Published: May 22, 2012
Citation: International Journal of Cardiology, 2012, Vol. 3, No. 5, pp. 33–40, DOI: 10.46882/2012/IJC/000038